@article{fdi:010042632,
  title = {18-month occurrence of severe events among early diagnosed {HIV}-infected children before antiretroviral therapy in {A}bidjan, {C}ote d'{I}voire : a cohort study - art. no. 169},
  author = {{H}arambat, {J}. and {F}assinou, {P}. and {B}ecquet, {R}. and {T}our{\'e}, {P}. and {R}ouet, {F}. and {D}abis, {F}. and {M}sellati, {P}hilippe and {B}lanche, {S}. and {T}imit{\'e}-{K}onan, {M}. and {S}alamon, {R}. and {L}eroy, {V}.},
  editor = {},
  language = {{ENG}},
  abstract = {{O}bjective: {T}o assess the 18-month field effectiveness on severe events of a pediatric package combining early {HIV}-diagnosis and targeted cotrimoxazole prophylaxis in {HIV}-infected children from age six-week before the antiretroviral era, in {A}bidjan, {C}ote d'{I}voire. {M}ethods: {D}ata from two consecutive prevention of {HIV} mother-to-child transmission programs were compared: the {ANRS} 1201/1202 {D}itrame-{P}lus cohort (2001-2005) and the pooled data of the {ANRS} 049a {D}itrame randomized trial and its following open-labeled cohort (1995-2000), used as a reference group. {HIV}-infected pregnant women >= 32-36 weeks of gestation were offered a short-course peri-partum antiretroviral prophylaxis ({ZDV} in {D}itrame, and {ZDV} +/- 3{TC}+single-dose (sd) {NVP} in {D}itrame-{P}lus). {N}eonatal prophylaxis was provided in {D}itrame-{P}lus only: 7-day {ZDV} and sd{NVP} 48-72 h after birth. {A} 6-week pediatric {HIV}-{RNA} diagnosis was provided on-line in the {D}itrame-{P}lus while it was only oriented on clinical symptoms in {D}itrame. {S}ix-week {HIV}-infected children received a daily cotrimoxazole prophylaxis in {D}itrame-{P}lus while no prophylaxis was provided in {D}itrame. {T}he determinants of severe events (death or hospitalization > 1 day) were assessed in a {C}ox regression model. {R}esults: {B}etween 1995 and 2003, 98 out of the 1121 live-births were diagnosed as {HIV}-infected in peri-partum: 45 from {D}itrame-{P}lus and 53 from {D}itrame. {T}he 18-month {K}aplan-{M}eier cumulative probability of presenting a severe event was 66% in {D}itrame-{P}lus (95% confidence interval [95% {CI}]: 50%-81%) and 77% in {D}itrame (95% {CI}: 65%-89%), {L}og {R}ank test: p = 0.47. {A}fter adjustment on maternal {WHO} clinical stage, maternal death, 6-week pediatric viral load, birth-weight, and breastfeeding exposure, the 18-month risk of severe event was lower in {D}itrame-{P}lus than in {D}itrame (adjusted {H}azard {R}atio (a{HR}): 0.55, 95% {CI}: 0.3-1.1), although the difference was not statistically significant; p = 0.07). {M}aternal death was the only variable determinant of the occurrence of severe events in children (a{HR}: 3.73; {CI}: 2.2-11.2; p = 0.01). {C}onclusion: {E}arly cotrimoxazole from 6 weeks of age in {HIV}-infected infants seemed to reduce probability of severe events but the study lacked statistical power to prove this. {E}ven with systematic cotrimoxazole prophylaxis, infant morbidity and mortality remained high pointing towards a need for early pediatric {HIV}-diagnosis and antiretroviral treatment in {A}frica.},
  keywords = {},
  booktitle = {},
  journal = {{BMC} {P}ublic {H}ealth},
  volume = {8},
  numero = {169},
  pages = {20},
  ISSN = {1471-2458},
  year = {2008},
  DOI = {10.1186/1471-2458-8-169},
  URL = {https://www.documentation.ird.fr/hor/fdi:010042632},
}