Relationship between viral load and behavioral measures of adherence to antiretroviral therapy in children living with human immunodeficiency virus in Latin America

Few studies have examined antiretroviral therapy adherence in Latin American children. Standardized behavioral measures were applied to a large cohort of human immunodeficiency virus-infected children in Brazil, Mexico, and Peru to assess adherence to prescribed antiretroviral therapy doses during the three days prior to study visits, assess timing of last missed dose, and evaluate the ability of the adherence measures to predict viral suppression. Time trends in adherence were modeled using a generalized estimating equations approach to account for possible correlations in outcomes measured repeatedly in the same participants. Associations of adherence with human immunodeficiency virus viral load were examined using linear regression. Mean enrollment age of the 380 participants was 5 years; 57.6% had undetectable' viral load (<400 copies/mL). At enrollment, 90.8% of participants were perfectly (100%) adherent, compared to 87.6% at the 6-month and 92.0% at the 12-month visit; the proportion with perfect adherence did not differ over time (p = 0.1). Perfect adherence was associated with a higher probability of undetectable viral load at the 12-month visit (odds ratio = 4.1, 95% confidence interval: 1.8-9.1; p < 0.001), but not at enrollment or the 6-month visit (p > 0.3). Last time missed any antiretroviral therapy dose was reported as "never" for 52.0% at enrollment, increasing to 60.7% and 65.9% at the 6- and 12-month visits, respectively (p < 0.001 for test of trend). The proportion with undetectable viral load was higher among those who never missed a dose at enrollment and the 12-month visit (p ≤ 0.005), but not at the 6-month visit (p = 0.2). While antiretroviral therapy adherence measures utilized in this study showed some association with viral load for these Latin American children, they may not be adequate for reliably identifying non-adherence and consequently children at risk for viral resistance. Other strategies are needed to improve the evaluation of adherence in this population.

Language aspects of children infected with HIV / Aspectos da linguagem em crianças infectadas pelo HIV

PURPOSE: to assess the lexical proficiency and the incidence of phonologic disorders in the language of children infected with HIV. METHOD: the study population consisted of 31 children between three and seven year-old. For evaluation purposes the Test of Infantile Language - ABFW was applied in the areas of phonology and vocabulary. RESULTS: the results obtained were analyzed according to the clinical criteria for the classification of the disease proposed by the CDC and regarding the immunological profile and the viral burden using the Mann-Whitney test for statistical analysis. In the vocabulary evaluation, 100% of the children presented an inappropriate response for their age in at least two distinct conceptual fields. In the phonologic evaluation, 67.7% of the assessed children were considered to be affected by some phonologic disorder. When we compared adequate and inadequate results of phonologic evaluation to the clinical and immunological parameters of AIDS such as clinical classification (p=0,16), CD4 count (p=0,37) and viral burden (p=0,82), we did not detect a statistically significant relation between language alterations and disease severity. CONCLUSION: this research has shown that the studied group presents a high risk for language disorders and that constant phonoaudiological follow-up is essential to identify the alterations in early stage.

OBJETIVO: avaliar a proficiência lexical e a incidência de distúrbios fonológicos na linguagem de crianças infectadas com HIV. MÉTODO: a população do estudo consistiu de 31 crianças com idades entre três e sete anos. Para avaliação foi utilizado o Teste de Linguagem Infantil - ABFW foi nas áreas de fonologia e vocabulário. RESULTADOS: os resultados obtidos foram analisados de acordo com os critérios clínicos para a classificação da doença, proposta pelo CDC e sobre o perfil imunológico e a carga viral através do teste de Mann-Whitney para análise estatística. Na avaliação de vocabulário, 100% das crianças apresentaram uma resposta inadequada para a sua idade em pelo menos dois campos distintos conceptuais. Na avaliação fonológica, 67,7% das crianças avaliadas foram consideradas afetadas por algum distúrbio fonológico. Quando comparamos os resultados adequados e inadequados da avaliação fonológica para os parâmetros clínicos e immunovirological de AIDS, tais como classificação clínica (p = 0,16), contagem de CD4 (p = 0,37) e carga viral (p =0,82), não se detectou uma relação estatisticamente significativa entre alterações de linguagem e severidade da doença. CONCLUSÃO: a pesquisa mostrou que o grupo estudado apresenta um alto risco de distúrbios de linguagem e que acompanhamento fonoaudiológico constante é essencial para identificar as alterações precocemente.