Main Article Content
Abstract
RÉSUMÉ
Introduction. L’infection à VIH est une pandémie mondiale et les pays en développement y payent le plus gros tribut. Le nombre d’enfants infectés par le VIH atteignant l’adolescence est en constante augmentation. L’objectif était d’analyser les facteurs associés à la suppression de la charge virale chez les adolescents infectés par le VIH. Matériels et méthodes. Etude transversale à visée analytique chez 393 adolescents infectés par le VIH et suivis au CEP du CHU Gabriel Touré de 2010 à 2017. Les données ont été saisies et analysées avec les logiciel SPSS version 21.0 et R version 2.15.2. Résultats. L’âge moyen à l’initiation du traitement ARV était de 63,77±44,19 mois. Le sex ratio était de 1,2 en faveur des garçons. Ils étaient orphelins d'au moins un parent dans 55,1% des cas. Les adolescents sous 1ère ligne représentaient 40,5% et la dernière charge virale était indétectable chez 51,4%. Selon la classification de l’OMS, 67,8% étaient au stade clinique 3 ou 4 et 43,7% avaient un déficit immunitaire important ou sévère. La durée moyenne de traitement était de 9,79 ± 3,4 ans. Les facteurs associés à la suppression de la charge virale étaient la 1ère ligne thérapeutique 2,1 (1,36-3,23); l’âge actuel d’au moins 15 ans 9,04 (0,93-87,91), l’absence de déficit sévère à l’inclusion 1,67 (1,05-2,65). Conclusion. La 1ère ligne thérapeutique, l’âge des adolescents et la mise sous traitement ARV sans déficit sévère sont des facteurs associés à la suppression de la charge virale quel que soit le statut orphelin.
ABSTRACT
Objective. To analyze factors associated with viral load suppression among HIV infected adolescents in the Gabriel TOURÉ Medical Center. Methods. We conducted a cross sectional study of 393 HIV-infected adolescents in the Gabriel TOURÉ Medical Center, followed from 2010 to 2017. Adolescents sociodemographic, virologic and clinical characteristics were analyzed. Undetectable viral load was evaluated by status of orphan, treatment regimen, age at treatment initiation and length of follow up in a bivariate and then multivariate analysis (logistic regression). Data were analyzed using SPSS version 21.0. Results. We collected medical records of 393 HIV seropositive adolescents. The mean age at ARV therapy initiation was 63,77±44,19 months; 55,1% were orphans of at least one parent. At initiation, 67.8% were at WHO clinical stages III or IV; 40,5% were on first line regimen; the last viral load was undetectable in 51%. Adolescents on first line regimen are more likely to have undetectable viral loads 0,46 [0.31 – 0.70]. Those initiated before the age of 5 years and on first line regimen are 2.7 times more likely to have an undetectable viral load 2,7 [1.6 – 4.4] with P<0.001. Conclusion. First line ARV therapy is strongly associated with viral load suppression among adolescents regardless of the status of orphan.
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References
- Quinn TC. HIV epidemiology and the effects of antiviral therapy on long term consequences. AIDS 2008, 22 (3):7-12
- World Health Organization (WHO). Global report 2006. Progress on global access to HIV antiretroviral therapy. WHO/UNAIDS 2006 [cité le 05 Sept 2018]. Disponible sur:
- https://www.who.int/hiv/fullreport_en_highres.pdf
- ANECCA. Réseau africain pour les soins aux enfants affectés par le sida. Troisième édition 2017 [cité le 05 Sept 2018]. Disponible sur: anecca.org/wp content/uploads/2017/12/FR-HIV-in-Africa_web.pdf
- UNAIDS. 90-90-90. An ambitious treatment target to help end the AIDS epidemic. 2014 [cité le 05 Sept 2018]. Disponible sur: www.unaids.org/en/resources/documents/2017/90-90-90
- Alou S. Résultats de la prise en charge de l’infection à VIH au Mali. 2013 [cité le 05 Sept 2018]. Disponible sur: preventcrypto.org/wpcontent/uploads/.../MaliARTguidelines20131413102690.pdf
- Viani RAC, Fenton T, Acosta EP et al. Study team, safety, pharmacokinetics and efficacy of Dolutegravir in treatment-experienced HIV-1 infected adolescents : forty-eight-week results from IMPAACT. Pediatr Infect Dis J 2015, 18 (1): 114-120.
