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Adherence to High Activity Antiretrovial Therapy (HAART) in pediatric patients infected with HIV: Issues and interventions

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Abstract

It has been proven that HAART is effective in suppressing human immunodeficiency virus (HIV) replication, decreasing morbidity and mortality associated with HIV and improving quality of life in adults as well as children infected with HIV. However, drugs don’t work in patients who don’t take them and in the management of HIV infection it is now well established that optimum adherence to HAART is critical to successful outcome of patients receiving therapy. At least 95% adherence to HAART is optimum and studies have shown that < 95 % adherence is associated with virologic failure rate of > 50 %. Important factors that influence adherence to HAART such as regimen related complexities, patient/family related issues and factors related to healthcare delivery system makes adherence to HAART challenging. Although numerous interventions to improve adherence have been investigated in developed as well as developing countries, majority of work in this area is focused on adherence in adults and data in children is limited. Therefore, in order to facilitate adherence and improve outcome of HAART in pediatric population, it is necessary to have a deep understanding of the factors influencing adherence and interventions that can improve adherence in children.

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References

  1. AIDS epidemic update 2005. Available from URL: http://www.who.int/hiv/epiupdates/en/index.html. Accessed on April 1, 2006.

  2. Panel on clinical practices for treatment of HIV infection. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services (DHHS), October 6, 2005 (online). Available from URL: http://AIDSinfo.nih.gov. Accessed on April 1, 2006.

  3. Working group on antiretroviral therapy and medical management of HIV-infected children. Guidelines for the use of antiretroviral agents in pediatric HIV infection: National Resource Center at the François-Xavier Bagnoud Center, UMDNJ. The Health Resources and Services Administration (HRSA); and the National Institutes of Health (NIH), November 3, 2005 (online). Available from URL: http://AIDSinfo.nih.gov. Accessed on April 1, 2006.

  4. Naïma Hammami, Christiana Nöstlinger, Tom Hoerée, Pierre Lefèvre, Tyl Jonckheer, Patrick Kolsteren. Integrating adherence to highly active antiretroviral therapy into children’s daily lives: A qualitative study. Pediatrics 2004; 114; 591–597.

    Article  Google Scholar 

  5. Starace F, Massa A, Amico KR, Fisher JD. Adherence to antiretroviral therapy: An empirical test of the information-motivation-behavioral skills model. Health Psychol 2006; 25(2): 153–162.

    Article  PubMed  Google Scholar 

  6. K. C. Nischal, Uday Khopkar, D. G. Saple. Improving adherence to antiretroviral therapy. Indian J Dermatol Venereol Leprol 2005; 71(5): 316–320.

    Article  PubMed  CAS  Google Scholar 

  7. Sabate E. Geneva: World Health Organization WHO adherence meeting report. 2001.

  8. Lars Osterberg, Terrence Blaschke. Adherence to medication. N Engl J Med 2005; 353: 487–497.

    Article  Google Scholar 

  9. Chesney MA. Factors affecting adherence to antiretroviral therapy. Clin Infect Dis 2000; 30 Suppl 2: 171–176S.

    Article  Google Scholar 

  10. Emanuele Pontali. Facilitating adherence to highly active antiretroviral therapy in children. Pediatr Drugs 2005; 7: 137–149.

    Article  Google Scholar 

  11. Descamps D, Flandre P, Calvez V, Peytavin G, Meiffredy V, Collin G et al. Mechanisms of virologic failure in previously untreated HIV-infected patients from a trial of induction-maintenance therapy. JAMA 2000; 283: 205–211.

    Article  PubMed  CAS  Google Scholar 

  12. Mellins CA, Brackis-Cott E, Dolezal C, Abrams EJ. The role of psychosocial and family factors in adherence to antiretroviral treatment in human immunodeficiency virus-infected children. Pediatr Infect Dis J 2004; 23(11): 1035–1041.

    Article  PubMed  Google Scholar 

  13. Reddington C, Cohen J, Baldillo A, Toye M, Smith D, Kneut C et al. Adherence to medication regimens among children with human immuno deficiency virus infection. Pediatr Infect Dis J 2000; 19: 148–153.

    Google Scholar 

  14. Byrne M, Honig J, Jurgrau A, Heffernan SM, Donahue MC. Achieving adherence with antiretroviral medications for pediatric HIV disease. AIDS Read 2002; 12(4): 151–54, 161–164.

    PubMed  Google Scholar 

  15. Ferris MG, Kline MW. Editorial comment: challenges to pediatric adherence to antiretroviral medications. AIDS Read 2002; 12(4): 162–163.

    PubMed  Google Scholar 

  16. Gibb DM, Goodall RL, Giacomet V, McGee L, Compagnucci A, Lyall H. Adherence to prescribed antiretroviral therapy in human immunodeficiency virus-infected children in the PENTA 5 trial. Pediatr Infect Dis J 2003; 22(1): 56–62.

