12-month mortality and loss-to-program in antiretroviral-treated children: The IeDEA pediatric West African Database to evaluate AIDS (pWADA), 2000-2008
Identifieur interne : 000851 ( Main/Exploration ); précédent : 000850; suivant : 00085212-month mortality and loss-to-program in antiretroviral-treated children: The IeDEA pediatric West African Database to evaluate AIDS (pWADA), 2000-2008
Auteurs : Didier K. Ekouevi [France, Côte d'Ivoire] ; Alain Azondekon [Bénin] ; Fatoumata Dicko [Mali] ; Karen Malateste [France] ; Pety Touré [Côte d'Ivoire] ; François T. Eboua [Côte d'Ivoire] ; Kouakou Kouadio [Côte d'Ivoire] ; Lorna Renner [Ghana] ; Kevin Peterson [Gambie] ; François Dabis [France] ; Haby Signaté Sy [Sénégal] ; Valeriane Leroy [France]Source :
- BMC Public Health [ 1471-2458 ] ; 2011.
Descripteurs français
- KwdFr :
- MESH :
- tendances : Mortalité.
- usage thérapeutique : Antirhumatismaux.
- épidémiologie : Afrique de l'Ouest.
- Abandons des patients, Adolescent, Bases de données factuelles, Enfant, Enfant d'âge préscolaire, Humains, Mâle, Nourrisson.
English descriptors
- KwdEn :
- MESH :
- chemical , therapeutic use : Antirheumatic Agents.
- geographic , epidemiology : Africa, Western.
- statistics & numerical data : Patient Dropouts.
- trends : Mortality.
- Adolescent, Child, Child, Preschool, Databases, Factual, Humans, Infant, Male.
Abstract
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.
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.
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.
Innovative and sustainable approaches are needed to better document causes of death and increase retention in HIV pediatric clinics in West Africa.
Url:
DOI: 10.1186/1471-2458-11-519
PubMed: 21718505
PubMed Central: 3142512
Affiliations:
- Bénin, Côte d'Ivoire, France, Gambie, Ghana, Mali, Sénégal
- Aquitaine, Nouvelle-Aquitaine, Région du Grand Accra
- Accra, Bordeaux
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Ekouevi</name><affiliation wicri:level="3"><nlm:aff id="I1">INSERM, U897, & Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen Bordeaux 2, Bordeaux, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>INSERM, U897, & Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen Bordeaux 2, Bordeaux</wicri:regionArea><placeName><region type="region">Nouvelle-Aquitaine</region><region type="old region">Aquitaine</region><settlement type="city">Bordeaux</settlement></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire</nlm:aff><country xml:lang="fr">Côte d'Ivoire</country><wicri:regionArea>Programme PAC-CI, CHU de Treichville, Abidjan</wicri:regionArea><wicri:noRegion>Abidjan</wicri:noRegion></affiliation></author><author><name sortKey="Azondekon, Alain" sort="Azondekon, Alain" uniqKey="Azondekon A" first="Alain" last="Azondekon">Alain Azondekon</name><affiliation wicri:level="1"><nlm:aff id="I3">Hôpital d'Instruction des Armées, Cotonou, Benin</nlm:aff><country xml:lang="fr">Bénin</country><wicri:regionArea>Hôpital d'Instruction des Armées, Cotonou</wicri:regionArea><wicri:noRegion>Cotonou</wicri:noRegion></affiliation></author><author><name sortKey="Dicko, Fatoumata" sort="Dicko, Fatoumata" uniqKey="Dicko F" first="Fatoumata" last="Dicko">Fatoumata Dicko</name><affiliation wicri:level="1"><nlm:aff id="I4">Hôpital Gabriel Touré, Service de Pédiatrie Bamako, Mali</nlm:aff><country xml:lang="fr">Mali</country><wicri:regionArea>Hôpital Gabriel Touré, Service de Pédiatrie Bamako</wicri:regionArea><wicri:noRegion>Service de Pédiatrie Bamako</wicri:noRegion></affiliation></author><author><name sortKey="Malateste, Karen" sort="Malateste, Karen" uniqKey="Malateste K" first="Karen" last="Malateste">Karen Malateste</name><affiliation wicri:level="3"><nlm:aff id="I1">INSERM, U897, & Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen Bordeaux 2, Bordeaux, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>INSERM, U897, & Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen Bordeaux 2, Bordeaux</wicri:regionArea><placeName><region type="region">Nouvelle-Aquitaine</region><region type="old region">Aquitaine</region><settlement type="city">Bordeaux</settlement></placeName></affiliation></author><author><name sortKey="Toure, Pety" sort="Toure, Pety" uniqKey="Toure P" first="Pety" last="Touré">Pety Touré</name><affiliation wicri:level="1"><nlm:aff