September 3, 1999
Teens with AIDS helped by new program
New clinical research on teenagers with AIDS not only examines how quickly their immune systems recover with combination therapy, but also gives many of them the opportunity to obtain the latest treatment.
Earlier this year, the Teen Young Adult Clinic in the Madison Clinic at Harborview Medical Center was one of 12 sites around the nation to receive funding from the National Institute of Health for more clinical research on teens with HIV.
“If kids were not on this research protocol, they might not be on the combination therapy,” says Dr. James Farrow, who directs the Teen AIDS program at Harborview, and is also faculty in adolescent medicine and associate professor of medicine and pediatrics at the University of Washington. “When they first start treatment, we try to use a protease inhibitor-sparing regime ? this means using combinations of other AIDS medications. We add the protease inhibitor if the illness becomes serious, as this maximizes its effectiveness.”
Some data show that this regime works just as well as the full treatment among teens. The figures among adults are not as compelling, he points out. Because adults are infected longer and their viral loads are higher, they often require the full combination treatment.
Treatment compliance is a major problem among adolescents, adds Farrow, as the treatment requires taking large quantities of pills and produces side effects, although there are attempts to simplify the regimen. “It requires a strong case-management approach to appointments,” he says. “We try to act as an advocate and treatment partner, and emphasize health education, focusing on diet and exercise.”
There are an estimated 80 teenagers in King County with AIDS. Among them, some 60 percent know they have the disease, about 30 percent of them are receiving care, and about 15 of them are active patients at Harborview or in the pediatric AIDS program at Children?s Hospital. Unlike the adult AIDS population, which is 91 percent male, females make up 50 percent of the teen sector. Most females under 16 contracted AIDS through sexual activity. In the 16-20 age group, about 75 percent of males were infected through homosexual activity. Only 25 percent of all teen patients have a history of injection drug use or have known sexual contacts with injection drug users.
More than half of the patients over 16 have been homeless. Many of them live in shelters, group homes or transitional housing. Typically there is at least a year delay from diagnosis to seeking care, and usually it is the case manager or their primary care provider who talks them into initiating care.
“There is a lot of denial, even when they have their first appointment,” says Farrow. “Our message to them is that HIV intention is now quite compatible with long life and they have to view it that way. There are a lot of options for treatment. Several new drugs are coming on line each year so we can stay ahead of the infection with regular care. Unlike many adults, very few adolescents are drug-resistant and continuous treatment improves the ability to control resistance.”
The Teen Young Adult Clinic at Harborview is a collaborative treatment program of the Madison Clinic, Northwest Family Center, the UW Adolescent Medicine Program and the Pediatric Aids Clinical Trials Unit.
