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Craig Wilson, MD Comments On the Future of HIV/AIDS Research

Summer 2001

Craig Wilson, MD: University of Alabama at Birmingham, Departments of Pediatrics and Medicine, Chair of the Adolescent Medicine Trials Network for HIV/AIDS Interventions

HIV-infected adolescents present many management challenges but also a few unique opportunities for directed interventions. Identifying youth infected with HIV through risk behaviors is a particular challenge since many of these youth do not identify the risk behaviors with acquiring HIV. Once in care, the challenges of managing HIV-infected adolescents on complex regimens, as well as issues of disclosure and confidentiality, are only made more complex by their age, quite often disrupted traditional social supports and other psychosocial conditions.

One of the most intriguing and under-appreciated areas of inquiry relates to the nature and extent of immune resiliency in adolescents and to what degree it can be used to therapeutic advantage in vaccine-based prevention as well as clinical management of HIV infection. Recent observational data from the Adolescent Medicine HIV/AIDS Research Network have demonstrated that youth, HIV-infected as teens, exhibit increased naïve CD8+ T lymphocytes at all stages of HIV disease compared to HIV-infected adults, and they display relatively normal levels of naïve CD4+ T lymphocytes when compared to uninfected controls. These findings suggest that HIV-infected adolescents may maintain (and have the potential to repopulate) naïve CD4+T lymphocytes to a greater degree than adults owing to persistent thymic function. These findings also suggest HIV-infected adolescents have an increased potential to respond to therapeutic vaccines. It is time to employ a structured treatment interruption strategy interspersed with immune-based therapeutic challenge in recently-infected youth to determine the potential for immune recovery and control of viral replication.

Ongoing studies of the Adolescent Medicine HIV/AIDS Research Network in minority youth will substantially expand our knowledge about responses to HIV proteins and be informative for vaccine development for minority populations. Since adolescents will ultimately be a primary target for preventive vaccination, it is imperative that the enrollment of HIV negative adolescents be accommodated in every efficacy trial of vaccine candidates.

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In addition, researching and promulgating effective, multifaceted, and consistent primary prevention programs and messages directed at youth will be an ongoing need for years to come. The newly-funded Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) will be pursuing these objectives in collaboration with existing research networks.





  
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This article was provided by AIDS Community Research Initiative of America. It is a part of the publication CRIA Update. Visit ACRIA's website to find out more about their activities, publications and services.
 

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