id="I5">MTCT-Plus initiative, ACONDA, Abidjan, Côte d'Ivoire</nlm:aff><country xml:lang="fr">Côte d'Ivoire</country><wicri:regionArea>MTCT-Plus initiative, ACONDA, Abidjan</wicri:regionArea><wicri:noRegion>Abidjan</wicri:noRegion></affiliation><affiliation><nlm:aff id="I6">CePReF, ACONDA, Abidjan Côte d'Ivoire</nlm:aff><wicri:noCountry code="subfield">Abidjan Côte d'Ivoire</wicri:noCountry></affiliation></author><author><name sortKey="Eboua, Francois T" sort="Eboua, Francois T" uniqKey="Eboua F" first="François T" last="Eboua">François T. Eboua</name><affiliation wicri:level="1"><nlm:aff id="I7">CHU de Yopougon, Service de Pédiatrie, Abidjan, Côte d'Ivoire</nlm:aff><country xml:lang="fr">Côte d'Ivoire</country><wicri:regionArea>CHU de Yopougon, Service de Pédiatrie, Abidjan</wicri:regionArea><wicri:noRegion>Abidjan</wicri:noRegion></affiliation></author><author><name sortKey="Kouadio, Kouakou" sort="Kouadio, Kouakou" uniqKey="Kouadio K" first="Kouakou" last="Kouadio">Kouakou Kouadio</name><affiliation wicri:level="1"><nlm:aff id="I8">Centre Intégré de Recherche Bioclinique d'Abidjan (CIRBA), Abidjan, Côte d'Ivoire</nlm:aff><country xml:lang="fr">Côte d'Ivoire</country><wicri:regionArea>Centre Intégré de Recherche Bioclinique d'Abidjan (CIRBA), Abidjan</wicri:regionArea><wicri:noRegion>Abidjan</wicri:noRegion></affiliation></author><author><name sortKey="Renner, Lorna" sort="Renner, Lorna" uniqKey="Renner L" first="Lorna" last="Renner">Lorna Renner</name><affiliation wicri:level="3"><nlm:aff id="I9">Korlebu Hospital, Pediatric ward, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Korlebu Hospital, Pediatric ward, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Peterson, Kevin" sort="Peterson, Kevin" uniqKey="Peterson K" first="Kevin" last="Peterson">Kevin Peterson</name><affiliation wicri:level="1"><nlm:aff id="I10">Medical Research Council, Fajara Cohort, Banjul, Gambia</nlm:aff><country xml:lang="fr">Gambie</country><wicri:regionArea>Medical Research Council, Fajara Cohort, Banjul</wicri:regionArea><wicri:noRegion>Banjul</wicri:noRegion></affiliation></author><author><name sortKey="Dabis, Francois" sort="Dabis, Francois" uniqKey="Dabis F" first="François" last="Dabis">François Dabis</name><affiliation wicri:level="3"><nlm:aff id="I1">INSERM, U897, & Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen Bordeaux 2, Bordeaux, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>INSERM, U897, & Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen Bordeaux 2, Bordeaux</wicri:regionArea><placeName><region type="region">Nouvelle-Aquitaine</region><region type="old region">Aquitaine</region><settlement type="city">Bordeaux</settlement></placeName></affiliation></author><author><name sortKey="Sy, Haby Signate" sort="Sy, Haby Signate" uniqKey="Sy H" first="Haby Signaté" last="Sy">Haby Signaté Sy</name><affiliation wicri:level="1"><nlm:aff id="I11">Hôpital d'Enfants Albert-Royer, Dakar, Senegal</nlm:aff><country xml:lang="fr">Sénégal</country><wicri:regionArea>Hôpital d'Enfants Albert-Royer, Dakar</wicri:regionArea><wicri:noRegion>Dakar</wicri:noRegion></affiliation></author><author><name sortKey="Leroy, Valeriane" sort="Leroy, Valeriane" uniqKey="Leroy V" first="Valeriane" last="Leroy">Valeriane Leroy</name><affiliation wicri:level="3"><nlm:aff id="I1">INSERM, U897, & Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen Bordeaux 2, Bordeaux, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>INSERM, U897, & Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen Bordeaux 2, Bordeaux</wicri:regionArea><placeName><region type="region">Nouvelle-Aquitaine</region><region type="old region">Aquitaine</region><settlement type="city">Bordeaux</settlement></placeName></affiliation></author></analytic><series><title level="j">BMC Public Health</title><idno type="eISSN">1471-2458</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Africa, Western (epidemiology)</term><term>Antirheumatic Agents (therapeutic use)</term><term>Child</term><term>Child, Preschool</term><term>Databases, Factual</term><term>Humans</term><term>Infant</term><term>Male</term><term>Mortality (trends)</term><term>Patient Dropouts (statistics & numerical data)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Abandons des patients ()</term><term>Adolescent</term><term>Afrique