Search

Background There is no gold standard for tuberculosis diagnosis in children. Clinical Case Definitions for Classification of Intrathoracic Tuberculosis in Children were proposed by international experts in 2012 and updated in 2015. We aimed to compare the 2012 and 2015 Clinical Case Definitions in HIV-infected children with suspected tuberculosis. Methods We enrolled HIV-infected children with suspected tuberculosis in Burkina Faso, Cambodia, Cameroon, and Vietnam (ANRS [Agence Nationale de Recherches sur le SIDA et les hépatites virales] 12229 PAANTHER [Pediatric Asian African Network for Tuberculosis and HIV Research] 01 Study). We classified children using the 2012 and 2015 Case Definitions considering as tuberculosis cases those with confirmed tuberculosis and those with probable and unconfirmed tuberculosis in the 2012 and the 2015 classifications, respectively. We assessed agreement between both classifications. Results Of 438 children enrolled, 197 (45.0%) children were classified as tuberculosis (45 confirmed, 152 probable) using the 2012 Case Definition and 251 (57.3%) were classified as tuberculosis (55 confirmed, 196 unconfirmed) using the 2015 classification. Inter-classification agreement for tuberculosis diagnosis was 364/438, 83.1%, with a kappa statistic of 0.667 (95% confidence interval 0.598-0.736). Of 152 children with probable tuberculosis (2012), 142 (93.4%) were considered as tuberculosis by the 2015 version and 10 (6.6%) as unlikely tuberculosis including 9 with spontaneous clinical improvement. Of 132 possible tuberculosis (2012), 58 (43.9%) were reclassified as tuberculosis (2015). Conclusions Agreement between the 2 versions of the Case Definition was substantial but more children were considered as tuberculosis using the 2015 version. Spontaneous symptom resolution reinforces both confidence in the “unlikely” category as being children without tuberculosis and the importance of the clinician’s treatment decision in the study.

Background In most studies, the virological response is assessed during the first two years of antiretroviral treatment initiated in HIV-infected infants. However, early initiation of antiretroviral therapy exposes infants to very long-lasting treatment. Moreover, maintaining viral suppression in children is difficult. We aimed to assess the virologic response and mortality in HIV-infected children after five years of early initiated antiretroviral treatment (ART) and identify factors associated with virologic success in Cameroon. Methods In the ANRS-12140 Pediacam cohort study, 2008–2013, Cameroon, we included all the 149 children who were still alive after two years of early ART. Virologic response was assessed after 5 years of treatment. The probability of maintaining virologic success between two and five years of ART was estimated using Kaplan-Meier curve. The immune status and mortality were also studied at five years after ART initiation. Factors associated with a viral load Results The viral load after five years of early ART was suppressed in 66.8% (60.1–73.5) of the 144 children still alive and in care. Among the children with viral suppression after two years of ART, the probability of maintaining viral suppression after five years of ART was 64.0% (54.0–74.0). The only factor associated with viral suppression after five years of ART was achievement of confirmed virological success within the first two years of ART (OR = 2.7 (1.1–6.8); p = 0.033). Conclusions The probability of maintaining viral suppression between two and five years of early initiated ART which was quite low highlights the difficulty of parents to administer drugs daily to their children in sub-Saharan Africa. It also stressed the importance of initial viral suppression for achieving and maintaining virologic success in the long-term. Further studies should focus on identifying strategies that would enhance better retention in care and improved adherence to treatment within the first two years of ART early initiated in Sub-Saharan HIV-infected children.

