CD4 Cell Response Before and After HAART Initiation According to Viral Load and Growth Indicators in HIV-1-Infected Children in Abidjan, Côte dʼIvoire
ABSTRACT To analyze the determinants of CD4 change in children during 3 periods: before highly active antiretroviral therapy (HAART), during the first year after HAART initiation, and past 1 year after HAART initiation.
One hundred seventy-seven children enrolled in a prospective cohort in Abidjan received HAART during a mean follow-up of 30 months. A linear mixed-effects model was used for the first period, a mixed-effects piecewise model for the second period, and an asymptotic mixed-effects model for long-term CD4 dynamics.
Before HAART initiation, CD4 percentage decreased along time [beta = -0.59 (-0.92 to -0.26)] was positively associated with body mass index for age [beta = 0.47 (0.22 to 0.72)] and negatively associated with viral load [beta = -1.01 (-1.90 to -0.13)]. During the first year of treatment, the CD4 decrease reverted to a steep increase that was negatively associated with age at HAART initiation [beta = -0.24 (-0.4 to -0.07)] and with the mean viral load under HAART [beta = -1.51 (-2.21 to -0.81)]. The long-term CD4 percentage was also negatively associated with the mean viral load under HAART [beta = -4.97 (-6.22 to -3.72)] and age at HAART initiation [beta = -0.82 (-1.12 to -0.51)].
Before HAART initiation, the CD4 cell percentage was associated with growth indicators whereas, after HAART, an early increase and a long-term plateau were negatively associated with the viral load and age at HAART initiation.
- SourceAvailable from: Valeriane Leroy
[Show abstract] [Hide abstract]
- "De Beaudrap 2008  "
ABSTRACT: With 2.1 million HIV-infected children in 2008 in the world, especially in sub-Saharan Africa, the paediatric HIV/AIDS care remains an important public health challenge and is principally based on cotrimoxazole prophylaxis and antiretroviral treatments. This paper aims to review the effectiveness of cotrimoxole prophylaxis and antiretroviral treatment in HIV-infected children in Africa, specifically mortality and treatment outcomes. In two times, we searched the online databases PubMed™ and Scopus™ for articles and abstracts published in English and French between January 2004 and November 2009, with the following terms : « HIV » and « Africa » and ["paediatric" or "children" or "child"] and ["mortality" or "survival"] and ["cotrimoxazole" or "prophylaxis"] at the first time, « HIV » and « Africa » and ["paediatric" or "children" or "child"] and ["mortality" or "survival"] and ["antiretroviral"] and ["treatment" or "therapy"] at the second time. Longitudinal studies on HIV-infected children under cotrimoxazole prophylaxis or antiretroviral treatment were selected when survival outcomes were reported. The probability of death was significantly reduced by 43% where children received cotrimoxazole prophylaxis compared to placebo. Compared to the survival without treatment, the benefit of antiretroviral therapy on HIV-infected children survival was evident in all publications but early mortality was observed within the six first months of antiretroviral treatment. Over fifty percent of deaths occurred in this period. Severe malnutrition, anaemia and lower CD4% were identified as mortality predicting factors in both children received cotrimoxazole prophylaxis or treated by antiretroviral therapy. Better knowledge of determinants of early mortality for these children are important to optimized their survival and improve their quality of care and life. Finally, the beneficial effect of cotrimoxazole prophylaxis when associated with antiretroviral treatment has not been reported and need to be exploring in detail for more information.La Presse Médicale 02/2011; 40(7-8):e338-57. · 1.08 Impact Factor
[Show abstract] [Hide abstract]
- "In Uganda, 39% and 16% of all children under five years of age are stunted and underweight respectively . Although there is a high prevalance of growth failure in HIV infected children from sub-Saharan Africa, recent studies have reported a growth response among children initiated on highly active antiretroviral therapy (HAART), including significant weight gain and increase in height after some delay [9-11]. "
