This paper presents the topic of adherence as it related to the keeping of clinic appointments for the HIV-exposed infant. The importance of adherence for this infant, the scope of the problems which may arise from not detecting the infant's HIV status in time, and the numbers of children who are exposed and infected with HIV due to non-adherence, will be presented.
Studies have shown non-adherence rates for HIV mothers. Successful adherence is believed to be 80% by some, however findings are that 95% adherence results in virologic failure rates of 20%, 90-95% adherence results in a failure rate of 36%, and 70-80% adherence results in failure rates of 75% (Millar, Cummins, & Trotter, 2002). In one study, poor adherence resulted from forgetting (43%), sleeping through the dose (36%), not being home (32%), change in routine (27%), being too busy (22%), being sick (11%), being depressed (11%), no motivation, side effects, and misinformation. Mothers are burdened and unable to incur the complicated drug regimens (Kalichman, Rompa, DiFonzo, & Simpson, 2001).
Studies regarding the management of HIV infection in children lack data. However, the principle of viral load suppression is applied to children, as it is in adults. The care of infants includes unique considerations such as utero exposure to antiretroviral drugs, perinatal exposure to infections, diagnostic and disease manifestation differences compared to adults, altered antiretroviral pharmacodynamics, and poor palatability issues which result in medication adherence problems. It is estimated that for HIV infants, transmission occurred during labor in 65% of cases. HIV infection in infants may have a prolonged course which progresses to AIDS in 8 to 10 years, or an aggressive course with early conversion to AIDS and increased risk of infection and mortality. Early infection results in increased risk of rapid development of AIDS; it is
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