Objective: To evaluate the relationship between cognitive functioning and medication adherence in children and adolescents with perinatally acquired HIV infection. Methods: Children and adolescents, ages 3-18 (N = 1,429), received a cognitive evaluation and adherence assessment. Multiple logistic regression models were used to identify associations between adherence and cognitive status, adjusting for potential confounding factors. Results: Children's average cognitive performance was within the low-average range; 16% of children were cognitively impaired (MDI/FSIQ <70). Cognitive status was not associated with adherence to full medication regimens; however, children with borderline/low average cognitive functioning (IQ 70-84) had increased odds of nonadherence to the protease inhibitor class of antiretroviral therapy. Recent stressful life events and child health characteristics, such as HIV RNA detectability, were significantly associated with nonadherence. Conclusion: Cognitive status plays a limited role in medication adherence. Child and caregiver psychosocial and health characteristics should inform interventions to support adherence.
Bibliographical noteFunding Information:
We thank the children and their families, the Study Team and the individuals and institutions involved in the conduct of PACTG 219C for contributing to this research. This study was funded by the United States National Institute of Allergy and Infectious Diseases. This work was supported by the Statistical and Data Analysis Center (SDAC) of the Pediatric AIDS Clinical Trials group at the Harvard School of Public Health under the National Institute of Allergy and Infectious Diseases cooperative agreement No. 5U01 A141110. The following institutions were involved in the design, data collection, and conduct of PACTG 219C, but were not involved in the present analysis, the interpretation of the data, the writing of the article, or the decision to submit for publication.
- Cognitive functioning
- Medication adherence