title: Association between age at antiretroviral therapy initiation and 24-month immune response in West-African HIV-infected children.
abstract: OBJECTIVE
  We describe the association between age at antiretroviral therapy (ART) initiation and 24-month CD4 cell response in West African HIV-infected children.
  
  
  METHODS
  All HIV-infected children from the IeDEA paediatric West African cohort, initiating ART, with at least two CD4 cell count measurements, including one at ART initiation (baseline) were included. CD4 cell gain on ART was estimated using a multivariable linear mixed model adjusted for baseline variables: age, CD4 cell count, sex, first-line ART regimen. Kaplan-Meier survival curves and a Cox proportional hazards regression model compared immune recovery for age within 24 months post-ART.
  
  
  RESULTS
  Of the 4808 children initiated on ART, 3014 were enrolled at a median age of 5.6 years; 61.2% were immunodeficient. After 12 months, children at least 4 years at baseline had significantly lower CD4 cell gains compared with children less than 2 years, the reference group (P<0.001). However, by 24 months, we observed higher CD4 cell gain in children who initiated ART between 3 and 4 years compared with those less than 2 years (P<0.001). The 24-month CD4 cell gain was also strongest in immunodeficient children at baseline. Among these children, 75% reached immune recovery: 12-month rates were significantly highest in all those aged 2-5 years at ART initiation compared with those less than 2 years. Beyond 12 months on ART, immune recovery was significantly lower in children initiated more than 5 years (adjusted hazard ratio: 0.69, 95% confidence interval: 0.56-0.86).
  
  
  CONCLUSIONS
  These results suggest that both the initiation of ART at the earliest age less than 5 years and before any severe immunodeficiency is needed for improving 24-month immune recovery on ART.
authors.affiliation: aUniversity Bordeaux bINSERM, ISPED, Centre Inserm U897-Epidémiologie-Biostatistique, Bordeaux, France cHôpital Gabriel Toure, Bamako, Mali dHôpital pédiatrique, Centre Hospitalier Universitaire Charles de Gaulle, Ouagadougou, Burkina Faso eCentre Hospitalo-Universitaire de Yopougon, Service Pédiatrie fProgramme MTCT + gCentre de Prise en charge, de Recherche et de Formation (CePReF), Abidjan, Côte, d'Ivoire hCentre Hospitalier Universitaire de Tokoin, Lome, Togo iCentre Hospitalo-Universitaire de Cocody, Service Pédiatrie jCIRBA, Abidjan, Côte d'Ivoire kCentre National Hospitalier Universitaire Hubert K. Maga, Cotonou, Bénin lKorle Bu Hospital, Accra, Ghana mHôpital des Enfants Albert-Royer, Dakar, Senegal.
authors.forename: Sophie
authors.initials: S
authors.lastname: Desmonde
authors.forename: Fatoumata
authors.initials: F
authors.lastname: Dicko
authors.forename: Fla
authors.initials: F
authors.lastname: Koueta
authors.forename: Tanoh
authors.initials: T
authors.lastname: Eboua
authors.forename: Eric
authors.initials: E
authors.lastname: Balestre
authors.forename: Clarisse
authors.initials: C
authors.lastname: Amani-Bosse
authors.forename: Edmond A
authors.initials: EA
authors.lastname: Aka
authors.forename: Koko
authors.initials: K
authors.lastname: Lawson-Evi
authors.forename: Madeleine
authors.initials: M
authors.lastname: Amorissani-Folquet
authors.forename: Kouadio
authors.initials: K
authors.lastname: Kouakou
authors.forename: Siriatou
authors.initials: S
authors.lastname: Koumakpai
authors.forename: Lorna
authors.initials: L
authors.lastname: Renner
authors.forename: Haby
authors.initials: H
authors.lastname: Signaté Sy
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
mesh_terms: D000354:Africa, Western; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007223:Infant; D008297:Male; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents