Cliniques en santé maternelle et infantile

Abstrait

HIV Morbidity and Mortality in the Pediatric Population of Côte d’Ivoire

Folquet AM, Dainguy ME, Kangoute M, Kouakou C, Kouadio E, Zobo Konan N, Oka Berete G, Kouadio Yapo G, Gro Bi A, Djivohessoun A, Djoman I and Jager F

Introduction: The aim of our study was to describe the morbidity and mortality patterns in HIV-positive pediatric patients followed at the unit in charge of Pediatric HIV, in the pediatrics department of Cocody University Teaching Hospital (CHU-Cocody).

Method: This hospital-based retrospective study focused on 218 pediatric patients enrolled at the CHU-Cocody from November 28th 2005 until June 30th 2010. Outcomes of children with anti-retroviral therapy (group A) and children without (Group B) anti-retroviral therapy were described and compared. Antiretroviral Therapy (ART) - eligibility followed national guidelines thus withholding treatment for immune-competent children or those with contraindications to ARTs such as increased transaminases (>10x) or vital distress.

Results: The average age of children in group A, was 66.11 months, they were symptomatic in 84.74% of cases, and presented with severe immunodeficiency in 54.74%. The children in group B were younger (mean age=49.14 months), mostly only mildly symptomatic (39.80%) and thus usually without severe immunodeficiency (64.29%). Nearly all children were infected with HIV-1 and receiving cotrimoxazole prophylaxis. There were 764 disease events that occurred during follow-up including 633 in group A and 131 in group B. Anemia (p=0.036) and pneumonia (p=0.011) were more frequent in group A. Hospitalizations were more common in group A children (124/190) than group B children (10/28, p=0.0027). In Group B, the mortality rate was very high (75%) (OR=16, 95% CI [5.79-45.90.], P<0.001) and concerned predominantly children under the age of 24 months (OR=0.08, 95% CI [0.01-0.47.], p=0.0017) and earlier (OR=0.21, 95% CI [0.03-1.25.], P=0.047).

Conclusion: Much remains to be done in countries with limited resources to improve pediatric HIV- treatment and survival, especially among the very young, which are weakened by childhood diseases. The implementation of WHO recommendations by the government must become a priority, this in order to improve the survival of affected children.