Pediatric HIV Treatment

HIV Treatment and Care

Data for best practices in pediatric human immunodeficiency virus (HIV) treatment are limited compared to what is known for adults. Pediatric HIV treatment research at CPCE focuses on closing this knowledge gap by addressing issues of importance to the care and treatment of children and adolescents with HIV. Specifically, CPCE researchers are addressing challenges with treatment adherence unique among adolescents with HIV. Our investigators are also working to increase the knowledge needed to make pediatric formulations of newer HIV medications available and to understand which medicines work best in children. They are also working to decrease the stigma relating to HIV and to increase the rate of earlier diagnosis of HIV before irreparable damage has occurred.

Infection with HIV can lead to acquired immunodeficiency syndrome (AIDS), one of the most feared diseases of recent times. More than 3 million children and adolescents worldwide are infected with HIV. With access to care and treatment, children infected with HIV at birth can live to be healthy adults.

Pediatric and Adolescent HIV Care and Treatment

Adolescent HIV Treatment Adherence

Pediatric HIV Treatment Published Research


Pediatric and Adolescent HIV Care and Treatment

The goal of this line of research is to help close the knowledge gap for pediatric and adolescent HIV care by addressing issues of importance to these patients, including access to care and treatment and ways to provide support to clinicians in limited resource settings.

CPCE researchers evaluated the Pediatric Symptom Checklist (PSC) as a simple screening tool to identify HIV-positive children and adolescents with psychosocial needs. A prospective study showed that high scores on the PSC precede adherence problems and treatment failure. Once these psychosocial areas are identified, healthcare providers could use them as starting points for interventions. Additional factors associated with treatment failure, including coming to clinic without a parent or caregiver, have also been identified.

Highlights of research results include:

• describing the comparative effectiveness of the two most commonly used drug regimens for treating children and adolescents with HIV worldwide, resulting in changes to international treatment guidelines

• identifying risk factors for poor outcomes among adolescents with HIV

Read the Lancet Infectious Diseases review paper that describes the unique challenges adolescents with HIV face.

What’s Next:
CPCE researchers are actively working on studies to develop interventions to help target risk factors for poor outcomes in adolescents with HIV. This includes studies related to reducing the stigma related to HIV and improving parent-child communication.

Funding: National Institute of Mental Health (NIMH); Centers for Disease Control and Prevention (CDC)

Please contact Elizabeth Lowenthal, MD, MSCE, attending physician, Special Immunology Family Care Center at CHOP, for more information about this line of research.

See the Published Research


Adolescent HIV Treatment Adherence

Good treatment outcomes have allowed more children with HIV to reach young adulthood. This age group, however, faces unique challenges in staying healthy. Between 2005 and 2012, worldwide HIV-related deaths declined by 30 percent but increased 50 percent among adolescents. Adolescents’ unique challenges with treatment adherence contribute to the disparity. These lifesaving medications only work if taken consistently.

To save lives, we are investigating the best ways to monitor and support adolescent treatment adherence using mixed (qualitative and quantitative) methods in a variety of clinical studies. Our research projects evaluate many perspectives to help predict which adolescents are going to have difficulty with adhering to their medication long-term. Recognizing those young adults who would most likely benefit from support services could be an important first step in prolonging their lives.

Highlights of research results include:

• identifying risk factors for non-adherence, allowing for prioritization of limited laboratory resources in resource-limited settings

• identifying interventional targets to help improve adherence support

Read this Fox News article about CPCE’s Adolescent HIV Treatment Adherence Research.

What’s Next: CPCE researchers are actively working on studies to improve adherence to antiretroviral therapies among HIV-infected adolescents in Botswana. We are comparing methods that measure adherence to determine which are the most useful, including self-report, electronic monitoring devices, pill counts, medication refill rate, and monitoring virus suppression. We are also considering how adolescents’ autonomy over medication is associated with these measurement methods.

Funding: National Institute of Mental Health (NIMH); Centers for Disease Control and Prevention (CDC)

Please contact Elizabeth Lowenthal, MD, MSCE, Attending Physician, Special Immunology Family Care Center at CHOP, for more information about this line of research.

See the Published Research


Pediatric HIV Treatment Published Research

Mckeegan K, Rutstein R, Lowenthal E. Postnatal infant HIV prophylaxis: a survey of U.S. practice. AIDS Patient Care and STDs. 2011 Jan; 25(1): 1-4.

Connolly M, Rutstein R, Lowenthal ED. Virologic testing in infants with perinatal exposure to HIV receiving multi-drug prophylaxis. Pediatric Infectious Disease Journal. 2013 Feb;32(2): 196-7.

Bearden D, Steenhoff AP, Dlugos DL, Kolson D, Mehta P, Kessler S, Lowentha El, Monokwane B, Anabwani G, Bisson GP. Early antiretroviral therapy is protective against epilepsy in children with Human Immunodeficiency Virus Infection in Botswana. J Acquir Immune Defic Syndr. 2015 Jun 1;69(2):193-9.

Lowenthal ED, Ellenberg JH, Machine E, Sagdeo A, Boiditswe S, Steenhoff AP, Rutstein R, Anabwani G, Gross R. Association Between efavirenz-based compared with nevirapine-based antiretroviral regimens and virologic failure in HIV-Infected children. JAMA.  2013 May; 309(17): 1803-1809.

Lowenthal ED, Jibril HB, Sechele ML, Mathuba K, Tshume O,  Anabwani GM. Disclosure of HIV status to HIV-infected children in a large African treatment center: Lessons learned in Botswana. Children and Youth Services Review. 2014 April 15; Elsevier( 45): 143-149.

Lazarus JR, Rutstein R, Lowenthal E. Treatment initiation factors and cognitive outcome in youth with perinatally acquired HIV infection. HIV Medicine. 2015 Jul;16(6):355-61.