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Psychiatric symptoms and antiretroviral nonadherence in US youth with perinatal HIV: a longitudinal study
Deborah Kacanek1, Konstantia Angelidou, Paige L Williams
1aDepartment of Biostatistics bCenter for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts cDepartment of Psychiatry dDepartment of Pediatrics, Stony Brook University, New York, USA.
Insights
Psychiatric conditions like depression and disruptive behavior are linked to lower antiretroviral adherence in youth with perinatal HIV infection (PHIV). Interventions addressing these conditions are crucial for sustained treatment success.
Area of Science:
- Pediatric HIV/AIDS Research
- Child and Adolescent Psychiatry
- Infectious Disease Management
Background:
- Longitudinal data on psychiatric conditions and antiretroviral adherence in youth with perinatal HIV infection (PHIV) are limited.
- Understanding these associations is critical for optimizing treatment outcomes in this vulnerable population.
Purpose of the Study:
- To examine the relationship between specific psychiatric conditions and antiretroviral nonadherence over a two-year period in youth with PHIV.
- To identify psychiatric comorbidities that predict nonadherence to antiretroviral therapy.
Main Methods:
- A longitudinal study involving 294 youth (ages 6-17) with PHIV in the United States and Puerto Rico.
- Annual assessments of nonadherence (missed doses, unsuppressed viral load) and psychiatric conditions (ADHD, disruptive behavior, depression, anxiety).
- Multivariable logistic regression and Generalized Estimating Equations were used to analyze associations.
Main Results:
- Prevalence of nonadherence was substantial at baseline (14%-38%) and remained consistent over two years.
- Depression and disruptive behavior at baseline were associated with increased odds of 3-day recall nonadherence at 96 weeks.
- Attention deficit hyperactivity disorder (ADHD) was linked to higher odds of unsuppressed viral load at 48 and 96 weeks.
Conclusions:
- Specific psychiatric conditions, including depression, disruptive behavior, and ADHD, are associated with antiretroviral nonadherence in youth with PHIV.
- Comprehensive adherence interventions that integrate mental health support are necessary.
- These interventions should be implemented throughout the transition to adult care to ensure sustained viral suppression.
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.
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