Case Series Of Extreme Treatment Fatigue Among Hiv-Infected Adolescents On Antiretroviral Therapy

Background: Survival among infected children and adolescents with HIV has been markedly improved since the advent of antiretroviral therapy (ART). Unfortunately adherence to ART among HIV-infected adolescents, which is critical for sustained suppression of viral replication, is frequently suboptimal. At MildmayUgandait has become increasingly common for some adolescents to choose to stop taking ART altogether, despite the psychosocial interventions provided to them including counselling, medical treatment of depression and spiritual guidance aimed at providing full knowledge of the implications of sub-optimal or non adherence. Witnessing severe illness and death among their non-adherent peers does not seem to deter this group from sub-optimal ART adherence and appears not to significantly impact their motivation to take their ART. Methods & Materials: A retrospective case series of adolescents who despite psychosocial and medical interventions refused to continue with ART. Results: 32.5% of all fatalities on the in-patient ward at Mildmay between October 2012-September 2013 were adolescents. We present 3 cases of adolescents who following several years of ART were determined to have failed on their 2nd line ART regimens. The patients admitted to having terminated their ART medication. Intensive counselling, social interventions, peer interventions and management of clinical depression did not convince the patients to resume their ART. All 3 patients expressed total resignation and adamant refusal to continue treatment. In the terminal stages all 3 patients were diagnosed with Tuberculosis and other WHO Stage IV conditions but only 2 accepted treatment of the opportunistic conditions. Deteriorating health conditions did not deter them from their resolve. Conclusion: Lifelong medication and adherence is challenging for most individuals who have to take it. HIV-infected adolescents have often been on ART from childhood, become fatigued and the prospect of lifelong treatment is daunting for them. Some adolescents, despite supportive efforts may remain fatalistic, completely losing motivation to continue living.