Alarming rates of virological failure and HIV-1 drug resistance amongst adolescents living with perinatal HIV in both urban and rural settings: evidence from the EDCTP READY-study in Cameroon.

OBJECTIVES: Adolescents living with perinatal HIV infection (ALPHI) experience persistently high mortality rates, particularly in resource-limited settings. It is therefore clinically important for us to understand the therapeutic response, acquired HIV drug resistance (HIVDR) and associated factors among ALPHI, according to geographical location. METHODS: A study was conducted among consenting ALPHI in two urban and two rural health facilities in the Centre Region of Cameroon. World Health Organization (WHO) clinical staging, self-reported adherence, HIVDR early warning indicators (EWIs), immunological status (CD4 count) and plasma viral load (VL) were assessed. For those experiencing virological failure (VF, VL ≥ 1000 copies/mL), HIVDR testing was performed and interpreted using the Stanford HIV Drug Resistance Database v.8.9-1. RESULTS: Of the 270 participants, most were on nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens (61.7% urban vs. 82.2% rural), and about one-third were poorly adherent (30.1% vs. 35.1%). Clinical failure rates (WHO-stage III/IV) in both settings were < 15%. In urban settings, the immunological failure (IF) rate (CD4  < 250 cells/µL) was 15.8%, statistically associated with late adolescence, female gender and poor adherence. The VF rate was 34.2%, statistically associated with poor adherence and NNRTI-based antiretroviral therapy. In the rural context, the IF rate was 26.9% and the VF rate was 52.7%, both statistically associated with advanced clinical stages. HIVDR rate was over 90% in both settings. EWIs were delayed drug pick-up, drug stock-outs and suboptimal viral suppression. CONCLUSIONS: Poor adherence, late adolescent age, female gender and advanced clinical staging worsen IF. The VF rate is high and consistent with the presence of HIVDR in both settings, driven by poor adherence, NNRTI-based regimen and advanced clinical staging.

[12-months efficacy of option B+ for prevention of mother-to-child transmission of HIV in Yaoundé, Cameroon]. / Efficacité à 12 mois de l'option B+ pour prévenir la transmission mère-enfant (PTME) du VIH à Yaoundé, Cameroun.

BACKGROUND: Cameroon has adopted the option B+ for the prevention of mother-to-child transmission (MTCT) program of HIV in August 2014 in order to eradicate MTCT of HIV. OBJECTIVE: To analyze in routine life settings, efficacy of option B+ for PMTCT and associate factors. METHODS: We conducted a cross-sectional study over a 6-month period in the ESSOS hospital center. Study population comprised HIV-positive mothers and their infants aged 0-24 months. Variables included were : moment of HIV maternal testing, timing of commencement of maternal antiretroviral therapy (ART) and self-reported adherence to ART. Efficacy was measured through early and late MTCT rate and associated factors. RESULTS: We included 200 mothers and 124 infants. Under option B+, the rate of transmission was at 4.20% at 6 weeks and 5.83% at 12 months. The rate of HIV transmission in breastfed infants stood at 3.7%. In unadjusted analysis, bottle-feeding, term at birth, early screening and management during pregnancy were associated with lower risk of HIV transmission. After adjustment, term at delivery after 37 weeks adjusted odds ratio (AOR) [0.059; (0.0061; 0.56)] was protective; while lack of prophylaxis was among HIV-exposed infants emerged as the main factor associated with residual transmission of HIV [AOR 117.23 ; (3.55 ; 3874.9)]. CONCLUSION: In this setting of Yaoundé, routine option B+ posted laudable results at 12 months even amongst breastfed children and should therefore be made sustainable.

Predictors of mortality among HIV-infected children receiving highly active antiretroviral therapy.

