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Teens with HIV fare worse when parents don't come to clinic appointments

[April 01, 2015] By Lisa Rapaport

(Reuters Health) - Teens with HIV do better at keeping the virus in check when their parents or guardians come with them for clinic visits, a study from Botswana suggests.

HIV medication regimens can be very complicated. And for more than 90 percent of HIV-infected children and teens in sub-Saharan Africa, there are few government services to support them when parents or other caregivers can’t help, said lead study author Dr. Elizabeth Lowenthal of Children's Hospital of Philadelphia.

"When families and communities do not provide the support that a child needs, there are few options," she told Reuters Health by email.

An estimated 2.1 million adolescents, aged 10 to 19, live with human immunodeficiency virus (HIV) in low- and middle-income countries, Lowenthal and colleagues write in JAMA Pediatrics. Generally, this age group is less likely to stick with treatment than younger children or adults, the researchers note.

Lowenthal and colleagues studied 300 HIV-positive adolescents coming in for quarterly clinic visits at the Botswana-Baylor Children's Clinical Center of Excellence beginning in 2012. Most of them were infected by their mothers during pregnancy or delivery.

At the start of the study, 50 of the children had detectable viral loads, which can happen when HIV-suppressing medicines aren't taken consistently or when the body stops responding to the current drug regimen.

Half the youngsters were no more than 13 years old. And half of them had been receiving HIV treatment for at least seven and a half years.

The study group included 50 orphans who had lost both parents, 85 who had lost their mothers and 70 who’d lost their fathers.

Overall, 238 youngsters had advanced disease and 199 had advanced or severe immunologic suppression at the start of the study. But 267 had been symptom-free for six months.

After three months, the virus had become undetectable in about 77 percent of teens who were joined at clinic visits by a parent or guardian, compared with about 57 percent of adolescents who came to the clinic without a parent or guardian.

When the six-month checkup was also factored in, roughly 89 percent of teens accompanied by a parent or guardian had undetectable virus levels, compared with about 75 percent for those who came without that support.

The study can’t prove that having an adult along for clinic visits is what caused the difference. It can only show, as the authors point out, that “absence of a parent from an adolescent’s clinic visit was strongly associated with HIV virologic failure.”

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It's common for teens who acquired HIV from their mother during pregnancy or delivery to have one or both parents die from HIV, said Dr. William Moss, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health, in an email.

"Adherence to a daily drug regimen for a life-long, chronic disease is challenging in the best of settings," said Moss, who wasn't involved in the study. "As children transition to adolescence and strive for greater independence, the role of a supportive adult in the home remains critical to maintaining high levels of adherence while at the same time allowing the adolescent to take more responsibility for their own health."

Strategies that work for teens with other chronic diseases may also help improve treatment compliance for adolescents living with HIV, said Jennifer Dohrn, director of the office of global initiatives at Columbia University School of Nursing, in an email.

Parents or guardians of teens living with HIV may need to be educated about the challenges of supporting their treatment as they transition to adolescence, and these teens may also need more involvement from peers and friends around their own age, said Dohrn, who wasn't involved in the study. If they have cell phones, mobile devices might be used for reminders to take daily medications and keep clinic appointments.

"Now that this vulnerability for treatment failure has been identified, there are many ways to tackle how it can be prevented," Dohrn said.

SOURCE: http://bit.ly/1MpKZSQ JAMA Pediatrics, online March 30, 2015.

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