30 results on '"Amani-Bosse, C."'
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2. Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe
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Medicina i Cirurgia, Universitat Rovira i Virgili, Schomaker M., Leroy V., Wolfs T., Technau K., Renner L., Judd A., Sawry S., Amorissani-Folquet M., Noguera-Julian A., Tanser F., Eboua F., Navarro M., Chimbetete C., Amani-Bosse C., Warszawski J., Phiri S., N'Gbeche S., Cox V., Koueta F., Giddy J., Sygnaté-Sy H., Raben D., Chêne G., Davies M., Medicina i Cirurgia, Universitat Rovira i Virgili, and Schomaker M., Leroy V., Wolfs T., Technau K., Renner L., Judd A., Sawry S., Amorissani-Folquet M., Noguera-Julian A., Tanser F., Eboua F., Navarro M., Chimbetete C., Amani-Bosse C., Warszawski J., Phiri S., N'Gbeche S., Cox V., Koueta F., Giddy J., Sygnaté-Sy H., Raben D., Chêne G., Davies M. more...
- Abstract
BACKGROUND: There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents. METHODS: A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in Europe, Southern Africa and West Africa, were included. We compared mortality and growth outcomes for different ART initiation criteria, aligned with previous and recent World Health Organization criteria, for 5 years of follow-up, adjusting for all measured baseline and time-dependent confounders using the g-formula. RESULTS: Median (1st;3rd percentile) CD4 count at baseline was 676 cells/mm 3 (394; 1037) (children aged ≥ 1 and 10 years at enrolment we did not find any difference in mortality or growth with immediate ART initiation, with estimated differences of -0.1% (-0.2%; 0.6%) and -0.03 (-0.05; 0.00), respectively. Growth differences in children aged < 10 years persisted for treatment thresholds using higher CD4 values. Regular follow-up led to better height and mortality outcomes. CONCLUSIONS: Immediate ART is associated with lower mortality and better growth for up to 5 years in children < 10 years old. Our results on adolescents were inconclusive. more...
- Published
- 2017
Catalog
3. Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe
- Author
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Universitat Rovira i Virgili, Schomaker M., Leroy V., Wolfs T., Technau K., Renner L., Judd A., Sawry S., Amorissani-Folquet M., Noguera-Julian A., Tanser F., Eboua F., Navarro M., Chimbetete C., Amani-Bosse C., Warszawski J., Phiri S., N'Gbeche S., Cox V., Koueta F., Giddy J., Sygnaté-Sy H., Raben D., Chêne G., Davies M., Universitat Rovira i Virgili, and Schomaker M., Leroy V., Wolfs T., Technau K., Renner L., Judd A., Sawry S., Amorissani-Folquet M., Noguera-Julian A., Tanser F., Eboua F., Navarro M., Chimbetete C., Amani-Bosse C., Warszawski J., Phiri S., N'Gbeche S., Cox V., Koueta F., Giddy J., Sygnaté-Sy H., Raben D., Chêne G., Davies M. more...
- Abstract
BACKGROUND: There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents. METHODS: A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in Europe, Southern Africa and West Africa, were included. We compared mortality and growth outcomes for different ART initiation criteria, aligned with previous and recent World Health Organization criteria, for 5 years of follow-up, adjusting for all measured baseline and time-dependent confounders using the g-formula. RESULTS: Median (1st;3rd percentile) CD4 count at baseline was 676 cells/mm 3 (394; 1037) (children aged ≥ 1 and 10 years at enrolment we did not find any difference in mortality or growth with immediate ART initiation, with estimated differences of -0.1% (-0.2%; 0.6%) and -0.03 (-0.05; 0.00), respectively. Growth differences in children aged < 10 years persisted for treatment thresholds using higher CD4 values. Regular follow-up led to better height and mortality outcomes. CONCLUSIONS: Immediate ART is associated with lower mortality and better growth for up to 5 years in children < 10 years old. Our results on adolescents were inconclusive. more...
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- 2017
4. Acceptabilite´ du test VIH propose´ aux nourrissons dans les services pe´ diatriques, en Coˆ te d’Ivoire, Significations pour la couverture du diagnostic pe´diatrique
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Oga, M, Brou, H, Dago-Akribi, H, Coffie, P, Amani-Bosse´, C, E´ koue´vi, D, Yapo, V, Menan, H, Ndondoki, C, and Timite-Konan, M
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Acceptabilite´, Test VIH, Enfants, Nourrissons - Abstract
Proble`me: Le de´pistage VIH chez les enfants a rarement e´te´ au centre des pre´occupations des chercheurs. Quand le de´pistage pe´diatrique a retenu l’attention, cela a e´te´ pour e´clairer seulement sur les performances diagnostiques en ignorant meˆme que le test pe´diatrique comme bien d’autres peut s’accepter ou se refuser. Cet article met au coeur de son analyse les raisons qui peuvent expliquer qu’on accepte ou qu’on refuse de faire de´pister son enfant.Objectif: Etudier chez les parents, les me`res, les facteurs explicatifs de l’acceptabilite´ du test VIH des nourrissons de moins de six mois.Me´thodes: Entretien semi-directif a` passages re´pe´te´s avec les parents de nourrissons de moins de six mois dans les formations sanitaires pour la pese´e/vaccination et les consultations pe´diatriques avec proposition syste´matique d’un test VIH pour leur nourrisson.Re´sultats: Nous retenons que la re´alisation effective du test pe´diatrique du VIH chez le nourrisson repose sur trois e´le´ments. Primo, le personnel de sante´ par son discours (qui de´note de ses connaissances et perceptions meˆme sur l’infection) oriente´ vers les me`res influence leur acceptation ou non du test. Secundo, la me`re qui par ses connaissances et perceptions meˆme sur le VIH, dont le statut particulier, l’impression de bien-eˆtre chez elle et son enfant influence toute re´alisation du test pe´diatrique VIH. Tertio, l’environnement conjugal de la me`re, particulie`rement caracte´rise´ par les rapports au sein du couple, sur la facilite´ de parler du test VIH et sa re´alisation chez les deux parents ou chez la me`re seulement sont autant de facteurs qui influencent la re´alisation effective du de´pistage du VIH chez l’enfant. Le principe pre´ventif du VIH, et le de´sir de faire tester l’enfant ne suffisent pas a` eux seuls pour aboutir a` sa re´alisation effective, selon certaines me`res confronte´es au refus du conjoint. A l’oppose´, les autres me`res refusant la re´alisation du test pe´diatrique disent s’y opposer ; bien entendu, meˆme dans le cas ou` le conjoint l’accepterait.Discussion: Les me`res sont les principales mises en cause et craignent les re´primandes et la stigmatisation. Le pe`re, le conjoint peut eˆtre un obstacle, quand il s’oppose au test VIH du nourrisson, ou devenir le facilitateur de sa re´alisation s’il est convaincu. Le positionnement du pe`re demeure donc essentiel dans la question de l’acceptabilite´ du VIH pe´diatrique. Les me`res en ont conscience et pre´sagent des difficulte´s a` faire de´pister ou non les enfants sans avis pre´alable du conjoint a` la fois pe`re, et chef de famille.Conclusion: La question du de´pistage pe´diatrique du VIH, au terme de notre analyse, met en face trois e´le´ments qui exigent une gestion globale pour assurer une couverture effective. Ces trois e´le´ments n’existeraient pas sans s’influencer, donc ils sont constamment en interaction et empeˆchent ou favorisent la re´alisation ou non du test pe´diatrique. Aussi, dans une intention d’aboutir a` une couverture effective du de´pistage VIH des nourrissons, faut-il tenir compte d’une gestion harmonieuse de ces trois e´le´ments: La premie`re, la me`re seule (avec ses connaissances, ses perceptions), son environnement conjugal (de proposition du test inte´grant 1- l’e´poux et / ou pe`re de l’enfant avec ses perceptions et connaissances sur l’infection 2- la facilite´ de parler du test et sa re´alisation chez les deux ou un des parents, la me`re) et les connaissances, attitudes et pratiques du personnel de l’e´tablissement sanitaire sur l’infection du VIH.Recommandations: Nos recommandations proposent une rede´finition de l’approche du VIH/sida vers des familles expose´es au VIH et une inte´gration plus accentue´e du pe`re facilitant leur propre acceptation du test VIH et celle de leur enfant.Mots cle´s: Acceptabilite´, Test VIH, Enfants, Nourrissons Problem: HIV testing in children had rarely been a central concern for researchers. When pediatric tracking retained the attention, it was more to inform on the diagnosis tools performances rather than the fact the pediatric test can be accepted or refused. This article highlights the parent’s reasons which explain why pediatric HIV test is accepted or refused.Objective: To study among parents, the explanatory factors of the acceptability of pediatric HIV testing among infant less than six months.Methods: Semi-structured interview with repeated passages in the parents of infants less than six months attending in health care facilities for the pediatric weighing/vaccination and consultations.Results: We highlight that the parent’s acceptance of the pediatric HIV screening is based on three elements.Firstly, the health care workers by his speech (which indicates its own knowledge and perceptions on the infection) directed towards mothers’ influences their acceptance or not of the HIV test. Secondly, the mother who by her knowledge and perceptions on HIV, whose particular status, give an impression of her own wellbeing for her and her child influences any acceptance of the pediatric HIV test. Thirdly, the marital environment of the mother, particularly characterized by the ease of communication within the couple, to speak about the HIV test and its realization for the parents or the mother only are many factors which influence the effective realization of the pediatric HIV testing. The preventive principle of HIV transmission and the desire to realize the test in the newborn are not enough alone to lead to its effective realization, according to certain mothers confronted with the father’s refusal. On the other hand, the other mothers refusing the realization of the pediatric test told to be opposed to it; of course, even if their partner would accept it.Discussion: The mothers are the principal facing the pediatric HIV question and fear the reprimands and stigma. The father, the partner could be an obstacle, when he is opposed to the infant HIV testing, or also the facilitator with his realization if he is convinced. The father position thus remains essential face to the question of pediatric HIV testing acceptability. The mothers are aware of this and predict the difficulties of achieving their infant to be tested without the preliminary opinion of their partner at the same time father, and head of the family.Conclusion: The issue of pediatric HIV testing, at the end of our analysis, highlights three elements which require a comprehensive management to improve the coverage of pediatric HIV test. These three elements would not exist without being influenced; therefore they are constantly in interaction and prevent or support the realization or not pediatric test. Also, with the aim to improve the pediatric HIV test coverage, it is necessary to take into account the harmonious management of these elements. Firstly, the mother alone (with her knowledge, and perceptions), its marital environment (with the proposal of the HIV test integrating (1) the partner and/or father with his perceptions and knowledge on HIV infection and (2) facility of speaking about the test and its realization at both or one about the parents, the mother) and of the knowledge, attitudes and practices about the infection of health care workers of the sanitary institution.Recommendations: Our recommendations proposed taking into account a redefinition of the HIV/AIDS approach towards the families exposed to HIV and a more accentuated integration of the father facilitating their own HIV test acceptation and that of his child.Keywords: acceptability, HIV testing, children, infantsArticle in French. more...
