Scaling Up Antiretroviral Therapy for HIV-Infected Children in Cote d'Ivoire: Determinants of Survival and Loss to programme/Elargissement Du Traitement Antiretroviral Pour Les Enfants Infectes Par le VIH En Cote d'Ivoire: Determinants De la Survie et Des Pertes Pour le programme/Expansion del Tratamiento Antirretroviral Entre Ninos Infectados Por El VIH En Cote d'Ivoire:

By Anaky, M. -F.; Duvignac, J. et al. | Bulletin of the World Health Organization, July 2010 | Go to article overview
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Scaling Up Antiretroviral Therapy for HIV-Infected Children in Cote d'Ivoire: Determinants of Survival and Loss to programme/Elargissement Du Traitement Antiretroviral Pour Les Enfants Infectes Par le VIH En Cote d'Ivoire: Determinants De la Survie et Des Pertes Pour le programme/Expansion del Tratamiento Antirretroviral Entre Ninos Infectados Por El VIH En Cote d'Ivoire:


Anaky, M. -F., Duvignac, J., Wemin, L., Kouakoussui, A., Karcher, S., Toure, S., Seyler, C., Fassinou, P., Dabis, F., N'Dri-Yoman, T., Anglaret, X., Leroy, V., Bulletin of the World Health Organization


Scaling up antiretroviral therapy for HIV-infected children in Cote d'Ivoire: determinants of survival and loss to programme/Elargissement du traitement antiretroviral pour les enfants infectes par le VIH en Cote d'Ivoire: determinants de la survie et des pertes pour le programme/Expansion del tratamiento antirretroviral entre ninos infectados por el VIH en Cote d'Ivoire:determinantes de la supervivencia y de las perdidas de seguimiento.

Objective To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIV-infected children in Cote d'Ivoire.

Methods Between 2004 and 2007, HIV-exposed children at 19 centres were offered free HIV serum tests (polymerase chain reaction tests in those aged < 18 months) and ART. Computerized monitoring was used to determine: (i) the number of confirmed HIV infections, (ii) losses to the programme (i.e. death or loss to follow-up) before ART, (iii) mortality and loss-to-programme rates during 12 months of ART, and (iv) determinants of mortality and losses to the programme.

Findings The analysis included 3876 ART-naive children. Of the 1766 with HIV-1 infections (17% aged < 18 months), 124 (7.0%) died, 52 (2.9%) left the programme, 354 (20%) were lost to follow-up before ART, 259 (15%) remained in care without ART, and 977 (55%) started ART (median age: 63 months). The overall mortality rate during ART was significantly higher in the first 3 months than in months 4-12: 32.8 and 6.9 per 100 child-years of follow-up, respectively. Loss-to-programme rates were roughly double mortality rates and followed the same trend with duration of ART. Independent predictors of 12-month mortality on ART were pro- ART weight for-age z-score < -2, percentage of CD4+ T lymphocytes < 10, World Health Organization HIV/AIDS clinical stage 3 or 4, and blood haemoglobin < 8 g/dl.

Conclusion The large-scale programme to scale up paediatric ART in Cote d'Ivoire was effective. However, ART was often given too late, and early mortality and losses to programme before and just after ART initiation were major problems.

Objectif Etudier la mortalite et le nombre de perdus de vue dans le cadre d'un programme concu pour etendre le traitement antiretroviral (ART) des enfants infectes par le VIH en Cote d'Ivoire.

Methodes Entre 2004 et 2007, on a propose gratuitement, dans 19 centres, a l'intention des enfants exposes au VIH, un depistage serologique de ce virus (un test d'amplification genique pour les moins de 18 mois) et un traitement ART. On a fait appel a un suivi informatise pour determiner: (i) le nombre d'infections a VIH confirmees, (ii) les pertes pour le programme (c'est-a-dire les morts et les perdus de vue) avant l'administration du traitement ART, (iii) la mortalite et les taux de perte pour le programme au cours des 12 mois de traitement ART, et (iv) les determinants de la mortalite et des pertes pour le programme.

Resultats L'analyse a porte sur 3876 enfants encore jamais traites par des antiretroviraux. Parmi les 1766 enfants atteints d'une infection a VlH-1 (dont 17% de moins de 18 mois), 124 (7,0%) sont decedes, 52 (2,9%) ont quitte le programme, 354 (20%) ont ete perdus de vue avant la mise en route du traitement ART, 259 (15%) ont continue de recevoir des soins sans prendre d'ARV et 977 (55%) ont debute un traitement ART (age median: 63 mois). Le taux de mortalite global au cours du traitement etait significativement plus eleve pendant les 3 premiers mois qu'au cours des mois 4 a 12, soit 32,8 et 6,9 deces pour 100 enfantsannees de suivi, respectivement. Les taux de perte pour le programme atteignaient approximativement le double des taux de mortalite et suivaient les memes tendances avec la duree du traitement. Les facteurs predictifs independants de la mortalite a 12 mois sous ART etaient: rapport poids/ age avant le traitement en z-score < -2, pourcentage de lymphocytes T CD4+ < 10, stade clinique du VIH/sida selon l'Organisation mondiale de la Sante 3 ou 4 et taux d'hemoglobine < 8 g/dl.

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Scaling Up Antiretroviral Therapy for HIV-Infected Children in Cote d'Ivoire: Determinants of Survival and Loss to programme/Elargissement Du Traitement Antiretroviral Pour Les Enfants Infectes Par le VIH En Cote d'Ivoire: Determinants De la Survie et Des Pertes Pour le programme/Expansion del Tratamiento Antirretroviral Entre Ninos Infectados Por El VIH En Cote d'Ivoire:
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