Related Experiment Videos
Gastrostomy tube placement in nonadherent HIV-infected children
M E Temple1, K I Koranyi, M C Nahata
1College of Pharmacy, The Ohio State University, Columbus 43210, USA.
Insights
Gastrostomy tubes (G-tubes) significantly improved medication adherence and viral load in HIV-infected children on HAART. This intervention offers a viable option when antiretroviral medication administration is extremely challenging.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- HIV/AIDS Management
Background:
- Medication administration difficulties can compromise treatment adherence in children with HIV.
- Highly active antiretroviral therapy (HAART) requires consistent adherence for efficacy.
Purpose of the Study:
- To evaluate the benefits of gastrostomy tube (G-tube) placement in HIV-infected children receiving HAART.
- To assess the impact of G-tubes on medication adherence and clinical outcomes.
Main Methods:
- Retrospective review of six HIV-infected children who underwent G-tube placement for medication administration issues.
- Analysis of medication adherence (pharmacy refills, pill counts) and laboratory parameters (viral RNA, CD4+ counts) pre- and post-G-tube placement.
- Parental surveys on satisfaction and perceived ease of medication administration.
Main Results:
- G-tube placement was well-tolerated in all six children.
- Medication adherence improved from an average of 47% to 90-100% post-G-tube.
- Significant viral load reduction (≥2-log10 decrease) in five patients and improved CD4+ percentages.
Conclusions:
- G-tubes are a safe and effective option for improving HAART adherence in select HIV-infected children facing severe medication administration challenges.
- This intervention can lead to improved virologic and immunologic outcomes.
- G-tube placement should be considered when other methods of antiretroviral medication delivery have failed.
Objective:
To determine the benefits of gastrostomy tube (G-tube) placement in HIV-infected children receiving highly active antiretroviral therapy (HAART).
Methods:
Children who had a G-tube placed due to medication adminsitration difficulties were followed to determine changes in medication adherence and changes in laboratory parameters. Medication adherence and laboratory parameters were reviewed for three months prior to G-tube placement and then were followed for six months after G-tube placement. Viral RNA and CD4+ counts were assessed between the two time periods. Medication adherence was followed by review of pharmacy refill records and pill counts. Parents were surveyed about their opinion regarding the G-tube placement and medication administration in their children.
Results:
Six children had G-tubes placed due to medication administration difficulties. The G-tube was tolerated in all six cases, although one child developed a staphylococcal infection 13 months after G-tube placement. Before G-tube placement, the medication adherence to HAART averaged 47% +/- 20% SD, with a range of 15-90%. After G-tube placement, medication adherence improved to 90-100%. All parents were satisfied with the G-tube and all reported shorter medication administration times and fewer behavioral problems. Five of six patients had at least a 2-log10 decrease in viral load, and CD4+ percentages improved by an average of 6.4%.
Conclusions:
G-tubes were well tolerated by HIV-infected children. Although G-tube placement is not needed in most children with HIV, it may provide an option for parents and children where administration of antiretroviral medication poses extreme difficulty and all other avenues have been exhausted.