Management of pediatric hiv remains challenging in Africa

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