Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jun 19;29(10):1227-37.
doi: 10.1097/QAD.0000000000000697.

Psychiatric symptoms and antiretroviral nonadherence in US youth with perinatal HIV: a longitudinal study

Deborah Kacanek  1 , Konstantia Angelidou, Paige L Williams, Miriam Chernoff, Kenneth D Gadow, Sharon Nachman; International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) P1055 Study Team
Collaborators, Affiliations

Psychiatric symptoms and antiretroviral nonadherence in US youth with perinatal HIV: a longitudinal study

Deborah Kacanek et al. AIDS. .

Abstract

Objectives: The relationship of specific psychiatric conditions to adherence has not been examined in longitudinal studies of youth with perinatal HIV infection (PHIV). We examined associations between psychiatric conditions and antiretroviral nonadherence over 2 years.

Design: Longitudinal study in 294 PHIV youth, 6-17 years old, in the United States and Puerto Rico.

Methods: We annually assessed three nonadherence outcomes: missed above 5% of doses in the past 3 days, missed a dose within the past month, and unsuppressed viral load (>400 copies/ml). We fit multivariable logistic models for nonadherence using Generalized Estimating Equations, and evaluated associations of psychiatric conditions (attention deficit hyperactivity disorder, disruptive behavior, depression, anxiety) at entry with incident nonadherence using multivariable logistic regression.

Results: Nonadherence prevalence at study entry was 14% (3-day recall), 32% (past month nonadherence), and 38% (unsuppressed viral load), remaining similar over time. At entry, 38% met symptom cut-off criteria for at least one psychiatric condition. Greater odds of 3-day recall nonadherence were observed at week 96 for those with depression [adjusted odds ratio (aOR) 4.14, 95% confidence interval (CI) 1.11-15.42] or disruptive behavior (aOR 3.36, 95% CI 1.02-11.10], but not at entry. Those with vs. without attention deficit hyperactivity disorder had elevated odds of unsuppressed viral load at weeks 48 (aOR 2.46, 95% CI 1.27-4.78) and 96 (aOR 2.35, 95% CI 1.01-5.45), but not at entry. Among 232 youth adherent at entry, 16% reported incident 3-day recall nonadherence. Disruptive behavior conditions at entry were associated with incident 3-day recall nonadherence (aOR 3.01, 95% CI 1.24-7.31).

Conclusion: In PHIV youth, comprehensive adherence interventions that address psychiatric conditions throughout the transition to adult care are needed.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: For the remaining authors none were declared.

Figures

Figure 1
Figure 1
Prevalence of non-adherence (a) and psychiatric conditions (b) by study week among youth in the IMPAACT P1055 study
Figure 1
Figure 1
Prevalence of non-adherence (a) and psychiatric conditions (b) by study week among youth in the IMPAACT P1055 study
Figure 2
Figure 2
Adjusted predicted probabilities (with 95% confidence intervals) of 3-day recall non-adherence in youth with vs. without disruptive behavior (a), 3-day recall non-adherence in youth with vs. without depression (b), Missed dose within the past month in youth with vs. without depression (c), and unsuppressed viral load among youth with vs. without ADHD (d).
See this image and copyright information in PMC

References

    1. UNAIDS. Report on the Global AIDS Epidemic. 2012
    1. Centers for Disease Control and Prevention. HIV among youth. [Accessed 05/09/2014]; http://www.cdc.gov/hiv/risk/age/youth/index.html?s_cid=tw_drdeancdc-00125#C.
    1. Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133:21–30. [PMCID 10877736] - PubMed
    1. Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis. 2006;43:939–941. [PMCID 10877736] - PubMed
    1. Tassiopoulos K, Moscicki AM, Mellins C, Kacanek D, Malee K, Allison S, et al. Sexual risk behavior among youth with perinatal HIV infection in the United States: predictors and implications for intervention development. Clin Infect Dis. 2013;56(2):283–290. - PMC - PubMed

Publication types

Substances