The association of perceived health, clinical status, and initiation of HAART (highly active antiretroviral therapy) in adolescents.
OBJECTIVE
To examine factors associated with the initiation of highly active antiretroviral therapy (HAART) in adolescents to understand better how current National Institutes of Health (NIH) Guidelines are being used in practice.


METHODS
HIV infected and HAART-naive adolescents seen at 15 REACH clinical sites were selected. Repeated measures methodology using generalized estimating equations was applied to identify associations between subject demographic characteristics, risk behaviors, perceived health, and clinical status with the outcome measure of HAART initiation during the first 24 study months.


RESULTS
A total of 219 subjects were eligible for analysis; HAART was prescribed in 115 (53%). Significant univariate associations with HAART prescription included lower CD4(+) T cell counts (OR = 1.7, 95% CI: 1.1-2.6), higher viral loads (OR = 2.7, 95% CI: 1.5-5.0), and calendar year of HAART prescription (OR as high as 2.4, 95% CI: 1.1-5.2). Multivariate results showed that after controlling for CD4(+) T cell counts below 500 cells/mm(3), higher plasma HIV-1 RNA (<or=10,000 copies per ml), and temporal factors, having a high school diploma/GED but no further education (OR = 2.7, 95% CI: 1.3-5.5) and subject's perception of poor health status (OR = .987; 95% CI: .975- .999) were independently associated with prescription of HAART. HAART was most likely to be prescribed during the first half of 1998 in this cohort (OR = 10.8; 95% CI: 4.0-29.0).


CONCLUSIONS
In this first ever study of HAART prescription in adolescents infected with HIV, perception of poor health status and having a high school diploma/GED were independently associated with prescription of HAART suggesting that the personal decision to accept therapy is related to the belief that one's health is deteriorating and that the decision to prescribe therapy may be linked in some fashion to the prescriber's assessment of the patient's ability to master the regimen as well as clinical status.
Schwarz
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DF
The Department of Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadephia, Pennsylvania 19104, USA. schwarz@email.chop.edu
Henry-Reid
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Houser
J
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Y
Y
D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D003657:Decision Making; D004522:Educational Status; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006304:Health Status; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010465:Perception; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'