儿童艾滋病治疗-2016.6..pptVIP

* * * Issues associated with adherence to treatment are especially important in considering whether and when to initiate therapy. Antiretroviral therapy is likely to be most effective in patients who are na?ve to treatment and who therefore are less likely to have antiretroviral-resistant viral strains. Lack of adherence to prescribed regimens and subtherapeutic levels of antiretroviral medications, particularly protease inhibitors, may enhance the development of drug resistance and likelihood of virologic failure [51, 52]. Participation by the caregivers and child in the decision-making process is crucial, especially in situations for which definitive data concerning efficacy are not available. Issues related to adherence to therapy should be fully assessed, discussed and addressed with the child’s caregiver and the child (when age-appropriate) before the decision to initiate therapy is made. Potential problems should be identified and resolved before starting therapy, even if this delays initiation of therapy. Additionally, frequent follow-up is important to provide assessment of virologic response to therapy, drug intolerance, viral resistance, and adherence. Infants and young children are dependent on others for administration of medication; thus, assessment of the capacity for adherence to a complex multidrug regimen requires evaluation of the caregivers and their environments and the ability and willingness of the child to take the drug. Some caregivers may place too much responsibility on older children and adolescents for managing medications. Educating families about adherence should begin before antiretroviral medications are initiated, and should include a discussion of the goals of therapy, the reasons for making adherence a priority, and the specific plans for supporting and maintaining the child’s medication adherence. Strategies could include information and adherence tools, such as: written and visual materials,a daily schedule illustrating ti