Pontali Emanuele
Department of Infectious Diseases, Galliera Hospital, Genoa, Italy.
Paediatr Drugs. 2005;7(3):137-49. doi: 10.2165/00148581-200507030-00002.
Treatment of HIV infection with highly active antiretroviral therapy (HAART) requires sustained adherence to treatment to maintain efficacy. In pediatric patients, adherence to HAART represents a significant challenge for treated children and for their caregivers and healthcare providers. Many factors can affect adherence to HAART including: (i) factors related to the patient and his/her family; (ii) factors related to the drug/medication; and (iii) factors related to the healthcare system. Different strategies can be employed to tackle the specific obstacles identified in these three groups, and thus to facilitate adherence. Among the key interventions centered on the patient and his/her family are the tailoring of the HAART regimen to the daily activities of the child and his/her family, and the implementation of an intensive education program on adherence for the child and the caregiver, prior to starting the treatment. Specific medication-related problems (depending on drug pharmacokinetic and pharmacodynamic properties, taste and palatability, food interactions, etc.) exist; such problems can not be solved solely by clinicians or by families. Greater commitment of the pharmaceutical industry is needed, and innovative solutions have to be identified by clinicians in partnership with drug manufacturers. Furthermore, the development of an 'adherence strategy/program' can be recommended to all institutions working in pediatric HIV infection. Most of the necessary interventions to be included in such programs can be easily implemented, but they require trained and committed staff (and institutions), and time to be spent with patients and their caregivers.
使用高效抗逆转录病毒疗法（HAART）治疗HIV感染需要持续坚持治疗以维持疗效。在儿科患者中，坚持HAART对接受治疗的儿童及其照顾者和医疗服务提供者而言是一项重大挑战。许多因素会影响对HAART的坚持，包括：（i）与患者及其家庭相关的因素；（ii）与药物相关的因素；以及（iii）与医疗系统相关的因素。可以采用不同策略来应对这三组中确定的具体障碍，从而促进坚持治疗。以患者及其家庭为中心的关键干预措施包括根据儿童及其家庭的日常活动调整HAART方案，以及在开始治疗前为儿童和照顾者实施强化的坚持治疗教育计划。存在特定的与药物相关的问题（取决于药物的药代动力学和药效学特性、味道和适口性、食物相互作用等）；此类问题不能仅由临床医生或家庭解决。制药行业需要做出更大的努力，临床医生必须与药物制造商合作找到创新解决方案。此外，建议为所有从事儿科HIV感染工作的机构制定“坚持治疗策略/计划”。此类计划中包含的大多数必要干预措施都可以轻松实施，但它们需要训练有素且敬业的工作人员（和机构），以及花费时间与患者及其照顾者相处。
