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Antiretroviral Treatment and Adherence

Introduction

Although treatment can greatly increase longevity and quality of life for HIV-infected patients, some HIV-infected adolescents are not receiving the benefits of this care. In line with recent guidelines from the U.S. Centers for Disease Control and Prevention (CDC),1 providers should make HIV testing a routine part of health care to help identify undiagnosed HIV-infected youth and link them to life-saving treatments and services. Once HIV-infected youth have been identified, clinical care for these patients should meet the following goals:

  • Determine staging of HIV illness and health status
  • Provide health care maintenance: HIV and primary care, treating concurrent medical problems
  • Provide ongoing monitoring: immunologic, virologic, clinical
  • Provide state-of-the-art treatment and therapies: antiretrovirals (ARVs), opportunistic infection (OI) prophylaxis, etc
  • Educate patients about HIV disease
  • Educate patients about ARV therapy (ART) and facilitate treatment adherence
  • Establish linkages with appropriate clinical trials

This section highlights important issues that can facilitate culturally competent care; gives providers an overview of general clinical care considerations for treating HIV-infected youth; and addresses the challenges of initiating ARV medications in adolescent patients, including the medical, psychosocial, and cultural issues youth may face when initiating ART. It also illustrates how to assess for medication readiness and how to select a regimen that is compatible with patients' different lifestyles.

Learning Objectives:

Upon completing this module, participants will be able to:

  1. Identify at least 3 sociocultural and religious barriers affecting the initiation of ART in adolescents (youth perspective).
  2. Recognize at least 3 clinical factors unique to adolescents that impact the initiation of ART.
  3. Identify 3 common reasons for virologic failure.
  4. Identify and address 4 common barriers to ART adherence.
  5. Identify 2 ARV drugs that can potentially decrease the effectiveness of estrogen-containing oral and transdermal birth control medications.
  6. Identify 3 side effects of ARV medications most likely to result in poor adherence in adolescents and specify which side effects are perceived as severe by Black/African American teens.

Instructions

  • The course may be navigated either by selecting the "Next Page" button at the bottom of each screen, or by using the course outline buttons in the left navigation column.

  • All users will be asked to complete a final evaluation to help the sponsors assess the value of the course.

References

  1. Branson BM, Handsfield HH, Lampe MA, et al. U.S. Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006 Sep 22;55(RR-14):1-17.