title: Virologic response using directly observed therapy in adolescents with HIV: an adherence tool.
abstract: Virologic response to highly active antiretroviral therapy (HAART) treatment of HIV infection depends on viral sensitivity to antiretrovirals and excellent medication adherence. Adolescents with vertically acquired HIV may require complicated regimens because of significant treatment experience and often have poor medication adherence. A retrospective chart review identified five adolescents with vertically acquired HIV and plasma HIV viral load rebound or nonresponse on a stable HAART regimen followed by a period of directly observed therapy (DOT) in a clinic or hospital setting with serial viral load measurements. Four subjects had a virologic response (mean decline, 1.15 log10) after DOT. A response to HAART can be seen despite antiretrovirals resistance using DOT and treatment-experienced patients seemingly unresponsive to HAART may be nonadherent even with reassuring adherence measures. A period of clinic-monitored DOT may allow diagnosis of nonadherence, discussion of medication barriers, and avoidance of unnecessary medication changes.
authors.affiliation: National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Julia Bilodeau
authors.initials: JB
authors.lastname: Purdy
authors.forename: Alexandra F
authors.initials: AF
authors.lastname: Freeman
authors.forename: Staci C
authors.initials: SC
authors.lastname: Martin
authors.forename: Celia
authors.initials: C
authors.lastname: Ryder
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Elliott-DeSorbo
authors.forename: Steven
authors.initials: S
authors.lastname: Zeichner
authors.forename: Rohan
authors.initials: R
authors.lastname: Hazra
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D023241:Antiretroviral Therapy, Highly Active / Q000451:nursing / Q000523:psychology*; D023801:Directly Observed Therapy / Q000379:methods* / Q000451:nursing / Q000523:psychology; D016903:Drug Monitoring / Q000379:methods* / Q000451:nursing; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000821:virology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D009730:Nursing Assessment; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D000297:Psychology, Adolescent; D012189:Retrospective Studies; D019562:Viral Load / Q000379:methods*