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3rd International AIDS Society Conference on HIV Pathogenesis and TreatmentRio de Janeiro - July 24 - 27, 2005 |
CLINICAL AND BIOLOGICAL FACTORS AT RECRUITMENT IN HIV INFECTED CHILDREN IN RELATION WITH THREE YEARS SURVIVAL IN ABIDJAN, CÔTE D'IVOIRE: THE EXPERIENCE OF THE ANRS 1244/1278 STUDY
IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. WeOa0101
Msellati P.1, Anaky M.F.2, Rouet F.3, Kouakoussui A.2, Mercier S.4, Wemin M.L.5, N'Gbeche M.S.2, Fassinou P.6, Blanche S.7
1UMR 145 IRD, Bobo Dioulasso, Burkina Faso, 2Projet Enfant, PACCI, Abidjan, Côte d'Ivoire, 3Cedres, Abidjan, Côte d'Ivoire, 4UR 024, IRD, Montpellier, France, 5Pédiatrie, CHU Treichville, Abidjan, Côte d'Ivoire, 6Pédiatrie, CHU Yopougon, Abidjan, Côte d'Ivoire, 7Hopital Necker Enfants Malades, Paris, France
OBJECTIVE: To identify characteristics at inclusion of HIV infected children in relation with three years survival.
METHODS: Observational cohort in Abidjan. All HIV-infected children enrolled between October 2000 and December 2003 were followed until end of September 2004. At recruitment, we obtained status of parents (alive, or deceased), age and sex, route of acquisition of HIV, history of tuberculosis, malnutrition and of HAART before recruitment, anthropometrics measures (weight and height). Among biological data collected, we analysed hepatitis B antigenemia, hemoglobin, platelets, total lymphocytes number, CD4 counts and viral load as potential prognostic factors in relation with survival. Probabilities of survival at three years were estimated using the Kaplan-Meier method. Cox proportional hazards regression models were used.
RESULTS: 282 HIV-infected children were recruited (129 girls and 153 boys, mean age of 5.8 years). Total follow-up was 612 child-years, and average was 2.17 years. Global survival was 85.5% at one year and 80.9% at three years. Z-score of Weight for age < – 3, history of tuberculosis and viral load over 5 log cp/ml have a negative impact on survival at three years (relative risk [RR] of respectively 5.86, 2.37 and 2.04). CD4 >15% and HAART before recruitment or during the six first months of follow-up have a protective effect (RR respectively 0.49 and 0.29). When considering a model without viral load, age over 2 years and cd4 >15% had a protective effect, respectively 0.46 and 0.45 and Z-score of Weight for age < – 3 had still a negative impact with a relative risk of 4.64.
CONCLUSIONS: Very low weight for age Z-score, history of tuberculosis and viral load >5 log are strong predictors of poor survival at 3 years and CD4 >15% is a predictor of good survival. This confirms guidelines we use for HAART initiation and advocates for an early identification of HIV-infected children.
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Clinical | WeOa0101 | Philippe Msellati
Initiation of therapy
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