We report the attitudes and practices of health care workers involved in the disclosure process to adolescents living with HIV (ALHIV) in a network including West and Central African French-speaking countries, and the experiences of young living with HIV (YLHIV). During a three-day workshop in Abidjan, Cote d'Ivoire, caregivers (doctors, psychologists, social workers) from 19 pediatric HIV treatment sites shared their practices and difficulties, and four YPLHIV their own disclosure experience. Thirty five participants from eight West/Central African countries (Benin, Burkina Faso, Ivory Coast, Cameroon, Mali, Democratic Republic of Congo, Senegal, Togo) contributed: 14 doctors, eight psychologists, six counselors, three social workers. The experience of the centers was variable, but the age at disclosure was late: 34% of 1296 adolescents between 10 and 12 years of age knew their status. The median age at disclosure was 13 years (range: 11-15 years). The practice of the disclosure was often complex, because of multiple factors (fear of the parents of the breaking of the secrecy, lack of communication between professionals). The individual disclosure was the main practice. Four centers practiced HIV disclosure in group sessions to facilitate mirror support, and one used peer-to-peer support. YPLHIV have advocated for an earlier disclosure, from 10 years. In West and Central Africa, the process of HIV disclosure remains complex for parents and caregivers, and occurs too late. The development of a good practice guideline for HIV disclosing adapted to socio-cultural contexts should help to improve this process.

Objective The objective of this study is to evaluate the feasibility and tolerability of new bacteriological samples to diagnose tuberculosis (TB) in HIV-infected children. Method and patients HIV1-infected children with suspicion of TB in Universitary Hospital Sourô Sanon (Burkina Faso) were included in a prospective cohort study. Children underwent three gastric aspirates (GA) if aged Results Sixty-three patients were included. Mean age was 8.92 years, 52.38% were females. Ninety-five GA, 67 sputum, 62 NPA, 60 stool and 55 ST had been performed. During sampling, the main adverse events were cough at 68/95 GA and 48/62 NPA; sneeze at 50/95 GA and 38/62 NPA and vomiting at 4/55 ST. On the behavioral scale, the average pain score during collection was 6.38/10 for GA; 7.70/10 for NPA and 1.03/10 for ST. Of the 31 cases of TB, bacteriological confirmation was made in 12 patients. Conclusion ST, stool is well-tolerated alternatives specimens for diagnosing TB in children. NPA has a poor feasibility and tolerability in children.

Background: In most studies, the virological response is assessed during the first two years of antiretroviral treatment initiated in HIV-infected infants. However, early initiation of antiretroviral therapy exposes infants to very long-lasting treatment. Moreover, maintaining viral suppression in children is difficult. We aimed to assess the virologic response and mortality in HIV-infected children after five years of early initiated antiretroviral treatment (ART) and identify factors associated with virologic success in Cameroon. Methods: In this cohort study, we included 149 children who were still alive after two years of early ART. Virologic response was assessed after 5 years of treatment. The probability of maintaining virologic success between two and five years of ART was estimated using Kaplan-Meier curve. Factors associated with a viral load < 400 copies/mL in children still alive at five years of ART were studied using logistic regressions.Results: The viral load after five years of early ART was suppressed in 66.8% (60.1 - 73.5) of the 144 children still alive and in care. Among the children with viral suppression after two years of ART, the probability of maintaining viral suppression after five years of ART was 64.0% (54.0 - 74.0). The only factor associated with viral suppression after five years of ART was achievement of confirmed virological success within the first two years of ART (OR = 2.7 (1.1-6.8); p = 0.033).Conclusions: This study reported difficulty in maintaining virologic success in sub-Saharan HIV-infected children between two and five years of early initiated ART. It also highlighted the importance of initial viral suppression for achieving and maintaining virologic success in the long-term.

OBJECTIVES To describe prevalence and risk factors for wasting and stunting among HIV-infected children with a median duration of 3 years of antiretroviral therapy (ART) at the time of their enrollment in the cohort study. METHODS Wasting and stunting at ART initiation and enrollment were defined as weight-for-height/body mass index-for-age Z scores < -2 and height-for-age Z scores < -2, respectively. Logistic regression was used to assess risk factors for wasting and stunting. Main predictive factors were age at enrollment, nutritional status and age (< or ≥5 years) at ART initiation and ART duration (< or ≥3 years on first-line, or ≥3 years including a switch to second-line ART). RESULTS Two hundred forty-four children 2-16 years of age were enrolled. Overall, wasting and stunting prevalence dropped off consistently in children 2-10 years of age, between ART initiation and enrollment, while it remained at high levels, 52% and 42%, respectively, in children 10-16 years of age. Risk factors for wasting at enrollment were ART duration of ≥3 years including a switch to second-line [adjusted odds ratio (aOR): 3.9, 95% confidence interval (CI): 1.7-8.9] and wasting at ART initiation (aOR: 2.7, 95% CI: 1.4-5.2). The risk factor for stunting at enrollment was stunting at ART initiation (aOR: 11.6, 95% CI: 5.4-25.0), independent of ART duration. CONCLUSIONS Malnutrition at the time of ART initiation was the main predictor of malnutrition at enrollment among HIV-infected children on ART. Longer duration on ART had no overall protective effect on wasting and stunting. Growth and virologic monitoring are of utmost importance in the comprehensive care of children with HIV infection.

