[31] HIGHLY ACTIVE ANTIRETROVIRAL THERAPIES AMONG HIV-1-INFECTED CHILDREN IN ABIDJAN, COTE D'IVOIRE (ANRS 1244)

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] HIGHLY ACTIVE ANTIRETROVIRAL THERAPIES AMONG HIV-1-INFECTED CHILDREN IN ABIDJAN, CÔTE D'IVOIRE (ANRS 1244)

[AUTHOR(S):] P Msellati⁵, P Fassinou¹, N Elenga², F Rouet³, R Laguide², KA Kouakoussui², M Timite¹ and S Blanche⁴
¹Pédiatrie, CHU de Yopougon, Abidjan, Côte d'Ivoire; ²Programme Enfant Yopougon, PACCI, Abidjan, Côte d'Ivoire; ³Cedres, Abidjan, Côte d'Ivoire; ⁴Hôpital Necker-Enfants Malades, Paris, France; and ⁵UMR-D151, IRD/LPE, Marseille, France

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 31
Antiviral Therapy 2003; 8(Suppl. 1):S192

[ABSTRACT:] No data have been published about HAART of children in Africa.

Objective: To describe clinical and biological impact of HAART among HIV-infected children.

Observational cohort: At baseline and quarterly, clinical evaluation. Children were seen for any intercurrent disease as necessary. All health-related events were registered. All children under 25% of CD4 received cotrimoxazole prophylaxis. CD4 count and plasma HIV-1 RNA assay (VL) (threshold of 250 copies/ml) were performed at baseline and every 6 months. Eligibility for HAART: To be symptomatic, AIDS stage or CD4 percentage <15%. Before and during treatment: weight-for-age (WAZ) and height-for-age (HAZ) z-score, probability of survival, incidence of pneumoniae and acute diarrhoea, CD4 lymphocyte counts and percent, VL.

Results: 77 children received HAART between 2000 and September 2002: 61 naïve for ARV drugs after inclusion. (pre-treatment follow-up 337 childmonths). Global follow-up under HAART is 1,091 child-months. HAART consisted of 2 nucleosides analogues and nelfinavir or efavirenz. Mean of WAZ before and 315 days after HAART were respectively .1.96 and 1.56 (P=0.053). For HAZ, it was –1.94 before and –1.98 after (P=0.96). There was a significantly lower incidence of pneumonia and acute diarrhoea with HAART than before treatment: incidence of pneumonia fell from 0.07 to 0.027 per child-month (P=0.0015) and that of acute diarrhoea from 0.13–0.047 (P<0.0001). For children <5% of CD4 before HAART, probability of survival under HAART was 72.6% at 18 months versus 97.8% in children ≥5% CD4 (P<0.01). Incidence of morbidity related with drugs side effects was 0.022 per child-month under HAART. Globally adherence to treatment was good. 72 children were tested for HIV-1 RNA VL and CD4 before HAART initiation (median 52 days): median VL 5.41 log, median number of CD4 182/mm³, median percentage 7.9%. After 335 days with HAART, 48% under 2.4 log and 10.7% are between 2.4 and 3.0 log cp/ml, median VL 2.53 log cp/ml, median number of CD4 479 and median percentage 18.4. HAART treatment of children in Africa is feasible and as effective as in developed countries.

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