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ELECTRONIC ARTICLE:
Delane Shingadia, Rolando M. Viani, Ram Yogev, Helen Binns, Wayne M. Dankner, Stephen A. Spector, and Ellen Gould Chadwick
Gastrostomy Tube Insertion for Improvement of Adherence to Highly Active Antiretroviral Therapy in Pediatric Patients With Human Immunodeficiency Virus
Pediatrics 2000; 105: e80 [Abstract] [Full text] [PDF]
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[Read P3R] Child-specific determinants of non adherence
Alfredo Guarino   (26 July 2000)

Child-specific determinants of non adherence 26 July 2000
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Alfredo Guarino,
MD, Associate Professor of Pediatrics
Dept of Pediatrics, Univ. of Naples, Italy

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Re: Child-specific determinants of non adherence

alfguari{at}unina.it Alfredo Guarino

The major problem with the study of Shingadia is the lack of criteria to receive gastrostomy. A precise definition of adherence is also lacking. Consequently the indications to insert gastrostomy tubes are unclear. The fact that in more than 50% of children adherence was good or not known in the year before gastrostomy insertion, may explain why 7 out of 17 children were not responders. Non responders may have been children whose adherence was already good prior to receiving gastrostomy and their virologic failure could have in fact been related to resistance. The efficacy of shifting drugs, described in the paper as an adjunct effective measure, support this hypothesis. In a previous study we observed an incidence as high as 50% of non adherence to zidovudine therapy and suggested that determinants of non adherence in HIV-infected children probably include those related to care providers (AIDS care 1999,11:711-4).

Thus the use of gastrostomy tubes may be non appropriate as first line intervention to increase adherence in HIV-infected children, although - as the paper shows nicely- it is more tolerated that we can anticipate. Rather, identification of determinants of non adherence is needed to design child-specific strategies to increase adherence.