In this previous study, high scores for anxiety were found to be associated with an increased risk of non-adherence, whereas no association was found with depression scores. 25 Caregivers of children and adolescents who were diagnosed in the context Afatinib supplier of routine screening of perinatally-exposed children were more likely to report no missed cART dose in the last three days when compared

to those whose HIV testing had been motivated by clinical events/symptoms (not necessarily an AIDS-defining illness). The present findings differ from those shown by PENTA 5, where sicker children had better adherence to treatment.14 The present data suggest that families who accept screening procedures for children whenever a parent or sibling has a diagnosis of HIV infection may be more likely to adhere to treatment. The WHO estimates that only 15% of HIV-exposed infants

are tested in the first months of life in low- and middle-income countries. In Brazil, many programs devoted to prevention of mother-to-child-transmission of HIV (PMTCT) seek to stimulate the full integration of maternal and pediatric care, and offer continued family follow-up, which is the case of the five participating sites in this study. This study’s results reinforce the importance of this familiar approach, which enables the early diagnosis of infected children and may contribute to improved adherence. These findings on viral suppression are similar to previous studies carried out in the present Luminespib in vitro cART era. A previous Brazilian study, in Campinas, SP, found that 50% of children and adolescents had a viral load < 50 copies/mL in their last exam.12 A recent study among 65 HIV-infected Cobimetinib children

in Gambia found that 58% had viral suppression after 36 months of cART initiation; in Kenya, 47% and 67% of 43 children achieved viral suppression to less than 100 copies/mL and 400 copies/mL, respectively, after six months of cART. In a United States-based study, among 126 children aged 3-13 years using cART for an average of 2.6 years, 36% achieved viral suppression. Among 437 children from 13 European countries, 53% achieved viral suppression at 12 months of treatment. In the present study, no significant differences were found with respect toviral suppression in children and adolescents previously exposed to mono- or dual therapy, compared with those whose first regimen was cART. This finding is in accordance with the observation that starting treatment with mono- or dual therapy did not have significant impact on survival among children transitioning to cART.26 The independent association of alcohol and drug abuse among caregivers as measured by ASSIST7 and viral suppression among children indicates the usefulness of this instrument in pediatric HIV clinics. This finding is not surprising, since alcohol use among HIV-infected adults has been associated with lower treatment adherence, incomplete viral suppression, and disease progression.