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Abstract：
The success of HIV treatment programmes globally has resulted in children with perinatally acquired HIV reaching adolescence in large numbers. The number of adolescents living with HIV is growing further due to persisting high HIV incidence rates among adolescents in low- and middle-income settings, particularly in sub-Saharan Africa. Although expanding access to HIV viral load monitoring is necessary to achieve the 90-90-90 targets across the HIV care continuum, implementation is incomplete. We discuss the rationale for prioritizing viral load monitoring among adolescents and the associated challenges.
Adolescents with HIV are a complex group to treat successfully due to extensive exposure to antiretroviral therapy for those with perinatally acquired HIV and the challenges in sustained medication adherence in this age group. Given the high risk of treatment failure among adolescents and the limited drug regimens available in limited resource settings, HIV viral load monitoring in adolescents could prevent unnecessary and costly switches to second-line therapy in virologically suppressed adolescents. Because adolescents living with HIV may be heavily treatment experienced, have suboptimal treatment adherence, or may be on second or even third-line therapy, viral load testing would allow clinicians to make informed decisions about increased counselling and support for adolescents together with the need to maintain or switch therapeutic regimens.
Given scarce resources, prioritization of viral load testing among groups with a high risk of virological failure may be required. Adolescents have disproportionately high rates of virological failure, and targeting this age group for viral load monitoring may provide valuable lessons to inform broader scale-up.
Adolescents with HIV are a complex group to treat successfully due to extensive exposure to antiretroviral therapy for those with perinatally acquired HIV and the challenges in sustained medication adherence in this age group. Given the high risk of treatment failure among adolescents and the limited drug regimens available in limited resource settings, HIV viral load monitoring in adolescents could prevent unnecessary and costly switches to second-line therapy in virologically suppressed adolescents. Because adolescents living with HIV may be heavily treatment experienced, have suboptimal treatment adherence, or may be on second or even third-line therapy, viral load testing would allow clinicians to make informed decisions about increased counselling and support for adolescents together with the need to maintain or switch therapeutic regimens.
Given scarce resources, prioritization of viral load testing among groups with a high risk of virological failure may be required. Adolescents have disproportionately high rates of virological failure, and targeting this age group for viral load monitoring may provide valuable lessons to inform broader scale-up.
摘要：
全球艾滋病毒治疗方案的成功导致围产期获得艾滋病毒的儿童大量进入青春期。由于低收入和中等收入地区青少年艾滋病毒感染率居高不下，感染艾滋病毒的青少年人数进一步增加，特别是在撒哈拉以南非洲。虽然扩大获得HIV病毒载量监测是必要的，以实现整个HIV护理连续体的90-90-90目标，执行是不完整的。我们讨论了在青少年中优先进行病毒载量监测的理由以及相关的挑战。
青少年HIV感染者是一个复杂的群体，由于广泛接受抗逆转录病毒治疗，这些患者围产期获得性HIV患者以及该年龄组持续服药依从性的挑战，因此需要成功治疗。鉴于青少年治疗失败的风险很高，并且在资源有限的环境中可用的药物治疗方案有限，青少年HIV病毒载量监测可以防止病毒学抑制青少年不必要和昂贵的二线治疗转换。因为感染艾滋病毒的青少年可能经历了大量的治疗，治疗依从性欠佳，或者可能在二线甚至三线治疗，病毒载量检测将使临床医生能够就增加对青少年的咨询和支持以及维持或转换治疗方案的需要做出明智的决定.
鉴于稀缺资源，可能需要在病毒学失败的高风险人群中优先进行病毒载量测试。青少年有不成比例的高病毒学失败率，针对这一年龄组的病毒载量监测可能提供有价值的经验教训，以告知更广泛的扩大规模。
青少年HIV感染者是一个复杂的群体，由于广泛接受抗逆转录病毒治疗，这些患者围产期获得性HIV患者以及该年龄组持续服药依从性的挑战，因此需要成功治疗。鉴于青少年治疗失败的风险很高，并且在资源有限的环境中可用的药物治疗方案有限，青少年HIV病毒载量监测可以防止病毒学抑制青少年不必要和昂贵的二线治疗转换。因为感染艾滋病毒的青少年可能经历了大量的治疗，治疗依从性欠佳，或者可能在二线甚至三线治疗，病毒载量检测将使临床医生能够就增加对青少年的咨询和支持以及维持或转换治疗方案的需要做出明智的决定.
鉴于稀缺资源，可能需要在病毒学失败的高风险人群中优先进行病毒载量测试。青少年有不成比例的高病毒学失败率，针对这一年龄组的病毒载量监测可能提供有价值的经验教训，以告知更广泛的扩大规模。
