Too Late to Treatment for Many Young HIV Patients

HIV positive teens and young adults not seeking help until advanced stages

(RxWiki News) HIV treatment can help patients manage their condition if it is started early. However, not everyone seeks out treatment early enough.

A recent study found that around half of HIV-infected teenagers and young adults delayed care and treatment until their disease had significantly advanced.

The researchers discovered that black patients, Hispanic patients and male patients were at the highest risk for starting treatment late.

"Get tested for HIV regularly."

The lead author of this study was Allison L. Agwu, MD, ScM, from the Division of Pediatric Infectious Disease and the Division of Infectious Diseases at the Johns Hopkins School of Medicine in Baltimore, Maryland.

The study included 1,497 HIV-positive patients between the ages of 12 and 24 years old.

All participants were in care at one of 13 HIV Research Network clinics across the country between 2002 and 2010.

A total of 61 percent of the participants were black and 78 percent were male. None of the participants had acquired HIV through birth transmission.

Every participant had at least one CD4 count on record, but had not started treatment upon entering care.

CD4 cells are white blood cells that the HIV virus attaches to. As the virus destroys these cells, an HIV-positive person can become very vulnerable to other bacterial, viral and fungal infections.

A healthy, HIV-negative person has a CD4 count of between 500 and 1,500 cells per cubic millimeter. In an HIV-positive person, a CD4 count of less than 500 cells per cubic millimeter is typically the time that antiretroviral therapy (ART) should be started.

Dr. Agwu and colleagues found that between 30 and 45 percent of the participants during each year of the study had a CD4 count of less than 350 cells per cubic millimeter.

A CD4 count of less than 350 cells per cubic millimeter indicates an advanced stage of HIV.

Compared to the white participants, the black participants had twice the odds of having a CD4 count of less than 350 cells per cubic centimeter on presentation, and Hispanic participants had 69 percent increased odds compared to whites.

Men were 63 percent more likely to have a CD4 count of less than 350 cells per cubic millimeter than women.

Participants who acquired HIV through heterosexual transmission were 43 percent more likely than the participants who acquired the virus through homosexual transmission to have a CD4 count less of than 350 cells per cubic millimeter.

The findings also revealed that each year of increasing age was associated with a 14 percent increased risk of having a CD4 count of less than 350 cells per cubic millimeter.

The researchers concluded that people diagnosed with HIV should start therapy early on after being infected, and follow the regimen strictly to ensure that the virus is under control, to prevent complications and to reduce the risk of spreading the infection to others.

“These are decidedly disappointing findings that underscore the need to develop better ways to diagnose teens sooner and, just as importantly, to get them into care and on therapy sooner,” said Dr. Agwu in a press release.

The authors mentioned a few limitations of their study. First, the HIV Research Network does not gather data on socioeconomic factors. Second, data on mental health and substance abuse were incomplete and not evaluated.

A third limitation was that there was a very small amount of participants between the ages of 12 and 16 years old, of injection drug users and of heterosexual males in the study population. Lastly, some of the participants may have received care at other sites not in the HIV Research Network.

This study was published on February 3 in JAMA Pediatrics.

The Agency for Healthcare Research and Quality and the Health Resources and Services Administration provided funding.

Review Date: 
February 6, 2014