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

Tuberculosis in Pediatric Antiretroviral Therapy Programs in Low- and Middle-Income Countries: Diagnosis and Screening Practices

Background The global burden of childhood tuberculosis (TB) is estimated to be 0.5 million new cases per year. Human immunodeficiency virus (HIV)-infected children are at high risk for TB. Diagnosis of TB in HIV-infected children remains a major challenge. Methods We describe TB diagnosis and screening practices of pediatric antiretroviral treatment (ART) programs in Africa, Asia, the Caribbean, and Central and South America. We used web-based questionnaires to collect data on ART programs and patients seen from March to July 2012. Forty-three ART programs treating children in 23 countries participated in the study. Results Sputum microscopy and chest Radiograph were available at all programs, mycobacterial culture in 40 (93%) sites, gastric aspiration in 27 (63%), induced sputum in 23 (54%), and Xpert MTB/RIF in 16 (37%) sites. Screening practices to exclude active TB before starting ART included contact history in 41 sites (84%), symptom screening in 38 (88%), and chest Radiograph in 34 sites (79%). The use of diagnostic tools was examined among 146 children diagnosed with TB during the study period. Chest Radiograph was used in 125 (86%) children, sputum microscopy in 76 (52%), induced sputum microscopy in 38 (26%), gastric aspirate microscopy in 35 (24%), culture in 25 (17%), and Xpert MTB/RIF in 11 (8%) children. Conclusions Induced sputum and Xpert MTB/RIF were infrequently available to diagnose childhood TB, and screening was largely based on symptom identification. There is an urgent need to improve the capacity of ART programs in low- and middle-income countries to exclude and diagnose TB in HIV-infected childre

The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis

Background Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in “real-life” settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia. Methods and findings Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5–5.2) years for the total cohort and 6.4 (3.6–8.0) years in Europe, 3.7 (2.0–5.4) years in North America, 2.5 (1.2–4.4) years in South and Southeast Asia, 5.0 (2.7–7.5) years in South America and the Caribbean, and 2.1 (0.9–3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3–2.1) years in North America to 7.1 (5.3–8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4–2.6) years in North America to 7.9 (6.0–9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%–2.8%), 15.6% (15.1%–16.0%), and 11.3% (10.9%–11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%–1.1%]) and highest in South America and the Caribbean (4.4% [3.1%–6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%–6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%–13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. Conclusion To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses

Bebe collodion, a propos de 4 cas et revue de la littérature : Baby collodion, about 4 cases and review of the literature

Introduction : Le bébé collodion est une forme sévère de l’ichtyose congénitale à révélation néonatale. L’objectif de cette étude était de décrire les caractéristiques cliniques et évolutives de cette affection.Matériel et méthode : Il s’agit d’une étude rétrospective portant sur les cas de bébé collodion répertoriés dans le service de néonatologie du CHU de Yopougon de 2010 à 2015.Pour chaque patient les paramètres étudiés étaient le sexe, l’âge à l’admission, la notion de consanguinité, les signes cliniques, les malformations associées, le traitement et l’évolution.Résultats : Durant la période d’étude quatre cas d’ichtyoses congénitales ont été répertoriés, il s’agissait de nouveau-nés à terme, dont l’âge moyen à l’admission était de 18h. Le sex-ratio était de 1. Deux nouveau-nés présentaient des malformations à type d’omphalocèle (1/4) et syndrome de Down (1/4). La notion de consanguinité a été retrouvée chez un nouveau-né. L’examen clinique objectivait des nouveau-nés enveloppés dans une membrane de collodion, un ectropion, un eclabium, des oreilles recroquevillées, la peau était lisse et craquelée, avec des fissures. Le traitement entrepris était constitué d’une hydratation de la peau, de soins oculaires et d’une antibiothérapie. L’évolution a été marquée par une desquamation progressive de la membrane laissant place à une xerose cutanée.Conclusion : Le diagnostic de bébé collodion à la naissance est clinique, le traitement est essentiellement symptomatique. Introduction: The collodion baby is a severe form of congenital ichthyos is with neonatal revelation. The purpose of this study was to describe the clinical and progressive features of this condition.Material and method: This is a retrospective study of baby collodion cases listed in the Yopougon CHU neonatal department from 2010 to 2015. For each patient, the parameters studied were sex, ageat admission, the notion of consanguinity, clinical signs, associated malformations, treatment and evolution.Results: During the study period, four cases of congenital ichthyosis were recorded, these were term newborns, whose average ageat admission was 18h. The sex ratio was 1. Two neonates had omphalocele-like (1/4) and Down (1/4) malformations. The concept of consanguinity was found in a newborn. The clinical examination revealed neonates wrapped in a collodion membrane, an ectropion, an eclabium, curled ears, the skin was smooth and cracked, with cracks. The treatment under taken consisted of moisturizing the skin, eye care and antibiotic therapy. The evolution was marked by a gradual desquamation of the membrane leaving room for cutaneous xerosis.Conclusion: The diagnosis of baby collodion at birth is clinical, the treatment is essentially symptomatic

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 adolescents at HIV disclosure or last contact.

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

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

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

Cohort profile for the adolescent HIV disclosure study.

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