title: Morbidity after antiretroviral therapy initiation in HIV-1-infected children in West Africa: temporal trends and relation to CD4 count.
abstract: BACKGROUND
  Although 90% of HIV-1-infected children live in sub-Saharan Africa, morbidity data after highly active antiretroviral therapy (HAART) initiation in these settings are limited. The objective of this study was to document the incidence of AIDS-defining events and non-AIDS-defining diseases in African children receiving HAART.
  
  
  METHODS
  Incidences rates (IRs) of AIDS-defining events and 10 other common diseases were estimated overall and by current CD4-strata (<15%, 15 - <25% and ≥25%) from 2 prospective cohorts of African children.
  
  
  RESULTS
  One hundred eighty-eight children contributing to 355 children-years were included. The documented morbidity IRs per 100 children-years were upper respiratory infections, 100 (87-114); infectious diarrhea, 37 (31-44); World Health Organization (WHO) stage 2 events, 22.9 (18.2-28.1); and WHO stage 3/4 events, 12.3 (9.1-16.7). IRs of WHO stage 2 events, severe bacterial infections, infectious diarrhea and pneumonia decreased linearly across all CD4%-strata, whereas WHO stage 3/4 events and viral infections occurred mostly when CD4% <15%. Overall, IRs decreased during the first 2 years on HAART except for upper respiratory infection, mycosis and oral candidiasis.
  
  
  CONCLUSIONS
  This incidence of AIDS- and non-AIDS-defining diseases declined substantially after HAART in 2 African cohorts, although estimates remained high compared with high-resource settings. Without renewed efforts to increase antiretroviral scale-up, children in developing countries will continue to have a high burden of infections.
authors.affiliation: UMI 233 Institut de Recherche pour le Développement, Université Montpellier I, Université Cheikh Anta Diop, Université de Yaoundé I. pierre.debeaudrap@ird.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: De Beaudrap
authors.forename: Charlotte
authors.initials: C
authors.lastname: Boullé
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lewden
authors.forename: Delphine
authors.initials: D
authors.lastname: Gabillard
authors.forename: Boubacar
authors.initials: B
authors.lastname: Nacro
authors.forename: Serge
authors.initials: S
authors.lastname: Diagbouga
authors.forename: Patricia
authors.initials: P
authors.lastname: Fassinou
authors.forename: Hervé
authors.initials: H
authors.lastname: Hien
authors.forename: Christian
authors.initials: C
authors.lastname: Laurent
authors.forename: Philippe
authors.initials: P
authors.lastname: Msellati
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D000293:Adolescent; D000349:Africa / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents