Introducción En años recientes, varias iniciativas globales para combatir la epidemia de sida han producido avances prometedores mediante el acceso a programas efectivos de tratamiento. Sin embargo, la falta de adhesión a la terapia antirretroviral es un problema en los pacientes pediátricos.
Objetivo Explorar la adhesión a la terapia antirretroviral de niños y adolescentes con VIH/SIDA en Cuba y examinar su relación con factores psicosociales, individuales y asociados al tratamiento.
Métodos Se efectuó un estudio cualitativo con 21 cuidadores de niños y adolescentes con VIH/SIDA. Mediante la revisión de documentos, se obtuvo información demográfica y del régimen de tratamiento. Se realizaron entrevistas minuciosas para evaluar la adhesión y examinar su relación con factores psicosociales, individuales y asociados al tratamiento. Las entrevistas se transcribieron y la información se agrupó según la categoría de los factores. La adhesión se analizó en relación con estos tres grupos de factores.
Resultados Los cuidadores entrevistados reportaron adhesión adecuada en 17 de los 21 niños. La falta de adhesión estuvo relacionada principalmente con factores psicosociales tales como responsabilidad adicional asumida por el cuidador mientras enfrentaba su propia enfermedad, la presencia de síntomas psicológicos no tratados en el cuidador, dificultades percibidas en el apoyo familiar, la edad del niño y la asignación de las responsabilidades en el tratamiento del niño sin tomar en cuenta su madurez psicológica.
Conclusiones El estudio reveló un alto nivel de adhesión a la terapia antirretroviral. Confirmó la importancia fundamental del cuidador y del apoyo familiar para el éxito terapéutico en niños y adolescentes que padecen VIH/SIDA. Estos resultados, así como los factores identificados en casos de no adhesión, ofrecen un marco para la evaluación y para intervenciones especializadas para optimizar la adhesión pediátrica a la terapia antirretroviral.
Palabras clave VIH, sida, terapia antirretroviral, adhesión del paciente, conformidad del paciente, adhesión a tratamiento, conformidad con tratamiento, no adhesión a tratamiento, Cuba
INTRODUCTION In recent years, global initiatives to address the AIDS epidemic have produced promising advances through access to effective treatment programs. However, lack of adherence to antiretroviral therapy is a problem for pediatric patients.
OBJECTIVE Explore antiretroviral therapy adherence in children and adolescents living with HIV/AIDS in Cuba and examine its relationship with psychosocial, individual and treatment factors.
METHODS A qualitative study was carried out of 21 caregivers of children and adolescents with HIV/AIDS. Demographics and information on treatment regimen were collected by chart review. In-depth interviews were conducted to assess adherence and examine its relationship with psychosocial, individual and treatment factors. Interviews were transcribed and the information was grouped by factor category. Adherence was analyzed in relation to these three sets of factors.
RESULTS Caregivers interviewed reported adequate adherence in 17 of the 21 children. Lack of adherence was linked primarily to psychosocial factors such as additional responsibility taken on by the caregiver while grappling with his or her own illness, the presence of untreated psychological symptoms in the caregiver, perceived difficulties with family support, the child’s age, and assigning treatment responsibilities to the child without taking into account his/her psychological maturity.
CONCLUSIONS The study revealed a high level of antiretroviral therapy adherence. It reconfirmed the fundamental importance of the caregiver and family support for therapeutic success in children and adolescents living with HIV/AIDS. These results, as well as the factors identified in cases of nonadherence, can contribute to a framework for assessment and specialized interventions to optimize pediatric antiretroviral adherence.
KEYWORDS HIV, AIDS, antiretroviral therapy, patient adherence, patient compliance, patient nonadherence, treatment adherence, treatment compliance, treatment nonadherence, Cuba
INTRODUCTION The use of highly active antiretroviral therapy has reduced progression to AIDS and increased survival among seropositive persons; yet, appearance of resistant viruses may jeopardize these benefits. In Cuba, HIV mainly affects adults; at the end of 2009 of the 41 children infected, 25 were still alive; of these, 22 were under antiretroviral treatment. Until now, nothing was known about HIV-1 antiviral resistance and viral subtypes in the pediatric population in Cuba.
OBJECTIVE This study aims to identify presence of antiretroviral-resistant HIV-1 strains in Cuban children and their mothers, and to provide a phylogenetic characterization and comparison of pol gene sequences in the same.
METHODS Plasma samples were collected from 22 children and their mothers, all HIV-1–infected, from 2004 through 2009. Reverse transcription polymerase chain reaction was used to amplify the pol gene fragment coding for HIV protease and reverse transcriptase enzymes; this was then sequenced and subjected to phylogenetic analysis of HIV subtypes and recombinant forms to compare sequences between mothers and children. HIV mutations conferring antiretroviral resistance were determined.
RESULTS Viral amplification was achieved in samples from 11 children and 8 mothers. Subtypes detected were: CRF19_cpx in five children, subtype B in three, CRF18_cpx in two, and subtype C in one child. In all mother–child pairs, samples were grouped within the same viral subtype in the phylogenetic tree. One mother was under treatment and five children had been treated before the sample was collected. In viruses amplified from samples of children under treatment, resistance was most frequently found to lamivudine (3 cases) and nevirapine (4 cases). Two untreated children carried resistant viruses possibly acquired from their mothers.
CONCLUSIONS This is the first study to describe HIV-1 antiviral resistance in the pediatric population in Cuba; it also identified viral subtypes infecting the mother−child pairs studied. We recommend antiretroviral resistance assays before initiating treatment in pregnant seropositive women and their newborns.
KEYWORDS HIV, AIDS, antiretroviral therapy, antiviral drug resistance, phylogeny, infectious disease transmission, vertical, Cuba
The following errata have been corrected in all versions of this article
Page 24: Byline, ”Joan Alemán” should read “Yoan Alemán.”
Page 31, The Authors: ”Joan Alemán” should read “Yoan Alemán Campos.”