    Article  PubMed  Google Scholar 

  17. Lwin R, Melvin D. Pediatric HIV infection. J Child Psycholo Psychiat 2001; 42: 427–438.

    Article  CAS  Google Scholar 

  18. Gavin PJ, Yogev R. The role of protease inhibitor therapy in children with HIV infection. Paediatr Drugs 2002; 4(9): 581–607.

    PubMed  Google Scholar 

  19. Steele RG, Anderson B, Rindel B, Dreyer ML, Perrin K, Christensen R et al. Adherence to antiretroviral therapy among HIV-positive children: examination of the role of caregiver health beliefs. AIDS Care 2001; 13(5): 617–629.

    Article  PubMed  CAS  Google Scholar 

  20. Wedekind CA, Pugatch D. Lipodystrophy syndrome in children infected with human immunodeficiency virus. Pharmacotherapy 2001; 21(7): 861–866.

    Article  PubMed  CAS  Google Scholar 

  21. Thorne C, Newell ML, Botet FA, Bohlin AB, Ferrazin A, Giaquinto C et al. Older children and adolescents surviving with vertically acquired HIV infection. J Acquir Immune Defic Syndr 2002; 29(4): 396–401.

    PubMed  Google Scholar 

  22. Giacomet V, Albano F, Starace F, de Franciscis A, Giaquinto C, Gattinara GC et al. Adherence to antiretroviral therapy and its determinants in children with human immunodeficiency virus infection: a multicentre, national study. Acta Pediatr 2003; 92(12): 1398–1402.

    Article  CAS  Google Scholar 

  23. Murphy DA, Wilson CM, Durako SJ, Muenz LR, Belzer M. Antiretroviral medication adherence among the REACH HIV-infected adolescent cohort in the USA. AIDS Care 2001; 13(1): 27–40.

    Article  PubMed  CAS  Google Scholar 

  24. Temple ME, Koranyi KI, Nahata MC. The safety and antiviral effect of protease inhibitors in children. Pharmacotherapy 2001; 21(3): 287–294.

    Article  PubMed  CAS  Google Scholar 

  25. Ledlie SW. The psychosocial issues of children with perinatally acquired HIV disease becoming adolescents: a growing challenge for providers. AIDS Patient Care STDS 2001; 15(5): 231–236.

    Article  PubMed  CAS  Google Scholar 

  26. Pontali E, Feasi M, Toscanini F. Adherence to combination antiretroviral treatment in children. HIV Clin Trials 2001; 2: 466–473.

    Article  PubMed  CAS  Google Scholar 

  27. Van Dyke RB, Lee S, Johnson GM, Wiznia A, Mohan K, Stanley K et al. Reported adherence as a determinant of response to highly active antiretroviral therapy in children who have human immunodeficiency virus infection. Pediatrics 2002; 109(4): e61.

    Article  PubMed  Google Scholar 

  28. Dolezal C, Mellins C, Brackis-Cott E, Abrams EJ. The reliability of reports of medical adherence from children with HIV and their adult caregivers. J Pediatr Psychol 2003; 28(5): 355–361.

    Article  PubMed  Google Scholar 

  29. van Rossum AM, Bergshoeff AS, Fraaij PL, Hugen PW, Hartwig NG, Geelen SP et al. Therapeutic drug monitoring of indinavir and nelfinavir to assess adherence to therapy in human immunodeficiency virus-infected children. Pediatr Infect Dis J 2002; 21(8): 743–747.

    Article  PubMed  Google Scholar 

  30. Demas PA, Webber MP, Schoenbaum EE, Weedon J, McWayne J, Enriquez E et al. Maternal adherence to the zidovudine regimen for HIV-exposed infants to prevent HIV infection: a preliminary study. Pediatrics 2002; 110(3): e35.

    Article  PubMed  Google Scholar 

  31. King JR, Kimberlin DW, Aldrovandi GM, Acosta EP. Antiretroviral pharmacokinetics in the paediatric population: a review. Clin Pharmacokinet 2002; 41(14): 1115–1133.

    Article  PubMed  CAS  Google Scholar 

  32. Leonard EG, McComsey GA. Metabolic complications of antiretroviral therapy in children. Pediatr Infect Dis J 2003; 22(1): 77–84.

    Article  PubMed  Google Scholar 

  33. Goode M, McMaugh A, Crisp J, Wales S, Ziegler JB. Adherence issues in children and adolescents receiving highly active antiretroviral therapy. AIDS Care 2003; 15(3): 403–408.

    Article  PubMed  CAS  Google Scholar 

  34. United Nations Children’s Fund. The joint United Nations programme on HIV/AIDS, World Health Organization. Medecins sans frontieres. Sources and prices of selected medicines and diagnostics for people living with HIV/AIDS. Geneva: World Health Organization 2003.