ABSTRACT: Scale up of paediatric antiretroviral therapy in resource limited settings continues despite limited access to routine laboratory monitoring. We documented the weight and height responses in HIV infected Ugandan children on highly active antiretroviral therapy and determined clinical factors associated with successful treatment outcomes. A prospective cohort of HIV infected children were initiated on HAART and followed for 48 weeks. Body mass index for age z scores(BAZ), weight and height-for-age z scores (WAZ & HAZ) were calculated: CD4 cell % and HIV-1 RNA were measured at baseline and every 12 weeks. Treatment outcomes were classified according to; both virological and immunological success (VS/IS), virological failure and immunological success (VF/IS). virological success and immunological failure (VS/IF) and both virological and immunological failure (VF/IF). From March 2004 until May 2006, 124 HIV infected children were initiated on HAART. The median age (IQR) was 5.0 years (2.1 - 7.0) and 49% (61/124) were female. The median [95% confidence interval (CI)] BAZ, WAZ and HAZ at baseline were 0.29 (-2.9, -1.2), -1.2 (-2.1, -0.5) and -2.06 (-2.9, -1.2) respectively. Baseline median CD4 cell % and log10 HIV-1 RNA were; 11.8% (7.5-18.0) and 5.6 (5.2-5.8) copies/ml. By 48 weeks, mean WAZ and HAZ in the VF/IS group, which was younger, increased from - 0.98 (SD 1.7) to + 1.22 (SD 1.2) and from -1.99 (1.7) to + 0.76 (2.4) respectively. Mean increase in WAZ and HAZ in the VS/IF group, an older group was modest, from -1.84 (1.3) to - 0.41 (1.2) and -2.25 (1.2) to -1.16 (1.3) respectively. Baseline CD4 cell % [OR 6.97 95% CI (2.6 -18.6)], age [OR 4.6 95% CI (1.14 -19.1)] and WHO clinical stage [OR 3.5 95%CI (1.05 -12.7)] were associated with successful treatment outcome. HIV infected Ugandan children demonstrated a robust increase in height and weight z scores during the first 48 weeks of HAART, including those who failed to completely suppress virus. Older children initiating HAART with severe immune suppression were less likely to achieve a successful treatment outcome. These data emphasize the importance of initiating HAART early to ensure adequate immune and growth responses.BMC Pediatrics 08/2010; 10(1):56. DOI:10.1186/1471-2431-10-56 · 1.93 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Responses to antiretroviral therapy (ART) among human immunodeficiency virus (HIV)-infected children in resource-limited settings have recently been reported, but outcomes vary. We sought to derive pooled estimates of the 12-month rate of virologic suppression (HIV RNA, <400 copies/mL) and gain in CD4 cell percentage (DeltaCD4%) for children initiating ART in resource-limited settings. We conducted a systematic review and meta-analysis of published reports of HIV RNA and CD4 outcomes for treatment-naive children aged 0-17 years old by means of the Medline, EMBASE (Excerpta Medica Database), and LILACS (Latin American and Caribbean Health Sciences Literature) electronic databases and the Cochrane Clinical Trials Register. Pooled estimates of the reported proportion with HIV RNA <400 copies/mL and DeltaCD4% after 12 months of ART were derived using patient-level estimates and fixed- and random-effects models. To approximate intention-to-treat analyses, in sensitivity analyses children with missing 12-month data were assumed to have HIV RNA>400 copies/mL or DeltaCD4% of zero. In patient-level estimates after 12 months of ART, the pooled proportion with virologic suppression was 70% (95% confidence interval [CI], 67%-73%); the pooled DeltaCD4% was 13.7% (95% CI, 11.8%-15.7%). Results from the fixed- and random-effects models were similar. In approximated intention-to-treat analyses, the pooled estimates decreased to 53% with virologic suppression (95% CI, 50%-55%) and to a DeltaCD4% of 8.5% (95% CI, 5.5%-11.4%). Pooled estimates of reported virologic and immunologic benefits after 12 months of ART among HIV-infected children in resource-limited settings are comparable with those observed among children in developed settings. Consistency in reporting on reasons for missing data will aid in the evaluation of ART outcomes in resource-limited settings.Clinical Infectious Diseases 11/2009; 49(12):1915-27. DOI:10.1086/648079 · 8.89 Impact Factor