We enrolled 427 human immunodeficiency virus–infected children (median age, 7.3 years), 59.2% severely immunodeficient, with suspected tuberculosis in Southeast Asian and African settings. Nontuberculous mycobacteria were isolated in 46 children (10.8%); 45.7% of isolates were Mycobacterium avium complex. Southeast Asian origin, age 5–9 years, and severe immunodeficiency were independently associated with nontuberculous mycobacteria isolation. Clinical Trials Registration NCT01331811.

Funding Institut National de la Santé et de la Recherche Médicale, Reacting, the French Ebola Task Force, Institut de Recherche pour le Développement, and Montpellier University Of Excellence-University of Montpellier.; International audience; BACKGROUND : The prevalence of Ebola virus infection among people who have been in contact with patients with Ebola virus disease remains unclear, but is essential to understand the dynamics of transmission. This study aimed to identify risk factors for seropositivity and to estimate the prevalence of Ebola virus infection in unvaccinated contact persons.METHODS : In this retrospective, cross-sectional observational study, we recruited individuals between May 12, 2016, and Sept 8, 2017, who had been in physical contact with a patient with Ebola virus disease, from four medical centres in Guinea (Conakry, Macenta, N'zérékoré, and Forécariah). Contact persons had to be 7 years or older and not diagnosed with Ebola virus disease. Participants were selected through the Postebogui survivors' cohort. We collected self-reported information on exposure and occurrence of symptoms after exposure using a questionnaire, and tested antibody response against glycoprotein, nucleoprotein, and 40-kDa viral protein of Zaire Ebola virus by taking a blood sample. The prevalence of Ebola virus infection was estimated with a latent class model.FINDINGS : 1721 contact persons were interviewed and given blood tests, 331 of whom reported a history of vaccination so were excluded, resulting in a study population of 1390. Symptoms were reported by 216 (16%) contact persons. The median age of participants was 26 years (range 7-88) and 682 (49%) were male. Seropositivity was identified in 18 (8·33%, 95% CI 5·01-12·80) of 216 paucisymptomatic contact persons and 39 (3·32%, 5·01-12·80) of 1174 (2-4) asymptomatic individuals (p=0·0021). Seropositivity increased with participation in burial rituals (adjusted odds ratio [aOR] 2·30, 95% CI 1·21-4·17; p=0·0079) and exposure to blood or vomit (aOR 2·15, 1·23-3·91; p=0·0090). Frequency of Ebola virus infection varied from 3·06% (95% CI 1·84-5·05) in asymptomatic contact persons who did not participate in burial rituals to 5·98% (2·81-8·18) in those who did, and from 7·17% (3·94-9·09) in paucisymptomatic contact persons who did not participate in burial rituals to 17·16% (12·42-22·31) among those who did.INTERPRETATION : This study provides a new assessment of the prevalence of Ebola virus infection among contact persons according to exposure, provides evidence for the occurrence of paucisymptomatic cases, and reinforces the importance of closely monitoring at-risk contact persons.