- WHO. Consolidated guidelines on The use of Anti retroviral Drugs for Treating and Preventing HIV Infection. Recommendations for a public Heath approach 2013 [cité le 05 Sept 2018]. Disponible sur: http://www.who.int/hiv/pub/guidelines/ arv2013/download/en/.
- Funck B, Blanche S. Différences et normalités dans l'infection à VIH de l'enfant et de l'adolescent : une problématique identitaire complexe. Neuropsychiatrie de l'enfance et de l'adolescence 2009; 57: 303-315.
- Trocmé N. Deux années de rencontres au sein d’un groupe d’adolescents séropositifs. Le Journal de la Démocratie sanitaire 2002, 7 (2): 24–32.
- Médecine tropical. le sida tropical (infection par le VIh/sida et tropique). Med. Trop 2008 [cité le 10 Sept 2018]. Disponible sur: medecinetropicale.free.fr/cours/sida_tropical.pdf
- Ma Y, Zhao D, Yu L et al. Predictors of virologic failure in HIV-1 infected adults receiving first-line antiretroviral therapy in 8 provinces in China. Clin Infect Dis 2010; 50(2): 264–271.
- Mutwa PR, Boer KR, Rusine J et al. Long-term Effectiveness of Combination Antiretroviral Therapy and Prevalence of HIV Drug Resistance in HIV-1-infected Children and Adolescents in Rwanda. Pediatr Infect Dis J 2014; 33(1): 63–69.
- WHO. HIV and adolescents: guidance for HIV testing and counselling and care for adolescents living with HIV 2013 [cité le 10 Sept 2018]. Disponible sur: http://apps.who.int/iris/bitstream
- Jobanputra K, Parker LA, Azih C et al. Impact and programmatic implications of routine viral load monitoring in Swaziland. JAIDS 2014; 27 (2): 88–92.
- Gilles F, Benjamin P. Le virus du sida 2015 [cité le 10 Sept 2018]. Disponible sur: https://planet-vie.ens.fr/article/1463/virus-sida
- Trocmé N. Quand adolescence rime avec séropositivité. Santé mentale, 2003; 75: 12-16.
- Dollfus C. Long-term outcomes in adolescents perinatally infected with HIV-1 and followed up since birth in the French perinatal cohort. Clin Infect Dis 2010; 51(2): 214-224.
- Martino M, Tovo PA, Balducci M. Reduction in mortality with availability of antiretroviral therapy for children with perinatal HIV-1 infection. Italian Register for HIV Infection in Children and the Italian National. JAMA 2000; 28(4): 190-197.
- Gortmaker SL, Hughes M, Cervia J. Pediatric AIDS Clinical Trials Group Protocol 219 Team. Effect of combination therapy including protease inhibitors on mortality among children and adolescents infected with HIV-1. N Engl J Med 2001; 345: 1522-1528.
- Patel LK, Hernan MA, Williams PL. Long-term effectiveness of highly active antiretroviral therapy on the survival of children and adolescents with HIV infection: a 10-year follow-up study. Clin Infect Dis 2008; 46: 507-515.
- Larru B, Resino S, Bellon JM. Long-term response to highly active antiretroviral therapy with lopinavir/ritonavir in pre-treated vertically HIV-infected children. J Antimicrob Chemother 2008; 61: 183-190.
- Judd A, Doerholt K, Tookey PA. National Study of HIV in Pregnancy and childhood (NSHPC). Morbidity, mortality, and response to treatment by children in the United Kingdom and Ireland with perinatally acquired HIV infection during 1996-2006 : planning for teenage and adult care. Clin Infect Dis 2007; 47: 918-924.
- Doerholt K, Duong T, Tookey P. Outcomes for human immunodeficiency virus-1-infected infants in the United kingdom and Republic of Ireland in the era of effective antiretroviral therapy. Pediatr Infect Dis J 2006; 25: 420-426.
- Guillen S, Ramos JT, Resino R. Impact on weight and height with the use of HAART in HIV-infected children. Pediatr Infect Dis J 2007; 26: 334-338.