de l'Ouest (épidémiologie)</term><term>Antirhumatismaux (usage thérapeutique)</term><term>Bases de données factuelles</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Humains</term><term>Mortalité (tendances)</term><term>Mâle</term><term>Nourrisson</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antirheumatic Agents</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Africa, Western</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Patient Dropouts</term></keywords><keywords scheme="MESH" qualifier="tendances" xml:lang="fr"><term>Mortalité</term></keywords><keywords scheme="MESH" qualifier="trends" xml:lang="en"><term>Mortality</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antirhumatismaux</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Afrique de l'Ouest</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Child</term><term>Child, Preschool</term><term>Databases, Factual</term><term>Humans</term><term>Infant</term><term>Male</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Abandons des patients</term><term>Adolescent</term><term>Bases de données factuelles</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Humains</term><term>Mâle</term><term>Nourrisson</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><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></sec><sec><title>Methods</title><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></sec><sec><title>Results</title><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></sec><sec><title>Conclusion</title><p>Innovative and sustainable approaches are needed to better document causes of death and increase retention in HIV pediatric clinics in West Africa.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Anaky, Mf" uniqKey="Anaky M">MF Anaky</name></author><author><name sortKey="Duvignac, J" uniqKey="Duvignac J">J Duvignac</name></author><author><name sortKey="Wemin, L" uniqKey="Wemin L">L Wemin</name></author><author><name sortKey="Kouakoussui, A" uniqKey="Kouakoussui A">A Kouakoussui</name></author><author><name sortKey="Karcher, S" uniqKey="Karcher S">S Karcher</name></author><author><name sortKey="Toure, S" uniqKey="Toure S">S 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name="Nouvelle-Aquitaine"><name sortKey="Ekouevi, Didier K" sort="Ekouevi, Didier K" uniqKey="Ekouevi D" first="Didier K" last="Ekouevi">Didier K. Ekouevi</name></region><name sortKey="Dabis, Francois" sort="Dabis, Francois" uniqKey="Dabis F" first="François" last="Dabis">François Dabis</name><name sortKey="Leroy, Valeriane" sort="Leroy, Valeriane" uniqKey="Leroy V" first="Valeriane" last="Leroy">Valeriane Leroy</name><name sortKey="Malateste, Karen" sort="Malateste, Karen" uniqKey="Malateste K" first="Karen" last="Malateste">Karen Malateste</name></country><country name="Côte d'Ivoire"><noRegion><name sortKey="Ekouevi, Didier K" sort="Ekouevi, Didier K" uniqKey="Ekouevi D" first="Didier K" last="Ekouevi">Didier K. Ekouevi</name></noRegion><name sortKey="Eboua, Francois T" sort="Eboua, Francois T" uniqKey="Eboua F" first="François T" last="Eboua">François T. Eboua</name><name sortKey="Kouadio, Kouakou" sort="Kouadio, Kouakou" uniqKey="Kouadio K" first="Kouakou" last="Kouadio">Kouakou Kouadio</name><name sortKey="Toure, Pety" sort="Toure, Pety" uniqKey="Toure P" first="Pety" last="Touré">Pety Touré</name></country><country name="Bénin"><noRegion><name sortKey="Azondekon, Alain" sort="Azondekon, Alain" uniqKey="Azondekon A" first="Alain" last="Azondekon">Alain Azondekon</name></noRegion></country><country name="Mali"><noRegion><name sortKey="Dicko, Fatoumata" sort="Dicko, Fatoumata" uniqKey="Dicko F" first="Fatoumata" last="Dicko">Fatoumata Dicko</name></noRegion></country><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Renner, Lorna" sort="Renner, Lorna" uniqKey="Renner L" first="Lorna" last="Renner">Lorna Renner</name></region></country><country name="Gambie"><noRegion><name sortKey="Peterson, Kevin" sort="Peterson, Kevin" uniqKey="Peterson K" first="Kevin" last="Peterson">Kevin Peterson</name></noRegion></country><country name="Sénégal"><noRegion><name sortKey="Sy, Haby Signate" sort="Sy, Haby Signate" uniqKey="Sy H" first="Haby Signaté" last="Sy">Haby Signaté Sy</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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