- Published
- 2014
5. Est-il possible de simplifier un traitement à base de lopinavir chez les enfants infectés par le VIH ? Essai ANRS12206
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Dahourou, D.L., primary, Amorissani-Folquet, M., additional, Malateste, K., additional, Amani-Bosse, C., additional, Coulibaly, M., additional, and Devaux, C., additional
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- 2016
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6. Mise en œuvre d'un système d'information pour optimiser la cascade de prévention de la prévention de la transmission mère-enfant du VIH avec dépistage maternel systématique à l'accouchement et suivi du couple mère-enfant dans le continuum de soins à Abidjan, Côte d'Ivoire - Le projet DEPISTNEO-VIH
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Bangali, M., Desmonde, S., Amorissani-Folquet, M., Lenaud, S., Karcher, S., Amani-Bosse, C., Inwoley, A., Ahoba, I., and Leroy, V.
- Abstract
Pour améliorer l'accès au dépistage et la prise en charge du VIH des couples mère-enfant, un dépistage systématique du VIH en salle d'accouchement avec système d'information (SI) suivant les couples mère-enfant en postnatal a été mis en place à Abidjan, Côte d'Ivoire. more...
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- 2023
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7. Population Pharmacokinetics of Tenofovir in HIV-1-Infected Pregnant Women and Their Neonates (ANRS 12109)
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Hirt, D, primary, Urien, S, additional, Ekouévi, DK, additional, Rey, E, additional, Arrivé, E, additional, Blanche, S, additional, Amani-Bosse, C, additional, Nerrienet, E, additional, Gray, G, additional, Kone, M, additional, Leang, SK, additional, McIntyre, J, additional, Dabis, F, additional, and Tréluyer, J-M, additional more...
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- 2008
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8. SFCP P-096 - Accès au traitement antirétroviral avant deux ans à Abidjan
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Timite-Konan, M., Avit-Edi, D., Méa-Assandé, V., Aka, E., Kouadio, S., Folquet-Amorissani, M., Amani-Bossé, C., Eliam-Kouakou, J., Daingui, E., Abo, K., Ahoba, I., and Leroy, V.
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- 2014
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9. Field efficacy of zidovudine, lamivudine and single-dose nevirapine to prevent peripartum HIV transmission
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Dabis, F., Bequet, L., Ekouevi, Dk, Viho, I., Rouet, F., Horo, A., Sakarovitch, C., Becquet, R., Fassinou, P., Dequae-Merchadou, L., Welffens-Ekra, C., Rouzioux, C., Valeriane Leroy, Timite-Konan, M., Tonwe-Gold, B., Amani-Bosse, C., Ayekoe, I., Bedikou, G., Coulibaly, N., Danel, C., Likikouet, R., Toure, H., Bonard, D., Inwoley, A., Montcho, C., Allou, G., Castethon, K., Touchard, D., Aka-Dago, H., Brou, H., Du Lou, Ad, Sihe, A., Zanou, B., Blanche, Sp, Delfraissy, Jf, Lepage, P., Mandelbrot, L., and Salanion, R. more...
10. Growth and mortality outcomes for different antiretroviral therapy initiation criteria in children ages 1-5 years: A causal modeling analysis
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Schomaker, M., Davies, M.-A., Malateste, K., Renner, L., Sawry, S., N'Gbeche, S., Technau, K.-G., Eboua, F., Tanser, F., Sygnaté-Sy, H., Phiri, S., Amorissani-Folquet, M., Cox, V., Koueta, F., Chimbete, C., Lawson-Evi, A., Giddy, J., Amani-Bosse, C., Wood, R., Egger, M., Leroy, V., Schomaker, M., Davies, M.-A., Malateste, K., Renner, L., Sawry, S., N'Gbeche, S., Technau, K.-G., Eboua, F., Tanser, F., Sygnaté-Sy, H., Phiri, S., Amorissani-Folquet, M., Cox, V., Koueta, F., Chimbete, C., Lawson-Evi, A., Giddy, J., Amani-Bosse, C., Wood, R., Egger, M., and Leroy, V. more...
- Abstract
BACKGROUND: There is limited evidence regarding the optimal timing of initiating antiretroviral therapy (ART) in children. We conducted a causal modeling analysis in children ages 1-5 years from the International Epidemiologic Databases to Evaluate AIDS West/Southern-Africa collaboration to determine growth and mortality differences related to different CD4-based treatment initiation criteria, age groups, and regions. METHODS: ART-naïve children of ages 12-59 months at enrollment with at least one visit before ART initiation and one follow-up visit were included. We estimated 3-year growth and cumulative mortality from the start of follow-up for different CD4 criteria using g-computation. RESULTS: About one quarter of the 5,826 included children was from West Africa (24.6%).The median (first; third quartile) CD4% at the first visit was 16% (11%; 23%), the median weight-for-age z-scores and height-for-age z-scores were -1.5 (-2.7; -0.6) and -2.5 (-3.5; -1.5), respectively. Estimated cumulative mortality was higher overall, and growth was slower, when initiating ART at lower CD4 thresholds. After 3 years of follow-up, the estimated mortality difference between starting ART routinely irrespective of CD4 count and starting ART if either CD4 count <750 cells/mm³ or CD4% <25% was 0.2% (95% CI = -0.2%; 0.3%), and the difference in the mean height-for-age z-scores of those who survived was -0.02 (95% CI = -0.04; 0.01). Younger children ages 1-2 and children in West Africa had worse outcomes. CONCLUSIONS: Our results demonstrate that earlier treatment initiation yields overall better growth and mortality outcomes, although we could not show any differences in outcomes between immediate ART and delaying until CD4 count/% falls below 750/25%. more...
11. Incidence and risk factors of severe adverse events with nevirapine-based antiretroviral therapy in HIV-infected women. MTCT-Plus program, Abidjan, Côte d'Ivoire.
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Coffie PA, Tonwe-Gold B, Tanon AK, Amani-Bosse C, Bédikou G, Abrams EJ, Dabis F, Ekouevi DK, Coffie, Patrick A, Tonwe-Gold, Besigin, Tanon, Aristophane K, Amani-Bosse, Clarisse, Bédikou, Gédéon, Abrams, Elaine J, Dabis, François, and Ekouevi, Didier K more...
