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August 2005

Longitudinal Antiretroviral Adherence Among Adolescents Infected With Human Immunodeficiency Virus

Author Affiliations

Author Affiliations: Health Risk Reduction Projects, Department of Psychiatry, University of California, Los Angeles (Dr Murphy); Children’s Hospital of Los Angeles, Los Angeles, Calif (Dr Belzer); Westat Inc, Rockville, Md (Mr Durako and Drs Sarr and Muenz); and Department of Geographic Medicine, University of Alabama at Birmingham (Dr Wilson).

Arch Pediatr Adolesc Med. 2005;159(8):764-770. doi:10.1001/archpedi.159.8.764

Objectives  To longitudinally follow a cohort of adolescents with human immunodeficiency virus (HIV) and to investigate long-term antiretroviral therapy adherence and factors associated with adherence.

Design, Setting, and Patients  Adolescents infected with HIV (N = 231; mean age, 18.4 years; 72.7% female; 74.9% African American) from 13 cities throughout the United States were assessed at 3-month intervals.

Main Outcome Measures  Self-reported adherence measures were validated by comparison with HIV-1 RNA viral load, and behavioral factors that may be associated with antiretroviral therapy adherence were assessed.

Results  At the initial visit, approximately 69% of the adolescents reported being adherent to antiretroviral therapy. Adolescents in the later HIV disease stage were less likely to be adherent compared with those in the earlier disease stage. Less alcohol use and being in school were associated with adherence by adolescents on weekends and over the preceding month. Longitudinal adherence was investigated among 65 subjects initially adherent with available information for at least 4 consecutive visits. The median time to nonadherence was 12 months, and failure to maintain adherence was significantly associated with younger age and depression. Among adolescents who attained an undetectable viral load, only about 50% maintained an undetectable viral load for the year.

Conclusions  These findings indicate an urgent need for better interventions to assist adolescents with HIV in adhering to their medication regimens. Adolescents with advanced disease are likely to need more intervention. New treatments recently found effective for adolescent depression may assist in improving adherence for a majority of adolescents with HIV.