Psychiatric Disorders, Antiretroviral Medication Adherence, and Viremia in a Cohort of Perinatally HIV-Infected Adolescents and Young Adults

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Abstract

Background:

Perinatally HIV-infected (PHIV+) adolescents and young adults (AYA) are at risk for sub-optimal antiretroviral therapy (ART) adherence, and mental health and substance use problems that, in HIV-infected adults, predict non-adherence. Studies on the relationship between psychiatric and substance use disorders (SUD) and adherence among PHIV+ AYA are limited, but may be important to informing evidence-based interventions to promote adherence.

Methods:

Data were analyzed from three annual follow-up interviews (FU2-4, N=179) in a longitudinal study of PHIV+ AYA. Psychiatric disorders (anxiety, disruptive behavior, mood, SUD) were assessed with the Diagnostic Interview Schedule for Children. Adherence was self-reported missed ART doses within the past week. Viral load (VL) results were abstracted from medical charts. Multiple logistic regression analyzed cross-sectional associations between psychiatric disorders and 1)missed ART dose and 2)VL>1,000 copies/ml. Multiple linear regression assessed associations between psychiatric disorders and proportion of VL values >1,000 copies/ml over time.

Results:

At FU2 53% of PHIV+ AYA had any psychiatric disorder, 35% missed an ART dose in the past week, and 47% had a VL >1,000 copies/ml. At FU2, behavioral disorders were associated with missed dose (p=.009) and VL>1000 (p=.019), and mood disorders were associated with missed dose (p=.041). At FU4, behavioral disorders were associated with missed dose (p=.009). Behavioral disorders (p=.041), SUD (p=.016), and any disorder (p=.008) at FU2 were associated with higher proportion of VLs >1000 across FU2-4.

Conclusions:

Addressing psychiatric disorder and SUD among PHIV+ AYA may improve ART adherence outcomes in this population. Targeted interventions should be developed and tested.

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