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Medication adherence in children and adolescents with HIV infection: associations with behavioral impairment

Kathleen Malee1, Paige Williams, Grace Montepiedra

  • 1Department of Child and Adolescent Psychiatry, Children's Memorial Hospital, Chicago, Illinois 60614, USA. kmalee@childrensmemorial.org

AIDS Patient Care and Stds
|February 18, 2011
PubMed

Insights

Behavioral issues like conduct problems and hyperactivity significantly increase the risk of medication nonadherence in children with perinatally acquired HIV. Addressing these behavioral challenges is crucial for improving treatment outcomes.

Area of Science:

  • Pediatric HIV/AIDS research
  • Behavioral science
  • Clinical trial analysis

Background:

  • Medication adherence is critical for managing perinatally acquired HIV in children.
  • The influence of behavioral functioning on adherence in this population is not well-understood.
  • Pediatric AIDS Clinical Trials Group Protocol 219C provided a cohort for this investigation.

Purpose of the Study:

  • To examine the relationship between behavioral functioning and medication adherence in children and adolescents with perinatally acquired HIV.
  • To identify specific behavioral impairments associated with nonadherence.
  • To inform the development of targeted interventions for improving adherence.

Main Methods:

  • Analysis of data from 1134 participants (aged 3-17) in Pediatric AIDS Clinical Trials Group Protocol 219C (2000-2007).
  • Behavioral evaluations and adherence assessments (self-report or caregiver report) were conducted.
  • Multivariable logistic regression models were used to assess associations, adjusting for demographic, psychosocial, and health factors.

Main Results:

  • Elevated rates of behavioral impairment were observed, including conduct problems (14%), learning problems (22%), somatic complaints (22%), impulsivity-hyperactivity (20%), and hyperactivity (19%).
  • Children with any behavioral impairment had significantly higher odds of nonadherence (adjusted odds ratio [aOR]=1.49, p=0.04).
  • Conduct problems (aOR=2.03, p=0.005) and hyperactivity (aOR=1.68, p=0.02) were strongly associated with nonadherence. Stressful life events and higher HIV RNA levels also correlated with nonadherence.

Conclusions:

  • Behavioral functioning, particularly conduct problems and hyperactivity, is a significant predictor of medication nonadherence in children with perinatally acquired HIV.
  • Psychosocial and health factors also play a role in adherence.
  • Interventions to improve medication adherence should consider the child's and family's behavioral, social, and health context.

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