Medication Adherence in Children and Adolescents with HIV Infection: Associations with Behavioral Impairment

Previous studies of adherence to antiretroviral therapy (ART) for HIV among young injection drug users (IDU) have been limited because financial barriers to care disproportionately affect youth, thus confounding results. This study examines adherence among IDU in a unique setting where all medical care is provided free-of-charge. From May 1996 to April 2008, we followed a prospective cohort of 545 HIV-positive IDU of 18 years of age or older in Vancouver, Canada. Using generalized estimating equations (GEE), we studied the association between age and adherence (obtaining ART ‡ 95% of the prescribed time), controlling for potential confounders. Using Cox proportional hazards regression, we also studied the effect of age on time to viral load suppression ( < 500 copies per milliliter), and examined adherence as a mediating variable. Five hundred forty-five participants were followed for a median of 23.

Section: Discussionmentioning

confidence: 99%

Young Age Predicts Poor Antiretroviral Adherence and Viral Load Suppression Among Injection Drug Users

Hadland

Milloy

Kerr

et al. 2012

“…68 Logistical barriers such as forgetting medication doses, [65][66][67] travel, 66 and inconvenience/inconsistent routine 66,67 commonly affect adherence in youth. Psychological barriers including depression/ anxiety, [69][70][71][72] perceived stigma, 69 lack of support, 72-74 behavioral and conduct problems 71 are present in more than 50% of HIV-infected youth. 75 …”

Section: Adherence Among Adolescentsmentioning

confidence: 99%

The Adolescent and Young Adult HIV Cascade of Care in the United States: Exaggerated Health Disparities

Zanoni

Mayer²

2014

362

315

Little is known about how adolescents and young adults contribute to the declines in the cascade of care from HIV-1 diagnosis to viral suppression. We reviewed published literature from the Unites States reporting primary data for youth (13-29 years of age) at each stage of the HIV cascade of care. Approximately 41% of HIVinfected youth in the United States are aware of their diagnosis, while only 62% of those diagnosed engage medical care within 12 months of diagnosis. Of the youth who initiate antiretroviral therapy, only 54% achieve viral suppression and a further 57% are not retained in care. We estimate less than 6% of HIV-infected youth in the United States remain virally suppressed. We explore the cascade of care from HIV diagnosis through viral suppression for HIV-infected adolescents and young adults in the United States to highlight areas for improvement in the poor engagement of the infected youth population.

“…Recent stressful life events were associated with poor adherence in children with HIV infection. 24 One or more negative life events had been associated with diminished QOL, especially in health perception domain from a cross Higher score indicated better quality of life. Education of caregivers; higher (high school or higher than high school) versus lower (primary school or no education).…”

Section: Quality Of Life In Hiv-infected Childrenmentioning

confidence: 99%

Impact of Antiretroviral Therapy on Quality of Life in HIV-Infected Southeast Asian Children in the PREDICT Study

Bunupuradah

Kosalaraksa²,

Vibol³

et al. 2013

Quality of life (QOL) is an important antiretroviral treatment (ART) outcome. We compared QOL among 299 Thai and Cambodian children ages 1-12 years-old, CD4 15-24% randomized to early (ART at week 0, N = 149) versus deferred groups (ART when at CD4 < 15%, N = 150) and also compared with QOL data from age-matched healthy controls (N = 275). Primary caregivers completed PACTG QOL questionnaires at week 0 and every 24 weeks until 144 weeks. Children were enrolled during March 2006 to September 2008. Mean (SD) age of children was 6.3 (2.8) years, 58% were female, 60% were Thai, %CDC N:A:B:C was 2:62:36:0%. During 144 weeks, all children in the early-group and 69 (46%) of deferred-group children started ART. There was no significant difference of QOL scores between treatment groups at baseline (all p > 0.05) and at week 144 (all p > 0.05). By multivariate analysis, the early-group had higher QOL score changes in five domains, including health perception ( p = 0.04), physical resilience ( p = 0.02), psychosocial well-being ( p = 0.04), social and role functioning ( p < 0.01), and symptoms ( p = 0.01) compared to the deferred group. QOL of HIV-infected children in both groups were lower than healthy control in all 7 domains at baseline (all p < 0.05) and 5 of 7 domains at weeks 144 ( p < 0.01). In conclusion, no significant difference of QOL scores between treatment groups. Early ART commencement associated with greater increase of QOL scores over 144 weeks. QOL scores in HIV-infected children were lower than healthy controls.