As young people born with HIV age from preadolescence to adolescence, many of them have difficulty adhering to their antiretroviral (ARV) treatment; as a result, they become more likely to have a detectable viral load.
Publishing their findings in the journal AIDS, Deborah Kacanek, ofthe Harvard T.H. Chan School of Public Health in Boston, and colleagues conducted a longitudinal study of 381 8- to 22-year-olds born with HIV, whom they followed for a median of 3.3 years. The young people were recruited at 15 U.S. clinical sites, including in Puerto Rico.
The members of the study cohort received routine viral load tests. The study used a viral load of greater than 400 as the threshold to determine whether a young person had fully suppressed virus. A total of 379 of the study members completed 1,190 evaluations of their self-reported or caregiver-reported adherence to ARVs.
The study defined those 8 to 11 years old as in preadolescence, those 12 to 14 years old as in early adolescence, those 15 to 17 years as in middle adolescence and those 18 to 22 years old as in late adolescence and young adulthood.
As the children aged from preadolescence to late adolescence and young adulthood, lack of adherence to ARVs increased from 31% to 50%, while the rate of unsuppressed HIV increased from 16% to 40%.
After adjusting the data to account for various differences between the young people, the study authors found that during preadolescence, middle-adolescence, late adolescence and young adulthood, concerns about ARV side effects were associated with nonadherence to treatment.
Other factors associated with nonadherence differed by age group. Among preadolescents, using a buddy system as a reminder to adhere was, in contrast with previous studies’ findings, a predictor of nonadherence. Among early adolescents, identifying as Black and using a buddy system were factors predicting nonadherence. During middle adolescence, having an unmarried caregiver, indirect exposure to violence, stigma or fear of having one’s HIV status inadvertently disclosed by the use of ARVs and stressful life events were factors.
Factors associated with having unsuppressed HIV included: in early adolescence, a lack of awareness of one’s HIV status during one’s younger years and a lower household income; in middle adolescence, concerns about ARV side effects and lower incomes; and during late adolescence and young adulthood, distressing physical symptoms and concerns about medication side effects.
“Recognition of age-specific factors is important when considering strategies to support adherence,” the study authors concluded.
To read a press release about the study, click here.
To read the study abstract, click here.