Compliance to combination antiretroviral therapy in HIV-1 infected children

Adherence to antiretroviral therapy is considered one of the most important factors determining the success of treatment. Its crucial role in antiretroviral treatment has been proven in both adults and children [1–4]. Monitoring adherence to combination anti-HIV therapy is a crucial tool in improving compliance and consequently in obtaining a durable suppression of plasma viral load [5]. Many variables influence adherence to a single drug or to a more complex regimen: formulation of drugs, number of tablets, schedule of administration, taste, food interference with absorption, duration of treatment, adverse events (quality, quantity and frequency), clinical status and efficacy. Taste, palatability, liquid formulation, ease of administration, number of tablets and interactions with food are determinant features in the treatment of children. Such features can become great problems for their parents and their physicians if therapy is long term. Our cohort included 37 children with perinatally acquired HIV infection. Thirty four of them were on combination antiretroviral treatment at the time of the study. Twenty five consecutively treated children were enrolled in our study after written consent had been obtained from parents or guardians. A questionnaire was used to evaluate the degree of adherence to treatment and the main problems faced by people who had to give medicines to the children every day. Our form included a series of questions about antiretroviral treatment and was an adaptation of a similar one used in the USA in 1997–1998 [6]. Children of our cohort who were included in the study were mainly males (56%); their mean age was 8.2 years (median: 8 years). Each child took a mean of 7.36 tablets and/or syrup doses. Evaluation of the answers from the questionnaire gave the following results: 1. The mother was the main person giving medicines to the child (80%). 2. The father or grandmother were the other chief figures (16% each). 3. A written list of child’s medicines was kept by 24% of families and a full written schedule of the child’s treatment by 44% of families. 4. Twenty four percent of children had missed at least one dose in the 3 days before the visit and almost half the children (44%) had missed at least one dose since the last visit.