- Kourtis AP, Bansil P, Posner SF. Trends in hospitalizations of HIV-infected children and adolescents in the United States : analysis of data from the 1994-2003 Nationwide Inpatient Sample. Pediatrics 2007; 120: 236-243.
- Nesheim SR, Kapogiannis BG, Soe MM. Trends in opportunistic infections in the pre- and post-highly active antiretroviral therapy eras among HIV-infected children in the Perinatal AIDS Collaborative Transmission Study, Pediatrics 2007; 120: 100-109.
- Resino S, Resino R, Micheloud D. Long-term effects of highly active antiretroviral therapy in pretreated,vertically HIV type 1-infected children : 6 years of follow-up. Clin Infect Dis 2006; 42: 862-869.
- Vanrossum AM, Fraaij PL, Degroot R. Efficacy of highly active antiretroviral therapy in HIV-1 infected children. Lancet Infect Dis, 2002; 2: 93-102.
- Delaugerre C, Warszawski J, Chaix ML. Prevalence and risk factors associated with antiretroviral resistance in HIV-1-infected children. J Med Viro 2007; 79: 1261-1269.
- Vignoles M, Barboni G, Agosti MR. High frequency of primary mutations associated with antiretroviral drug resistance in recently diagnosed HIV-infected children. Antivir Ther, 2007; 12: 1133-1137.
- Van Oosterhout JJ, Brown L, Weigel R et al. Diagnosis of antiretroviral therapy failure in Malawi : poor performance of clinical and immunological WHO criteria. Trop Med Int Health 14(8): 856-861.
- Hosseinipour MC, Schechter M. Monitoring antiretroviral therapy in resource-limited settings : balancing clinical care technology and human resources. Curr HIV/AIDS Rep 2010; 7(3): 168-174.
- Mee P, Fielding KL, Charalambous S et al. Evaluation of the WHO criteria for antiretroviral treatment failure among adults in South Africa. AIDS 2008; 22(15): 1971-1977.
- MSF-cohort, Pujades, CROI. Les switch tardifs augmentent la mortalité et la morbidité 2010 [cité le 10 Sept 2018]. Disponible sur: https://slideplayer.fr/slide/460369/
- Hansudewechakul R, Sirisanthana V, Kurniati N et al. Antiretroviral therapy outcomes of HIV-infected children in the treat Asia pediatric HIV observational database. J Acquir Immune Defic Syndr 2010; 55(4): 503-509.
- Calixte Ida P, Francine SB, Danielle KM et al. Échecs thérapeutiques chez les enfants infectés par le VIH en suivi de routine dans un contexte à ressources limitées au Cameroun: étude transversale rétrospective. PanAfrican Médical journal 2013; 21(2): 81–85.
- Ahoua L, Guenther G, Rouzioux C et al. Immunovirological response to combines antiretroviral therapy and drug resistance patterns in children: 1- and 2-year outcomes in rural Uganda. BMC Pediatr. 2011; 32(3): 124–132.
- Musoke PM, Mudiope P, Barlow-Mosha LN et al. Growth, immune and viral responses in HIV infected African children receiving highly active antiretroviral therapy: a prospective cohort study. BMC Pediatr 2010; 19(2): 42–46.
- Okomo U, Togun T, Oko F et al. Treatment outcomes among HIV-1 and HIV-2 infected children initiating antiretroviral therapy in a concentrated low prevalence setting in West Africa. BMC Pediatr 2012; 41(3): 77–82.
- Janssen N, Ndirangu J, Newel ML, Bland RM. Successful paediatric HIV treatment in rural primary care in Africa. Arch Dis Child 2010; 95(6): 414–421.
- Isaakidis P, Raguenaud ME, Te V et al. High survival and treatment success sustained after two and three years of first line ART for children in Cambodia. J Int AIDS Soc 2010; 70(5): 214-219.
- Edmonds A, Yotebieng M, Lusiama J et al. The effect of highly active antiretroviral therapy on the survival of HIV- infected children in a resource- deprived setting: A cohort study. Plos Med 2011; 8(6): 42.
- Reddi A, Leeper SC, Grobler AC et al. Preliminary outcomes of paediatric highly active antiretroviral therapy cohort from KwaZulu-Natal, South Africa. BMC Pediatrics 2007; 51(4): 124–130.
