title: Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa.
abstract: BACKGROUND
  We assessed the rate of treatment failure of HIV-infected children after 12 months on antiretroviral treatment (ART) in the Paediatric IeDEA West African Collaboration according to their perinatal exposure to antiretroviral drugs for preventing mother-to-child transmission (PMTCT).
  
  
  METHODS
  A retrospective cohort study in children younger than five years at ART initiation between 2004 and 2009 was nested within the pWADA cohort, in Bamako-Mali and Abidjan-Côte d'Ivoire. Data on PMTCT exposure were collected through a direct review of children's medical records. The 12-month Kaplan-Meier survival without treatment failure (clinical or immunological) was estimated and their baseline factors studied using a Cox model analysis. Clinical failure was defined as the appearance or reappearance of WHO clinical stage 3 or 4 events or any death occurring within the first 12 months of ART. Immunological failure was defined according to the 2006 World Health Organization age-related immunological thresholds for severe immunodeficiency.
  
  
  RESULTS
  Among the 1035 eligible children, PMTCT exposure was only documented for 353 children (34.1%) and remained unknown for 682 (65.9%). Among children with a documented PMTCT exposure, 73 (20.7%) were PMTCT exposed, of whom 61.0% were initiated on a protease inhibitor-based regimen, and 280 (79.3%) were PMTCT unexposed. At 12 months on ART, the survival without treatment failure was 40.6% in the PMTCT-exposed group, 25.2% in the unexposed group and 18.5% in the children with unknown exposure status (p=0.002). In univariate analysis, treatment failure was significantly higher in children unexposed (HR 1.4; 95% CI: 1.0-1.9) and with unknown PMTCT exposure (HR 1.5; 95% CI: 1.2-2.1) rather than children PMTCT-exposed (p=0.01). In the adjusted analysis, treatment failure was not significantly associated with PMTCT exposure (p=0.15) but was associated with immunodeficiency (aHR 1.6; 95% CI: 1.4-1.9; p=0.001), AIDS clinical events (aHR 1.4; 95% CI: 1.0-1.9; p=0.02) at ART initiation and receiving care in Mali compared to Côte d'Ivoire (aHR 1.2; 95% CI: 1.0-1.4; p=0.04).
  
  
  CONCLUSIONS
  Despite a low data quality, PMTCT-exposed West African children did not have a poorer 12-month response to ART than others. Immunodeficiency and AIDS events at ART initiation remain the main predictors associated with treatment failure in this operational context.
authors.affiliation: Inserm U897, ISPED, Université Bordeaux, Bordeaux, France; Centre Inserm U897 "Epidémiologie & Biostatistiques", ISPED, Université Bordeaux, Bordeaux, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Ndondoki
authors.affiliation: Hôpital Gabriel Touré, Bamako, Mali.
authors.forename: Fatoumata
authors.initials: F
authors.lastname: Dicko
authors.affiliation: IeDEA Regional Center, PACCI, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Patrick
authors.initials: P
authors.lastname: Ahuatchi Coffie
authors.affiliation: CHU de Yopougon, Abidjan, Côte d'Ivoire.
authors.forename: Tanoh
authors.initials: T
authors.lastname: Kassi Eboua
authors.affiliation: Inserm U897, ISPED, Université Bordeaux, Bordeaux, France; Centre Inserm U897 "Epidémiologie & Biostatistiques", ISPED, Université Bordeaux, Bordeaux, France; IeDEA Regional Center, PACCI, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Didier Koumavi
authors.initials: DK
authors.lastname: Ekouevi
authors.affiliation: Centre Intégré de Recherches Biocliniques d'Abidjan, Abidjan, Côte d'Ivoire.
authors.forename: Kouakou
authors.initials: K
authors.lastname: Kouadio
authors.affiliation: Centre de Prise en charge, de Recherche et de Formation (CePReF), Abidjan, Côte d'Ivoire.
authors.forename: Addi
authors.initials: A
authors.lastname: Edmond Aka
authors.affiliation: Inserm U897, ISPED, Université Bordeaux, Bordeaux, France; Centre Inserm U897 "Epidémiologie & Biostatistiques", ISPED, Université Bordeaux, Bordeaux, France.
authors.forename: Karen
authors.initials: K
authors.lastname: Malateste
authors.affiliation: Inserm U897, ISPED, Université Bordeaux, Bordeaux, France; Centre Inserm U897 "Epidémiologie & Biostatistiques", ISPED, Université Bordeaux, Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.affiliation: Centre MTCT-plus, Abidjan, Côte d'Ivoire.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Amani-Bosse
authors.affiliation: Centre de Prise en charge, de Recherche et de Formation (CePReF), Abidjan, Côte d'Ivoire.
authors.forename: Pety
authors.initials: P
authors.lastname: Toure
authors.affiliation: Inserm U897, ISPED, Université Bordeaux, Bordeaux, France; Centre Inserm U897 "Epidémiologie & Biostatistiques", ISPED, Université Bordeaux, Bordeaux, France; valeriane.leroy@isped.u-bordeaux2.fr.
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D007560:Cote d'Ivoire / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D008302:Mali / Q000453:epidemiology; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; PMTCT; West Africa; antiretroviral efficiency; children