Déterminants de la survie des enfants âgés de 6 mois à 15 ans, infectés par le VIH et suivis dans la ville d’Ebolowa au Cameroun de 2008 à 2018

INTRODUCTION: survival of HIV-infected children is a challenge in developing countries. In Cameroon, HIV-related mortality among children under the age of 15 in 2018 was 20%. Paradoxically, the Southern Cameroon region, despite high seroprevalence among children (4.1%) and low antiretroviral therapy coverage (around 64%), is not among the regions of Cameroon most affected by HIV/AIDS-related pediatric mortality. The purpose of this study was to calculate survival rate and to identify its determinants in HIV-infected children aged 6 months-15 years. METHODS: we conducted a retrospective, prospective cohort study data-collection in three health care facilities specialized in treating HIV-positive children in Ebolowa, South Cameroon from January 2008 to December 2018. The study was conducted in two phases, a retrospective collection phase for the selection of medical records of HIV-positive children that met inclusion criteria in consultation registries and a prospective collection phase in which we collected information from parents about the future of children. Informed parental consent was obtained during this second phase. Socio-demographic, clinical, paramedical, therapeutic data as well as data about the future of children were collected. Mean survival time and factors associated with survival were determined using the Kaplan Meier model. Cox proportional hazards regression allowed for the identification of survival determinants. Evaluation criterion was the death. Significance level was set at 5%. RESULTS: a total of 186 patients were enrolled in the study: the average follow-up period was 18.5 months. Survival rate was 66.7%. The majority of deaths (67%) occurred before the sixth month of follow-up. After multivariate analysis, an age less than 2 years [aHR: 18.6 (6.48-53.59); p=0.001), severe anemia [aHR: 7.69 (1.02-57.9); p=0.04) and the presence of opportunistic infections [aHR: 4.52 (2.51-8.14); p=0.05] were independently and significantly associated with survival. CONCLUSION: in addition to early antiretroviral therapy, good clinical and paraclinical monitoring is needed to improve the survival of HIV-infected children.