Management of pediatric hiv remains challenging in Africa


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Management of pediatric HIV remains challenging in Africa

  • Management of pediatric HIV remains challenging in Africa

  • Despite the progress in PMTCT interventions, the magnitude of the pediatric HIV epidemic remains:

    • 210 000 new cases in 2012
    • Limited access to early HIV pediatric diagnosis : 42% of children HIV-exposed were tested in 2013
    • Low access in HIV-infected children to antiretroviral therapy: 24% [22%-26%] in 2013
    • Late access: 5 years of age in median
  • Premature mortality and severe morbidity despite antiretroviral therapy initiation



To describe the incidence of severe morbidity before and after 12 months initiation of early antiretroviral therapy (EART) based on lopinavir/ritonavir in HIV-infected children before the age of two years in Abidjan, Côte d’Ivoire, and Ouagadougou, Burkina Faso

  • To describe the incidence of severe morbidity before and after 12 months initiation of early antiretroviral therapy (EART) based on lopinavir/ritonavir in HIV-infected children before the age of two years in Abidjan, Côte d’Ivoire, and Ouagadougou, Burkina Faso



Study design: before (pre-EART)/after inclusion (post-EART) in a 12-month therapeutic prospective cohort preceding inclusion in the ANRS 12206 MONOD trial (see Oral Dahourou MOAB0102, Folquet MOAB0104).

  • Study design: before (pre-EART)/after inclusion (post-EART) in a 12-month therapeutic prospective cohort preceding inclusion in the ANRS 12206 MONOD trial (see Oral Dahourou MOAB0102, Folquet MOAB0104).

  • Study period: From May 2011 to February 2014

  • Study population: All HIV-1 infected children (confirmed by DNA PCR), < 2 years old, whose parents agreed to participate in the MONOD ANRS-12206 project in Abidjan (Côte d’Ivoire) and Ouagadougou (Burkina Faso)

  • Initial antiretroviral therapy: LPV/r-based twice daily with a cotrimoxazole prophylaxis and therapeutic education



All severe morbid events (SME), leading to death or hospitalization were documented during the pre-inclusion period and within the first 12 months on early antiretroviral therapy (EART)

  • All severe morbid events (SME), leading to death or hospitalization were documented during the pre-inclusion period and within the first 12 months on early antiretroviral therapy (EART)

  • All SME were validated by a pediatric committee

  • Incidence rates (IR) of SME per 100 child-months (CM) of follow-up were computed with their 95% confidence intervals (CI).













Despite a late access to ART, the incidence of severe morbidity was eleven times lower after EART initiation compared to the pre-EART era,

  • Despite a late access to ART, the incidence of severe morbidity was eleven times lower after EART initiation compared to the pre-EART era,

  • A change in morbidity patterns: lower bacterial infections.

  • Early lopinavir-based ART and cotrimoxazole is effective to reduce severe morbidity in HIV-infected children in West Africa

  • An earlier ART initiation would reduce long-term costs of healthcare in HIV-infected children

  • Earlier diagnosis to initiate ART earlier is required






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