12-month mortality and loss-to-program in antiretroviral-treated children: The IeDEA pediatric West African Database to evaluate AIDS (pWADA), 2000-2008

<p>Abstract</p> <p>Background</p> <p>The IeDEA West Africa Pediatric Working Group (pWADA) was established in January 2007 to study the care and treatment of HIV-infected children in this region. We describe here the characteristics at antiretroviral treatment (ART) initiation and study the 12-month mortality and loss-to-program of HIV-infected children followed in ART programs in West Africa.</p> <p>Methods</p> <p>Standardized data from HIV-infected children followed-up in ART programs were included. Nine clinical centers from six countries contributed to the dataset (Benin, Côte d'Ivoire, Gambia, Ghana, Mali and Senegal). Inclusion criteria were the followings: age 0-15 years and initiated triple antiretroviral drug regimens. Baseline time was the date of ART initiation. WHO criteria was used to define severe immunosuppression based on CD4 count by age or CD4 percent < 15%. We estimated the 12-month Kaplan-Meier probabilities of mortality and loss-to-program (death or loss to follow-up > 6 months) after ART initiation and factors associated with these two outcomes.</p> <p>Results</p> <p>Between June 2000 and December 2007, 2170 children were included. Characteristics at ART initiation were the following: median age of 5 years (Interquartile range (IQR: 2-9) and median CD4 percentage of 13% (IQR: 7-19). The most frequent drug regimen consisted of two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitors (62%). During the first 12 months, 169 (7.8%) children died and 461(21.2%) were lost-to-program. Overall, in HIV-infected children on ART, the 12-month probability of death was 8.3% (95% Confidence Interval (CI): 7.2-9.6%), and of loss-to-program was 23.1% (95% CI: 21.3-25.0%). Both mortality and loss-to program were associated with advanced clinical stage, CD4 percentage < 15% at ART initiation and year (> 2005) of ART initiation.</p> <p>Conclusion</p> <p>Innovative and sustainable approaches are needed to better document causes of death and increase retention in HIV pediatric clinics in West Africa.</p

Successful mechanical thrombectomy of acute basilar artery occlusion caused by vertebral artery intimal dysplasia (web)

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Long-term treatment with valproic acid does not alleviate the condition of HAM/TSP

Long-Term Treatment with Valproic Acid Does Not Alleviate the Condition of HAM/TSP Olindo, S.,1 Belrose, G.,2 Lezin, A.,2 Gillet, N.,3 Defoiche, J.,4 Rodriguez, S.,4 Signaté, A.,1 Verlaeten, O.,4 Smadja, D.,1 Césaire, R.,2 Willems, L.4 1Service de Neurologie and JE 2503, Centre Hospitalier Universitaire de Fort-de-France, 97200 Fort-de-France, Martinique, France; 2Laboratoire de Virologie-Immunologie and JE 2503, Centre Hospitalier Universitaire de Fort-de-France, 97200 Fort-de-France, Martinique, France; 3Department of Immunology, Imperial College, London, UK; 4Molecular and Cellular Biology, University Academia ‘‘Wallonie-Europe’’, 5030 Gembloux, Belgium. LW is Research Director of the FNRS. We previously proposed to interfere with proviral loads in HAM/TSP patients by modulating lysine deacetylase activity using valproic acid (VPA). The strategy aims at activating viral gene expression in order to expose virus-positive cells to the host immune response. We conducted a single-center, two-year open-label trial, with 19 HAM/TSP volunteers treated with oral doses of VPA (20mg/Kg/day). Objectives were to assess biological response and clinical safety to VPA treatment in HAM/TSP patients. By microarray analysis, we show that VPA treatment moderately stimulated expression of cyclinD2 and Rho GTPase activating protein 18 in CD4-T cells. CD8-mediated lysis efficiency of Tax-expressing cells was unaltered by VPA treatment. The CD4-T cell turnover rate was calculated by GC/MS analysis from quantitative incorporation of deuterium into DNA. Transient increase in proviral loads correlated with accelerated proliferation. After 2 years, the proviral loads reached levels similar to those before treatment. The main clinical side effects were drowsiness (52%), tremor (47%), digestive symptoms (37%), vertigo (26%), and alopecia (10%). The frequency of side symptoms tended to decrease over the trial course. The neurological status over the study constituted the primary clinical safety measures. Disability Status Scale, muscle testing score, Ashworth score, and urinary dysfunction score showed no significant changes. Walking Time Test (WTT) slightly varied over the study except in 3 patients in whom the WTT variation rates were>20%. These 3 patients experienced drowsiness and tremor and improved rapidly after treatment discontinuation. Together, these observations indicated that long term treatment with VPA is safe but does not alleviate the condition of HAM/TSP

Association between age at antiretroviral therapy initiation and 24-month immune response in West-African HIV-infected children

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