It's very tempting to think of HIV infection as affecting the disenfranchised: gay men who engage in promiscuous sexual behavior, IV drug users, lower echelon folks unfortunate enough to engage in sex with someone who is already harboring the virus. Yet as Rick and I discuss in this week's podcast, there's at least one group of people who are HIV infected through no action of their own who suffer the consequences of poorly administered medication regimens: children. That's in this week's Lancet.
Multiple studies were used in this analysis, representing more than 1000 children who had been infected with HIV from their mothers during the birth process. One third of these children were started on a third class of anti-HIV medication during follow up. Of this number 105 developed 'triple class virological failure,' which means that in spite of using one drug from each of the three classes of HIV medications available, the virus escaped containment and replicated freely.
The risk of treatment failure increased with time. After five years of treatment about 12% of kids had failed treatment, with 20% having failed after eight years. To these children such failure means that the many consequences of uncontrolled HIV infection would be much more likely to develop: serious immune compromise, infections, cancers, and death. Indeed, as Rick cites in the podcast, of the 2 million children infected with HIV worldwide, 700 die each day.
Well, okay. Can't help some treatment failures, right? What's ever so disheartening about this study is the fact that for the youngest of kids in this study, aged 2 and younger, treatment failure is the result of medications not being administered correctly by caregivers. Yikes. So not only are these kids infected through no fault of their own, they're being poorly managed by those in charge of their care. Star-crossed indeed, but crying out for some intervention such as witnessed medication utilization such as that in use for tuberculosis in many parts of the world.
Older kids, those in the adolescent years, seem to take themselves off antiretroviral therapy. This is a bigger problem in my mind as we can't seem to change that popular adolescent fantasy of immortality in any arena, be it smoking, texting while driving and other behaviors of magical thinking. So it seems with these medications, and I'll leave it to better minds than mine to construct an effective solution.
For the rest of us, this means premature death of children and adolescents, and that's never good for society at large. Moreover, those who do survive are increasingly likely to be harboring resistant viruses as a result of intermittent drug taking practices, and those turned lose could wreak havoc on our fragile stalemate with HIV, once again giving the virus the upper hand. There's something to contemplate along with skyrocketing gas prices.
Other topics this week include when to start antiretroviral therapy in adults infected with HIV in this week's Annals of Internal Medicine, new criteria for Alzheimer's disease in Alzheimer's and Dementia, and new interpretations of the significance of triglycerides in Circulation. Until next week, y'all live well.