- Dalmeida M, Sagbo G, Lalya F et al. Profil des enfants infectés par le VIH suivis au centre national hospitalier et universitaire (CNHU) de Cotonou : Etude transversale, descriptive et analytique. Mali Médical 2013; 28(2): 44-46.
- Atakouma DY, Tsolenyanu E, Gbadoe A et al. Le traitement antirétroviral des enfants infectés par le VIH/SIDA à Lomé (Togo): Premiers résultats. Arch Pédiatr 2007; 14: 1178-1182.
- M’pemba Loufoua-Lemay AB, Nzingoula S. Le SIDA au CHU de Brazzaville : expérience du service de pédiatrie "Grands enfants". Bull Soc Pathol Exot 2003; 96(4): 291-294.
- Gilbert T, Maria L, Chloe T. High Retention Among HIV-infected Children in Rwanda During Scale-up and Decentralization of HIV Care and Treatment Programs. Pediatr Infect Dis J 2013; 72(3): 112–117.
- Brittain K, Asafu-Agyei NA, Hoare J et al. Association of Adolescent- and Caregiver-Reported Antiretroviral Therapy Adherence with HIV Viral Load Among Perinatally-infected South African Adolescents. AIDS Behav 2018; 22(3): 909-917.
- Githinji LN, Gray DM, Hlengwa S et al. Lung function in south african adolescents infected perinatally with HIV and treated long-term with antiretroviral therapy. Ann Am Thorac Soc 2017; 14(5): 722-729.
References
Quinn TC. HIV epidemiology and the effects of antiviral therapy on long term consequences. AIDS 2008, 22 (3):7-12
World Health Organization (WHO). Global report 2006. Progress on global access to HIV antiretroviral therapy. WHO/UNAIDS 2006 [cité le 05 Sept 2018]. Disponible sur:
https://www.who.int/hiv/fullreport_en_highres.pdf
ANECCA. Réseau africain pour les soins aux enfants affectés par le sida. Troisième édition 2017 [cité le 05 Sept 2018]. Disponible sur: anecca.org/wp content/uploads/2017/12/FR-HIV-in-Africa_web.pdf
UNAIDS. 90-90-90. An ambitious treatment target to help end the AIDS epidemic. 2014 [cité le 05 Sept 2018]. Disponible sur: www.unaids.org/en/resources/documents/2017/90-90-90
Alou S. Résultats de la prise en charge de l’infection à VIH au Mali. 2013 [cité le 05 Sept 2018]. Disponible sur: preventcrypto.org/wpcontent/uploads/.../MaliARTguidelines20131413102690.pdf
Viani RAC, Fenton T, Acosta EP et al. Study team, safety, pharmacokinetics and efficacy of Dolutegravir in treatment-experienced HIV-1 infected adolescents : forty-eight-week results from IMPAACT. Pediatr Infect Dis J 2015, 18 (1): 114-120.
WHO. Consolidated guidelines on The use of Anti retroviral Drugs for Treating and Preventing HIV Infection. Recommendations for a public Heath approach 2013 [cité le 05 Sept 2018]. Disponible sur: http://www.who.int/hiv/pub/guidelines/ arv2013/download/en/.
Funck B, Blanche S. Différences et normalités dans l'infection à VIH de l'enfant et de l'adolescent : une problématique identitaire complexe. Neuropsychiatrie de l'enfance et de l'adolescence 2009; 57: 303-315.
Trocmé N. Deux années de rencontres au sein d’un groupe d’adolescents séropositifs. Le Journal de la Démocratie sanitaire 2002, 7 (2): 24–32.
Médecine tropical. le sida tropical (infection par le VIh/sida et tropique). Med. Trop 2008 [cité le 10 Sept 2018]. Disponible sur: medecinetropicale.free.fr/cours/sida_tropical.pdf
Ma Y, Zhao D, Yu L et al. Predictors of virologic failure in HIV-1 infected adults receiving first-line antiretroviral therapy in 8 provinces in China. Clin Infect Dis 2010; 50(2): 264–271.
