Perinatal HIV Infection: Nonadherence Risk Increases in Adolescents

Prevalence of HIV infection among adolescents and young adults is increasing globally. Although part of the increase is linked to new infections, a significant proportion of adolescents and young adults who are living with HIV were exposed to the virus perinatally. These children have a unique risk of nonadherence in adolescence, as well as an elevated risk of mental health and substance use problems.

A new article published in Pediatric Infectious Disease Journal looks at specific psychiatric diagnoses and the possible relationship of such diagnoses to medication adherence and viral suppression. The researchers indicate that adolescents and young adults who were infected perinatally and have behavioral or mood disorders are at the highest risk of missing antiviral doses.

The researchers confirmed previous research that found a high prevalence of psychiatric disorders and suboptimal adherence among youths who had been HIV-infected since birth.

Individuals diagnosed with disruptive behavior disorders (especially attention-deficit hyperactivity disorder) and mood disorders were most likely to have difficulty adhering to antiviral therapies. The individuals had the highest rates of viral load exceeding 1000 copies/mL within 90 days of a psychiatric assessment.

The researchers followed study participants for an additional 2 to 3 years after initial assessment. They noted that individuals diagnosed with disruptive behavior disorder, substance use disorder, or any psychiatric disorder had an elevated risk of viral load exceeding 1000 copies/mL in the follow-up period.

The authors noted that many study participants lived in low-income households and were cared for by individuals who were not their biological parents. This raises the issue of social and contextual circumstances that influence antiviral adherence and is an area for future research.

Although previous work had found associations between adolescents living with HIV and conduct disorders, or depression, the researchers examined additional diagnoses including oppositional defiant disorder and other behavior disorder subcategories.

The authors suggested that addressing mental health and substance use problems may be closely related to improved adherence and health outcomes. They also indicated that proactive intervention could prevent new infections, as increased adherence decreases viremia and the likelihood of transmission. The authors concluded that integrating mental health services into HIV care, identifying and treating psychiatric disorders, and emphasizing adherence during the adolescent and young adult years may improve adherence and prevent poor health outcomes.

Reference

Bucek A, Leu CS, Benson S, et al. Psychiatric disorders, antiretroviral medication adherence, and viremia in a cohort of perinatally HIV-Infected adolescents and young adults. Pediatr Infect Dis J. 2017 Dec 8. doi: 10.1097/INF.0000000000001866. [Epub ahead of print]