Abstract
IntroductionDespite improved treatment and access to care, adolescent AIDS deaths are decreasing more slowly than in any other age group. There is lack of longitudinal data around adolescent adherence and the dynamics of viraemia over time. We aimed to describe patterns of detectable viral load (VL) in a cohort of adolescents attending an ARV clinic in Cape Town, South Africa.MethodsWe conducted a retrospective cohort study of all patients on antiretroviral therapy aged 10 to 19 years.Participants were included if they underwent at least two VL measurements and remained in care at the Groote Schuur Hospital HIV Clinic for at least 24 months between 2002 and 2016.The primary outcome was two consecutive HIV VL >100 copies/mL, in line with the lower limit of detection of assays in use over the follow‐up period.Results and discussionOf the 482 screened participants, 327 met inclusion criteria. Most participants had perinatally acquired HIV (n = 314; 96%), and 170 (52%) were males. Overall, there were 203 episodes of confirmed detectable VL involving 159 (49% (95% CI 43% to 54%)) participants during the follow‐up period. Six participants had genotyped resistance to protease inhibitors. Four of these never suppressed, while two suppressed on salvage regimens.Total follow‐up time was 1723 person years (PY), of which 880 (51%) were contributed by the 159 participants who experienced detectable VL. Overall time with detectable VL was 370 PY. This comprised 22% of total follow‐up time, and 42% of the follow‐up time contributed by those who experienced detectable VL.The rate of detectable VL was 11.8 (95% CI 10.3 to 13.5) episodes per 100 PY. The risk increased by 24% for each year of increasing age (Relative Risk 1.24 (95% CI 1.17 to 1.31); p < 0.0001).There was no sex difference with respect to duration (p = 0.4), prevalence (p = 0.46) and rate (p = 0.608) of detectable VL.ConclusionsClinicians need to be alert to the high prevalence of detectable VL during adolescence so as to pre‐empt it and act swiftly once it is diagnosed. This study helps to highlight the risk of detectable VL that is associated with increase in age as well the high proportion of time that poorly adherent adolescents spend in this state.
Highlights
Despite improved treatment and access to care, adolescent AIDS deaths are decreasing more slowly than in any other age group
Our study describes the prevalence, incidence and duration of time spent with detectable viral load (VL) in a cohort of HIV-positive adolescents attending a public-sector clinic in a low- and middle-income (LMIC) setting
When the age of adolescents was categorized into agebands to fit with early, middle and late adolescence, participants aged 10 to 12 years had a rate of detectable VL of 5.6 per 100 person years (PY) while those aged 13 to 15 and 16 to 19 years had rates of 11.1 per 100 PY and 19.9 per 100 PY respectively
Summary
Despite improved treatment and access to care, adolescent AIDS deaths are decreasing more slowly than in any other age group. Total follow-up time was 1723 person years (PY), of which 880 (51%) were contributed by the 159 participants who experienced detectable VL. This study helps to highlight the risk of detectable VL that is associated with increase in age as well the high proportion of time that poorly adherent adolescents spend in this state. AIDS-related deaths in adolescents are decreasing much slower than in all other age groups despite improved treatment and access to care [1,2]. HIV/AIDS is one of the top ten leading causes of death in adolescents globally [1,3,4] This is thought to result from poor adherence to antiretroviral therapy (ART) [5,6]. There is evidence that even low-level viraemia is associated with subsequent treatment failure and the development of resistance mutations [15,16,17,18,19]
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