Medication adherence poor for many HIV-infected children

Almost half of parents or other caregivers of HIV-infected children disclosed that their child had missed at least one medication dose in the previous week, according to study findings published in the December issue of the Paediatric Infectious Disease Journal. Dr Jeanne Bertolli and colleagues from the Centres for Disease Control and Prevention in Atlanta note that “rigorous adherence to antiretroviral medications is necessary to achieve and maintain undetectable viral levels.”

To determine levels of adherence in children, the researchers interviewed 90 caregivers. A total of 78% of their children were taking 3 or more medications, 17% had missed a medication dose in the previous 24 hours, and 43% had missed at least one dose in the past week. While 50% of children whose caregivers reported no missed doses in the previous week had a viral load level of <400 copies/mL, this was true for only 24% of children with “nonadherent” caregivers.

A total of 44% of nonadherent caregivers believed that full adherence was impossible. Only 12% of adherent caregivers thought that this was the case. Nonadherent caregivers were also more likely to want help with medication administration than adherent caregivers (26% vs 6%) and were less likely to have informed the school or day care centre about the child’s infection (42% vs. 67%).

Among interventions that most caregivers thought would be “very helpful” in improving compliance were better tasting medication, longer dosing intervals, no need for refrigeration, and telephone access to medical advice. “Given the wide range of caregiver opinions and preferences,” the researchers conclude that “support for adherence should be tailored to the individual family’s needs.”