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13 - Adherence to antiretroviral therapy in children and youth

from Part II - General issues in the care of pediatric HIV patients

Published online by Cambridge University Press:  03 February 2010

By
John Farley
Edited by
Steven L. Zeichner  and
Jennifer S. Read
John Farley
Affiliation:
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
Steven L. Zeichner
Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read
Affiliation:
National Cancer Institute, Bethesda, Maryland
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Summary

Improved health outcomes for HIV-infected children and youth will not be achieved without maximal viral suppression. Highly active antiretroviral therapy (HAART) represents a major breakthrough in HIV management, but not all patients respond optimally to HAART. Non-adherence is well established as a major cause of clinical failure, and intermittent non-adherence is a particular problem. Studies in adults have demonstrated that ≥ 95% adherence to HAART is necessary for durable suppression of viral load [1–3]. In the presence of selective pressure by antiretroviral agents, high rates of viral replication and viral mutation lead to the development of drug resistance. Mutations conferring resistance against one antiretroviral agent often confer cross-resistance to other agents; poor adherence can render a whole class of antiretrovirals ineffective.

Although a crucial component of good clinical care, assessment of adherence to HAART in HIV-infected children and youth is challenging and labor intensive. Patient and parent (or other caregiver) characteristics associated with optimal adherence are not well characterized. Studies evaluating interventions to improve adherence in this group are encouraging but few.

HIV as a chronic illness

Pediatric HIV infection is now referred to as the ‘newest chronic illness in childhood’ [4, 5]. Chronic illness alters a person's life by creating permanent changes in daily living. The person must adhere to a medical regimen even though there is no cure, often in the absence of visible symptoms. While our understanding of HIV therapy is evolving, life-long treatment will likely be required.

Type
Chapter
Information
Textbook of Pediatric HIV Care , pp. 188 - 196
Publisher: Cambridge University Press
Print publication year: 2005

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