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 naļve 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.