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Background: In resource-limited settings where nevirapine-containing regimen is the preferred regimen in women, data on severe adverse events (SAEs) according to CD4 cell count are limited. We estimated the incidence of SAEs according to CD4 cell count and identify their risk factors in nevirapine-treated women.Methods: All HIV-infected women who initiated nevirapine-containing regimen in the MTCT-Plus operational program in Abidjan, Côte d'Ivoire, were eligible for this study. Laboratory and clinical (rash) SAEs were classified as grade 3 and 4. Cox models were used to identify factors associated with the occurrence of SAEs.Results: From August 2003 to October 2006, 290 women initiated a nevirapine-containing regimen at a median CD4 cell count of 186 cells/mm3 (IQR 124-266). During a median follow-up on treatment of 25 months, the incidence of all SAEs was 19.5/100 patient-years. The 24-month probability of occurrence of hepatotoxicity or rash was not different between women with a CD4 cell count >250 cells/mm3 and women with a CD4 cell count 250 cells/mm3 at treatment initiation nor initiation NVP-based regimen initiated during pregnancy were associated with the occurrence of SAEs.Conclusion: CD4 cell count >250 cells/mm3 was not associated with a higher risk of severe hepatotoxicity and/or rash, as well as initiation of ART during pregnancy. Pharmacovogilance data as well as meta-analysis on women receiving NVP in these settings are needed for better information about NVP toxicity. [ABSTRACT FROM AUTHOR] more...- Published
- 2010
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12. Early mixed feeding and breastfeeding beyond 6 months increase the risk of postnatal HIV transmission: ANRS 1201/1202 Ditrame Plus, Abidjan, Côte d'Ivoire.
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Becquet R, Ekouevi DK, Menan H, Amani-Bosse C, Bequet L, Viho I, Dabis F, Timite-Konan M, Leroy V, and ANRS 1201/1202 Ditrame Plus Study Group
- Abstract
OBJECTIVE: To evaluate the risk of postnatal HIV transmission among women in Abidjan, Côte d'Ivoire offered alternatives to prolonged breastfeeding, and to assess the impact of the breastfeeding pattern and duration on this risk. METHODS: In 2001-2003, HIV-infected pregnant women received peri-partum antiretroviral prophylaxis and were counselled antenatally regarding infant feeding options: formula feeding or exclusive breastfeeding with early cessation from 4 months of age. The primary outcome was HIV postnatal transmission by 18 months of age, defined by a positive HIV test after a negative test > or =30 days. The effect of the pattern (mixed feeding, defined as breastmilk plus food-based fluid, solid food or non-human milk) and duration (less vs. more than 6 months) of breastfeeding on postnatal transmission was assessed. RESULTS: Of 622 live-born infants who were HIV uninfected at or after 30 days, 15 were infected postnatally, 13/324 among breastfed, and 2/298 among formula-fed infants. The 18-month probability of remaining free from HIV infection was 0.95 [95% CI, 0.92-0.97] and 0.99 [95% CI, 0.97-1.00] in the breastfeeding and formula-feeding groups respectively (p<0.001). In adjusted analysis, breastfeeding for more than 6 months and mixed feeding during the first month of life were independently associated with a 7.5 (AOR 95% CI, 2.0-28.2, p=0.003)- and a 6.3 (95% CI, 1.1-36.4, p=0.04)-fold increase of postnatal transmission among breastfed children. CONCLUSIONS: Mixed feeding during the first month of life and breastfeeding beyond 6 months are strong determinants of HIV transmission and should be avoided when replacement feeding after breastfeeding cessation can be safely and sustainably provided. Copyright © 2008 by Elsevier Inc. [ABSTRACT FROM AUTHOR] more...
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- 2008
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13. Virological response and resistances over 12 months among HIV-infected children less than two years receiving first-line lopinavir/ritonavir-based antiretroviral therapy in Cote d'Ivoire and Burkina Faso: the MONOD ANRS 12206 cohort.
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Amani-Bosse C, Dahourou DL, Malateste K, Amorissani-Folquet M, Coulibaly M, Dattez S, Emieme A, Barry M, Rouzioux C, N'gbeche S, Yonaba C, Timité-Konan M, Mea V, Ouédraogo S, Blanche S, Meda N, Seguin-Devaux C, and Leroy V more...
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- Drug Combinations, Drug Resistance, Viral, Female, HIV Infections immunology, HIV Infections virology, Humans, Infant, Male, Prospective Studies, Anti-HIV Agents administration & dosage, HIV Infections drug therapy, Lopinavir administration & dosage, Ritonavir administration & dosage
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Introduction: Lopinavir/ritonavir-based antiretroviral therapy (ART) is recommended for all HIV-infected children less than three years. However, little is known about its field implementation and effectiveness in West Africa. We assessed the 12-month response to lopinavir/ritonavir-based antiretroviral therapy in a cohort of West African children treated before the age of two years., Methods: HIV-1-infected, ART-naive except for a prevention of mother-to-child transmission (PMTCT), tuberculosis-free, and less than two years of age children with parent's consent were enrolled in a 12-month prospective therapeutic cohort with lopinavir/ritonavir ART and cotrimoxazole prophylaxis in Ouagadougou and Abidjan. Virological suppression (VS) at 12 months (viral load [VL] <500 copies/mL) and its correlates were assessed., Results: Between May 2011 and January 2013, 156 children initiated ART at a median age of 13.9 months (interquartile range: 7.8-18.4); 63% were from Abidjan; 53% were girls; 37% were not exposed to any PMTCT intervention or maternal ART; mother was the main caregiver in 81%; 61% were classified World Health Organization Stage 3 to 4. After 12 months on ART, 11 children had died (7%), 5 were lost-to-follow-up/withdrew (3%), and VS was achieved in 109: 70% of children enrolled and 78% of those followed-up. When adjusting for country and gender, the access to tap water at home versus none (adjusted odds ratio (aOR): 2.75, 95% confidence interval (CI): 1.09-6.94), the mother as the main caregiver versus the father (aOR: 2.82, 95% CI: 1.03-7.71), and the increase of CD4 percentage greater than 10% between inclusion and 6 months versus <10% (aOR: 2.55, 95% CI: 1.05-6.18) were significantly associated with a higher rate of VS. At 12 months, 28 out of 29 children with VL ≥1000 copies/mL had a resistance genotype test: 21 (75%) had ≥1 antiretroviral (ARV) resistance (61% to lamivudine, 29% to efavirenz, and 4% to zidovudine and lopinavir/ritonavir), of which 11 (52%) existed before ART initiation., Conclusion: Twelve-month VS rate on lopinavir/ritonavir-based ART was high, comparable to those in Africa or high-income countries. The father as the main child caregiver and lack of access to tap water are risk factors for viral failure and justify a special caution to improve adherence in these easy-to-identify situations before ART initiation. Public health challenges remain to optimize outcomes in children with earlier ART initiation in West Africa., Competing Interests: The authors have no conflicts of interest to disclose. more...
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- 2017
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14. Efavirenz-based simplification after successful early lopinavir-boosted-ritonavir-based therapy in HIV-infected children in Burkina Faso and Côte d'Ivoire: the MONOD ANRS 12206 non-inferiority randomised trial.
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Dahourou DL, Amorissani-Folquet M, Malateste K, Amani-Bosse C, Coulibaly M, Seguin-Devaux C, Toni T, Ouédraogo R, Blanche S, Yonaba C, Eboua F, Lepage P, Avit D, Ouédraogo S, Van de Perre P, N'Gbeche S, Kalmogho A, Salamon R, Meda N, Timité-Konan M, and Leroy V more...
