Cargando…

Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa

INTRODUCTION: We assessed the rate of treatment failure of HIV-infected children after 12 months on antiretroviral treatment (ART) in the Paediatric IeDEA West African Collaboration according to their perinatal exposure to antiretroviral drugs for preventing mother-to-child transmission (PMTCT). MET...

Descripción completa

Detalles Bibliográficos
Autores principales: Ndondoki, Camille, Dicko, Fatoumata, Coffie, Patrick Ahuatchi, Eboua, Tanoh Kassi, Ekouevi, Didier Koumavi, Kouadio, Kouakou, Aka, Addi Edmond, Malateste, Karen, Dabis, François, Amani-Bosse, Clarisse, Toure, Pety, Leroy, Valériane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International AIDS Society 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048591/
https://www.ncbi.nlm.nih.gov/pubmed/24894377
http://dx.doi.org/10.7448/IAS.17.1.18737
_version_ 1782480553128230912
author Ndondoki, Camille
Dicko, Fatoumata
Coffie, Patrick Ahuatchi
Eboua, Tanoh Kassi
Ekouevi, Didier Koumavi
Kouadio, Kouakou
Aka, Addi Edmond
Malateste, Karen
Dabis, François
Amani-Bosse, Clarisse
Toure, Pety
Leroy, Valériane
author_facet Ndondoki, Camille
Dicko, Fatoumata
Coffie, Patrick Ahuatchi
Eboua, Tanoh Kassi
Ekouevi, Didier Koumavi
Kouadio, Kouakou
Aka, Addi Edmond
Malateste, Karen
Dabis, François
Amani-Bosse, Clarisse
Toure, Pety
Leroy, Valériane
author_sort Ndondoki, Camille
collection PubMed
description INTRODUCTION: We assessed the rate of treatment failure of HIV-infected children after 12 months on antiretroviral treatment (ART) in the Paediatric IeDEA West African Collaboration according to their perinatal exposure to antiretroviral drugs for preventing mother-to-child transmission (PMTCT). METHODS: A retrospective cohort study in children younger than five years at ART initiation between 2004 and 2009 was nested within the pWADA cohort, in Bamako-Mali and Abidjan-Côte d’Ivoire. Data on PMTCT exposure were collected through a direct review of children’s medical records. The 12-month Kaplan-Meier survival without treatment failure (clinical or immunological) was estimated and their baseline factors studied using a Cox model analysis. Clinical failure was defined as the appearance or reappearance of WHO clinical stage 3 or 4 events or any death occurring within the first 12 months of ART. Immunological failure was defined according to the 2006 World Health Organization age-related immunological thresholds for severe immunodeficiency. RESULTS: Among the 1035 eligible children, PMTCT exposure was only documented for 353 children (34.1%) and remained unknown for 682 (65.9%). Among children with a documented PMTCT exposure, 73 (20.7%) were PMTCT exposed, of whom 61.0% were initiated on a protease inhibitor-based regimen, and 280 (79.3%) were PMTCT unexposed. At 12 months on ART, the survival without treatment failure was 40.6% in the PMTCT-exposed group, 25.2% in the unexposed group and 18.5% in the children with unknown exposure status (p=0.002). In univariate analysis, treatment failure was significantly higher in children unexposed (HR 1.4; 95% CI: 1.0–1.9) and with unknown PMTCT exposure (HR 1.5; 95% CI: 1.2–2.1) rather than children PMTCT-exposed (p=0.01). In the adjusted analysis, treatment failure was not significantly associated with PMTCT exposure (p=0.15) but was associated with immunodeficiency (aHR 1.6; 95% CI: 1.4–1.9; p=0.001), AIDS clinical events (aHR 1.4; 95% CI: 1.0–1.9; p=0.02) at ART initiation and receiving care in Mali compared to Côte d’Ivoire (aHR 1.2; 95% CI: 1.0–1.4; p=0.04). CONCLUSIONS: Despite a low data quality, PMTCT-exposed West African children did not have a poorer 12-month response to ART than others. Immunodeficiency and AIDS events at ART initiation remain the main predictors associated with treatment failure in this operational context.
format Online
Article
Text
id pubmed-4048591
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher International AIDS Society
record_format MEDLINE/PubMed
spelling pubmed-40485912014-06-12 Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa Ndondoki, Camille Dicko, Fatoumata Coffie, Patrick Ahuatchi Eboua, Tanoh Kassi Ekouevi, Didier Koumavi Kouadio, Kouakou Aka, Addi Edmond Malateste, Karen Dabis, François Amani-Bosse, Clarisse Toure, Pety Leroy, Valériane J Int AIDS Soc Research Article INTRODUCTION: We assessed the rate of treatment failure of HIV-infected children after 12 months on antiretroviral treatment (ART) in the Paediatric IeDEA West African Collaboration according to their perinatal exposure to antiretroviral drugs for preventing mother-to-child transmission (PMTCT). METHODS: A retrospective cohort study in children younger than five years at ART initiation between 2004 and 2009 was