title: Feasibility of Routinely Offering Early Combined Antiretroviral Therapy to HIV-infected Infants in a Resource-limited Country: The ANRS-PediaCAM Study in Cameroon.
abstract: BACKGROUND
  Early diagnosis of HIV is increasingly available for infants in resource-limited settings. We assessed the timing of events until combined antiretroviral therapy (cART) initiation in infants diagnosed before 7 months of age in Cameroon.
  
  
  METHODS
  The ANRS-PediaCAM cohort included HIV-infected infants followed from birth associated with prevention of mother-to-child transmission activities (group 1) or diagnosed for any other reason before 7 months of age (group 2). All infants were offered free cART early after diagnosis. Frequency and factors associated with no or delayed cART initiation, were studied using univariable and multivariable logistic regressions.
  
  
  RESULTS
  Between 2007 and 2011, 210 HIV-infected infants (group 1: 69; group 2: 141) were included. Fewer group 1 (14.3%) than group 2 (59.1%) infants were symptomatic (World Health Organization stage 3 or 4). Overall, 5.7% (n = 12) died before receiving any cART. Of the remaining 198 infants, 3.0% (n = 6) were not treated. The median age at initiating cART was 4.1 months [interquartile range (IQR): 3.2-5.6]. The median time until cART initiation after HIV testing was 6.2 weeks (IQR: 4.4-9.4) in group 1 and 5.1 weeks (IQR: 2.9-9.4) in group 2. No or delayed cART, observed for 37.9% (75 of 198) of the infants, was associated with clinical site [adjusted odds ratio (aOR): 4.8; 95% confidence interval: (2.1-11.2)], late diagnosis [aOR: 2.0 (0.9-4.1)], and delayed pretherapeutic biological assessment [aOR: 3.7 (1.4-10.0)].
  
  
  CONCLUSIONS
  Although most children included were treated before age 7 months, the initiation of therapy was delayed for more than 1 in 3. The period around HIV diagnosis is critical and should be better managed to reduce delays before cART initiation.
authors.affiliation: From the *Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroon; †Equipe 4 (VIH et IST)-INSERM U1018 (CESP); ‡Assistance Publique des Hôpitaux de Paris, Service d'Epidémiologie et de Santé Publique, Hôpital de Bicêtre, Le Kremlin Bicêtre, France; §Univ Paris Sud 11, Paris, France; ¶Centre Mère et Enfant de la Fondation Chantal Biya; ‖Centre Hospitalier d'Essos; **Service de Virologie, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroon; ††Hôpital Laquintinie; ‡‡Université de Douala, Faculté de Médecine et de Sciences Pharmaceutiques, Douala, Cameroon; §§Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale, Hôpital Robert Debré; and ¶¶Université de Paris Diderot, Paris Sorbonne Cité, Paris, France.
authors.forename: Mathurin Cyrille
authors.initials: MC
authors.lastname: Tejiokem
authors.forename: Josiane
authors.initials: J
authors.lastname: Warszawski
authors.forename: Francis
authors.initials: F
authors.lastname: Ateba Ndongo
authors.forename: Suzie
authors.initials: S
authors.lastname: Tetang Ndiang
authors.forename: Jean Audrey
authors.initials: JA
authors.lastname: Ndongo
authors.forename: Félicité
authors.initials: F
authors.lastname: Owona
authors.forename: Paul Alain
authors.initials: PA
authors.lastname: Ngoupo
authors.forename: Patrice
authors.initials: P
authors.lastname: Tchendjou
authors.forename: Anfumbom
authors.initials: A
authors.lastname: Kfutwah
authors.forename: Ida Calixte
authors.initials: IC
authors.lastname: Penda
authors.forename: Albert
authors.initials: A
authors.lastname: Faye
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002163:Cameroon / Q000453:epidemiology; D003906:Developing Countries; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D061665:Time-to-Treatment
chemical_list: D044966:Anti-Retroviral Agents