BACKGROUND: Diagnosis of tuberculosis should be improved in children infected with HIV to reduce mortality. We developed prediction scores to guide antituberculosis treatment decision in HIV-infected children with suspected tuberculosis. METHODS: HIV-infected children with suspected tuberculosis enrolled in Burkina Faso, Cambodia, Cameroon, and Vietnam (ANRS 12229 PAANTHER 01 Study), underwent clinical assessment, chest radiography, Quantiferon Gold In-Tube (QFT), abdominal ultrasonography, and sample collection for microbiology, including Xpert MTB/RIF (Xpert). We developed 4 tuberculosis diagnostic models using logistic regression: (1) all predictors included, (2) QFT excluded, (3) ultrasonography excluded, and (4) QFT and ultrasonography excluded. We internally validated the models using resampling. We built a score on the basis of the model with the best area under the receiver operating characteristic curve and parsimony. RESULTS: A total of 438 children were enrolled in the study; 251 (57.3%) had tuberculosis, including 55 (12.6%) with culture- or Xpert-confirmed tuberculosis. The final 4 models included Xpert, fever lasting >2 weeks, unremitting cough, hemoptysis and weight loss in the past 4 weeks, contact with a patient with smear-positive tuberculosis, tachycardia, miliary tuberculosis, alveolar opacities, and lymph nodes on the chest radiograph, together with abdominal lymph nodes on the ultrasound and QFT results. The areas under the receiver operating characteristic curves were 0.866, 0.861, 0.850, and 0.846, for models 1, 2, 3, and 4, respectively. The score developed on model 2 had a sensitivity of 88.6% and a specificity of 61.2% for a tuberculosis diagnosis. CONCLUSIONS: Our score had a good diagnostic performance. Used in an algorithm, it should enable prompt treatment decision in children with suspected tuberculosis and a high mortality risk, thus contributing to significant public health benefits.

Objectives: To assess the acceptability of ready-to-use food (RUF)-based outpatient protocols in HIV-infected children and adolescents with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). Methods: Plumpy Nut and Plumpy Sup were supplied every 2 weeks and prescribed by weight to SAM and MAM children, respectively. Forty-three children, 24 MAM and 19 SAM, were enrolled. Organoleptic appreciation, feeding modalities, and perceptions surrounding RUF were recorded at week 2. Sachets were counted to measure adherence throughout the study. Results: Median age was 12.2 years (interquartile range: 9.3-14.8), and 91% were on antiretroviral treatment. Overall, 80%, 76%, 68%, and 68% of children initially rated RUF color, taste, smell, and mouth feeling as good. However, feelings of disgust, refusal to eat, fragmentation of intake, self-stigma, and sharing within the household were commonly reported. Eighteen MAM and 7 SAM experienced weight recovery. Recovery duration was 54 days (31-90) in MAM versus 114 days (69-151) in SAM children ( P = .02). Their rate of RUF consumption compared to amount prescribed was approximately 50% from week 2 to week 10. Nine failed to gain weight or consume RUF and were discontinued for clinical management, and 9 dropped out due to distance to the clinic. Conclusion: Initial RUF acceptability was satisfactory. More than half the children had successful weight recovery, although adherence to RUF prescription was suboptimal. However, further research is needed to propose therapeutic foods with improved palatability, alternative and simpler intervention design, and procedures for continuous and tailored psychosocial support in this vulnerable population. Trial registration: NCT01771562 (Current Controlled Trials).

International audience; BACKGROUND:The diagnosis of tuberculosis in human immunodeficiency virus (HIV)-infected children is challenging. We assessed the performance of alternative specimen collection methods for tuberculosis diagnosis in HIV-infected children using Xpert MTB/RIF (Xpert).METHODS:HIV-infected children aged ≤13 years with suspected intrathoracic tuberculosis were enrolled in 8 hospitals in Burkina Faso, Cambodia, Cameroon, and Vietnam. Gastric aspirates were taken for children aged

A huge number of HIV-infected children and teenagers have no access to care or receive it very late. Of the 3.2 million infected children, 2.8 million should be receiving highly active antiretroviral treatment (HAART) but only around 700,000 actually are. The first reason for this failure is the lack of HIV testing among HIV-exposed infants and thus early diagnosis or, even more frequently, the lack of testing among older children and teenagers. The objectives of this article are twofold: to review the current situation and to advocate routine offers of HIV testing to HIV-exposed children and teenagers (exposed either through mother-to-child transmission or repeated transfusions) and those suspected to be HIV-infected (because of malnutrition, tuberculosis, or other associated diseases). Finally, adults living with HIV should be made aware of the need for routine HIV screening of their children, even when asymptomatic.

