Today, instead of fending off swift, deadly infections, practitioners - and HIV-infected youth - are grappling with subtle complications. Two danger areas, according to HIV researchers, are cardiovascular health and neurological illness. Early results from the pHAcs study and others show that many of the children who have been treated with anti-HIV medications since a young age have heart abnormalities, higher cholesterol levels, and above-normal rates of obesity and glucose intolerance—a precursor to diabetes. “In the long run, these factors put the kids at higher risk of heart attacks and strokes,” says Siberry. But scientists emphasise that these results don’t necessarily herald an epidemic of cardiovascular disease among HIV-positive youth over the next decades. They are initial findings and more work needs to be done to understand what factors contribute to the risk. “It just means we are mindful of the risk and exploring the use of new medications that don’t increase cardiovascular side-effects,” says Paul Krogstad, a physician and virologist at the University of California, Los Angeles.
These kids also have higher than normal rates of mental health issues including depression, substance abuse, attention deficit disorder and learning difficulties. We don’t yet know the effect of HIV on the brain during development,” says Krogstad. It’s still unclear whether the cause is social - a consequence of the kids’ socioeconomic backgrounds and speckled family history - or biological. “It deserves close scrutiny,” he says.
Whilst questions like this will take time to answer, there are more immediate challenges facing Generation HIV.
Sex can be a messy issue for many young adults, but when an adolescent is HIV positive, it is even more complex. Unlike their peers, these teens have to think about public disclosure of their HIV status, the impact of their sexual encounters on their partners, and whether they want to have kids of their own. “I kinda grew up with this disease and it’s totally different now,” says Ledlie. Pediatric Aids specialists are wading into unfamiliar territory when they begin talking about pregnancy with their patients. Because of the inextricable relationship between sexuality and HIV transmission, some small studies in the UK and the US have followed the pregnancies of young, HIV-positive women, to assess their reproductive and sexual health, and found their fertility remains relatively intact. One study did however find that a high proportion of girls had abnormal cervical cells, although this could be attributed to their increased susceptibility to genital infections like the human papilloma virus, a cause of cervical cancer.
Tanya’s long-term boyfriend still doesn’t know she is HIV positive. “It’s hard to tell a person whom you’re already so [physically] close with,” she says. Tanya says she always insists on using protection, but sometimes her boyfriend asks if it’s because she “has something.” “My excuse is that I don’t want to get pregnant,” says Tanya. But she has had a pregnancy scare. “Susan sat me down and she was like, ‘How do you wanna do this?’” says Tanya. Although Ledlie tried to convince Tanya to tell her boyfriend, she has refused to reveal her secret.
Regime change
Clearly, there are still huge challenges and unknowns. But studies of Generation HIV have also thrown up glimmers of hope. For years, physicians worried that children infected with the virus would grow up with crippled immune systems. But, research shows that most of the children have suppressed the infection and have nearly normal levels of the CD4+ immune cells that are typically destroyed by early HIV infection. That’s good news.