nested within the pWADA cohort, in Bamako-Mali and Abidjan-Côte d’Ivoire. Data on PMTCT exposure were collected through a direct review of children’s medical records. The 12-month Kaplan-Meier survival without treatment failure (clinical or immunological) was estimated and their baseline factors studied using a Cox model analysis. Clinical failure was defined as the appearance or reappearance of WHO clinical stage 3 or 4 events or any death occurring within the first 12 months of ART. Immunological failure was defined according to the 2006 World Health Organization age-related immunological thresholds for severe immunodeficiency. RESULTS: Among the 1035 eligible children, PMTCT exposure was only documented for 353 children (34.1%) and remained unknown for 682 (65.9%). Among children with a documented PMTCT exposure, 73 (20.7%) were PMTCT exposed, of whom 61.0% were initiated on a protease inhibitor-based regimen, and 280 (79.3%) were PMTCT unexposed. At 12 months on ART, the survival without treatment failure was 40.6% in the PMTCT-exposed group, 25.2% in the unexposed group and 18.5% in the children with unknown exposure status (p=0.002). In univariate analysis, treatment failure was significantly higher in children unexposed (HR 1.4; 95% CI: 1.0–1.9) and with unknown PMTCT exposure (HR 1.5; 95% CI: 1.2–2.1) rather than children PMTCT-exposed (p=0.01). In the adjusted analysis, treatment failure was not significantly associated with PMTCT exposure (p=0.15) but was associated with immunodeficiency (aHR 1.6; 95% CI: 1.4–1.9; p=0.001), AIDS clinical events (aHR 1.4; 95% CI: 1.0–1.9; p=0.02) at ART initiation and receiving care in Mali compared to Côte d’Ivoire (aHR 1.2; 95% CI: 1.0–1.4; p=0.04). CONCLUSIONS: Despite a low data quality, PMTCT-exposed West African children did not have a poorer 12-month response to ART than others. Immunodeficiency and AIDS events at ART initiation remain the main predictors associated with treatment failure in this operational context. International AIDS Society 2014-06-02 /pmc/articles/PMC4048591/ /pubmed/24894377 http://dx.doi.org/10.7448/IAS.17.1.18737 Text en © 2014 Ndondoki C et al; licensee International AIDS Society http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Ndondoki, Camille
Dicko, Fatoumata
Coffie, Patrick Ahuatchi
Eboua, Tanoh Kassi
Ekouevi, Didier Koumavi
Kouadio, Kouakou
Aka, Addi Edmond
Malateste, Karen
Dabis, François
Amani-Bosse, Clarisse
Toure, Pety
Leroy, Valériane
Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa
title Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa
title_full Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa
title_fullStr Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa
title_full_unstemmed Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa
title_short Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa
title_sort antiretroviral treatment response of hiv-infected children after prevention of mother-to-child transmission in west africa
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048591/
https://www.ncbi.nlm.nih.gov/pubmed/24894377
http://dx.doi.org/10.7448/IAS.17.1.18737
work_keys_str_mv AT ndondokicamille antiretroviraltreatmentresponseofhivinfectedchildrenafterpreventionofmothertochildtransmissioninwestafrica
AT dickofatoumata antiretroviraltreatmentresponseofhivinfectedchildrenafterpreventionofmothertochildtransmissioninwestafrica
AT coffiepatrickahuatchi antiretroviraltreatmentresponseofhivinfectedchildrenafterpreventionofmothertochildtransmissioninwestafrica
AT ebouatanohkassi antiretroviraltreatmentresponseofhivinfectedchildrenafterpreventionofmothertochildtransmissioninwestafrica
AT ekouevididierkoumavi antiretroviraltreatmentresponseofhivinfectedchildrenafterpreventionofmothertochildtransmissioninwestafrica
AT kouadiokouakou antiretroviraltreatmentresponseofhivinfectedchildrenafterpreventionofmothertochildtransmissioninwestafrica
AT akaaddiedmond antiretroviraltreatmentresponseofhivinfectedchildrenafterpreventionofmothertochildtransmissioninwestafrica
AT malatestekaren antiretroviraltreatmentresponseofhivinfectedchildrenafterpreventionofmothertochildtransmissioninwestafrica
AT dabisfrancois antiretroviraltreatmentresponseofhivinfectedchildrenafterpreventionofmothertochildtransmissioninwestafrica
AT amanibosseclarisse antiretroviraltreatmentresponseofhivinfectedchildrenafterpreventionofmothertochildtransmissioninwestafrica
AT tourepety antiretroviraltreatmentresponseofhivinfectedchildrenafterpreventionofmothertochildtransmissioninwestafrica
AT leroyvaleriane antiretroviraltreatmentresponseofhivinfectedchildrenafterpreventionofmothertochildtransmissioninwestafrica
AT antiretroviraltreatmentresponseofhivinfectedchildrenafterpreventionofmothertochildtransmissioninwestafrica