    Google Scholar 

  35. Byakika-Tusiime J, Oyugi JH, Tumwikirize WA et al. Ability to purchase and secure stable therapy are significant predictors of non-adherence to antiretroviral therapy in Kampala, Uganda. 10th Conference on retroviruses and opportunistic infections. Boston MA, 2003, abstract no. 170.

  36. World Health Organization. Human immunodeficiency virus and aquired immunodeficiency syndrome. Chapter 12. In: World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization 2003; 117–128.

    Google Scholar 

  37. Daar ES, Cohen C, Remien R, Sherer R, Smith K. Improving adherence to antiretroviral therapy. AIDS Read 2003; 3(2): 81–2, 85–6, 88–90.

    Google Scholar 

  38. Katko E, Johnson GM, Fowler SL, Turner RB. Assessment of adherence with medications in human immunodeficiency virus-infected children. Pediatr Infect Dis J 2001; 20(12): 1174–1176.

    Article  PubMed  CAS  Google Scholar 

  39. Bale H. How the pharmaceutical industry can help in enhancing adherence to long-term therapies. Annex II. In: World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization 2003; 178–179.

    Google Scholar 

  40. King JR, Acosta EP, Chadwick E, Yogev R, Crain M, Pass R et al. Evaluation of multiple drug therapy in human immunodeficiency virus-infected pediatric patients. Pediatr Infect Dis J 2003; 22(3): 239–244.

    Article  PubMed  Google Scholar 

  41. Joyce Cohen, Catherine Reddington, Dawn Jacobs, Regina Meade, Donna Picard, Kathy Singleton et al. School-related issues among HIV-infected children. Pediatrics 1997; 100: p. e8.

    Article  PubMed  CAS  Google Scholar 

  42. Gretchen M. Roberts, J. Gary Wheeler, Nancy C. Tucker, Chris Hackler, Karen Young, Holly D. Maples et al. Nonadherence with pediatric human immunodeficiency virus therapy as medical neglect. Pediatrics 2004; 114: e346–e353.

    Article  PubMed  Google Scholar 

  43. Farmer, P Leandre F, Mukherjee J, Gupta R, Tarter L, Kim JY. Community-based treatment of advanced HIV disease: introducing DOT-HAART (directly observed therapy with highly active antiretroviral therapy). Bull WHO 2001; 79: 1145–1151.

    PubMed  CAS  Google Scholar 

  44. Gigliotti F, Murante BL, Weinberg GA. Short course directly observed therapy to monitor compliance with antiretroviral therapy in human immunodeficiency virus-infected children. Pediatr Infect Dis J 2001; 20(7): 716–718.

    Article  PubMed  CAS  Google Scholar 

  45. Brackis-Cott E, Mellins CA, Abrams E, Reval T, Dolezal C. Pediatric HIV medication adherence: the views of medical providers from two primary care programs. J Pediatr Health Care 2003; 17(5): 252–260.

    Article  PubMed  Google Scholar 

  46. Marhefka SL, Farley JJ, Rodrigue JR, Sandrik LL, Sleasman JW, Tepper VJ. Clinical assessment of medication adherence among HIV-infected children: examination of the Treatment Interview Protocol (TIP). AIDS Care 2004; 16(3): 323–338.

    Article  PubMed  CAS  Google Scholar 

  47. Sharland M, di Zub GC, Ramos JT, Blanche S, Gibb DM. PENTA guidelines for the use of antiretroviral therapy in paediatric HIV infection. Pediatric European Network for Treatment of AIDS. HIV Med 2002; 3(3): 215–226.

    Article  PubMed  CAS  Google Scholar 

  48. Farley J, Hines S, Musk A, Ferrus S, Tepper V. Assessment of adherence to antiviral therapy in HIV-infected children using the Medication Event Monitoring System, pharmacy refill, provider assessment, caregiver self-report and appointment keeping. J Acquir Immune Defic Syndr 2003; 33(2): 211–218.

    Article  PubMed  Google Scholar 

  49. Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health approach WHO 2003 revision. Available from URL:www.who.int/3by5/publications/guidelines/en/arv guidelines.pdf. Accessed on April 1, 2006.

  50. Steele RG, Grauer D. Adherence to antiretroviral therapy for pediatric HIV infection: review of the literature and recommendations for research. Clin Child Fam Psychol Rev 2003; 6(1): 17–30.

    Article  PubMed  Google Scholar 

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  1. Community Welfare Foundation India, Bunglow no 8, Balakrishana Housing Society, Dhankawadi, Pune, 411043, India

    Chirag A. Shah

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Shah, C.A. Adherence to High Activity Antiretrovial Therapy (HAART) in pediatric patients infected with HIV: Issues and interventions. Indian J Pediatr 74, 55–60 (2007). https://doi.org/10.1007/s12098-007-0028-8

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