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- Alkynes, Burkina Faso, Child, Preschool, Cote d'Ivoire, Cyclopropanes, Dideoxynucleosides administration & dosage, Drug Combinations, Drug Therapy, Combination, Female, Genotype, HIV Infections virology, HIV-1, Humans, Infant, Infant, Newborn, Lamivudine administration & dosage, Male, Treatment Outcome, Viral Load drug effects, Anti-HIV Agents administration & dosage, Benzoxazines administration & dosage, HIV Infections drug therapy, Lopinavir administration & dosage, Reverse Transcriptase Inhibitors administration & dosage, Ritonavir administration & dosage
- Abstract
Background: The 2016 World Health Organization guidelines recommend all children <3 years start antiretroviral therapy (ART) on protease inhibitor-based regimens. But lopinavir/ritonavir (LPV/r) syrup has many challenges in low-income countries, including limited availability, requires refrigeration, interactions with anti-tuberculous drugs, twice-daily dosing, poor palatability in young children, and higher cost than non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs. Successfully initiating LPV/r-based ART in HIV-infected children aged <2 years raises operational challenges that could be simplified by switching to a protease inhibitor-sparing therapy based on efavirenz (EFV), although, to date, EFV is not recommended in children <3 years., Methods: The MONOD ANRS 12026 study is a phase 3 non-inferiority open-label randomised clinical trial conducted in Abidjan, Côte d'Ivoire, and Ouagadougou, Burkina Faso (ClinicalTrial.gov registry: NCT01127204). HIV-1-infected children who were tuberculosis-free and treated before the age of 2 years with 12-15 months of suppressive twice-daily LPV/r-based ART (HIV-1 RNA viral load (VL) <500 copies/mL, confirmed) were randomised to two arms: once-daily combination of abacavir (ABC) + lamivudine (3TC) + EFV (referred to as EFV) versus continuation of the twice-daily combination zidovudine (ZDV) or ABC + 3TC + LPV/r (referred to as LPV). The primary endpoint was the difference in the proportion of children with virological suppression by 12 months post-randomisation between arms (14% non-inferiority bound, Chi-squared test)., Results: Between May 2011 and January 2013, 156 children (median age 13.7 months) were initiated on ART. After 12-15 months on ART, 106 (68%) were randomised to one of the two treatment arms (54 LPV, 52 EFV); 97 (91%) were aged <3 years. At 12 months post-randomisation, 46 children (85.2%) from LPV versus 43 (82.7%) from EFV showed virological suppression (defined as a VL <500 copies/mL; difference, 2.5%; 95% confidence interval (CI), -11.5 to 16.5), whereas seven (13%) in LPV and seven (13.5%) in EFV were classed as having virological failure (secondary outcome, defined as a VL ≥1000 copies/mL; difference, 0.5%; 95% CI, -13.4 to 12.4). No significant differences in adverse events were observed, with two adverse events in LPV (3.7%) versus four (7.7%) in EFV (p = 0.43). On genotyping, 13 out of 14 children with virological failure (six out of seven EFV, seven out of seven LPV) had a drug-resistance mutation: nine (five out of six EFV, four out of seven LPV) had one or more major NNRTI-resistance mutations whereas none had an LPV/r-resistance mutation., Conclusions: At the VL threshold of 500 copies/mL, we could not conclusively demonstrate the non-inferiority of EFV on viral suppression compared to LPV because of low statistical power. However, non-inferiority was confirmed for a VL threshold of <1000 copies/mL. Resistance analyses highlighted a high frequency of NNRTI-resistance mutations. A switch to an EFV-based regimen as a simplification strategy around the age of 3 years needs to be closely monitored., Trial Registration: ClinicalTrial.gov registry n° NCT01127204 , 19 May 2010. more...
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- 2017
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15. Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.
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Schomaker M, Leroy V, Wolfs T, Technau KG, Renner L, Judd A, Sawry S, Amorissani-Folquet M, Noguera-Julian A, Tanser F, Eboua F, Navarro ML, Chimbetete C, Amani-Bosse C, Warszawski J, Phiri S, N'Gbeche S, Cox V, Koueta F, Giddy J, Sygnaté-Sy H, Raben D, Chêne G, and Davies MA more...
- Subjects
- Adolescent, Africa, Southern epidemiology, Africa, Western epidemiology, Age Distribution, Body Weight, CD4 Lymphocyte Count, Child, Child, Preschool, Data Interpretation, Statistical, Demography, Europe epidemiology, Female, HIV Infections mortality, Humans, Infant, Male, Sex Distribution, Time Factors, Anti-Retroviral Agents administration & dosage, Antiretroviral Therapy, Highly Active, HIV Infections drug therapy
- Abstract
Background: There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents., Methods: A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in Europe, Southern Africa and West Africa, were included. We compared mortality and growth outcomes for different ART initiation criteria, aligned with previous and recent World Health Organization criteria, for 5 years of follow-up, adjusting for all measured baseline and time-dependent confounders using the g-formula., Results: Median (1st;3rd percentile) CD4 count at baseline was 676 cells/mm 3 (394; 1037) (children aged ≥ 1 and < 5 years), 373 (172; 630) (≥ 5 and < 10 years) and 238 (88; 425) (≥ 10 and < 16 years). There was a general trend towards lower mortality and better growth with earlier treatment initiation. In children < 10 years old at enrolment, by 5 years of follow-up there was lower mortality and a higher mean height-for-age z-score with immediate ART initiation versus delaying until CD4 count < 350 cells/mm 3 (or CD4% < 15% or weight-for-age z-score < -2) with absolute differences in mortality and height-for-age z-score of 0.3% (95% confidence interval: 0.1%; 0.6%) and -0.08 (-0.09; -0.06) (≥ 1 and < 5 years), and 0.3% (0.04%; 0.5%) and -0.07 (-0.08; -0.05) (≥ 5 and < 10 years). In those aged > 10 years at enrolment we did not find any difference in mortality or growth with immediate ART initiation, with estimated differences of -0.1% (-0.2%; 0.6%) and -0.03 (-0.05; 0.00), respectively. Growth differences in children aged < 10 years persisted for treatment thresholds using higher CD4 values. Regular follow-up led to better height and mortality outcomes., Conclusions: Immediate ART is associated with lower mortality and better growth for up to 5 years in children < 10 years old. Our results on adolescents were inconclusive., (© The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association) more...
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- 2017
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16. Costs of Care of HIV-Infected Children Initiating Lopinavir/Ritonavir-Based Antiretroviral Therapy before the Age of Two in Cote d'Ivoire.
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Desmonde S, Avit D, Petit J, Amorissani Folquet M, Eboua FT, Amani Bosse C, Dainguy E, Mea V, Timite-Konan M, Ngbeché S, Ciaranello A, and Leroy V
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- Anti-HIV Agents therapeutic use, Cote d'Ivoire, Female, Follow-Up Studies, HIV Infections economics, HIV Infections mortality, Health Care Costs, Humans, Infant, Lost to Follow-Up, Male, Outcome Assessment, Health Care economics, Outcome Assessment, Health Care methods, Outcome Assessment, Health Care statistics & numerical data, Prospective Studies, Survival Rate, Acquired Immunodeficiency Syndrome prevention & control, HIV Infections drug therapy, Lopinavir therapeutic use, Ritonavir therapeutic use
- Abstract
Objectives: To access the costs of care for Ivoirian children before and after initiating LPV/r-based antiretroviral therapy (ART) before the age of two., Methods: We assessed the direct costs of care for all HIV-infected children over the first 12 months on LPV/r-based ART initiated <2 years of age in Abidjan. We recorded all drug prescriptions, ART and cotrimoxazole prophylaxis delivery, medical analyses/examinations and hospital admissions. We compared these costs to those accrued in the month prior to ART initiation. Costs and 95% confidence intervals (95%CI) were estimated per child-month, according to severe morbidity., Results: Of the 114 children screened, 99 initiated LPV/r-based ART at a median age of 13.5 months (IQR: 6.8-18.6); 45% had reached World Health Organization stage 3 or 4. During the first 12 months on ART, 5% died and 3% were lost to follow-up. In the month before ART initiation, the mean cost of care per child-month reached $123.39 (95%CI:$121.02-$125.74). After ART initiation, it was $42.53 (95%CI:$42.15-$42.91); 50% were ART costs. The remaining costs were non-antiretroviral drugs (18%) and medical analyses/examinations (14%). Mean costs were significantly higher within the first three months on ART ($48.76, 95%CI:$47.95-$49.56) and in children experiencing severe morbidity ($49.76, 95%CI:$48.61-50.90)., Conclusion: ART reduces the overall monthly cost of care of HIV-infected children < 2 years. Because children were treated at an advanced HIV disease stage, the additional costs of treating severe morbidity on ART remain substantial. Strategies for treating HIV-infected children as early as possible must remain a priority in Côte d'Ivoire., Competing Interests: The authors have declared that no competing interests exist. more...
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- 2016
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17. Missed opportunities of inclusion in a cohort of HIV-infected children to initiate antiretroviral treatment before the age of two in West Africa, 2011 to 2013.
