Adolescent HIV treatment issues in South Africa

Abstract

Following the discovery of the human immunodeficiency virus (HIV), our knowledge of HIV infection and management has increased
rapidly, but implementation of interventions has been slow in resource-limited settings. In particular, interventions such as antiretroviral
treatment (ART) and prevention of mother-to-child transmission were hindered owing to lack of access to antiretroviral drugs. This resulted
in ongoing HIV transmission, morbidity and mortality associated with opportunistic infections. Notwithstanding the current progress in
HIV prevention and treatment, challenges remain in preventing new infections in adolescents and supporting and treating HIV-infected
adolescents. Barriers to successful treatment of infection in adolescents include denial of diagnosis, poor understanding or perception
of future benefits of treatment and current-orientated thinking that may contribute to non-adherence to ART. Side-effects that lead to
stigmatisation, such as lipoatrophy (stavudine, zidovudine), diarrhoea and flatulence (lopinavir/ritonavir) and gynaecomastia (efavirenz), may
be intolerable and prevent adherence to treatment. This article highlights common treatment issues in HIV adolescent care and provides
guidance on their management in the South African setting.