Survival, plasma HIV-1 RNA concentrations and drug resistance in HIV-1-infected Haitian adolescents and young adults on antiretrovirals.
OBJECTIVE
To assess outcomes after antiretroviral therapy (ART) in adolescents and youth in Haiti, a country with a generalized epidemic of infection with HIV-1.


METHODS
An assessment was made of survival, plasma HIV-1 ribonucleic acid (RNA) concentrations and HIV-1 drug resistance patterns after 12 months of ART in patients aged 13-25 years who presented to a clinic in Port-au-Prince, Haiti, with AIDS between 1 March 2003 and 31 December 2005. Participants received ART in accordance with WHO guidelines. Kaplan-Meier analysis was used to estimate survival probabilities and their 95% confidence intervals (CI) for the period from ART initiation to death.


RESULTS
Of a total of 146 patients, 96 (66%) were female; the median CD4+ T-cell count at baseline was 129 cells/ml. By Kaplan-Meier analysis, 13% of the patients had died at 12 months, 17% at 24 months and 20% at 36 months. A plasma HIV-1 RNA concentration > or = 50 copies/ml was seen in 40 (51%) of 79 patients 12 months after treatment initiation and was associated with poor ART adherence. Among 29 patients with > 1000 copies/ml at 12 months, resistance mutations to non-nucleoside reverse transcriptase inhibitors (NNRTIs) were detected in 23 cases (79%); to both NNRTIs and lamivudine in 21 (72%) cases; and to NNRTIs, lamivudine and other nucleoside reverse transcriptase inhibitors in 10 (35%) cases. One hundred and six participants (73%) reported sexual intercourse without condoms, and 35 of the 96 women (36%) were pregnant during follow-up.


CONCLUSIONS
Adolescents and youth with AIDS receiving ART are at risk of virologic failure and disease progression and can therefore transmit HIV-1 to sexual partners and infants. Strategies to target the special needs of this age group are urgently needed.
Charles
Macarthur
M
Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti.
Noel
Francine
F
Leger
Paul
P
Severe
Patrice
P
Riviere
Cynthia
C
Beauharnais
Carole Anne
CA
Miller
Erica
E
Rutledge
John
J
Bang
Heejung
H
Shealey
Wesley
W
D'Aquila
Richard T
RT
Gulick
Roy M
RM
Johnson
Warren D
WD
Wright
Peter F
PF
Pape
Jean William
JW
Fitzgerald
Daniel W
DW
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D024921:Drug Resistance, Multiple, Viral / Q000187:drug effects / Q000235:genetics*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D015497:HIV-1 / Q000235:genetics*; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012313:RNA / Q000235:genetics*; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D055815:Young Adult
D019380:Anti-HIV Agents; D012313:RNA