International audience; To meet the objective of ending the AIDS pandemic in 2030, screening and access to anti-retroviral treatments (ARV) must be extended in Africa. This in turns requires that people agree to be screened and treated. Since the beginning of the epidemic, however, the stigmatization of people persons living with HIV (PlHIV) has been a major obstacle in the battle against HIV/AIDS. Despite a substantial reduction in its prevalence over the past 20 years in Burkina Faso, its stigma remains high. The objective of this study is to characterize the local expression of stigmatization in this country towards these women to help to combat it. The method used a long-term ethnographic survey that combined observations of the setting and qualitative interviews of 40 women-both seronegative and seropositive. The results show the appearance of a sort of normalization of HIV/AIDS because the bioclinical effects of the infection are less serious and less visible than they were before ARV. The social effects of the disease nonetheless continue to constitute a threat, or at least they are so perceived by both seropositive and seronegative women. Although less visible, stigmatization persists and constrains seropositive women to use strategies to withdraw from some social spaces to protect themselves. PlHIV active in community associations play an essential role in this setting. They help women to keep their stigmata ''under control'' and play a role in its normalization by helping to moderate representations of HIV/AIDS and the people who have it.; Pour atteindre l'objectif de fin de la pandémie de sida en 2030, il est nécessaire d'étendre le dépistage et l'accès aux traitements antirétroviraux (ARV) en Afrique, ce qui implique que les personnes soient volontaires pour être dépistées et traitées. Or, depuis les débuts de l'épidémie, la stigmatisation des personnes vivant avec le VIH (PvVIH) apparaît comme un obstacle majeur dans la lutte contre le VIH/sida. Malgré une importante réduction de la prévalence au cours des 20 dernières années au Burkina Faso, la stigmatisation reste élevée. Cette étude a pour objectif de caractériser les expressions locales de la stigmatisation dans ce pays vis-à-vis des femmes pour permettre de mieux la combattre. La méthode s'appuie sur une enquête ethnographique de longue durée qui combine des observations de contexte et des entretiens qualitatifs auprès de quarante femmes séronégatives et séropositives. Les résultats de l'étude montrent l'apparition d'une forme de banalisation du VIH/sida car les effets biocliniques de l'infection sont moins graves et moins visibles qu'avant les ARV. Les effets sociaux de la maladie constituent cependant toujours une menace perçue par les femmes séropositives et séronégatives. Bien que moins visible, la stigmatisation persiste et contraint les femmes séropositives à user de stratégies de retrait de certains espaces sociaux pour se protéger. Les PvVIH actives dans les associations communautaires jouent un rôle essentiel dans ce contexte. Elles aident les femmes à maintenir le stigmate « sous contrôle » et participent à la banalisation en permettant de faire évoluer les représentations sur le VIH/sida et les personnes atteintes.

International audience; BACKGROUND:Tuberculosis is a major cause of morbidity and mortality in HIV-infected children, but is difficult to diagnose. We studied mortality and its determinants in antiretroviral treatment (ART)-naive HIV-infected children presenting with suspected tuberculosis.METHODS:In this observational cohort study, HIV-infected children aged 13 years or younger with suspected tuberculosis were followed up for 6 months as part of the ANRS 12229 PAANTHER 01 cohort in eight hospitals in four countries (Burkina Faso, Cambodia, Cameroon, and Vietnam). Children started ART and antituberculosis treatment at the clinician's discretion and were retrospectively classified into one of three groups by tuberculosis documentation: confirmed by culture or Xpert MTB/RIF, unconfirmed, and unlikely. We assessed mortality and associated factors using Kaplan-Meier methods and Cox proportional hazard models. The ANRS 12229 PAANTHER 01 study is registered at ClinicalTrials.gov, number NCT01331811.FINDINGS:266 (61%) of 438 children enrolled in the study between April 27, 2011, and May 31, 2014, were ART-naive and included in the analysis (40 had confirmed tuberculosis, 119 unconfirmed tuberculosis, and 107 unlikely tuberculosis). 112·5 person-years of follow-up were available. 154 children (58%) started antituberculosis treatment and 212 (80%) started ART. 50 children (19%) died. Mortality by 6 months was higher in children with confirmed tuberculosis (14 deaths; 2 month survival probability 65·0% [95% CI 50·2-79·8]) compared with unconfirmed tuberculosis (19 deaths; 83·5% [76·8-90·3]) and unlikely tuberculosis (17 deaths; 83·5% [76·3-90·7]; log-rank p=0·0141) and was lower in children with confirmed or unconfirmed tuberculosis who started antituberculosis treatment (p

