Investing in Research to Improve Adolescent HIV Care
October 2011 - Providing effective treatment and care for HIV-positive adolescents can be a challenge for physicians. TREAT Asia is currently supporting three studies that it hopes will inform and improve adolescent HIV treatment and care in Southeast Asia.
ACASI study initiation meeting in Chiang Rai, Thailand
HPV infection risks
A team of researchers from HIV-NAT/Thai Red Cross AIDS Research Centre in Bangkok has received funding for a second year to study human papillomavirus (HPV) infection—a precursor to cervical and anal cancer—in HIV-positive adolescents. "We are already seeing a significant percentage of adolescents with HPV infection and abnormal Pap smear results," said Dr. Jintanat Ananworanich, lead researcher on the project. "This highlights the need to embrace the reality that HIV-positive adolescents are having sex, and we must find ways to help them have safe sex."
In addition to comparing HPV incidence between HIV-positive youth and their uninfected peers, Dr. Jintanat's team is assessing risk for HPV infection among adolescents who contracted HIV through sexual behavior and those who were born with the virus and therefore have experienced a longer duration of immune suppression. Dr. Jintanat explained, "We know that in adults with HIV infection, immune suppression is a risk for cervical/anal cancer development."
This study is expected to serve as the basis for future research that may ultimately impact the monitoring of cervical and anal cancer in adolescents in the region. Merck & Co., Inc. has made a generous donation of free HPV vaccine to HIV-NAT for this project. HPV vaccine is currently prohibitively expensive in most parts of Southeast Asia, and Dr. Jintanat hopes her team's research will be a driving force to improve vaccine availability in the region.
Bone density loss
Siriraj Hospital at Mahidol University in Bangkok is collaborating with HIV-NAT to look at bone mineral density (BMD) levels in HIV-positive adolescents. "Low BMD causes fragility of the bone which leads to fracture risk, osteoporosis, and osteopenia," explained Dr. Kulkanya Chokephaibulkit, lead researcher on the project at Siriraj Hospital. Bone mass accumulation occurs during childhood and adolescence, and normal BMD levels vary across geographic settings.
"There is very little knowledge about BMD in HIV-infected children in Asia," said Dr. Kulkanya. Using a special x-ray called a dual energy x-ray absorptiometry (DEXA) scan, Dr. Kulkanya's team has measured the BMD of both HIV-positive and uninfected adolescents over the age of 12 years.
"We found that many of our HIV-infected adolescents in Bangkok had low bone mass as measured by the report from the DEXA scan," said Dr. Kulkanya, whose team is currently comparing the data to Thai standards for normal BMD. "Preliminary data suggests that low BMD is associated with advanced HIV disease, use of protease inhibitors, and low body mass index." The study is ongoing, but Dr. Kulkanya expects the results will inform future adolescent HIV treatment guidelines to prevent bone fractures.
Understanding how adolescents experience living with HIV
In order to aid clinicians in obtaining more honest and accurate personal information from HIV-positive adolescents, TREAT Asia is supporting a pilot study of an audio-computer-assisted survey instrument (ACASI) in Thailand and Malaysia. Researchers created a questionnaire about behavioral risk factors, stigma, and adherence to antiretroviral therapy based on models developed by the U.S. National Institutes of Health, U.S. Centers for Disease Control and Prevention, and the Thailand Ministry of Public Health. The questionnaire—offered in Malay, Chinese, and Thai—is administered privately and presented as a computer survey, with a digital recording that reads the questions aloud to the adolescent. The ACASI is expected to increase responsiveness by fostering a more comfortable environment in which adolescents with HIV may disclose personal details about adherence to medication, sex, drug use, and stigma.
These research investments are improving the understanding of long-term consequences of HIV infection and treatment for adolescents in Asia.