Medication adherence in children and adolescents with HIV infection: Associations with behavioral impairment

Department of Child and Adolescent Psychiatry, Children's Memorial Hospital, Chicago, Illinois 60614, USA.
AIDS patient care and STDs (Impact Factor: 3.5). 02/2011; 25(3):191-200. DOI: 10.1089/apc.2010.0181
Source: PubMed


The impact of behavioral functioning on medication adherence in children with perinatally acquired HIV infection is not well-explored, but has important implications for intervention. This report addresses the relationship between behavioral functioning and child self-report or caregiver report of medication adherence among children and adolescents enrolled in Pediatric AIDS Clinical Trials Group Protocol 219C (conducted 2000-2007). A total of 1134 participants, aged 3-17 years, received a behavioral evaluation and adherence assessment. Complete adherence was defined as taking 100% of prescribed antiretroviral medications during three days preceding the study visit. Multivariable logistic regression models were used to evaluate associations between adherence and behavioral functioning, adjusting for potential confounders, including demographic, psychosocial, and health factors. Children demonstrated higher than expected rates of behavioral impairment (≈7% expected with T > 65) in the areas of conduct problems (14%, z = 7.0, p < 0.001), learning problems (22%, z = 12.2, p < 0.001), somatic complaints (22%, z = 12.6, p < 0.001), impulsivity-hyperactivity (20%, z = 11.1, p < 0.001), and hyperactivity (19%, z = 10.6, p < 0.001). Children with behavioral impairment in one or more areas had significantly increased odds of nonadherence [adjusted odds ratio (aOR) = 1.49, p = 0.04]. The odds of nonadherence were significantly higher for those with conduct problems and general hyperactivity (aOR = 2.03, p = 0.005 and aOR = 1.68, p = 0.02, respectively). Psychosocial and health factors, such as recent stressful life events and higher HIV RNA levels, were also associated with nonadherence. Knowledge of behavioral, health, and social influences affecting the child and family should guide the development of appropriate, evidence-based interventions for medication adherence.

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    • "Common to all settings is the challenge of maintaining life-long adherence and access to increasingly expensive ART regimens. Adolescent adherence is particularly complex because of the socio-economic pressures related to orphanhood, neurocognitive deficits associated with chronic and severe HIV infection, and stigma and discrimination [5, 20–22]. In a US cohort of treatment-experienced adolescents, poor adherence and pre-existing resistance led to poor viral load responses despite regular access to the third- and fourth-line ARVs darunavir, raltegravir and etravirine [14]. "
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    • "well-being regardless of caregiver HIV status, low caregiver self-efficacy, worse parent–child relationships, less responsibility for illness management, and being a biological parent or relative (vs. foster or adoptive parent) (Malee et al., 2009, 2011; Simoni et al., 2007). Extrafamilial factors related to antiretroviral treatment (ART) nonadherence include more stressful life events and less social support (Simoni et al., 2007). "
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