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

Low prevalence of lipodystrophy in HIV-infected Senegalese children on long-term antiretroviral treatment : the ANRS 12279 MAGGSEN Pediatric Cohort Study

Background: The long-term benefits of antiretroviral treatment (ART) are associated with metabolic complications, especially lipodystrophy, which has been well described among HIV-infected adults and children on ART in developed settings. Specifically, stavudine, and to a lesser extent zidovudine and protease inhibitors (PI), have been consistently implicated in the development of lipodystrophy. In 2006, following advice from the WHO, Senegal began phasing out stavudine from first-line ART. The objectives of this cross-sectional analysis are to assess and identify risk factors affecting the prevalence of lipodystrophy in Senegalese children and adolescents on long-term ART participating in a cohort study. Methods: Lipodystrophy was clinically assessed in two- to 18-year-old children on ART for at least six months and with no concurrent severe acute malnutrition. Risk factors for lipodystrophy were identified using stepwise multivariable logistic regression. Explanatory variables included clinical and personal data, immunovirologic status, and therapeutic history. Results: Overall, 254 children were assessed for lipodystrophy. The median age was 10.9 years (IQR: 8.1-142) and the median duration on ART was 54 months (32-84). Only 18% had been previously treated with stavudine, with a median treatment duration of 8 months (5-25). Ongoing treatment included 76% of children receiving zidovudine (median duration of 48 months (26-74)) and 27% receiving PI (lopinavir/ritonavir; median duration of 49 months (23-59)). Mild signs of lipodystrophy were observed in 33 children (13%): 28 with lipoatrophy, 4 with lipohypertrophy and one with combined type. Boys were more likely to present with lipoatrophy than girls (aOR: 4.3, 95% CI: 1.6-11.7). Children previously treated with stavudine for >= 1 year had a greater risk for lipoatrophy than those never exposed (3.8, 1.0-14.0), although the association was weak. There was no association between lipodystrophy and age or current or cumulative treatment with lopinavir/ritonavir or zidovudine. Conclusions: We report low prevalence of mild lipodystrophy in children and adolescents on long-term ART receiving a stavudine-sparing regimen. These findings are reassuring for clinicians in low-income settings where zidovudine is massively prescribed and lopinavir/ritonavir is the only widely available PI

Outcomes of Antiretroviral Therapy in Children in Asia and Africa: A Comparative Analysis of the IeDEA Pediatric Multiregional Collaboration

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Atlas des pêches et pêcheurs artisans d'Afrique de l'Ouest

En Afrique de l'Ouest, la pêche, surtout développée à l'échelle artisanale, est une activité importante pour de nombreuses populations de l'intérieur et des zones côtières. Elle leur fournit emplois et revenus, tout en contribuant à la sécurité alimentaire des pays. Cependant, la pêche artisanale est très peu prise en considération par les opérations de recensement qui sont périodiquement conduites par les services statistiques nationaux. L'une des conséquences est qu'elle parvient difficilement à trouver sa place au sein des politiques de développement. Prenant la mesure de cette situation, l’Union économique et monétaire ouest-africaine (UEMOA) a lancé depuis 2012 de grandes enquêtes déployées sur les huit pays de cette zone économique. Cet atlas présente l'essentiel des indicateurs obtenus à partir de ces enquêtes, que ce soit de façon directe ou par estimation. Il décrit les équipements et activités de pêche, les poissons capturés, la chaîne de traitement des produits après la capture, sans oublier les conditions de vie des pêcheurs dans leurs sites d’habitat. Les indicateurs, présentés sous forme de graphiques, cartes et tableaux, sont accompagnés d’analyses rédigées par les experts internationaux et les experts des administrations nationales qui ont conçu et réalisé ces enquêtes. Les décideurs publics et les opérateurs du développement trouveront dans cet atlas des informations pertinentes et actualisées susceptibles de guider leurs politiques et leurs actions. Les scientifiques et les étudiants du supérieur pourront tirer parti des connaissances inédites mises à disposition ainsi que des méthodologies décrites. Enfin, les lecteurs intéressés par la forte culture de la pêche développée par les populations des côtes, fleuves et lacs d’Afrique de l'Ouest y découvriront cette tradition, décrite de manière accessible et richement illustrée