Viral suppression in adolescents on antiretroviral treatment: review of the literature and critical appraisal of methodological challenges.

Rashida A Ferrand,Jane Ferguson,Martina Penazzato,Alice Armstrong,Katharina Kranzer,Datonye Briggs,Peter Macpherson,David A Ross

doi:10.1111/tmi.12656

Abstract

ObjectiveMedication adherence is often suboptimal for adolescents with HIV, and establishing correct weight‐based antiretroviral therapy dosing is difficult, contributing to virological failure. This review aimed to determine the proportion of adolescents achieving virological suppression after initiating ART.Methods MEDLINE, EMBASE and Web of Science databases were searched. Studies published between January 2004 and September 2014 including ≥50 adolescents taking ART and reporting on the proportion of virological suppressed participants were included.ResultsFrom a total of 5316 potentially relevant citations, 20 studies were included. Only eight studies reported the proportion of adolescents that were virologically suppressed at a specified time point. The proportion of adolescents with virological suppression at 12 months ranged from 27 to 89%.ConclusionAdolescent achievement of HIV virological suppression was highly variable. Improved reporting of virological outcomes from a wider range of settings is required to support efforts to improve HIV care and treatment for adolescents.

Highlights

An estimated 2.1 million adolescents (10–19 years of age) globally were living with HIV in 2012 [1]
Maintaining sustained high levels of adherence to antiretroviral therapy (ART) is the crux of successful treatment, preventing the development of drug resistance and disease progression, and decreasing risk of onward transmission once sexual debut occurs
Eight studies reported the proportion of adolescents that were virologically suppressed at a specified time point: six [9,10,11,12, 21, 23], two [12, 15] and one [19] study reported the proportion who were virologically suppressed at 12, 24 and 36 months after ART initiation, respectively (Table 2)

Summary

Introduction

An estimated 2.1 million adolescents (10–19 years of age) globally were living with HIV in 2012 [1]. Adolescents frequently find consistent, long-term medication adherence difficult, and HIV treatment is no exception [4,5,6]. Maintaining sustained high levels of adherence to ART is the crux of successful treatment, preventing the development of drug resistance and disease progression, and decreasing risk of onward transmission once sexual debut occurs. Accurate weight-based dosing is difficult to achieve during the growth spurt which occurs in adolescence, and frequent dose changes are necessary, which may be challenging in under-staffed healthcare facilities in low-resource settings, where the majority of HIV-infected adolescents live, and can be confusing for the patient

Objectives

Methods

Results

Conclusion