The Relationship between Drug Adherence to Antiretroviral Therapy and Viral Load in Children Living with HIV

Introduction: HIV infection is one of the major public health issues in India and globally. Adherence to ARV drugs is important for optimal virological suppression and should be assessed routinely and strictly reinforced. There is limited information on adherence patterns and its determinants in children in resource-constrained countries because these countries have limited options if viral resistance develops. The objective of our study was to determine the relationship between viral load and drug adherence in children living with HIV and to determine socio-demographic factors affecting adherence and reasons for non-adherence.

Materials and Methods: In this cross-sectional observational study, 70 children on ART were enrolled after applying the inclusion and exclusion criteria. All clinical, demographic details and investigations available were noted. Adherence was assessed by the pill counting method. Caregivers who reported missing doses were given the pediatric nonadherence questionnaire. Blood sample was analyzed for viral load estimation. Appropriate statistical tests were used and analysis was done.

Results: The mean age of diagnosis in study subjects was 8.13 ± 3.89 years and mean duration of treatment was 4.24 ± 3.05 years. Majority, 61(87.1%) patients had adherence more than 95%. Among 9 non-adherent children, the main reason was that they forgot to take medicine in 8(88.9%) cases. The adherent group had significant virological suppression and higher CD4 count. Mean viral load in the adherent group was 2379 ± 5996.74 copies per ml against 46529.22 ± 86633.12 copies per ml in the non-adherent group.

Conclusion: We found that adherent group had a higher CD4 count and a suppressed viral load and adherence to ART was unrelated to age, sex, duration of HIV infection and treatment, socioeconomic status, and route of transmission.