Adolescent antiretroviral management: Understanding the complexity of non-adherence

Abstract

This case-based discussion highlights challenges in adolescent antiretroviral management, focusing on non-disclosure of status and the
subsequent impact of suboptimal treatment adherence. Despite the scale-up of antiretroviral therapy (ART) and recommendations made by
the World Health Organization (WHO) for ART for all human immunodeficiency virus (HIV)-infected paediatric patients, ART coverage
in adolescents lags behind that in adults. Challenges of sustaining lifelong ART in children and adolescents require consideration of specific
behavioural, physiological and psychosocial complexities associated with this special group. To preserve future drug options and sustain
lifelong access to therapy, addressing non-adherence to treatment is critical to minimising acquisition of ART drug resistance and treatment
failure. We review the psychosocial and developmental components that influence the course of the disease in adolescents and consider the
complexities arising from perinatal exposure to ART and the growing risk of transmitted ART drug resistance in high-burden resourcelimited
settings.