To examine effects of maternal factors on choice of infant feeding method, and to assess the effects of feeding method and other maternal and infant factors on morbidity and mortality a prospective study was conducted within the Kesho Bora study that evaluated antiretroviral therapy impact on mother to child transmission of human immune deficiency virus 1. Mean age for the mothers was 27.55 years (range 18-41 years); 69.3% were homemakers and 41.4% had no formal education. Breastfeeding was chosen by 109 mothers (81.3%) compared to 25 mothers (18.7%) choosing formula feeding. The decision to formula feed was more common among mothers who had disclosed their human immune deficiency virus status to a family member (P = 0.0036) and among women who had attained a relatively high level of education (P = 0.001). Morbidity and mortality were assessed for 138 infants (113 exclusively breastfed and 25 formula fed). There were no statistically significant differences in incidence of diarrhea or upper respiratory infection between the two groups of children (P = 0.7 and P = 0.255, respectively), but formula fed children tended to require more frequent hospital care (P = 0.016). Infant mortality after the age of 6 months was not statistically different in the two groups of children (7% in the exclusive breastfeeding group compared to 12% in the formula fed group, P = 0.42). Premature birth and low birth weight were associated with a significant risk of infant mortality (P = 0.001 and P = 0.007 respectively). Considering the prevailing socio-economic conditions in Bobo-Dioulasso, we conclude that exclusive breastfeeding should be the recommended infant feeding method for most women here.

L’espace CEDEAO subit de profondes mutations spatiales liees a une forte croissance demographique, au changement climatique et a une croissance economique exceptionnelle. Entre 1950 et 2015, cet espace a accueilli 280 millions nouveaux habitants, soit une moyenne de 4,3 millions nouveaux arrivants par an, parmi lesquels 2,4 millions nouveaux urbains et 1,9 millions nouveaux ruraux. Les dynamiques de peuplements impulsees par ces forces demographiques, climatiques et economiques, s’effectuent parfois en direction des terres neuves parmi lesquelles les espaces proteges. Ces derniers constituent des reserves de biodiversite qui hebergent des reservoirs de pathogenes et d’insectes vecteurs. L’homme, en exploitant ces nouveaux territoires, s’exposent donc a la piqure d’insectes vecteurs de maladies ou au contact d’animaux reservoirs de pathogenes, tel que le virus Ebola. Par la densification de sa presence et son extension spatiale generalisee, l’homme cree egalement de plus en plus de promiscuite avec les animaux sauvages. Dans l’espace CEDEAO, les chimpanzes et quelques especes de chauve-souris semblent representer le plus grand danger pour l’homme au regard du risque de transmission du virus Ebola. Cette etude replace l’epidemie d’Ebola survenue en 2013 en Guinee dans son contexte historique et panafricain. Puis, elle presente brievement le role connu de la faune sauvage dans l’epidemiologie d’Ebola et de quelles manieres les changements environnementaux operent sur les principaux reservoirs connus de ce virus. Ensuite, elle retrace les grandes lignes de l’evolution spatio-temporelle de l’epidemie d’Ebola survenue dans l’espace CEDEAO, en tentant de faire apparaitre les tenants et les aboutissants geographiques de cette catastrophe epidemiologique.

