Abstract
IntroductionThe success of HIV treatment programmes globally has resulted in children with perinatally acquired HIV reaching adolescence in large numbers. The number of adolescents living with HIV is growing further due to persisting high HIV incidence rates among adolescents in low‐ and middle‐income settings, particularly in sub‐Saharan Africa. Although expanding access to HIV viral load monitoring is necessary to achieve the 90‐90‐90 targets across the HIV care continuum, implementation is incomplete. We discuss the rationale for prioritizing viral load monitoring among adolescents and the associated challenges.DiscussionAdolescents with HIV are a complex group to treat successfully due to extensive exposure to antiretroviral therapy for those with perinatally acquired HIV and the challenges in sustained medication adherence in this age group. Given the high risk of treatment failure among adolescents and the limited drug regimens available in limited resource settings, HIV viral load monitoring in adolescents could prevent unnecessary and costly switches to second‐line therapy in virologically suppressed adolescents. Because adolescents living with HIV may be heavily treatment experienced, have suboptimal treatment adherence, or may be on second or even third‐line therapy, viral load testing would allow clinicians to make informed decisions about increased counselling and support for adolescents together with the need to maintain or switch therapeutic regimens.ConclusionsGiven scarce resources, prioritization of viral load testing among groups with a high risk of virological failure may be required. Adolescents have disproportionately high rates of virological failure, and targeting this age group for viral load monitoring may provide valuable lessons to inform broader scale‐up.
Highlights
The success of HIV treatment programmes globally has resulted in children with perinatally acquired HIV reaching adolescence in large numbers
The paediatric HIV epidemic is maturing, with increasing numbers of children living into adolescence and young adulthood due to the scale-up of antiretroviral therapy (ART), and HIV-infected children with slow disease progression presenting to health services for the first time in adolescence [2,3]
The persisting high incidence of HIV among adolescents in low and middle-income settings (LMICs), among young women and girls, is a significant contributor to the increase in numbers of adolescents living with HIV over the past decade
Summary
The success of HIV treatment programmes globally has resulted in children with perinatally acquired HIV reaching adolescence in large numbers. The paediatric HIV epidemic is maturing, with increasing numbers of children living into adolescence and young adulthood due to the scale-up of antiretroviral therapy (ART), and HIV-infected children with slow disease progression presenting to health services for the first time in adolescence [2,3]. Children with perinatally acquired HIV who would otherwise have died in infancy and early childhood are reaching adolescence in large numbers due to earlier diagnosis, treatment initiation and the global scale-up of antiretroviral therapy (ART) [10].
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