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Journal of Pediatric Psychology Advance Access published online on July 22, 2008
Journal of Pediatric Psychology, doi:10.1093/jpepsy/jsn068
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© The Author 2008. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

The Role of Cognitive Functioning in Medication Adherence of Children and Adolescents with HIV Infection

Kathleen Malee, PhD1, Paige L. Williams, PhD2, Grace Montepiedra, PhD2, Sharon Nichols, PhD3, Patricia A. Sirois, PhD4, Deborah Storm, PhD5, John Farley, MD6, Betsy Kammerer, PhD7 and PACTG 219C Team*

1Children's Memorial Hospital, Northwestern University, 2Harvard School of Public Health, 3University of California at San Diego, 4Tulane University Health Sciences Center, 5University of Medicine and Dentistry of New Jersey, 6University of Maryland School of Medicine, and 7Children's Hospital, Boston

All correspondence concerning this article should be addressed to Kathleen Malee, PhD, Children's Memorial Hospital, 2300 Children's Plaza, Box 155, Chicago, IL 60614, USA. E-mail: kmalee{at}childrensmemorial.org


  Abstract

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.

Key words: adolescents; children; cognitive functioning; HIV; medication adherence.

*The members of PACTG 219C Team are listed in the Appendix.

Received October 5, 2007; revision received May 23, 2008; accepted June 3, 2008


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