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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Severe morbidity and mortality in untreated HIV-infected children in a paediatric care programme in Abidjan, Côte d'Ivoire, 2004-2009
BMC Infectious Diseases, Volume 11, Article 182, Year 2011
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Description
Background: Clinical evolution of HIV-infected children who have not yet initiated antiretroviral treatment (ART) is poorly understood in Africa. We describe severe morbidity and mortality of untreated HIV-infected children.Methods: All HIV-infected children enrolled from 2004-2009 in a prospective HIV programme in two health facilities in Abidjan, Côte d'Ivoire, were eligible from their time of inclusion. Risks of severe morbidity (the first clinical event leading to death or hospitalisation) and mortality were documented retrospectively and estimated using cumulative incidence functions. Associations with baseline characteristics were assessed by competing risk regression models between outcomes and antiretroviral initiation.Results: 405 children were included at a median age of 4.5 years; at baseline, 66.9% were receiving cotrimoxazole prophylaxis, and 27.7% met the 2006 WHO criteria for immunodeficiency by age. The risk of developing a severe morbid event was 14% (95%CI: 10.7 - 17.8) at 18 months; this risk was lower in children previously exposed to any prevention of mother-to-child-transmission (PMTCT) intervention (adjusted subdistribution hazard ratio [sHR]: 0.16, 95% CI: 0.04 - 0.71) versus those without known exposure. Cumulative mortality reached 5.5% (95%CI: 3.5 - 8.1) at 18 months. Mortality was associated with immunodeficiency (sHR: 6.02, 95% CI: 1.28-28.42).Conclusions: Having benefited from early access to care minimizes the severe morbidity risk for children who acquire HIV. Despite the receipt of cotrimoxazole prophylaxis, the risk of severe morbidity and mortality remains high in untreated HIV-infected children. Such evidence adds arguments to promote earlier access to ART in HIV-infected children in Africa and improve care interventions in a context where treatment is still not available to all. © 2011 Desmonde et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Desmonde, Sophie
France, Bordeaux
Université de Bordeaux
Coffié, Patrick Ahuatchi
Cote D'ivoire, Abidjan
Centre Hospitalier Universitaire de Treichville
Aka, Edmond Addi
Cote D'ivoire, Abidjan
Aconda
Amani-Bossé, Clarisse
Cote D'ivoire, Abidjan
Aconda
Messou, Eugéne
Cote D'ivoire, Abidjan
Aconda
Dabis, Franćois Ç.Ois
France, Bordeaux
Université de Bordeaux
Alioum, Ahmadou
France, Bordeaux
Université de Bordeaux
Ciaranello, Andrea L.
United States, Boston
Massachusetts General Hospital
Leroy, Valeriane
France, Bordeaux
Université de Bordeaux
Statistics
Citations: 44
Authors: 9
Affiliations: 4
Identifiers
Doi:
10.1186/1471-2334-11-182
e-ISSN:
14712334
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Randomised Control Trial
Cohort Study
Study Locations
Ivory Coast