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Dahourou DL, Amorissani-Folquet M, Coulibaly M, Avit-Edi D, Meda N, Timite-Konan M, Arendt V, Ye D, Amani-Bosse C, Salamon R, Lepage P, and Leroy V
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- Age Factors, Cohort Studies, Female, HIV Infections mortality, Humans, Infant, Infant, Newborn, Logistic Models, Male, Time Factors, Anti-HIV Agents therapeutic use, HIV Infections drug therapy
- Abstract
Introduction: The World Health Organization (WHO) 2010 guidelines recommended to treat all HIV-infected children less than two years of age. We described the inclusion process and its correlates of HIV-infected children initiated on early antiretroviral therapy (EART) at less than two years of age in Abidjan, Côte d'Ivoire, and Ouagadougou, Burkina Faso., Methods: All children with HIV-1 infection confirmed with a DNA PCR test of a blood sample, aged less than two years, living at a distance less than two hours from the centres and whose parents (or mother if she was the only legal guardian or the legal caregiver if parents were not alive) agreed to participate in the MONOD ANRS 12206 project were included in a cohort to receive EART based on lopinavir/r. We used logistic regression to identify correlates of inclusion., Results: Among the 217 children screened and referred to the MONOD centres, 161 (74%) were included and initiated on EART. The main reasons of non-inclusion were fear of father's refusal (48%), mortality (24%), false-positive HIV infection test (16%) and other ineligibility reasons (12%). Having previously disclosed the child's and mother's HIV status to the father (adjusted odds ratio (aOR): 3.20; 95% confidence interval (95% CI): 1.55 to 6.69) and being older than 12 months (aOR: 2.05; 95% CI: 1.02 to 4.12) were correlates of EART initiation. At EART initiation, the median age was 13.5 months, 70% had reached WHO Stage 3/4 and 57% had a severe immune deficiency., Conclusions: Fear of stigmatization by the father and early competing mortality were the major reasons for missed opportunities of EART initiation. There is an urgent need to involve fathers in the care of their HIV-exposed children and to promote early infant diagnosis to improve their future access to EART and survival. more...
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- 2016
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18. Growth and Mortality Outcomes for Different Antiretroviral Therapy Initiation Criteria in Children Ages 1-5 Years: A Causal Modeling Analysis.
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Schomaker M, Davies MA, Malateste K, Renner L, Sawry S, N'Gbeche S, Technau KG, Eboua F, Tanser F, Sygnaté-Sy H, Phiri S, Amorissani-Folquet M, Cox V, Koueta F, Chimbete C, Lawson-Evi A, Giddy J, Amani-Bosse C, Wood R, Egger M, and Leroy V more...
- Subjects
- Burkina Faso, CD4 Lymphocyte Count, Causality, Child, Preschool, Cohort Studies, Cote d'Ivoire, Databases, Factual, Female, Ghana, HIV Infections immunology, HIV Infections mortality, Humans, Infant, Malawi, Male, Senegal, South Africa, Time Factors, Togo, Zimbabwe, Anti-HIV Agents therapeutic use, Antiretroviral Therapy, Highly Active methods, Child Development, Early Medical Intervention, HIV Infections drug therapy
- Abstract
Background: There is limited evidence regarding the optimal timing of initiating antiretroviral therapy (ART) in children. We conducted a causal modeling analysis in children ages 1-5 years from the International Epidemiologic Databases to Evaluate AIDS West/Southern-Africa collaboration to determine growth and mortality differences related to different CD4-based treatment initiation criteria, age groups, and regions., Methods: ART-naïve children of ages 12-59 months at enrollment with at least one visit before ART initiation and one follow-up visit were included. We estimated 3-year growth and cumulative mortality from the start of follow-up for different CD4 criteria using g-computation., Results: About one quarter of the 5,826 included children was from West Africa (24.6%).The median (first; third quartile) CD4% at the first visit was 16% (11%; 23%), the median weight-for-age z-scores and height-for-age z-scores were -1.5 (-2.7; -0.6) and -2.5 (-3.5; -1.5), respectively. Estimated cumulative mortality was higher overall, and growth was slower, when initiating ART at lower CD4 thresholds. After 3 years of follow-up, the estimated mortality difference between starting ART routinely irrespective of CD4 count and starting ART if either CD4 count <750 cells/mm³ or CD4% <25% was 0.2% (95% CI = -0.2%; 0.3%), and the difference in the mean height-for-age z-scores of those who survived was -0.02 (95% CI = -0.04; 0.01). Younger children ages 1-2 and children in West Africa had worse outcomes., Conclusions: Our results demonstrate that earlier treatment initiation yields overall better growth and mortality outcomes, although we could not show any differences in outcomes between immediate ART and delaying until CD4 count/% falls below 750/25%. more...
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- 2016
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19. Association between age at antiretroviral therapy initiation and 24-month immune response in West-African HIV-infected children.
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Desmonde S, Dicko F, Koueta F, Eboua T, Balestre E, Amani-Bosse C, Aka EA, Lawson-Evi K, Amorissani-Folquet M, Kouakou K, Koumakpai S, Renner L, Signaté Sy H, and Leroy V
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- Africa, Western, Age Factors, CD4 Lymphocyte Count, Child, Child, Preschool, Female, Humans, Infant, Male, Sex Factors, Treatment Outcome, Anti-Retroviral Agents therapeutic use, CD4-Positive T-Lymphocytes immunology, HIV Infections drug therapy, HIV Infections immunology
- Abstract
Objective: We describe the association between age at antiretroviral therapy (ART) initiation and 24-month CD4 cell response in West African HIV-infected children., Methods: All HIV-infected children from the IeDEA paediatric West African cohort, initiating ART, with at least two CD4 cell count measurements, including one at ART initiation (baseline) were included. CD4 cell gain on ART was estimated using a multivariable linear mixed model adjusted for baseline variables: age, CD4 cell count, sex, first-line ART regimen. Kaplan-Meier survival curves and a Cox proportional hazards regression model compared immune recovery for age within 24 months post-ART., Results: Of the 4808 children initiated on ART, 3014 were enrolled at a median age of 5.6 years; 61.2% were immunodeficient. After 12 months, children at least 4 years at baseline had significantly lower CD4 cell gains compared with children less than 2 years, the reference group (P<0.001). However, by 24 months, we observed higher CD4 cell gain in children who initiated ART between 3 and 4 years compared with those less than 2 years (P<0.001). The 24-month CD4 cell gain was also strongest in immunodeficient children at baseline. Among these children, 75% reached immune recovery: 12-month rates were significantly highest in all those aged 2-5 years at ART initiation compared with those less than 2 years. Beyond 12 months on ART, immune recovery was significantly lower in children initiated more than 5 years (adjusted hazard ratio: 0.69, 95% confidence interval: 0.56-0.86)., Conclusion: These results suggest that both the initiation of ART at the earliest age less than 5 years and before any severe immunodeficiency is needed for improving 24-month immune recovery on ART. more...
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- 2014
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20. Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa.
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Ndondoki C, Dicko F, Ahuatchi Coffie P, Kassi Eboua T, Ekouevi DK, Kouadio K, Edmond Aka A, Malateste K, Dabis F, Amani-Bosse C, Toure P, and Leroy V
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- Child, Preschool, Cote d'Ivoire epidemiology, Female, HIV Infections drug therapy, HIV Infections epidemiology, Humans, Infant, Infectious Disease Transmission, Vertical statistics & numerical data, Kaplan-Meier Estimate, Male, Mali epidemiology, Retrospective Studies, Treatment Failure, Anti-HIV Agents therapeutic use, HIV Infections prevention & control, Infectious Disease Transmission, Vertical prevention & control
- Abstract
Introduction: We assessed the rate of treatment failure of HIV-infected children after 12 months on antiretroviral treatment (ART) in the Paediatric IeDEA West African Collaboration according to their perinatal exposure to antiretroviral drugs for preventing mother-to-child transmission (PMTCT)., Methods: A retrospective cohort study in children younger than five years at ART initiation between 2004 and 2009 was nested within the pWADA cohort, in Bamako-Mali and Abidjan-Côte d'Ivoire. Data on PMTCT exposure were collected through a direct review of children's medical records. The 12-month Kaplan-Meier survival without treatment failure (clinical or immunological) was estimated and their baseline factors studied using a Cox model analysis. Clinical failure was defined as the appearance or reappearance of WHO clinical stage 3 or 4 events or any death occurring within the first 12 months of ART. Immunological failure was defined according to the 2006 World Health Organization age-related immunological thresholds for severe immunodeficiency., Results: Among the 1035 eligible children, PMTCT exposure was only documented for 353 children (34.1%) and remained unknown for 682 (65.9%). Among children with a documented PMTCT exposure, 73 (20.7%) were PMTCT exposed, of whom 61.0% were initiated on a protease inhibitor-based regimen, and 280 (79.3%) were PMTCT unexposed. At 12 months on ART, the survival without treatment failure was 40.6% in the PMTCT-exposed group, 25.2% in the unexposed group and 18.5% in the children with unknown exposure status (p=0.002). In univariate analysis, treatment failure was significantly higher in children unexposed (HR 1.4; 95% CI: 1.0-1.9) and with unknown PMTCT exposure (HR 1.5; 95% CI: 1.2-2.1) rather than children PMTCT-exposed (p=0.01). In the adjusted analysis, treatment failure was not significantly associated with PMTCT exposure (p=0.15) but was associated with immunodeficiency (aHR 1.6; 95% CI: 1.4-1.9; p=0.001), AIDS clinical events (aHR 1.4; 95% CI: 1.0-1.9; p=0.02) at ART initiation and receiving care in Mali compared to Côte d'Ivoire (aHR 1.2; 95% CI: 1.0-1.4; p=0.04)., Conclusions: Despite a low data quality, PMTCT-exposed West African children did not have a poorer 12-month response to ART than others. Immunodeficiency and AIDS events at ART initiation remain the main predictors associated with treatment failure in this operational context. more...