Mutwa PR, Boer KR, Rusine J et al. Long-term Effectiveness of Combination Antiretroviral Therapy and Prevalence of HIV Drug Resistance in HIV-1-infected Children and Adolescents in Rwanda. Pediatr Infect Dis J 2014; 33(1): 63–69.
WHO. HIV and adolescents: guidance for HIV testing and counselling and care for adolescents living with HIV 2013 [cité le 10 Sept 2018]. Disponible sur: http://apps.who.int/iris/bitstream
Jobanputra K, Parker LA, Azih C et al. Impact and programmatic implications of routine viral load monitoring in Swaziland. JAIDS 2014; 27 (2): 88–92.
Gilles F, Benjamin P. Le virus du sida 2015 [cité le 10 Sept 2018]. Disponible sur: https://planet-vie.ens.fr/article/1463/virus-sida
Trocmé N. Quand adolescence rime avec séropositivité. Santé mentale, 2003; 75: 12-16.
Dollfus C. Long-term outcomes in adolescents perinatally infected with HIV-1 and followed up since birth in the French perinatal cohort. Clin Infect Dis 2010; 51(2): 214-224.
Martino M, Tovo PA, Balducci M. Reduction in mortality with availability of antiretroviral therapy for children with perinatal HIV-1 infection. Italian Register for HIV Infection in Children and the Italian National. JAMA 2000; 28(4): 190-197.
Gortmaker SL, Hughes M, Cervia J. Pediatric AIDS Clinical Trials Group Protocol 219 Team. Effect of combination therapy including protease inhibitors on mortality among children and adolescents infected with HIV-1. N Engl J Med 2001; 345: 1522-1528.
Patel LK, Hernan MA, Williams PL. Long-term effectiveness of highly active antiretroviral therapy on the survival of children and adolescents with HIV infection: a 10-year follow-up study. Clin Infect Dis 2008; 46: 507-515.
Larru B, Resino S, Bellon JM. Long-term response to highly active antiretroviral therapy with lopinavir/ritonavir in pre-treated vertically HIV-infected children. J Antimicrob Chemother 2008; 61: 183-190.
Judd A, Doerholt K, Tookey PA. National Study of HIV in Pregnancy and childhood (NSHPC). Morbidity, mortality, and response to treatment by children in the United Kingdom and Ireland with perinatally acquired HIV infection during 1996-2006 : planning for teenage and adult care. Clin Infect Dis 2007; 47: 918-924.
Doerholt K, Duong T, Tookey P. Outcomes for human immunodeficiency virus-1-infected infants in the United kingdom and Republic of Ireland in the era of effective antiretroviral therapy. Pediatr Infect Dis J 2006; 25: 420-426.
Guillen S, Ramos JT, Resino R. Impact on weight and height with the use of HAART in HIV-infected children. Pediatr Infect Dis J 2007; 26: 334-338.
Kourtis AP, Bansil P, Posner SF. Trends in hospitalizations of HIV-infected children and adolescents in the United States : analysis of data from the 1994-2003 Nationwide Inpatient Sample. Pediatrics 2007; 120: 236-243.
Nesheim SR, Kapogiannis BG, Soe MM. Trends in opportunistic infections in the pre- and post-highly active antiretroviral therapy eras among HIV-infected children in the Perinatal AIDS Collaborative Transmission Study, Pediatrics 2007; 120: 100-109.
Resino S, Resino R, Micheloud D. Long-term effects of highly active antiretroviral therapy in pretreated,vertically HIV type 1-infected children : 6 years of follow-up. Clin Infect Dis 2006; 42: 862-869.
Vanrossum AM, Fraaij PL, Degroot R. Efficacy of highly active antiretroviral therapy in HIV-1 infected children. Lancet Infect Dis, 2002; 2: 93-102.
Delaugerre C, Warszawski J, Chaix ML. Prevalence and risk factors associated with antiretroviral resistance in HIV-1-infected children. J Med Viro 2007; 79: 1261-1269.
Vignoles M, Barboni G, Agosti MR. High frequency of primary mutations associated with antiretroviral drug resistance in recently diagnosed HIV-infected children. Antivir Ther, 2007; 12: 1133-1137.
Van Oosterhout JJ, Brown L, Weigel R et al. Diagnosis of antiretroviral therapy failure in Malawi : poor performance of clinical and immunological WHO criteria. Trop Med Int Health 14(8): 856-861.
