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Resume Objectif Evaluer l’adhesion au traitement antiretroviral d’adolescents infectes par le virus de l’immunodeficience humaine (VIH) depuis l’enfance et en relever les determinants medicaux et sociopsychologiques. Methodologie Un entretien permettant le recueil des donnees sociodemographiques et la passation de 2 questionnaires evaluant l’adhesion ont ete completes par la lecture du dossier medical et la collecte des taux de CD4 et de la charge virale les plus recents. Resultats Trente-deux adolescents infectes par le VIH ont ete inclus dans l’etude. Seulement 15/32 (47 %) faisaient etat d’une adhesion superieure a 95 % durant la semaine precedant l’interview, alors que 26/32 (81 %) avaient une charge virale inferieure a 50 copies/mL. Les adolescents dont la charge virale etait inferieure a 50 copies/mL avaient un taux d’adhesion median superieur aux autres (100 versus 83,5 %, p = 0,01). Une adhesion inferieure a 95 % etait reconnue par 5/6 adolescents ayant un echappement virologique, mais egalement par 12/26 adolescents dont la charge virale etait inferieure a 50 copies/mL. L’oubli etait la raison de non-prise de traitement la plus frequemment evoquee. La crainte d’etre vu lors de la prise du traitement differenciait les adolescents adherents a plus de 95 % des autres (79 versus 33 % ; p = 0,01). Conclusions La qualite de l’adhesion evaluee par la methode de l’autoquestionnaire est associee au controle de la viremie mais son interpretation et l’utilisation de seuils doivent tenir compte des caracteristiques des traitements pris ainsi que de l’historique therapeutique du patient. Les raisons evoquees de non-prise du traitement dependent des particularites du processus adolescent et des representations qu’a l’adolescent de sa maladie.

Objectives: To estimate the prevalence of and identify risk factors for lipodystrophy syndrome (LS) and body fat abnormality in a population of HIV-infected children and adolescents. Design: Cross-sectional observational study. Methods: HIV-infected subjects aged 2-18 years were recruited from 15 HIV centers in Belgium Italy, and Poland between January 2007 and December 2008. Standardized assessments by the patient's long-term clinician were performed to establish the presence of abnormality. Risk factors were explored in logistic regression models for fat abnormality outcomes and LS (abnormality plus dyslipidemia). Results: Among 426 subjects (70% white), median age was 12.2 years (interquartile range: 9.0-15.0 years) and median duration of antiretroviral therapy was 5.2 years (interquartile range: 2.2-8.8 years). Prevalence was 57% (n = 235) for LS and 42% (n =176) for fat abnormality; 90 subjects with abnormality were affected in ≥3 locations. Lipoatrophy occurred in 28% (n =117) of subjects and lipohypertrophy in 27% (n = 115), most commonly in the face and trunk, respectively. In multivariable analysis, white ethnicity, body mass index, ritonavir/lopinavir, and nonnucleoside reverse transcriptase inhibitors were each associated with an increased risk of LS (P

To assess the adherence to antiretroviral therapy in adolescents infected by HIV since early childhood and to determine its medical and psychosocial determinants.The study was based on patient interviews to administer 2 adherence questionnaires. The medical charts were reviewed for the record of the latest CD4 counts, viral load, and sociodemographic characteristics.Thirty-two HIV-infected adolescents were enrolled in the study. Only 15 of 32 of them (47%) claimed adherence greater than 95%, whereas 26 of 32 (81%) had a viral load less than 50 copies/mL. The adolescents with an undetectable viral load had a median adherence rate significantly higher than adolescents with virological failure (100 versus 83.5%; P=0.01). Among the latter, 5 out of 6 patients acknowledged adherence less than 95% versus 12 of 26 patients with an undetectable viral load. Having forgotten was the main reason reported for skipping medication doses. Fear of being seen while taking the pills differentiated adolescents with adherence less than 95% from the others (79 versus 33%; P=0.01).The self-reported adherence rate evaluated by questionnaire was associated with control of the viremia. However, the significance of these rates and the thresholds used have to be interpreted taking into account the characteristics of the drugs as well as the patients' treatment history. The reasons for skipping treatment doses are related to the adolescent process and the representations that the adolescent has of his illness.

To improve the conditions of out-of-home care of HIV-infected children.Group discussions including staff members of 28 institutions having cared for an HIV-infected child with the objective to share 4 points of view: those of the HIV-infected child, of his parents, of the medical staff and of the out-of-home care professionals.Care professionals are uncomfortable with the confidentiality surrounding the diagnosis. The feeling of better controlling the risks justifies their wish to obtain medical information, although these risks are ill-defined. The contributions of the parents of HIV-infected children shed a light on the link between the disclosure of the child's diagnosis and their intimacy and family history. Role-playing games with constructed scenarios revealed fixed and absurd aspects of certain beliefs and the difficulties to put in practice the acquired knowledge. The legitimacy of desire of parenthood in HIV-infected adults was questioned by some of the care professionals and their social representation of the person living with HIV appeared ambiguous, reminding the stigma these families are still victims of.Improving the conditions of out-of-home care of HIV-infected children requires ethical, legal and scientific counseling and discussions in the setting that should occur independently of the presence of a child with HIV. The disclosure of the diagnosis should only occur, if necessary, for their well-being, with their or their parents' agreement.