ARTICLE SUMMARY

Article Summary

Article Summary

Monasch, R. Mathy, M. Young People. 2006. The Centre of the HIV epidemic World Health Organ Tech Rep Ser, pp. 317-341

Historical Overview

The transition process from pediatric to adult health care for adolescents with chronic diseases is always challenging and can be even more so for adolescents with HIV disease. The purpose of this study was to describe characteristics and current practices surrounding the transition of adolescents from the clinics of the Adolescent Trials Network for HIV/AIDS Interventions to adult medical care.

Purpose of the Study

This report focuses on the processes of transition, perceived barriers and facilitators, and anecdotal reports of successes and failures. Practice models used to assist adolescents during transition to adult medical care are described. Interviews were conducted with 19 key informants from 14 Adolescent Trials Network clinics. Findings revealed no consistent definition of “successful” transition, little consensus among the sites regarding specific elements of a transition program, and a lack of mechanisms to assess outcomes. Sites that viewed transition as a process rather than an event consistently described more structured program elements.

Therapeutic Targets, Treatment Options and Current Translational Research

An estimated 33 million individuals are infected with HIV worldwide and two-thirds of this burden is in sub-Saharan Africa. Of the estimated two million HIV-infected children, 90% reside in sub-Saharan Africa, where high rates of morbidity and mortality occur due to poor nutrition, limited access to healthcare and high risk of exposure to pathogens. Regardless of geographical location, untreated HIV infection reduces the capacity of a child's immune system to respond to infections and vaccines, resulting in high mortality rates in early childhood. Recently, access to HAART has increased due to funding from the US President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and several other sources. As of September 2009, PEPFAR alone supplied HAART to almost 2.5 million individuals. Children have benefited from the rapid scale-up of HAART, with several studies reporting increased survival rates among HAART-treated children. As mortality due to HIV-related conditions diminishes, an increasing number of children will be living with HIV, necessitating an increased understanding of how HAART affects immunity to vaccine-preventable infections.

Naive T cells emigrate from the thymus to the peripheral circulation, express the cell surface marker CD45RA and are activated via interaction with viral peptides displayed by MHC molecules on antigen-presenting cells. Activated cells develop into either memory phenotypes, which expand upon subsequent antigen exposure, or effectors cells that perform immediate protective functions such as stimulating further lymphocyte activation and proliferation or inducing cytolysis of virus-infected cells. The pathways of memory T-cell development are currently a subject of intense research as varying hypotheses have been proposed. One study concluded that two memory subsets, effectors memory and central memory, develop independently and are distinguished by expression of the lymph node-homing marker CCR7. Another indicated that a single naive cell may give rise to both effectors and memory daughter cells, suggesting that the CCR7 phenotype may not be ...