Adolescents and young adults with HIV and unsuppressed viral load: where do we go from here?

Natella Rakhmanina, Caroline Foster, Allison Agwu
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Abstract

Purpose of review: Adolescents and youth living with HIV (AYLHIV) have worse outcomes at all stages of the care cascade when compared with adults, yet adolescents and youth with unsuppressed viral load are typically excluded from phase 3 studies of novel HIV therapeutic agents and emerging strategies. Long-acting agents have the potential to radically change outcomes for young people struggling with adherence to daily oral HIV medications.

Recent findings: 1.5 million children aged less than 15 years live with HIV and more than 100 000 acquire HIV perinatally every year. Adolescents and youth aged 10-24 years comprise ∼40% of global incident HIV infections. Rates of viral suppression among AYLHIV vary markedly from 44 to 88%, resulting in morbidity and risks of transmission to partners and infants. Virological failure is mostly due to poor adherence, and AYLHIV express high levels of interest and acceptability of alternatives to oral daily medications, such as long-acting antiretroviral formulations. Emerging data regarding their use in populations with unsuppressed viral load are encouraging.

Summary: AYLHIV, including populations without virologic suppression, must be prioritized for the programmatic implementation and research of long-acting HIV drugs and other therapeutic strategies to prevent morbidity and mortality and to ultimately end the HIV epidemic.

感染艾滋病毒且病毒载量未得到抑制的青少年:我们该何去何从?
综述目的:与成年人相比,青少年艾滋病病毒感染者(AYLHIV)在治疗过程的各个阶段的治疗效果都较差,但青少年艾滋病病毒载量未得到抑制,他们通常被排除在新型艾滋病治疗药物和新策略的三期研究之外。长效药物有可能从根本上改变那些难以坚持每日口服 HIV 药物的青少年的治疗结果:每年有 150 万年龄小于 15 岁的儿童感染艾滋病毒,超过 10 万人在围产期感染艾滋病毒。10-24 岁的青少年占全球艾滋病病毒感染者的 40%。青少年艾滋病病毒感染者的病毒抑制率差异很大,从 44% 到 88%不等,这导致了发病率和传染给伴侣和婴儿的风险。病毒抑制失败的主要原因是服药依从性差,AYLHIV 对每日口服药物的替代品(如长效抗逆转录病毒制剂)表示出极大的兴趣和接受度。总结:AYLHIV,包括病毒载量未得到抑制的人群,必须优先考虑长效 HIV 药物和其他治疗策略的计划实施和研究,以预防发病和死亡,并最终结束 HIV 的流行。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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