Antiretroviral adherence for adolescents growing up with HIV: understanding real life, drug delivery and forgiveness
Author(s)
Foster, Caroline
Ayers, Sara
Fidler, Sarah
Type
Journal Article
Abstract
Poorer adherence to medication is normal in adolescence and is one of a range of risk-taking behaviours common during a developmental stage that encompasses enormous cognitive, physical, sexual, social and emotional change. For adolescents living with human immunodeficiency virus (HIV) infection, poor adherence to antiretroviral therapy (ART) confers two significant challenges: poor health, but also the specific additional burden of onward transmission to partners. Late adolescence (15–19 years) is the only age group where HIV-associated mortality is rising, driven by poor adherence to ART and lack of access to second-line therapy, particularly amongst surviving perinatally infected young people. A previous lack of well-powered randomised multimodal behavioural ART adherence interventions specifically targeting adolescents is now being addressed and ongoing studies registered to ClinicalTrials.gov are described in the context of previous data. Accepting that despite enhanced support, some adolescents will continue to struggle with adherence, we must address how best to use existing ART agents to reduce mortality and allow adolescents the time to mature into adult life. Single-tablet regimens with a high genetic barrier to resistance based on integrase inhibitors and boosted protease inhibitors exist, but global access, in resource limited settings of young people living with HIV reside, is limited. Pragmatically, such regimens tolerate the intermittent adherence so characteristic of adolescence, preserving immune function, without the rapid evolution of resistance. The potential role of long-acting injectable ART, specifically cabotegravir and rilpivirine, is discussed and future strategies including ultra-long-acting drug-delivery systems and broadly neutralising monoclonal antibodies explored.
Date Issued
2020-05-07
Date Acceptance
2020-03-22
Citation
Therapeutic Advances in Infectious Disease, 2020, 7, pp.1-12
ISSN
2049-9361
Publisher
SAGE Publications
Start Page
1
End Page
12
Journal / Book Title
Therapeutic Advances in Infectious Disease
Volume
7
Copyright Statement
© The Author(s), 2020.
Article reuse guidelines:
sagepub.com/journalspermissions. Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License
(https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission
provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Article reuse guidelines:
sagepub.com/journalspermissions. Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License
(https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission
provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
License URL
Sponsor
Imperial College Healthcare NHS Trust- BRC Funding
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000535750700001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
RDA02
Subjects
Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
adherence
adolescents
antiretroviral therapy
HIV
viral suppression
PERINATAL HIV
YOUNG-ADULTS
EXPERIENCED PATIENTS
DOUBLE-BLIND
DOLUTEGRAVIR
INFECTION
THERAPY
CARE
INTERVENTIONS
MULTICENTER
Publication Status
Published
Article Number
ARTN 2049936120920177
Date Publish Online
2020-05-07