Murphy Debra A, Belzer Marvin, Durako Stephen J, Sarr Moussa, Wilson Craig M, Muenz Larry R
Health Risk Reduction Projects, Department of Psychiatry, University of California, Los Angeles, CA 90025-3556, USA.
Arch Pediatr Adolesc Med. 2005 Aug;159(8):764-70. doi: 10.1001/archpedi.159.8.764.
To longitudinally follow a cohort of adolescents with human immunodeficiency virus (HIV) and to investigate long-term antiretroviral therapy adherence and factors associated with adherence.
DESIGN, SETTING, AND PATIENTS: Adolescents infected with HIV (N = 231; mean age, 18.4 years; 72.7% female; 74.9% African American) from 13 cities throughout the United States were assessed at 3-month intervals.
Self-reported adherence measures were validated by comparison with HIV-1 RNA viral load, and behavioral factors that may be associated with antiretroviral therapy adherence were assessed.
At the initial visit, approximately 69% of the adolescents reported being adherent to antiretroviral therapy. Adolescents in the later HIV disease stage were less likely to be adherent compared with those in the earlier disease stage. Less alcohol use and being in school were associated with adherence by adolescents on weekends and over the preceding month. Longitudinal adherence was investigated among 65 subjects initially adherent with available information for at least 4 consecutive visits. The median time to nonadherence was 12 months, and failure to maintain adherence was significantly associated with younger age and depression. Among adolescents who attained an undetectable viral load, only about 50% maintained an undetectable viral load for the year.
These findings indicate an urgent need for better interventions to assist adolescents with HIV in adhering to their medication regimens. Adolescents with advanced disease are likely to need more intervention. New treatments recently found effective for adolescent depression may assist in improving adherence for a majority of adolescents with HIV.
对一组感染人类免疫缺陷病毒（HIV）的青少年进行纵向跟踪，调查长期抗逆转录病毒治疗的依从性以及与依从性相关的因素。
设计、地点和患者：对来自美国13个城市的感染HIV的青少年（N = 231；平均年龄18.4岁；72.7%为女性；74.9%为非裔美国人）每3个月进行一次评估。
通过与HIV-1 RNA病毒载量进行比较来验证自我报告的依从性指标，并评估可能与抗逆转录病毒治疗依从性相关的行为因素。
在初次就诊时，约69%的青少年报告坚持抗逆转录病毒治疗。与疾病早期阶段的青少年相比，疾病晚期阶段的青少年坚持治疗的可能性较小。较少饮酒和在校与青少年在周末及前一个月的依从性相关。对65名最初坚持治疗且至少有4次连续可用信息的受试者进行了纵向依从性调查。不依从的中位时间为12个月，未能维持依从性与较年轻的年龄和抑郁显著相关。在病毒载量检测不到的青少年中，只有约50%在这一年中维持病毒载量检测不到。
这些发现表明迫切需要更好的干预措施来帮助感染HIV的青少年坚持他们的药物治疗方案。疾病晚期的青少年可能需要更多干预。最近发现对青少年抑郁症有效的新治疗方法可能有助于提高大多数感染HIV的青少年的依从性。
