Morbidity after antiretroviral therapy initiation in HIV-1-infected children in West Africa: temporal trends and relation to CD4 count - Debeaudrap, Pierre; Boulle, C.; Lewden, C.; Gabillard, Delphine; Nacro, B.; Diagbouga, S.; Fassinou, P.; Hien, Hervé; Laurent, C.; Msellati, Philippe (Pediatr Infect Dis J, 2013)
BACKGROUND: Although 90% of HIV-1-infected children live in sub-Saharan Africa, morbidity data after highly active antiretroviral therapy (HAART) initiation in these settings are limited. The objective of this study was to document the incidence of AIDS-defining events and non-AIDS-defining diseases in African children receiving HAART. METHODS: Incidences rates (IRs) of AIDS-defining events and 10 other common diseases were estimated overall and by current CD4-strata (<15%, 15 - <25% and >/=25%) from 2 prospective cohorts of African children. RESULTS: One hundred eighty-eight children contributing to 355 children-years were included. The documented morbidity IRs per 100 children-years were upper respiratory infections, 100 (87-114); infectious diarrhea, 37 (31-44); World Health Organization (WHO) stage 2 events, 22.9 (18.2-28.1); and WHO stage 3/4 events, 12.3 (9.1-16.7). IRs of WHO stage 2 events, severe bacterial infections, infectious diarrhea and pneumonia decreased linearly across all CD4%-strata, whereas WHO stage 3/4 events and viral infections occurred mostly when CD4% <15%. Overall, IRs decreased during the first 2 years on HAART except for upper respiratory infection, mycosis and oral candidiasis. CONCLUSION: This incidence of AIDS- and non-AIDS-defining diseases declined substantially after HAART in 2 African cohorts, although estimates remained high compared with high-resource settings. Without renewed efforts to increase antiretroviral scale-up, children in developing countries will continue to have a high burden of infections.
00000 The Pediatric infectious disease journal
Keywords: journalArticle; *Viral Load; AIDS-Related Opportunistic Infections/*epidemiology; Acquired Immunodeficiency Syndrome/*complications/*drug therapy/immunology; Adolescent; Africa/epidemiology; Anti-Retroviral Agents/*therapeutic use; Antiretroviral Therapy, Highly Active/*methods; CD4 Lymphocyte Count; Child; Child, Preschool; Female; HIV-1/*isolation & purification; Humans; INCIDENCE; Infant; Male