Psychiatric symptoms and antiretroviral nonadherence in US youth with perinatal HIV: A longitudinal study

Deborah Kacanek, Konstantia Angelidou, Paige L. Williams, Miriam Chernoff, Kenneth D. Gadow, Sharon Nachman, Sandra Burchett, Karin Nielsen, Nicole Falgout, Joseph Geffen, Jaime Deville, Audra Deveikis, Margaret Keller, Vicki Tepper, Ram Yogev, Diane Wara, Stephen Spector, Lisa Stangl, Mary Caffery, Rolando VianiKreema Whitfield, Sunita Patil, Joan Wilson, Mary Jo Hassett, Sandra Deygoo, William Borkowsky, Sulachni Chandwani, Mona Rigaud, Andrew Wiznia, Lisa Frenkel, Patricia Emmanuel, Jorge Lujan Zilberman, Carina Rodriguez, Carolyn Graisber, Roberto Posada, Mary Dolan, Midnela Acevedo-Flores, Lourdes Angeli, Milagros Gonzalez, Dalila Guzman, Warren Andiman, Leslie Hurst, Anne Murphy, Leonard Weiner, Denise Ferraro, Michele Kelly, Lorraine Rubino, Sohail Rana, Suad Kapetanovic, Mobeen Rathore, Ayesha Mirza, Kathleen Thoma, Chas Griggs, Robin McEvoy, Emily Barr, Suzanne Paul, Patricia Michalek, Ana Puga, Patricia Garvie, Richard Rutstein, Roberta LaGuerre, Murli Purswani, Mahrukh Bamji, Katherine Luzuriaga

Research output: Contribution to journalArticlepeer-review

49 Scopus citations


Objectives: The relationship of specific psychiatric conditions to adherence has not been examined in longitudinal studies of youth with perinatal HIV infection (PHIV). We examined associations between psychiatric conditions and antiretroviral nonadherence over 2 years. Design: Longitudinal study in 294 PHIV youth, 6'17 years old, in the United States and Puerto Rico. Methods: We annually assessed three nonadherence outcomes: missed above 5% of doses in the past 3 days, missed a dose within the past month, and unsuppressed viral load (>400 copies/ml). We fit multivariable logistic models for nonadherence using Generalized Estimating Equations, and evaluated associations of psychiatric conditions (attention deficit hyperactivity disorder, disruptive behavior, depression, anxiety) at entry with incident nonadherence using multivariable logistic regression. Results: Nonadherence prevalence at study entry was 14% (3-day recall), 32% (past month nonadherence), and 38% (unsuppressed viral load), remaining similar over time. At entry, 38% met symptom cut-off criteria for at least one psychiatric condition. Greater odds of 3-day recall nonadherence were observed at week 96 for those with depression [adjusted odds ratio (aOR) 4.14, 95% confidence interval (CI) 1.11'15.42] or disruptive behavior (aOR 3.36, 95% CI 1.02'11.10], but not at entry. Those with vs. without attention deficit hyperactivity disorder had elevated odds of unsuppressed viral load at weeks 48 (aOR 2.46, 95% CI 1.27'4.78) and 96 (aOR 2.35, 95% CI 1.01'5.45), but not at entry. Among 232 youth adherent at entry, 16% reported incident 3-day recall nonadherence. Disruptive behavior conditions at entry were associated with incident 3- day recall nonadherence (aOR 3.01, 95% CI 1.24'7.31). Conclusion: In PHIV youth, comprehensive adherence interventions that address psychiatric conditions throughout the transition to adult care are needed.

Original languageEnglish
Pages (from-to)1227-1237
Number of pages11
Issue number10
StatePublished - 19 Jun 2015


  • Adherence
  • Adolescents
  • Longitudinal
  • Mental health
  • Perinatal HIV infection


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