HIV Status Disclosure and Retention in Care in HIV-Infected Adolescents on Antiretroviral Therapy (ART) in West Africa

We assessed the effect of HIV status disclosure on retention in care from initiation of antiretroviral therapy (ART) among HIV-infected children aged 10 years or more in Cote d'Ivoire, Mali and Sénégal.Multi-centre cohort study within five paediatric clinics participating in the IeDEA West Africa collaboration. HIV-infected patients were included in this study if they met the following inclusion criteria: aged 10-21 years while on ART; having initiated ART ≥ 200 days before the closure date of the clinic database; followed ≥ 15 days from ART initiation in clinics with ≥ 10 adolescents enrolled. Routine follow-up data were merged with those collected through a standardized ad hoc questionnaire on awareness of HIV status. Probability of retention (no death or loss-to-follow-up) was estimated with Kaplan-Meier method. Cox proportional hazard model with date of ART initiation as origin and a delayed entry at date of 10th birthday was used to identify factors associated with death or loss-to-follow-up.650 adolescents were available for this analysis. Characteristics at ART initiation were: median age of 10.4 years; median CD4 count of 224 cells/mm³ (47% with severe immunosuppression), 48% CDC stage C/WHO stage 3/4. The median follow-up on ART after the age of 10 was 23.3 months; 187 adolescents (28.8%) knew their HIV status. The overall probability of retention at 36 months after ART initiation was 74.6% (95% confidence interval [CI]: 70.5-79.0) and was higher for those disclosed compared to those not: adjusted hazard ratio for the risk of being death or loss-to-follow-up = 0.23 (95% CI: 0.13-0.39).About 2/3 of HIV-infected adolescents on ART were not aware of their HIV status in these ART clinics in West Africa but disclosed HIV status improved retention in care. The disclosure process should be thus systematically encouraged and organized in adolescent populations

Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa

International audienc

Oral lesions among HIV‐infected children on antiretroviral treatment in West Africa

ObjectiveTo estimate the prevalence of oral mucosal diseases and dental caries among HIV-infected children receiving antiretroviral treatment (ART) in West Africa and to identify the factors associated with the prevalence of oral mucosal lesions.MethodsMulticentre cross-sectional survey in five paediatric HIV clinics in Côte d'Ivoire, Mali and Sénégal. A standardised examination was performed by trained dentists on a random sample of HIV-infected children aged 5-15 years receiving ART. The prevalence of oral and dental lesions and mean number of decayed, missing/extracted and filled teeth (DMFdefT) in temporary and permanent dentition were estimated with their 95% confidence interval (95% CI). We used logistic regression to explore the association between children's characteristics and the prevalence of oral mucosal lesions, expressed as prevalence odds ratio (POR).ResultsThe median age of the 420 children (47% females) enrolled was 10.4 years [interquartile range (IQR) = 8.3-12.6]. The median duration on ART was 4.6 years (IQR = 2.6-6.2); 84 (20.0%) had CD4 count<350 cells/mm(3). A total of 35 children (8.3%; 95% CI: 6.1-11.1) exhibited 42 oral mucosal lesions (24 were candidiasis); 86.0% (95% CI = 82.6-89.3) of children had DMFdefT ≥ 1. The presence of oral mucosal lesions was independently associated with CD4 count < 350 cells/mm(3) (POR = 2.96, 95% CI = 1.06-4.36) and poor oral hygiene (POR = 2.69, 95% CI = 1.07-6.76).ConclusionsOral mucosal lesions still occur in HIV-infected African children despite ART, but rarely. However, dental caries were common and severe in this population, reflecting the need to include oral health in the comprehensive care of HIV

Crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI) of risk of death or loss-to-follow-up of adolescents after ART initiation (n = 650).

<p>Pediatric IeDEA West Africa Collaboration.</p><p>All analyses used the center as a cluster variable, taking into account the correlation of the observations within a same center.</p><p>HR: Hazard ratio.</p><p>aHR: adjusted hazard ratio.</p><p>MD: missing data.</p><p>ART: Antiretroviral therapy.</p><p>NNRTI: non nucleoside reverse transcriptase inhibitor.</p><p>Severe anemia: haemoglobin≤6.9 g/dL.</p><p>Severe immunosuppression : CD4<200 cells/mm³.</p

Cohort profile for the adolescent HIV disclosure study.

<p>Pediatric IeDEA West Africa (WADA) Collaboration.</p

Characteristics of adolescents at ART initiation.

<p>Pediatric IeDEA West Africa (WADA) Collaboration.</p><p>ART: Antiretroviral treatment; NNRTI: non nucleoside reverse transcriptase inhibitor;</p><p>N: number; Med: median; IQR: Inter Quartile Range; Min: minimum; Max: maximum.</p

Probability of retention in HIV care while on antiretroviral therapy (ART) according to disclosed HIV status taking into account the delayed entry at age of 10 years (n = 650).

<p>Pediatric IeDEA West Africa Collaboration. * Estimation at 36 months from ART initiation.</p

Characteristics of adolescents at HIV disclosure or last contact.

<p>Pediatric IeDEA West Africa (WADA) Collaboration.</p><p>N: number.</p

Follow-up characteristics of adolescents on ART.

<p>Pediatric IeDEA West Africa (WADA) Collaboration.</p><p>ART: Antiretroviral therapy.</p><p>N: number; Med: median; IQR: Inter Quartile Range; Min: minimum; Max: maximum.</p

Characteristics of the process of HIV disclosure of adolescents.

<p>Pediatric IeDEA West Africa (WADA) Collaboration.</p><p>ART: Antiretroviral therapy.</p>*<p>Consisted in other persons of the family (uncle, aunt, grand-mother, grand-father, adoptive father or mother), persons from foster care shelters or NGOs (n = 14), nobody involved because of reading the notice (n = 4).</p