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. 2021 Apr 21;21(1):189.
doi: 10.1186/s12887-021-02664-6.

Long-term outcomes of early initiated antiretroviral therapy in sub-Saharan children: a Cameroonian cohort study (ANRS-12140 Pediacam study, 2008-2013, Cameroon)

Francis Ateba Ndongo  1 , Mathurin Cyrille Tejiokem  2 , Calixte Ida Penda  3 , Suzie Tetang Ndiang  4 , Jean-Audrey Ndongo  5 , Georgette Guemkam  5 , Casimir Ledoux Sofeu  6 , Paul Alain Tagnouokam-Ngoupo  7 , Anfumbom Kfutwah  7 , Philippe Msellati  8 , Albert Faye  9 , Josiane Warszawski  10
Affiliations

Long-term outcomes of early initiated antiretroviral therapy in sub-Saharan children: a Cameroonian cohort study (ANRS-12140 Pediacam study, 2008-2013, Cameroon)

Francis Ateba Ndongo et al. BMC Pediatr. .

Abstract

Background: In most studies, the virological response is assessed during the first two years of antiretroviral treatment initiated in HIV-infected infants. However, early initiation of antiretroviral therapy exposes infants to very long-lasting treatment. Moreover, maintaining viral suppression in children is difficult. We aimed to assess the virologic response and mortality in HIV-infected children after five years of early initiated antiretroviral treatment (ART) and identify factors associated with virologic success in Cameroon.

Methods: In the ANRS-12140 Pediacam cohort study, 2008-2013, Cameroon, we included all the 149 children who were still alive after two years of early ART. Virologic response was assessed after 5 years of treatment. The probability of maintaining virologic success between two and five years of ART was estimated using Kaplan-Meier curve. The immune status and mortality were also studied at five years after ART initiation. Factors associated with a viral load < 400 copies/mL in children still alive at five years of ART were studied using logistic regressions.

Results: The viral load after five years of early ART was suppressed in 66.8% (60.1-73.5) of the 144 children still alive and in care. Among the children with viral suppression after two years of ART, the probability of maintaining viral suppression after five years of ART was 64.0% (54.0-74.0). The only factor associated with viral suppression after five years of ART was achievement of confirmed virological success within the first two years of ART (OR = 2.7 (1.1-6.8); p = 0.033).

Conclusions: The probability of maintaining viral suppression between two and five years of early initiated ART which was quite low highlights the difficulty of parents to administer drugs daily to their children in sub-Saharan Africa. It also stressed the importance of initial viral suppression for achieving and maintaining virologic success in the long-term. Further studies should focus on identifying strategies that would enhance better retention in care and improved adherence to treatment within the first two years of ART early initiated in Sub-Saharan HIV-infected children.

Keywords: Early initiated antiretroviral treatment; HIV-infected children; Long-term outcomes.

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Conflict of interest statement

The authors have no conflicts of interest relevant to this article to disclose.

Figures

Fig. 1
Fig. 1
Flow chart of HIV-infected infants initiating ART (ANRS-Pediacam Study, 2008–2013, Cameroon). ART: Antiretroviral therapy
Fig. 2
Fig. 2
Kaplan-Meier curve: probability of maintaining a viral load < 400 copies/mL between 2 and 5 years after antiretroviral treatment initiation among the 90 children with a viral load < 400 copies/mL at 2 years after antiretroviral treatment initiation (ANRS-Pediacam Study, 2008–2013, Cameroon)
See this image and copyright information in PMC

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