title: Viral suppression and adherence among HIV-infected children and adolescents on antiretroviral therapy: results of a multicenter study.
abstract: OBJECTIVE
  To evaluate treatment adherence among perinatally-infected pediatric human immunodeficiency virus (HIV) patients followed in pediatric centers in Brazil.
  
  
  METHODS
  This was a cross-sectional multicenter study. Medical records were reviewed and adherence scale, assessment of caregivers' quality of life (WHOQOL-BREF), anxiety, depression, and alcohol/substances use/abuse were assessed. Outcomes included self-reported 100% adherence in the last three days and HIV viral load (VL)<50 copies/mL. Statistical analyses included contingency tables and respective statistics, and multivariable logistic regression.
  
  
  RESULTS
  260 subjects were enrolled: 78% children and 22% adolescents; 93% of caregivers for the children and 77% of adolescents reported 100% adherence; 57% of children and 49% of adolescents had VL<50 copies/mL. In the univariate analyses, HIV diagnosis for screening due to maternal infection, lower caregiver scores for anxiety, and higher scores in physical and psychological domains of WHOQOL-BREF were associated with 100% adherence. Shorter intervals between pharmacy visits were associated with VL<50 copies/mL (p ≤ 0.01). Multivariable regression demonstrated that caregivers who did not abuse alcohol/other drugs (OR=0.49; 95% CI: 0.27-0.89) and median interval between pharmacy visits<33 days (OR=0.97; 95% CI: 0.95-0.98) were independently associated with VL<50 copies/mL; whereas lower caregiver scores for anxiety (OR=2.57; 95% CI: 1.27-5.19) and children's HIV diagnosis for screening due to maternal infection (OR=2.25; 95% CI: 1.12-4.50) were found to be independently associated with 100% adherence.
  
  
  CONCLUSIONS
  Pediatric HIV programs should perform routine assessment of caregivers' quality of life, and anxiety and depression symptoms. In this setting, pharmacy records are essential to help identify less-than-optimal adherence.
authors: Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, RJ, Brazil; Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil. Electronic address: mleticia@diphse.com.br.
authors: Maria L S
authors: ML
authors: Cruz
authors: Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil.
authors: Claudete A A
authors: CA
authors: Cardoso
authors: Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil.
authors: Mariana Q
authors: MQ
authors: Darmont
authors: Instituto de Medicina Integral Prof. Fernando Figueira, Recife, PE, Brazil.
authors: Edvaldo
authors: E
authors: Souza
authors: Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, AM, Brazil.
authors: Solange D
authors: SD
authors: Andrade
authors: Centro de Doenças Infecciosas e Parasitárias, Campo Grande, MS, Brazil.
authors: Marcia M
authors: MM
authors: D'Al Fabbro
authors: Hospital Fêmina, Porto Alegre, RS, Brazil.
authors: Rosana
authors: R
authors: Fonseca
authors: Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
authors: Jaime G
authors: JG
authors: Bellido
authors: Instituto Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
authors: Simone S
authors: SS
authors: Monteiro
authors: Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
authors: Francisco I
authors: FI
authors: Bastos
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D001938:Brazil; D017028:Caregivers / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055118:Medication Adherence; D010594:Pharmacies / Q000706:statistics & numerical data; D011788:Quality of Life; D019966:Substance-Related Disorders; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents
keywords: Adesão; Adherence; Adolescentes vivendo com HIV; Antiretroviral treatment; Crianças vivendo com HIV; HIV-infected adolescents; HIV-infected children; Tratamento antirretroviral