BACKGROUND AND OBJECTIVES: The mortality rate of HIV-infected children can be reversed under highly active antiretroviral therapy (HAART). The impact of HAART on the mortality of HIV-infected children in Cameroon has not been extensively documented. We aimed to measure the mortality rate of HIV-infected children under HAART and to identify predictive factors of mortality. METHODS: Retrospective cohort study of 221 children initiated on HAART from 2005 to 2009 and followed-up until 2013. Survival data was analyzed using Kaplan Meier method and Cox regression model to identify independent predictors of child mortality on HAART. RESULTS: Overall, 9.9% of children (n=22) died over a follow-up period of 755 child-years (mortality of 2.9 per 100 child-years); 70% of deaths occurred during the first six months of HAART. The probability of survival after four years of treatment was 88.7% (95% CI=[84.2-93.3]). During the multivariate analysis of baseline variables, we observed that the WHO clinical stages III and IV (HR: 3.55 [1.09-13.6] and HR: 7.7 [3.07-31.2]) and age≤1year at HAART initiation were independently associated with death (HR: 2.1 [1.01-5.08]). Neither orphanhood, baseline CD4 count or hemoglobin level nor low nutritional status predicted death in this cohort. CONCLUSION: The mortality of children receiving HAART was low after five years of follow-up and it was strongly associated with WHO stages III and IV and a younger age at treatment initiation.

Therapeutic patient education and disclosure of status of HIV infected children in Yaounde, Cameroon Achievements and competence.

INTRODUCTION: Psychosocial support and therapeutic patient education are recommended practices that are poorly reported. Our objective was to describe the main achievements after a patient therapeutic education program conducted for pre-adolescents and adolescents with HIV infection. METHOD: This qualitative study of 37 children with a mean age of 11 years assessed the outcome of an educational program of 8 sessions that ended by the disclosure of their HIV status. Semistructured interviews that took place 8 weeks after the last session and lasted 20 minutes evaluated the following areas: knowledge of the disease, its treatment, its prevention, and their skills in managing their treatment and the secret. RESULTS: The level of knowledge was acceptable except about HIV transmission, and specifically, how they had acquired the disease. In all, 33/37 (89%) of the children were able to cite or write the name of their disease; 29/37 (78%) had acquired knowledge of their treatment (name of the drugs, objective, and daily treatment times); they were able to manage treatment intake away from home; and secrecy was the standard for all. However, many were unable to explain how they had acquired the virus. CONCLUSION: Therapeutic patient education for HIV status disclosure enables adolescents to acquire knowledge about their disease and the ability to manage it. The poor results observed for knowledge of transmission needs to be improved after disclosure in support groups.

[Trends in neonatal mortality of very-low-birth-weight infants between 1998 and 2013 in Essos Hospital, Yaoundé, Cameroon]. / Tendances évolutives de la mortalité néonatale des nouveau-nés de moins de 1500g de 1998 à 2013 au centre hospitalier d'Essos, Yaoundé, Cameroun.

OBJECTIVE: To measure the mortality rate and the survival of very-low-birth-weight (VLBW) infants at two given periods. METHOD: Descriptive retrospective study. Data were extracted from activity reports and pediatric registries during the years 1998, 1999, and 2004 for the first period and from 2010 to 2013 from the second period. This population study comprised all VLBW infants admitted to the unit weighing <1500g irrespective of gestational age. The main outcome measurement was the percentage of VLBW infants discharged alive during each period. RESULTS: During the cumulated period, we included a total of 5250 newborn babies, of whom 315 were VLBW, giving a prevalence of 6% (7.1% in period 1 vs 5.5% in period 2, P≤0.05). The overall survival rate of VLNW infants was 52%, corresponding to a mortality rate of 48%. The death rate was 53% during the first period vs 46% in period 2 (P=0.9). In infants weighing between 1000 and 1500g, the mortality rate ranged from 47% in period 1 to 37% in period 2 (P≤0.05). Below 1000g, the rate of survival was consistently below 5%, significantly lower than for infants born above 1000g (P<0.001). In period 2, the caesarian section rate was 7% (20/217), 11% between 1000 and 1500g, 0% below 1000g. The mortality rate was higher with vaginal delivery (47%; 93/196) versus 20% caesarian section (4/20) (OR 3, 61 [1.17-11], P≤0.02). CONCLUSION: In this center, the hospital mortality rate of VLBW infants seems to have improved, notably in those weighing more than 1000g. Significant efforts are needed to prevent VLBW births and improve management of both delivery and newborn care.