The frequency and magnitude of growth failure in a group of HIV-infected children in Cameroon

Background: Growth impairment is a major manifestation of HIV infection in children and has been implicated as a major contributor to both morbidity and mortality. This study the first to be done in this setting, was aimed at comparing the growth of HIV infected children to that of noninfected children in two referral health facilities in Yaoundé, Cameroon. Methods: A prospective case control study was carried out on 39 HIV infected children in two referral hospitals and followed up for a period of 12 months. Anthropometric measurements were taken and the sociodemographic variables of mothers and infants noted. Thirty nine infected children (mean age 45.3 months ± 41.6 SD) were age and sex matched with 39 non-infected children (mean age 44.4 ± 40.7 months). Results: Out of the 39 infected children, 26 (66.7%) had at least one of the three anthropometric indices (weight for height, weight for age, height for age) Z scores less than -2. Throughout follow-up, 20.5% of the infected children were wasted (weight to height Z score < -2) versus none in the control group, 56.4% underweight (weight for age Z score < -2) in the infected versus 2.6% in the control group, and 51.3% stunted (height for age Z score < -2) in contrast to 5.1% in the control group. Conclusion: This study demonstrated that wasting; underweight and stunting are common findings in HIV- infected children, thus stressing the importance of anthropometry in the routine care of these children

Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort

BACKGROUND: Globally, 49% of the estimated 1.8 million children living with HIV are accessing antiretroviral therapy (ART). There are limited data concerning long-term durability of first-line ART regimens and time to transition to second-line. METHODS: Children initiating their first ART regimen between 2 and 14 years of age and enrolled in one of 208 sites in 30 Asia-Pacific and African countries participating in the Pediatric International Epidemiology Databases to Evaluate AIDS consortium were included in this analysis. Outcomes of interest were: first-line ART failure (clinical, immunologic, or virologic), change to second-line, and attrition (death or loss to program ). Cumulative incidence was computed for first-line failure and second-line initiation, with attrition as a competing event. RESULTS: In 27,031 children, median age at ART initiation was 6.7 years. Median baseline CD4% for children ≤5 years of age was 13.2% and CD4 count for those >5 years was 258 cells per microliter. Almost all (94.4%) initiated a nonnucleoside reverse transcriptase inhibitor; 5.3% a protease inhibitor, and 0.3% a triple nucleoside reverse transcriptase inhibitor-based regimen. At 1 year, 7.7% had failed and 14.4% had experienced attrition; by 5 years, the cumulative incidence was 25.9% and 29.4%, respectively. At 1 year after ART failure, 13.7% had transitioned to second-line and 11.2% had experienced attrition; by 5 years, the cumulative incidence was 31.6% and 25.9%, respectively. CONCLUSIONS: High rates of first-line failure and attrition were identified in children within 5 years after ART initiation. Of children meeting failure criteria, only one-third were transitioned to second-line ART within 5 years