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- 2014
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21. Evaluation of dried blood spot diagnosis using HIV1-DNA and HIV1-RNA Biocentric assays in infants in Abidjan, Côte d'Ivoire. The Pedi-Test DBS ANRS 12183 Study.
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Yapo V, d'Aquin Toni Td, Desmonde S, Amani-Bosse C, Oga M, Lenaud S, Menan H, Timité-Konan M, Leroy V, and Rouzioux C
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- Child, Preschool, Cote d'Ivoire, DNA, Viral genetics, Desiccation, HIV Infections virology, HIV-1 genetics, Humans, Infant, Plasma virology, RNA, Viral genetics, Sensitivity and Specificity, Viral Load methods, Blood virology, DNA, Viral isolation & purification, HIV Infections diagnosis, HIV-1 isolation & purification, Molecular Diagnostic Techniques methods, RNA, Viral isolation & purification, Specimen Handling methods
- Abstract
This study evaluates HIV infant diagnosis on DBS using Biocentric HIV1-DNA and HIV1-RNA assays, in field conditions in Côte d'Ivoire. Paediatric screening was offered to children≤3 years in clinical sites in Côte d'Ivoire in 2008. For each HIV-infected child, two non-infected children were included and blood samples were collected. HIV-DNA results obtained on EDTA blood samples with Biocentric assay were the reference for HIV infant diagnosis. Plasma and DBS viral loads were measured using HIV-RNA Biocentric assay. DBS samples were also tested for HIV-DNA detection using both Biocentric and Amplicor Roche assays. Sensitivity, specificity and concordance between tests were calculated. Overall samples from 138 HIV-exposed children, 46 infected, 92 non-infected were included. All tests were 100% sensitive and specific including 100% concordance with the two HIV-DNA assays. The median level of HIV-DNA on EDTA samples was 3.15 log10 copies/10(6) PBMCs; the median level of HIV RNA in plasma and DBS were respectively 5.82 and 5.17 log10 copies/ml (Pearson's correlation R2=0.92, p<0.0001). The threshold for detectable HIV-RNA on DBS was 3.3 log10. Although there are differences between viral load measured on DBS and plasma, the two Biocentric assays present very good performances for HIV infant diagnosis on DBS while cheap and feasible., (Copyright © 2013 Elsevier B.V. All rights reserved.) more...
- Published
- 2013
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22. Universal HIV screening at postnatal points of care: which public health approach for early infant diagnosis in Côte d'Ivoire?
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Ndondoki C, Brou H, Timite-Konan M, Oga M, Amani-Bosse C, Menan H, Ekouévi D, and Leroy V
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- Adult, Antiretroviral Therapy, Highly Active, Attitude of Health Personnel, Child, Preschool, Cote d'Ivoire, Cross-Sectional Studies, Fathers, Female, Health Services Accessibility, Humans, Infant, Infant, Newborn, Male, Mothers, Patient Participation, Pediatrics methods, Regression Analysis, Reproducibility of Results, Young Adult, HIV Infections diagnosis, Infectious Disease Transmission, Vertical, Mass Screening methods, Patient Acceptance of Health Care
- Abstract
Background: Universal HIV pediatric screening offered at postnatal points of care (PPOC) is an entry point for early infant diagnosis (EID). We assessed the parents' acceptability of this approach in Abidjan, Côte d'Ivoire., Methods: In this cross-sectional study, trained counselors offered systematic HIV screening to all children aged 6-26 weeks attending PPOC in three community health centers with existing access to HAART during 2008, as well as their parents/caregivers. HIV-testing acceptability was measured for parents and children; rapid HIV tests were used for parents. Both parents' consent was required according to the Ivorian Ethical Committee to perform a HIV test on HIV-exposed children. Free HIV care was offered to those who were diagnosed HIV-infected., Findings: We provided 3,013 HIV tests for infants and their 2,986 mothers. While 1,731 mothers (58%) accepted the principle of EID, only 447 infants had formal parental consent 15%; 95% confidence interval (CI): [14%-16%]. Overall, 1,817 mothers (61%) accepted to test for HIV, of whom 81 were HIV-infected (4.5%; 95% CI: [3.5%-5.4%]). Among the 81 HIV-exposed children, 42 (52%) had provided parental consent and were tested: five were HIV-infected (11.9%; 95% CI: [2.1%-21.7%]). Only 46 fathers (2%) came to diagnose their child. Parental acceptance of EID was strongly correlated with prenatal self-reported HIV status: HIV-infected mothers were six times more likely to provide EID parental acceptance than mothers reporting unknown or negative prenatal HIV status (aOR: 5.9; 95% CI: [3.3-10.6], p = 0.0001)., Conclusions: Although the principle of EID was moderately accepted by mothers, fathers' acceptance rate remained very low. Routine HIV screening of all infants was inefficient for EID at a community level in Abidjan in 2008. Our results suggest the need of focusing on increasing the PMTCT coverage, involving fathers and tracing children issued from PMTCT programs in low HIV prevalence countries. more...
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- 2013
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23. Health care resource utilization in untreated HIV-infected children in a pediatric programme, Abidjan, Côte d'Ivoire, 2004-2009.
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Desmonde S, Coffie PA, Aka EA, Amani-Bosse C, Messou E, Dabis F, Ciaranello A, and Leroy V
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- Adolescent, Ambulatory Care statistics & numerical data, Child, Child, Preschool, Cohort Studies, Cote d'Ivoire, Female, Hospitalization statistics & numerical data, Humans, Infant, Infant, Newborn, Male, Prospective Studies, HIV Infections diagnosis, HIV Infections pathology, Health Services statistics & numerical data
- Abstract
Background: We describe health care resource utilization among HIV-1-infected children who have not yet undergone antiretroviral treatment (ART) in Abidjan, Côte d'Ivoire., Methods: HIV-infected children enrolled prospectively in an HIV care programme in 2 health facilities in Abidjan (2004-2009) were followed up from date of inclusion until database closeout, death, ART initiation, or loss to follow-up (no clinical contact for more than 6 months). Incidences of health care resource utilization (outpatient care, inpatient day care, and hospitalization) were described according to severe morbidity and mixed effect log linear models were computed to identify associated factors., Results: Overall, 405 children were included, entering care at a median age of 4.5 years, 66.9% were receiving cotrimoxazole prophylaxis, and 27.7% met 2006 WHO criteria for immunodeficiency by age. The median follow-up time was 11.6 months (interquartile range: 1.4; 30.7). Overall, 371 clinical events occurred in 162 children yielding to an incidence rate (IR) of 60.9/100 child-years (CY) [95% confidence interval (CI): 55.1 to 67.2]: 57% of clinical events led to outpatient care (IR: 33/100 CY), 38% to inpatient day care (IR: 22/100 CY), and 10% to hospitalization (IR: 5.9/100 CY). Further medical examinations were made allowing confirmed diagnoses in 40% of those (IR: 22.4/100 CY). Outpatient care was less common among immunodeficient children than those not (relative risk [RR] = 0.32, 95% CI: 0.18 to 0.56), in those whose main caregivers are both parents compared with those who are primarily cared for by their mother only (RR = 0.34, 95% CI: 0.15 to 0.77)., Conclusion: Untreated HIV-infected children require substantial inpatient and outpatient care in a context where ART is scaling up but still not available to all. more...
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- 2013
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24. Severe morbidity and mortality in untreated HIV-infected children in a paediatric care programme in Abidjan, Côte d'Ivoire, 2004-2009.
