No abstract

Adherence to highly active antiretroviral therapy (HAART) was investigated among HIV-infected adolescents recruited from 13 US cities into the REACH (Reaching for Excellence in Adolescent Care and Health) project, the first large-scale disease progression study of HIV-positive adolescents infected through sexual behaviour or injection drug use. Of 161 subjects, 7% could not correctly identify all their prescribed medications; 11% could identify them but reported never taking at least one medication. The majority (83%) reported taking all of their medications at least some of the time, but only 50% of these subjects reported full adherence. Therefore, only 41% of the sample reported full adherence. A strong association was found between adherence and reduced viral load. A CD4 level of > or = 500 cells/mm3 was also associated with adherence. Higher levels of depression were significantly associated with decreased adherence, and a trend was found for an association between number of medications prescribed and adherence. Strict adherence to HAART is critical for sustained suppression of viral replication allowing for immune recovery and reducing the risk of the selection of antiviral resistance. Adherence appears to be a serious problem among HIV-positive adolescents. Better education, intervention to relieve depression, and efforts to improve ease of medication use are essential.

No abstract

Mothers' disclosure of their HIV serostatus to their noninfected young children and factors associated with disclosure were investigated among 135 families. Overall, 30% of the mothers had personally disclosed their serostatus to their children. Mothers who disclosed reported higher levels of social support in their lives than mothers who did not disclose. Children whose mothers had disclosed to them displayed lower levels of aggressiveness and negative self-esteem compared to children whose mother had not disclosed. These findings indicate that for this sample, no negative effects were observed among young children to whom mothers have personally disclosed their HIV serostatus.