Background The aims of highly active antiretroviral therapy (HAART) in HIV-infected children are to achieve and sustain full HIV-RNA viral load (VL) suppression and CD4-reconstitution, in order to prevent the progression of the HIV infection and allow normal growth and development.
Adherence to HAART is a strong predictor of therapeutic efficacy. Previous studies have shown that therapeutic success requires adherence > 95%. Among paediatric HIV patients, adherence to HAART is reportedly suboptimal.
There are a number of factors that can compromise treatment compliance. These can be classified as those related to the medicine, the patient, the family/caregiver and the healthcare system.
Purpose To estimate the correlation between adherence to HAART and treatment efficacy.
To assess factors related to non-adherence among HIV-infected children.
Materials and Methods Retrospective cohort study from January 2008 to July 2012 including all HIV-infected patients on HAART followed by the Paediatrics Department.
Age, sex, lipoatrophy, number of pills/day (P/d) and frequency of daily dosing: once a day (QD) or twice a day (BID), were analysed.
Adherence was assessed by using the pharmacy refill records and pill count, according to the following formula:
Adherence (%) = (Nº dispensed doses- Nº returned doses)/Nº prescribed doses × 100
Undetectable VL was defined as VL < 20 copies/ml.
Data were analysed by multiple logistic regression methods using SPSS software (version 19.0).
Results 24 HIV-infected patients were included (mean age = 15.3 ± 5.5 years; 29.2% male, 70.8% female).
37.5% of patients presented lipoatrophy.
54.2% and 45.8% of the children were treated with a QD and BID regimen, respectively.
Only 50% of patients were considered adherent to treatment (adherence >95%).
The relationship between risk factors and adherence was: see Table
Patients with poor adherence had a higher risk of virological failure (OR = 11.67; CI95 = 1.14–119.54;p = 0.039)
Conclusions Adherence to HAART represents a significant challenge in the paediatric HIV population.
The P/d was significantly associated with adherence. Every pill/day increased up to 2.3-fold the risk of non-adherence to HAART.
Simplifying HAART by reducing the pill burden may contribute to improving compliance in the paediatric HIV population.
No conflict of interest.
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