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Desmonde S, Coffie P, Aka E, Amani-Bosse C, Messou E, Dabis F, Alioum A, Ciaranello A, and Leroy V
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- Adolescent, Anti-HIV Agents therapeutic use, Child, Child, Preschool, Cote d'Ivoire epidemiology, Female, HIV Infections drug therapy, Humans, Infant, Male, Morbidity, Mortality, Pediatrics statistics & numerical data, Prospective Studies, Retrospective Studies, HIV Infections epidemiology, HIV Infections mortality
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Background: Clinical evolution of HIV-infected children who have not yet initiated antiretroviral treatment (ART) is poorly understood in Africa. We describe severe morbidity and mortality of untreated HIV-infected children., Methods: All HIV-infected children enrolled from 2004-2009 in a prospective HIV programme in two health facilities in Abidjan, Côte d'Ivoire, were eligible from their time of inclusion. Risks of severe morbidity (the first clinical event leading to death or hospitalisation) and mortality were documented retrospectively and estimated using cumulative incidence functions. Associations with baseline characteristics were assessed by competing risk regression models between outcomes and antiretroviral initiation., Results: 405 children were included at a median age of 4.5 years; at baseline, 66.9% were receiving cotrimoxazole prophylaxis, and 27.7% met the 2006 WHO criteria for immunodeficiency by age. The risk of developing a severe morbid event was 14% (95%CI: 10.7 - 17.8) at 18 months; this risk was lower in children previously exposed to any prevention of mother-to-child-transmission (PMTCT) intervention (adjusted subdistribution hazard ratio [sHR]: 0.16, 95% CI: 0.04 - 0.71) versus those without known exposure. Cumulative mortality reached 5.5% (95%CI: 3.5 - 8.1) at 18 months. Mortality was associated with immunodeficiency (sHR: 6.02, 95% CI: 1.28-28.42)., Conclusions: Having benefited from early access to care minimizes the severe morbidity risk for children who acquire HIV. Despite the receipt of cotrimoxazole prophylaxis, the risk of severe morbidity and mortality remains high in untreated HIV-infected children. Such evidence adds arguments to promote earlier access to ART in HIV-infected children in Africa and improve care interventions in a context where treatment is still not available to all. more...
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- 2011
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25. Plasma and intracellular tenofovir pharmacokinetics in the neonate (ANRS 12109 trial, step 2).
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Hirt D, Ekouévi DK, Pruvost A, Urien S, Arrivé E, Blanche S, Avit D, Amani-Bosse C, Nyati M, Legote S, Ek ML, Say L, McIntyre J, Dabis F, and Tréluyer JM
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- Adenine pharmacokinetics, Female, Humans, Pregnancy, Tenofovir, Acquired Immunodeficiency Syndrome drug therapy, Adenine analogs & derivatives, Anti-HIV Agents pharmacokinetics, HIV-1, Infant, Newborn metabolism, Infectious Disease Transmission, Vertical prevention & control, Organophosphonates pharmacokinetics, Pregnancy Complications, Infectious drug therapy
- Abstract
The objective of this study was to investigate for the first time tenofovir (TFV) pharmacokinetics in plasma and peripheral blood mononuclear cells (PBMCs) of the neonate. HIV-1-infected pregnant women received two tablets of tenofovir disoproxil fumarate (TDF; 300 mg) and emtricitabine (FTC; 200 mg) at onset of labor and then one tablet daily for 7 days postpartum. A single dose of 13 mg/kg of body weight of TDF was administered to 36 neonates within 12 h of life after the HIV-1-infected mothers had been administered two tablets of TDF-emtricitabine at delivery. A total of 626 samples collected within the 2 days after the drug administration were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and analyzed by a population approach. In the neonate, the median TFV plasma area under the curve and minimal and maximal concentrations, respectively, were 3.73 mg/liter · h and 0.076 and 0.29 mg/liter. In PBMCs, TFV concentrations were detectable in all fetuses, whereas tenofovir diphosphate (TFV-DP) was quantifiable in only two fetuses, suggesting a lag in appearance of TFV-DP. The median TFV-DP neonatal concentration was 146 fmol/10⁶ cells (interquartile range [IQR], 53 to 430 fmol/10⁶ cells); two neonates had very high TFV-DP concentrations (1,530 and 2963 fmol/10⁶ cells). The 13-mg/kg TDF dose given to neonates produced plasma TFV and intracellular active TFV-DP concentrations similar to those in adults. This dose should be given immediately after birth to reduce the delay before the active compound TFV-DP appears in cells. more...
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- 2011
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26. Pregnancy outcomes in women exposed to efavirenz and nevirapine: an appraisal of the IeDEA West Africa and ANRS Databases, Abidjan, Côte d'Ivoire.
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Ekouevi DK, Coffie PA, Ouattara E, Moh R, Amani-Bosse C, Messou E, Sissoko M, Anglaret X, Eholié SP, Danel C, and Dabis F
- Subjects
- Abortion, Induced statistics & numerical data, Abortion, Spontaneous diagnosis, Adult, Africa, Western, Alkynes, Cyclopropanes, Female, Humans, Infant, Low Birth Weight, Infant, Newborn, Pregnancy, Premature Birth diagnosis, Retrospective Studies, Risk Assessment, Stillbirth, Anti-HIV Agents administration & dosage, Benzoxazines administration & dosage, HIV Infections drug therapy, Nevirapine administration & dosage, Pregnancy Complications, Infectious drug therapy, Pregnancy Outcome
- Abstract
Background: An increasing number of HIV-infected women become pregnant while receiving efavirenz (EFV). We compared the pregnancy outcomes of women exposed to EFV and to nevirapine (NVP) during the first trimester., Methods: A retrospective study in 4 HIV care centers participating to clinical trials and international cohort collaboration. All HIV-infected pregnant women who conceived on EFV-based or NVP-based antiretroviral therapy (ART) between 2003 and 2009 were included. Pregnancy outcomes were as follows: abortion (voluntary termination), miscarriage [unwanted termination <20 weeks of amenorrhea (WA)], stillborn (death ≥ 20 WA), preterm delivery (live-birth <37 WA), and low birth weight (LBW) (<2500 grams)., Results: Overall, 344 HIV-infected pregnant women conceived on ART (213 on EFV and 131 on NVP). Median age was 29 years, and median CD4 count 217 cells per microliter at ART initiation. The overall proportion was 11.7% for abortion, 5.2% for miscarriage, 6.7% for stillborn, 10.8% for preterm delivery, and 20.2% for LBW. There was no difference between EFV and NVP exposure, except for abortion (14.3% vs 7.3%; P = 0.05). No external and visible congenital malformation was observed neither in women exposed to EFV nor in women exposed to NVP., Conclusions: Among women exposed to EFV, no significant increased risk of unfavorable pregnancy outcome was reported except for abortion. more...
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- 2011
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27. Immunological response to highly active antiretroviral therapy following treatment for prevention of mother to child transmission of HIV-1: a study in Côte d'Ivoire.
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Ekouevi DK, Coffie PA, Chaix ML, Tonwe-Gold B, Amani-Bosse C, Leroy V, Abrams EJ, and Dabis F
- Subjects
- Adult, CD4 Lymphocyte Count, Cote d'Ivoire, Female, HIV Infections virology, HIV-1 isolation & purification, Humans, Lamivudine therapeutic use, Nevirapine therapeutic use, Treatment Outcome, Zidovudine therapeutic use, Anti-HIV Agents therapeutic use, Antiretroviral Therapy, Highly Active, HIV Infections drug therapy, HIV Infections immunology, Infectious Disease Transmission, Vertical prevention & control
- Abstract
Background: Information is currently limited on the long-term follow up of HIV-1 infected women who are on highly active antiretroviral therapy (HAART) that contains nevirapine and lamivudine and who were previously exposed to antiretroviral drugs for the prevention of mother to child transmission (PMTCT) of HIV., Methods: We studied the 36-month immunological response to HAART in HIV-1 infected women in Côte d'Ivoire. The women were previously exposed to antiretroviral drug regimens for PMTCT, including single-dose nevirapine and/or short-course zidovudine with or without lamivudine. All HAART regimens included a non-nucleoside reverse transcriptase inhibitor., Results: At 36 months: the median absolute increase in CD4+ T cell count was +359 cells/mm3 (IQR: 210-466) in 200 women who had undergone 36-month follow-up visits; +359 cells/mm3 (IQR: 222-491) in 88 women not exposed to PMTCT antiretrovirals; and +363 cells/mm3 (IQR: 200-464) in 112 women exposed to at least one antiretroviral PMTCT regimen. Overall, 49 (19.8%) of the 247 women who initiated HAART met the immunological failure criteria at least once during follow up. The overall probability of immunological failure was 0.08 (95% CI: 0.12-0.15) at 12 months, and 0.21 (95% CI: 0.16-0.27) at 36 months. No difference was observed according to the presence or absence of resistance mutations to nevirapine or lamivudine in women tested at four weeks postpartum. In addition, at 36 months, 23% of women were lost to follow up, dead or had stopped their treatment., Conclusions: A non-nucleoside reverse transcriptase inhibitor-based antiretroviral regimen, initiated a year or more after PMTCT exposure and that includes nevirapine, remains a good option for at least the first 36 months of treatment. more...
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- 2010
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28. Low retention of HIV-infected patients on antiretroviral therapy in 11 clinical centres in West Africa.