Hosseinipour MC, Schechter M. Monitoring antiretroviral therapy in resource-limited settings : balancing clinical care technology and human resources. Curr HIV/AIDS Rep 2010; 7(3): 168-174.
Mee P, Fielding KL, Charalambous S et al. Evaluation of the WHO criteria for antiretroviral treatment failure among adults in South Africa. AIDS 2008; 22(15): 1971-1977.
MSF-cohort, Pujades, CROI. Les switch tardifs augmentent la mortalité et la morbidité 2010 [cité le 10 Sept 2018]. Disponible sur: https://slideplayer.fr/slide/460369/
Hansudewechakul R, Sirisanthana V, Kurniati N et al. Antiretroviral therapy outcomes of HIV-infected children in the treat Asia pediatric HIV observational database. J Acquir Immune Defic Syndr 2010; 55(4): 503-509.
Calixte Ida P, Francine SB, Danielle KM et al. Échecs thérapeutiques chez les enfants infectés par le VIH en suivi de routine dans un contexte à ressources limitées au Cameroun: étude transversale rétrospective. PanAfrican Médical journal 2013; 21(2): 81–85.
Ahoua L, Guenther G, Rouzioux C et al. Immunovirological response to combines antiretroviral therapy and drug resistance patterns in children: 1- and 2-year outcomes in rural Uganda. BMC Pediatr. 2011; 32(3): 124–132.
Musoke PM, Mudiope P, Barlow-Mosha LN et al. Growth, immune and viral responses in HIV infected African children receiving highly active antiretroviral therapy: a prospective cohort study. BMC Pediatr 2010; 19(2): 42–46.
Okomo U, Togun T, Oko F et al. Treatment outcomes among HIV-1 and HIV-2 infected children initiating antiretroviral therapy in a concentrated low prevalence setting in West Africa. BMC Pediatr 2012; 41(3): 77–82.
Janssen N, Ndirangu J, Newel ML, Bland RM. Successful paediatric HIV treatment in rural primary care in Africa. Arch Dis Child 2010; 95(6): 414–421.
Isaakidis P, Raguenaud ME, Te V et al. High survival and treatment success sustained after two and three years of first line ART for children in Cambodia. J Int AIDS Soc 2010; 70(5): 214-219.
Edmonds A, Yotebieng M, Lusiama J et al. The effect of highly active antiretroviral therapy on the survival of HIV- infected children in a resource- deprived setting: A cohort study. Plos Med 2011; 8(6): 42.
Reddi A, Leeper SC, Grobler AC et al. Preliminary outcomes of paediatric highly active antiretroviral therapy cohort from KwaZulu-Natal, South Africa. BMC Pediatrics 2007; 51(4): 124–130.
Dalmeida M, Sagbo G, Lalya F et al. Profil des enfants infectés par le VIH suivis au centre national hospitalier et universitaire (CNHU) de Cotonou : Etude transversale, descriptive et analytique. Mali Médical 2013; 28(2): 44-46.
Atakouma DY, Tsolenyanu E, Gbadoe A et al. Le traitement antirétroviral des enfants infectés par le VIH/SIDA à Lomé (Togo): Premiers résultats. Arch Pédiatr 2007; 14: 1178-1182.
M’pemba Loufoua-Lemay AB, Nzingoula S. Le SIDA au CHU de Brazzaville : expérience du service de pédiatrie "Grands enfants". Bull Soc Pathol Exot 2003; 96(4): 291-294.
Gilbert T, Maria L, Chloe T. High Retention Among HIV-infected Children in Rwanda During Scale-up and Decentralization of HIV Care and Treatment Programs. Pediatr Infect Dis J 2013; 72(3): 112–117.
Brittain K, Asafu-Agyei NA, Hoare J et al. Association of Adolescent- and Caregiver-Reported Antiretroviral Therapy Adherence with HIV Viral Load Among Perinatally-infected South African Adolescents. AIDS Behav 2018; 22(3): 909-917.
Githinji LN, Gray DM, Hlengwa S et al. Lung function in south african adolescents infected perinatally with HIV and treated long-term with antiretroviral therapy. Ann Am Thorac Soc 2017; 14(5): 722-729.