Nonadherence and unsuppressed viral load across adolescence among US youth with perinatally acquired HIV

被引：35

作者：

Kacanek, Deborah ^{[1
,2
]}

Huo, Yanling ^{[1
,2
]}

Malee, Kathleen ^{[3
,11
]}

Mellins, Claude A. ^{[4
]}

Smith, Renee ^{[5
]}

Garvie, Patricia A. ^{[6
,14
]}

Tassiopoulos, Katherine ^{[7
]}

Lee, Sonia ^{[8
]}

Berman, Claire A. ^{[7
]}

Paul, Mary ^{[9
,12
]}

Puga, Ana ^{[6
,14
]}

Allison, Susannah ^{[10
]}

Chadwick, Ellen ^{[11
]}

Sanders, Margaret Ann ^{[11
]}

Pyun, Yoonsun ^{[11
]}

Shearer, William ^{[12
]}

Cooper, Norma ^{[12
]}

McMullen-Jackson, Chivon ^{[12
]}

Speer, Mandi ^{[12
]}

Harris, Lynette ^{[12
]}

Purswani, Murli ^{[13
]}

Baig, Mahboobullah Mirza ^{[13
]}

Villegas, Alma ^{[13
]}

Navarro, Lisa Gaye-Robinson Sandra ^{[14
]}

Burchett, Sandra K. ^{[15
]}

Anderson, Michelle E. ^{[15
]}

Cassidy, Adam R. ^{[15
]}

Wiznia, Andrew ^{[16
]}

Burey, Marlene ^{[16
]}

Shaw, Ray ^{[16
]}

Auguste, Raphaelle ^{[16
]}

Dieudonne, Arry ^{[17
]}

Bettica, Linda ^{[17
]}

Johnson, Juliette ^{[17
]}

Surowiec, Karen ^{[17
]}

Chen, Janet S. ^{[18
]}

Bulkley, Maria Garcia ^{[18
]}

White, Taesha ^{[18
]}

Grant, Mitzie ^{[18
]}

Knapp, Katherine ^{[19
]}

Allison, Kim ^{[19
]}

Wilkins, Megan ^{[19
]}

Russell-Bell, Jamie ^{[19
]}

Acevedo-Flores, Midnela ^{[20
]}

Rios, Heida ^{[20
]}

Olivera, Vivian ^{[20
]}

Silio, Margarita ^{[21
]}

Gabriel, Medea ^{[21
]}

Sirois, Patricia ^{[21
]}

Spector, Stephen A. ^{[22
]}

机构：

[1] Harvard TH Chan Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA

[2] Harvard TH Chan Sch Publ Hlth, Ctr Biostat AIDS Res, 665 Huntington Ave,FXB 505, Boston, MA 02115 USA

[3] Northwestern Univ, Dept Psychiat & Behav Sci, Feinberg Sch Med, Chicago, IL USA

[4] Columbia Univ, Dept Psychiat, HIV Ctr Clin & Behav Studies, Irving Med Ctr, New York, NY USA

[5] Univ Illinois, Dept Pediat, Chicago, IL USA

[6] Childrens Diagnost & Treatment Ctr, Res Dept, Ft Lauderdale, FL USA

[7] Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA

[8] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Maternal & Pediat Infect Dis Branch, Bethesda, MD USA

[9] Baylor Coll Med, Dept Pediat, Retrovirol, Houston, TX 77030 USA

[10] NIMH, Div AIDS Res, NIH, Bethesda, MD 20892 USA

[11] Ann & Robert H Lurie Childrens Hosp Chicago, Chicago, IL 60611 USA

[12] Baylor Coll Med, Houston, TX 77030 USA

[13] Bronx Lebanon Hosp Ctr, Bronx, NY 10456 USA

[14] Childrens Diagnost & Treatment Ctr, Ft Lauderdale, FL USA

[15] Boston Childrens Hosp, Boston, MA USA

[16] Jacobi Med Ctr, New York, NY USA

[17] Rutgers New Jersey Med Sch, Newark, NJ USA

[18] St Christophers Hosp Children, Philadelphia, PA 19133 USA

[19] St Jude Childrens Res Hosp, 332 N Lauderdale St, Memphis, TN 38105 USA

[20] San Juan Hosp, Dept Pediat, San Juan, PR USA

[21] Tulane Univ, Sch Med, New Orleans, LA 70118 USA

[22] Univ Calif San Diego, San Diego, CA 92103 USA

[23] Univ Colorado, Denver Hlth Sci Ctr, Denver, CO 80202 USA

[24] Univ Miami, Coral Gables, FL 33124 USA

来源：

AIDS | 2019年 / 33卷 / 12期

关键词：

adolescent development; medication adherence; social determinants of health; violence; viral load; young adult; youth; ANTIRETROVIRAL THERAPY ADHERENCE; HUMAN-IMMUNODEFICIENCY-VIRUS; MEDICATION ADHERENCE; INFECTED YOUTH; UNITED-STATES; IMMUNOLOGICAL OUTCOMES; COMMUNITY VIOLENCE; INHIBITOR THERAPY; GROWING-UP; CHILDREN;

D O I：

10.1097/QAD.0000000000002301

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Objective: To identify factors associated with nonadherence and unsuppressed viral load across adolescence among youth with perinatally acquired HIV. Design: Longitudinal study at 15 US clinical sites. Methods: Self-reported antiretroviral medication nonadherence (any missed dose, past week) and unsuppressed viral load (HIV RNA > 400 copies/ml) were assessed annually. Individual, caregiver, social, and structural factors associated with nonadherence and unsuppressed viral load were identified by age (years): 8-11 (preadolescence), 12-14 (early adolescence), 15-17 (middle adolescence), and 18-22 (late adolescence/young adulthood), utilizing multivariable generalized linear mixed effects models. Results: During a median 3.3-year follow-up, 381 youth with perinatally acquired HIV contributed viral load measurements and 379 completed 1190 adherence evaluations. From preadolescence to late adolescence/young adulthood, prevalence of nonadherence increased from 31 to 50% (P < 0.001); prevalence of unsuppressed viral load increased from 16 to 40% (P < 0.001). In adjusted analyses, in pre, middle, and late adolescence/young adulthood, perceived antiretroviral side effects were associated with nonadherence. Additional factors associated with nonadherence included: in preadolescence, using a buddy system (as an adherence reminder); in early adolescence, identifying as black, using buddy system; in middle adolescence, CD4(+)% less than 15%, unmarried caregiver, indirect exposure to violence, stigma/fear of inadvertent disclosure, stressful life events. Associations with unsuppressed viral load included: in early adolescence, youth unawareness of HIV status, lower income; in middle adolescence, perceived antiretroviral side effects, lower income; in late adolescence/young adulthood, distressing physical symptoms, and perceived antiretroviral side effects. Conclusion: Prevalence of nonadherence and unsuppressed viral load increased with age. Associated factors varied across adolescence. Recognition of age-specific factors is important when considering strategies to support adherence.

引用

页码：1923 / 1934

页数：12

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