Palatability of antiretroviral drugs in children with HIV: A survey of physician perceptions

Background Antiretroviral (ARV) therapy has greatly reduced the mortality and morbidity of children living with HIV but requires up to 90% adherence to be effective. Adherence in children is often suboptimal, and palatability is cited as the most important barrier. Poor adherence can necessitate ARV therapy change or the insertion of a gastronomy tube. Perceptions of HIV care physicians about ARV palatability in children have not been studied. Methods All the physicians currently caring for children with HIV in Canada were surveyed using a survey employing five-point Likert scales. Results The 12 respondents are believed to represent 80% of HIV care paediatricans in Canada. They treat a mean of 16 patients and receive 0 to 5 new patients annually. All physicians thought children detested liquid ritonavir. Liquid nelfinavir and liquid amprenavir were thought to be disliked, while efavinenz capsule, nevirapine tablet and indinavir capsule were rated better than neutral. Non-liquid medications were thought to be liked more than liquid medications (p=0.04). Liquid ritonavir required a treatment change due to palatability >50% of the time. Palatability prevented liquid ritonavir and liquid nelfinavir from being selected as first-line therapy ≥25% of the time. Conclusion Physicians perceive the palatability differences and the resulting drug changes among different ARV drugs used in children living with HIV, but this difference does not influence first-line therapy choice with the same frequency. Clinical Pharmacology & Therapeutics (2005) 77, P70–P70; doi: 10.1016/j.clpt.2004.12.158