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Ekouevi DK, Balestre E, Ba-Gomis FO, Eholie SP, Maiga M, Amani-Bosse C, Minga A, Messou E, Sow PS, Lewden C, Traoré HA, Bissagnene E, and Dabis F
- Subjects
- Adolescent, Adult, Age Factors, CD4 Lymphocyte Count, Epidemiologic Methods, Female, HIV Infections immunology, Health Services Accessibility statistics & numerical data, Humans, Male, Middle Aged, Sex Factors, Young Adult, Antiretroviral Therapy, Highly Active statistics & numerical data, HIV Infections drug therapy, Medication Adherence statistics & numerical data
- Abstract
Objective: To study factors associated with the probability of retention in antiretroviral therapy (ART) programmes in West Africa., Methods: The International epidemiologic Databases to Evaluate AIDS (IeDEA) in West Africa is a prospective, operational, observational cohort study based on collaboration between 11 cohorts of HIV-infected adult patients in Benin, Côte d'Ivoire, Gambia, Mali and Senegal. All patients aged 16 and older at ART initiation, with documented gender and date of ART initiation, were included. For those with at least 1 day of follow-up, Kaplan-Meier method and Weibull regression model were used to estimate the 12-month probability of retention in care and the associated factors., Results: In this data merger, 14 352 patients (61% female) on ART were included. Median age was 37 (interquartile range (IQR): 31-44 years) and median CD4 count at baseline was 131 cells/mm(3) (IQR: 48-221 cells/mm(3)). The first-line regimen was NNRTI-based for 78% of patients, protease inhibitor-based for 17%, and three NRTIs for 3%. The probability of retention was 0.90 [95% confidence interval (CI): 0.89-0.90] at 3 months, 0.84 (95% CI: 0.83-0.85) at 6 months and 0.76 (95% CI: 0.75-0.77) at 12 months. The probability of retention in care was lower in patients with baseline CD4 count <50 cells/mm(3) [adjusted hazard ratio (aHR) = 1.37; 95% CI: 1.27-1.49; P < 0.0001] (reference CD4 > 200 cells/mm(3), in men (aHR = 1.17; 95% CI: 1.10-1.24; P = 0.0002), in younger patients (<30 years) (aHR = 1.10; 95% CI: 1.03-1.19; P = 0.01) and in patients with low haemoglobinaemia <8 g/dl (aHR = 1.33; 95% CI: 1.21-1.45; P < 0.0001). Availability of funds for systematic tracing was associated with better retention (aHR = 0.29; 95% CI: 0.16-0.55; P = 0.001)., Conclusions: Close follow-up, promoting early access to care and ART and a decentralized system of care may improve the retention in care of HIV-infected patients on ART. more...
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- 2010
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29. Antiretroviral treatment and prevention of peripartum and postnatal HIV transmission in West Africa: evaluation of a two-tiered approach.
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Tonwe-Gold B, Ekouevi DK, Viho I, Amani-Bosse C, Toure S, Coffie PA, Rouet F, Becquet R, Leroy V, El-Sadr WM, Abrams EJ, and Dabis F
- Subjects
- Anti-HIV Agents administration & dosage, Anti-HIV Agents adverse effects, Breast Feeding adverse effects, CD4 Lymphocyte Count, Cohort Studies, Cote d'Ivoire epidemiology, Female, Follow-Up Studies, HIV Infections congenital, HIV Infections drug therapy, HIV Infections transmission, HIV-1, Humans, Infant, Infant, Low Birth Weight, Infant, Newborn, Lamivudine administration & dosage, Lamivudine therapeutic use, Male, Nevirapine administration & dosage, Nevirapine therapeutic use, Pregnancy, Program Evaluation, Puerperal Disorders drug therapy, Viral Load, Zidovudine administration & dosage, Zidovudine therapeutic use, Anti-HIV Agents therapeutic use, Antiretroviral Therapy, Highly Active adverse effects, Antiretroviral Therapy, Highly Active statistics & numerical data, HIV Infections prevention & control, Infectious Disease Transmission, Vertical prevention & control, Pregnancy Complications, Infectious drug therapy
- Abstract
Background: Highly active antiretroviral treatment (HAART) has only been recently recommended for HIV-infected pregnant women requiring treatment for their own health in resource-limited settings. However, there are few documented experiences from African countries. We evaluated the short-term (4 wk) and long-term (12 mo) effectiveness of a two-tiered strategy of prevention of mother-to-child transmission of HIV (PMTCT) in Africa: women meeting the eligibility criteria of the World Health Organization (WHO) received HAART, and women with less advanced HIV disease received short-course antiretroviral (scARV) PMTCT regimens., Methods and Findings: The MTCT-Plus Initiative is a multi-country, family-centred HIV care and treatment program for pregnant and postpartum women and their families. Pregnant women enrolled in Abidjan, Côte d'Ivoire received either HAART for their own health or short-course antiretroviral (scARV) PMTCT regimens according to their clinical and immunological status. Plasma HIV-RNA viral load (VL) was measured to diagnose peripartum infection when infants were 4 wk of age, and HIV final status was documented either by rapid antibody testing when infants were aged > or = 12 mo or by plasma VL earlier. The Kaplan-Meier method was used to estimate the rate of HIV transmission and HIV-free survival. Between August 2003 and June 2005, 107 women began HAART at a median of 30 wk of gestation, 102 of them with zidovudine (ZDV), lamivudine (3TC), and nevirapine (NVP) and they continued treatment postpartum; 143 other women received scARV for PMTCT, 103 of them with sc(ZDV+3TC) with single-dose NVP during labour. Most (75%) of the infants were breast-fed for a median of 5 mo. Overall, the rate of peripartum HIV transmission was 2.2% (95% confidence interval [CI] 0.3%-4.2%) and the cumulative rate at 12 mo was 5.7% (95% CI 2.5%-9.0%). The overall probability of infant death or infection with HIV was 4.3% (95% CI 1.7%-7.0%) at age week 4 wk and 11.7% (95% CI 7.5%-15.9%) at 12 mo., Conclusions: This two-tiered strategy appears to be safe and highly effective for short- and long-term PMTCT in resource-constrained settings. These results indicate a further benefit of access to HAART for pregnant women who need treatment for their own health. more...
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- 2007
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30. Impact of nevirapine (NVP) plasma concentration on selection of resistant virus in mothers who received single-dose NVP to prevent perinatal human immunodeficiency virus type 1 transmission and persistence of resistant virus in their infected children.
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Chaix ML, Ekouevi DK, Peytavin G, Rouet F, Tonwe-Gold B, Viho I, Bequet L, Amani-Bosse C, Menan H, Leroy V, Rouzioux C, and Dabis F
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- Adult, Anti-HIV Agents pharmacokinetics, Cohort Studies, Drug Resistance, Viral genetics, Female, HIV Infections transmission, HIV-1 genetics, Humans, Infant, Newborn, Monocytes virology, Mutation genetics, Nevirapine pharmacokinetics, Phylogeny, Predictive Value of Tests, Pregnancy, RNA, Viral blood, Anti-HIV Agents blood, Anti-HIV Agents pharmacology, Drug Resistance, Viral drug effects, HIV Infections prevention & control, HIV Infections virology, HIV-1 drug effects, Nevirapine blood, Nevirapine pharmacology
- Abstract
Nonnucleoside reverse transcriptase inhibitor resistance following the use of single-dose nevirapine (sdNVP) for the prevention of mother-to-child transmission (PMTCT) remains a concern. In the ANRS-1201/1202 Ditrame study, conducted in Abidjan, Côte d'Ivoire, a short-course regimen of zidovudine was associated with sdNVP for PMTCT. In this study, we estimate the frequency of NVP resistance and its relationship with NVP concentration in mothers. Genotypic resistance analysis was performed on mothers' plasma samples at week 4 postpartum (PP) and on human immunodeficiency virus (HIV) DNA in peripheral blood mononuclear cells (PBMC) when an NVP resistance mutation was detected. The same tests were performed for the infected children at week 4, month 3, and month 12. Mothers' NVP plasma concentrations were measured at 48 h PP. Twenty-one (33%) of the 63 women selected had NVP-resistant (NVP-R) virus at week 4 PP. The median plasma NVP concentration was 598 ng/ml for the mothers without NVP-R virus compared to 851 ng/ml for the mothers harboring NVP-R virus (P = 0.014). NVP-R mutations were detected in the HIV DNA of 15/20 women. Plasma NVP-R mutations were detectable in 6 of 26 infected children at week 4. All 6 children had detectable NVP-R mutations in HIV DNA of PBMC. Blood samples taken at month 3 (1 child) and month 12 (1 child) revealed the persistence of NVP-R mutations in plasma and cells. Emergence of NVP-R virus in mothers is strongly correlated with a high level of plasma NVP concentration, owing to a prolonged postpartum period of viral replication under NVP selective pressure. The follow-up of the cohort demonstrates the prolonged archive of resistant virus. more...
- Published
- 2007
- Full Text
- View/download PDF
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