The psychological and social sequela of HIV/AIDS infection are devastating to youth and their families. Individuals living with HIV/AIDS must cope with the uncertain progression of the disease, complicated medical regimes, the grief related to the possible loss of family members, multiple caretakers, the stigma associated with the mode of HIV transmission, as well as fears surrounding the disclosure of the diagnosis to others. Individuals infected with HIV are forced to deal with a multitude of stressors with very little support, which places them at increased risk for mental health disorders. HIV infected youth are also reported to exhibit a higher incidence of hyperactivity, attention disorders, learning disabilities, and developmental problems. These issues often interfere with the ability or willingness of HIV infected youth to access medical care and comply with complicated medical regimes.

The objectives of this study were to describe the incidence and type of psychiatric problems seen in a cohort of children/adolescents with perinatal HIV infection. The study also investigated the relationship between psychiatric co-morbidities and family variables, and treatment adherence in HIV-infected youth.

The Influence of Family Variables and Psychiatric Co-Morbidities Upon Treatment Adherence in Children and Adolescents with Perinatal HIV

InfectionGail Burack, PhD, Roseann Marone, RN, BSN, MPH, Sunanda Gaur, MD, Anna Petrova, MD

UMDNJ/Robert Wood Johnson Medical School, New Brunswick, NJ, Robert Wood Johnson AIDS Program

INTRODUCTION

Fifty-three patients participated in the study. Psychiatric co-morbidities were assessed using the Achenbach Child Behavior Checklist (CBCL) ages 6-18, which was completed by caretakers. The CBCL is an assessment of behavioral functioning and DSM IV symptomatology in children and adolescents. Treatment adherence was measured using a 4 point treatment adherence scale which assessed the number of appointments kept within six months of CBCL administration, viral load <400, patient/caretaker report, and nursing report/pill count. Number and type of caretakers were assessed through chart review. Youth were categorized as living with kin or non-kin (which included youth in residential settings). Continuity of care was measured by the number of caretakers the patient had lived with since birth. This resulted in 2 groups (1 caretaker, 2 or more.)

CONCLUSIONS

This study found the incidence of psychiatric disorders for HIV+ youth to be higher than in the general population particularly with respect to conduct disorders and externalizing problems. Youth who had lived with 2 or more caretakers exhibited significantly more behavioral difficulties. Adherence scores were lower for patients who received special education services. Youth receiving special education services also had higher scores on behavioral measures than youth not receiving special education. The adherence variables of keeping regualr clinic appointments, nursing reports, and patient/caretaker reports were inversely correlated with low viral loads (VL<400), suggesting that these variables are good predictors of immunological measures.

Contact Information:Gail Burack, PhD

burackgd@umdnj.edu732-235-9337

Forty-two percent of the patients were found to have emotional/behavioral difficulties, as measured by the CBCL. Using DSM-IV diagnostic criteria, the highest incidence of problems for the group was for the category of conduct disorders (27%), followed by somatic complaints (24%) and affective disorders (22%), and attention problems (20%). Externalizing problems (44%) were described more frequently than internalizing problems (32%). Fifty-four percent of the patients reported receiving special education services. Adherence scores for patients receiving special education were found to be significantly lower than those not receiving services (F=4.54; p=.04). Among those receiving special education, 46.9% were living with kin; 65% were not with kin. Patients in special education also had higher scores on behavioral pathology measures than those not in special education (Mean Total Score = 57.41 vs 48.26.) In general patients living with kin tended to have VL<400 more frequently than those not living with kin (35.5% vs. 41.2%). Patients not living with kin also had significantly more behavior problems (F=9.5; p-.038) There was a significant effect of number of caretakers and behavior problems, with patients having 2 or more caretakers exhibiting more behavioral difficulties in the areas of somatic complaints, thought problems, attention problems, aggressive behaviors, externalizing problems, and total behavioral problems.

RESULTS

SUBJECTS

All subjects were perinatally HIV infected patients from the Robert Wood Johnson AIDS Program (RWJAP), New Brunswick, NJ. All caretakers of children/adolescents ages 6-18 were asked to participate in the study. Participation was voluntary. Informed consent was obtained. The mean age of subjects was 11.5 years (37 females and 16 males. 62% were living with kin; 39% were living with non kin (non relatives or residential facility). 88% of the patients were prescribed antiretrovirals. Analyses of Variance were used to analyze group differences. PROCEDURES

Viral load was also found to be related to whether the patient was living with kin vs. non-kin.Viral load was highest for children/adolescents living with kin, and lowest for those residing in a group home situation (Figure 4).

# Caretakers Somatic complaints

Thought problems

Attention problems

Aggressive behaviors

Externalizing Total

1(n=24)

52.3 51.9 52.1 52.4 46.7 46.3

2 or more(n=29)

58.3f = 4.54p = .04

57.9f = 4.02p = .05

61.5f = 9.18p = .003

58.7f = 4.94p = .03

56.9f = 7.54p = .008

57.4f = 8.36p = 006

-0.69

-0.69

-0.76

-0.78 -0.76 -0.74 -0.72 -0.7 -0.68 -0.66 -0.64

PT. Regular

Caretaker Report

Nursing Report

Fa

cto

rs

Correlation Coefficient (r)

Me a n Me a n ± S E Me a n ± 2 *SD Ou tlie rs E xtre m e s

VL <4 0 0 VL >4 0 0-1

0

1

2

3

4

5

6

Sco

re

A significant inverse correlation was found between viral load <400 and adherence measures. Specifically, high values for patient caretaker reports, nursing reports and keeping regular appointments were negatively correlated with lower viral loads.

RESULTS (cont’d)

Relationship between adherence score and viral load.

Ad

here

nce