%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Beaudrap, Pierre de
%A Boulle, C.
%A Lewden, C.
%A Gabillard, D.
%A Nacro, B.
%A Diagbouga, S.
%A Fassinou, P.
%A Hien, H.
%A Laurent, Christian
%A Msellati, Philippe
%T Morbidity after antiretroviral therapy initiation in HIV-1-infected children in West Africa : temporal trends and relation to CD4 count
%D 2013
%L PAR00010401
%G ENG
%J Pediatric Infectious Disease Journal
%@ 0891-3668
%K HIV ; children ; highly active antiretroviral therapy ; AIDS-defining ; infection ; morbidity
%K AFRIQUE DE L'OUEST
%M ISI:000316669200021
%N 4
%P 354-360
%R 10.1097/INF.0b013e318278b222
%U https://www.documentation.ird.fr/hor/PAR00010401
%V 32
%W Horizon (IRD)
%X 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.
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