March 6, 2001
Fewer than 50% of adolescents with HIV take their medications as prescribed, according to a recent study published in the February issue of
AIDS Care. “Strict adherence to drug therapy is critical for keeping the virus suppressed,” says Craig Wilson, MD, UAB associate professor of pediatrics and a co-investigator of the study. “This is a serious problem for teens with HIV.”
Although the exact number of youth in the United States who are infected with HIV is unknown, public health officials estimate 20,000 people ages 13 to 24 are infected with HIV each year —2 every hour. “The rate of HIV infection among younger adolescents in the US is increasing 200% to 300% each year," says Wilson.
Interruptions in drug therapy allow the virus to resume rapid replication and to mutate into new drug-resistant strains. “This is a serious issue for the individual, because there are only a few drug combinations that may work,” Wilson says. “It also represents a significant public health concern, because drug-resistant strains of the virus can be transmitted to others.”
Research has shown in order for drug therapies to be effective, patients with HIV must strive for 100% adherence, which is especially difficult considering the complexity of the drug regimens and the adverse side effects associated with the drugs. “For teens especially, it is a hard sell,” Wilson says. “We are asking them to take medications when they do not feel sick knowing the medications may make them sick.”
Findings indicate the need for more research and drug development to more effectively treat HIV.
“It is still very early in terms of drug discovery for this disease, which accounts for the complexity of the drug regimens,” Wilson says. “It was the same with other diseases, such as hypertension and heart disease, that are now easier to manage.”
The study also found significantly higher levels of depression among teens not adhering to their drug therapies. “It is easy to see how symptoms of depression, such as tiredness, lack of hope, decreased motivation, and problems with memory and concentration, could have a major impact on adherence,” Wilson explains. “We need to identify and address whatever other problems these teens may have before beginning therapy. If not, they will not succeed.”
The study involved 161 adolescents taking prescribed drug therapy for HIV. Patients were part of a larger study, called Reaching for Excellence in Adolescent Care and Health (REACH), to gather data about HIV among adolescents and to develop targeted intervention programs. Participants were ages 13 to 18. Most were black females.
The data collection phase of REACH, ended in December. “We have enough observational data to start designing intervention programs,” Wilson reports. “We are the process of doing that as we continue to analyze data from observational studies.”
UAB houses the data and operations center for REACH, and will coordinate the national study and collect and analyze the data. Wilson serves as clinical research director and vice chair of the REACH project, which follows a group of about 400 HIV-positive boys and girls, ages of 12 to 18, in 13 cities across the country.