title: Psychiatric symptoms and antiretroviral nonadherence in US youth with perinatal HIV: a longitudinal study.
abstract: OBJECTIVE
  The relationship of specific psychiatric conditions to adherence has not been examined in longitudinal studies of youth with perinatal HIV infection (PHIV). We examined associations between psychiatric conditions and antiretroviral nonadherence over 2 years.
  
  
  METHODS
  Longitudinal study in 294 PHIV youth, 6-17 years old, in the United States and Puerto Rico.
  
  
  METHODS
  We annually assessed three nonadherence outcomes: missed above 5% of doses in the past 3 days, missed a dose within the past month, and unsuppressed viral load (>400 copies/ml). We fit multivariable logistic models for nonadherence using Generalized Estimating Equations, and evaluated associations of psychiatric conditions (attention deficit hyperactivity disorder, disruptive behavior, depression, anxiety) at entry with incident nonadherence using multivariable logistic regression.
  
  
  RESULTS
  Nonadherence prevalence at study entry was 14% (3-day recall), 32% (past month nonadherence), and 38% (unsuppressed viral load), remaining similar over time. At entry, 38% met symptom cut-off criteria for at least one psychiatric condition. Greater odds of 3-day recall nonadherence were observed at week 96 for those with depression [adjusted odds ratio (aOR) 4.14, 95% confidence interval (CI) 1.11-15.42] or disruptive behavior (aOR 3.36, 95% CI 1.02-11.10], but not at entry. Those with vs. without attention deficit hyperactivity disorder had elevated odds of unsuppressed viral load at weeks 48 (aOR 2.46, 95% CI 1.27-4.78) and 96 (aOR 2.35, 95% CI 1.01-5.45), but not at entry. Among 232 youth adherent at entry, 16% reported incident 3-day recall nonadherence. Disruptive behavior conditions at entry were associated with incident 3-day recall nonadherence (aOR 3.01, 95% CI 1.24-7.31).
  
  
  CONCLUSIONS
  In PHIV youth, comprehensive adherence interventions that address psychiatric conditions throughout the transition to adult care are needed.
authors.affiliation: aDepartment of Biostatistics bCenter for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts cDepartment of Psychiatry dDepartment of Pediatrics, Stony Brook University, New York, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Kacanek
authors.forename: Konstantia
authors.initials: K
authors.lastname: Angelidou
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
authors.forename: Miriam
authors.initials: M
authors.lastname: Chernoff
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Gadow
authors.forename: Sharon
authors.initials: S
authors.lastname: Nachman
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000635:transmission / Q000821:virology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D001523:Mental Disorders / Q000150:complications*; D011446:Prospective Studies; D011647:Puerto Rico; D014481:United States; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents