Diagnosis disclosure, medication hiding, and medical functioning among perinatally infected, HIV-positive children and adolescents
ABSTRACT Little is known about the immunological and virological impact of diagnosis disclosure among HIV-positive children and adolescents. The current cross-sectional study examined medication hiding as a mediator of the relationship between disclosure to friends and three medical outcomes: CD4+ absolute count, CD4+ percentage, and viral load. Participants included 25 perinatally infected, HIV-positive children and adolescents ages 11-18 years from the US. Diagnosis disclosure and medication hiding were self-reported by participants and medical markers were derived from blood samples drawn during the same clinic visit. Bootstrapping analyses revealed that disclosure to at least one friend (versus no friends) was associated with less medication hiding, which was associated with higher CD4+ absolute counts and percentages but not viral load. Further, among the subset of participants who had disclosed to at least one friend (n = 19), those who reported disclosing to 11 or more versus 1-10 friends were less likely to hide medication taking, which was associated with higher CD4+ absolute counts. Findings suggest HIV-positive children and adolescents' diagnosis disclosure to friends corresponds to less medication hiding, ultimately yielding better immune functioning. Health care providers should be cognizant of these potential medical benefits associated with disclosure when offering support around disclosure decision-making.
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ABSTRACT: Introduction We studied the frequency of documentation of disclosure of HIV status in medical charts and its correlates among HIV-infected adolescents in 2009, in Abidjan, Côte d'Ivoire. Methods The PRADO-CI is a cross-sectional study aimed at studying HIV-infected adolescents’ social, psychological, and behavioural difficulties and their determinants in Abidjan, Côte d'Ivoire. In this study, we present specific analyses on disclosure. All HIV-infected adolescents aged 13–21 years and followed at least once in 2009 in two urban HIV-care centres in Abidjan (Cepref and Yopougon Teaching Hospital) were enrolled in the study. Standardized data were extracted from medical records to document if there was notification of disclosure of HIV status in the medical record. Frequency of notification of HIV disclosure was estimated with its 95% confidence interval (CI) and correlates were analyzed using logistic regression. Results In 2009, 229 adolescents were included: 126 (55%) males; 93% on antiretroviral therapy (ART), 61% on cotrimoxazole prophylaxis. Their median age was 15 years at the time of the study. Among the 193 patients for whom information on HIV status disclosure was documented (84%), only 63 (32.6%; 95% CI=26.0–39.3%) were informed of their status. The proportion of adolescents informed increased significantly with age: 19% for 13–15 years, 33% for 16–18 years and 86% for 19–21 years (p <0.0001). Adolescents on ART tended to be more likely to be informed of their HIV status (34.5%) than those not treated (13.3%) (p=0.11). Those on cotrimoxazole were significantly more likely to be informed (39.6%) than those not (21.9%) (p=0.01). Disclosure was significantly higher in adolescents with a history of ART regimen change (p=0.003) and in those followed in the Cepref (48.4%) compared to the Yopougon Teaching Hospital (24.8%), (p=0.001). In multivariate analyses, disclosed HIV status was significantly higher in those followed-up in the Cepref compared to the other centre: adjusted odds ratio (aOR)=3.5 (95% CI: 1.1–10.9), and among older adolescents compared to those aged 13–15 years: [16–18 years] aOR=4.2 (95% CI: 1.5–11.5) and [>18 years]: aOR=22.1 (95% CI: 5.2–93.5). Conclusions HIV disclosure rate was low among Ivoirian HIV adolescents and was site- and age-dependent. There is a need for practical interventions to support HIV disclosure to adolescents which provides age-appropriate information about the disease.Journal of the International AIDS Society 06/2013; 16(1):18569. DOI:10.7448/IAS.16.1.18569 · 4.21 Impact Factor
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ABSTRACT: Three decades into the HIV/AIDS epidemic there is a growing cohort of perinatally HIV-infected adolescents globally. Their survival into adolescence and beyond represent one of the major successes in the battle against the disease that has claimed the lives of millions of children. This population is diverse and there are unique issues related to antiretroviral treatment and management. Drawing from the literature and experience, this paper discusses several broad areas related to antiretroviral management, including: 1) diverse presentation of HIV, (2) use of combination antiretroviral therapy including in the setting of co-morbidities and rapid growth and development, (3) challenges of cART, including nonadherence, resistance, and management of the highly treatment-experienced adolescent patient, (4) additional unique concerns and management issues related to PHIV-infected adolescents, including the consequences of longterm inflammation, risk of transmission, and transitions to adult care. In each section, the experience in both resource-rich and limited settings are discussed with the aim of highlighting the differences and importantly the similarities, to share lessons learnt and provide insight into the multi-faceted approaches that may be needed to address the challenges faced by this unique and resilient population.Journal of the International AIDS Society 06/2013; 16(1):18579. DOI:10.7448/IAS.16.1.18579 · 4.21 Impact Factor
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ABSTRACT: Citation: Seema Sahay (2013) Coming of Age with HIV: A Need for Disclosure of HIV Diagnosis among Children/Adolescents J HIV AIDS Infect Dis 1: 1-7. The success in the prevention and treatment of Paediatric HIV in high resource countries, and later on in low resource countries, has changed the face of the HIV epidemic in chil-dren. A number of clinical, social and psychological issues arise among children who acquire perinatal HIV infection. Paediatric survival post-HIV infection without anti-retro-viral treatment was calculated using pooled data from 12 studies showed that children infected perinatally had a much higher risk of dying than those infected through breastfeed-ing . Now most children live longer than before . How-ever, these successes pose new challenges as children with perinatal HIV infection survive into adolescence and adult-hood. Hence the perinatally infected children, who are HIV survivors, are 'coming of age' and need to meet biological and psychosocial challenges of life. Increased survival of HIV in-fected children is associated with challenges in maintaining adherence to what is likely life-long therapy [3,4]. One of the biggest psychosocial challenges that health care providers and parents face is the disclosure of HIV diagnosis among chil-dren . Children with a variety of chronic diseases, includ-ing those with cancer, have exhibited better coping skills and fewer psychosocial problems when appropriately informed about the nature and consequences of their illness [6,7]. Fur-ther, the World Health Organization (WHO) recommends the disclosure of HIV diagnosis to children (WHO 2011). ©2013 The Authors. Published by the JScholar under the terms of the Crea-tive Commons Attribution License http://creativecommons.org/licenses/ by/3.0/, which permits unrestricted use, provided the original author and source are credited. J HIV AIDS Infect Dis 2013 | Vol 1:103 Perinatal HIV-1 infection has been reported to interfere with sexual maturation. Associated linear growth failure may cause psychological stress . Another recent study has shown that Highly Active Anti-Retroviral Therapy (HAART) might have increased the longevity of children but these chil-dren remain at increased risk of psychosocial problems and impaired social functioning . The disclosure intervention would be a step towards preparing HIV infected children for10/2013; 1(vol.1):1-7. DOI:10.17303/jaid.2013.103