Posted on March 6, 2001 at 10:29 a.m.
BIRMINGHAM, AL — Fewer than 50 percent 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 Dr. Craig Wilson, associate professor of pediatrics at the University of Alabama at Birmingham (UAB) and a co-investigator of the study. “This is a serious problem for teens with HIV.”
Although the exact number of youth in the U.S. who are infected with HIV is unknown, public health officials estimate that 20,000 people between the ages of 13 and 24 are infected with HIV each year — two every hour. “The rate of HIV infection among younger adolescents in the U.S. is increasing 200 to 300 percent 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, since there are only a few drug combinations that may work,” Wilson says. “It also represents a significant public health concern, since drug-resistant strains of the virus can be transmitted to others.”
Research has shown that in order for drug therapies to be effective, patients with HIV must strive for 100 percent adherence, which is especially difficult considering the complexity of the drug regimens — combinations of drugs taken frequently throughout the day — and the adverse side effects associated with the drugs. “For teens especially, it’s a hard sell,” Wilson says. “We’re asking them to take medications when they don’t 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’s 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 says. “We need to identify and address whatever other problems these teens may have before beginning therapy. If not, they won’t 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. While participants ranged in age from 13 to 18, the average age was 17. Most were black females.
The first phase of REACH, the data collection phase, ended in December. “We now have enough observational data to start designing intervention programs,” Wilson says. “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, which coordinates the national study and collects and analyzes 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 United States.
Other researches who collaborated on the drug adherence study are Debra A. Murphy with the department of psychiatry at the University of California at Los Angles; Stephen J. Durako and Larry R. Muenz with Westat, Inc., in Rockville Maryland; and Marvin Belzer with Children’s Hospital of Los Angeles.
NOTE: The University of Alabama at Birmingham (UAB) is a separate, independent campus from the University of Alabama, which is located in Tuscaloosa. Please use the University of Alabama at Birmingham on first reference and UAB on second reference.