Dr. Allison Agwu on the Health Effects of In Utero vs HIV Receiving Later

Many young people develop resistance to antiretroviral drugs (ART), or they experience lipoatrophy or lipodystrophy; many also have metabolic complications related to ART or inflammation through immunization, notes Allison Agwu, MD, ScM, FAAP, FIDSA, specialist of pediatrics and gastroenterology, Division of Diseases; program director, Pediatric Adolescent Young Adult HIV / AIDS Program; and medical director, Access to Nursing Hospital at Johns Hopkins University School of Medicine.


How do the health outcomes of people born with HIV differ from those who later became infected?

I think in terms of adults born with HIV compared to those who may have been adopted later, if we look at adults of the same age -I mentioned those born with HIV are in their 30s and 40 of them – and looking at someone who has been infected with HIV and who are now adults – they get maybe in their late teens, etc. – they have maybe 10 years of HIV experience, while one born with HIV in 30 to 40 years of experience, right? That is antiretroviralexperience, and we know that treatment for HIV is not the first thing, than monotherapy, double therapy, right, and then continue until we get very active antiretroviral treatment [ART]. We know that one is not enough.

Many of these teens develop resistance, so they are more likely to have general resistance. There is a loyalty that has been developed to a wide range of agents; many have many medicines. So they may have limited treatment options in individual terms, they may have the effect of having ART life in their system. So many of them have scars of that: lipoatrophy, lipodystrophy. Many of them have autoimmune complications related to that as a result, compared to adolescents in adolescence or adulthood, where they are unlikely to have seen all of those agents, at least not to see monotherapy, less to prevent drug overdose

Of course the effect of the protein itself lies in the rules of inflammation, and therefore then it has those who have that inflammation, which continues whether or not it is on treatment and suppresses. We now know that that inflammation, acting as a vaccine, continues in its system. What is 30 years, 40 years of that compared to 10 years or less mean, and what does it mean when you have that inflammation and the viral correction is while growing in utero or over time? Which gives us the idea that if we are seeing overweight in older adults who have been on HIV treatment or have been HIV positive for a long time, what should we see and what should we worry about in Are people infected with HIV in a life of antiretroviral therapy?

Your ability to think critically, etc., that can have an impact, which in turn affects the education system, finances, and so on. Then you have depression, ADHD [attention-deficit/hyperactivity disorder], other known factors associated with HIV itself; antiretroviral therapy, suboptimal; and then the life effects of all that on yourself as a person living with HIV or family, etc., around you. So I think in the text, you see that literally there is every aspect and saying, “Okay, how does this affect these individuals?” And then in the second decade of life, the third decade, how life develops, and the things that always happen in life, and then HIV that affects over time. Some we know, and some we don’t know yet, because they’re still playing, and how do we really need to think about it in order to intervene earlier when possible?

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