International audience; BACKGROUND:The long-term benefits of antiretroviral treatment (ART) are associated with metabolic complications, especially lipodystrophy, which has been well described among HIV-infected adults and children on ART in developed settings. Specifically, stavudine, and to a lesser extent zidovudine and protease inhibitors (PI), have been consistently implicated in the development of lipodystrophy. In 2006, following advice from the WHO, Senegal began phasing out stavudine from first-line ART. The objectives of this cross-sectional analysis are to assess and identify risk factors affecting the prevalence of lipodystrophy in Senegalese children and adolescents on long-term ART participating in a cohort study.METHODS:Lipodystrophy was clinically assessed in two- to 18-year-old children on ART for at least six months and with no concurrent severe acute malnutrition. Risk factors for lipodystrophy were identified using stepwise multivariable logistic regression. Explanatory variables included clinical and personal data, immunovirologic status, and therapeutic history.RESULTS:Overall, 254 children were assessed for lipodystrophy. The median age was 10.9 years (IQR: 8.1-14.2) and the median duration on ART was 54 months (32-84). Only 18% had been previously treated with stavudine, with a median treatment duration of 8 months (5-25). Ongoing treatment included 76% of children receiving zidovudine (median duration of 48 months (26-74)) and 27% receiving PI (lopinavir/ritonavir; median duration of 49 months (23-59)). Mild signs of lipodystrophy were observed in 33 children (13%): 28 with lipoatrophy, 4 with lipohypertrophy and one with combined type. Boys were more likely to present with lipoatrophy than girls (aOR: 4.3, 95% CI: 1.6-11.7). Children previously treated with stavudine for ≥1 year had a greater risk for lipoatrophy than those never exposed (3.8, 1.0-14.0), although the association was weak. There was no association between lipodystrophy and age or current or cumulative treatment with lopinavir/ritonavir or zidovudine.CONCLUSIONS:We report low prevalence of mild lipodystrophy in children and adolescents on long-term ART receiving a stavudine-sparing regimen. These findings are reassuring for clinicians in low-income settings where zidovudine is massively prescribed and lopinavir/ritonavir is the only widely available PI.TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT01771562 (registration date: 01/18/2013).

ObjectiveTo investigate spatial heterogeneity of stunting prevalence among children in Côte d’Ivoire and examine changes in stunting between 1994 and 2011, to assess the impact of the 2002–2011 civil war that led to temporary partitioning of the country.DesignData from 1994, 1998 and 2011 Côte d’Ivoire Demographic and Health Surveys (DHS) were analysed using a geostatistical approach taking into account spatial autocorrelation. Stunting data were interpolated using ordinary kriging; spatial clusters with high and low stunting prevalence were identified using Kulldorff spatial scan statistics. Multilevel multivariable logistic regression was then carried out, with year of survey as the main independent variable and an interaction term for time by geographic zone (Abidjan, South, North).SettingCôte d’Ivoire, West Africa.SubjectsChildren aged 0–35 months included in three DHS (n6709).ResultsOverall stunting prevalence was 30·7, 28·7 and 27·8 % in 1994, 1998 and 2011, respectively (P=0·32). Clusters with high prevalence were found in 1994 (in the West region,PPP=0·01, respectively), but not in 2011. Abidjan was included in a cluster with low prevalence in all surveys (PConclusionsIn Côte d’Ivoire, significant changes in stunting prevalence were observed at the sub-national level between 1994 and 2011.

Objectives The objectives of this study were to describe the pretreatment HIV-1 DNA concentrations in children infected with HIV and to evaluate the impact of antiretroviral therapy (ART) on HIV-DNA concentrations. Methods This was a retrospective analysis of all children followed up in the 'Programme Enfant Yopougon' cohort, Abidjan, Cote d'Ivoire, from 2000 to 2004, who had cryopreserved peripheral blood mononuclear cells (PBMCs) and plasma samples. HIV-DNA was measured using a real-time PCR assay. Mixed-model analysis was used to analyse the factors associated with change in HIV-DNA concentration. Results The study included 121 children infected with HIV-1. The median age at inclusion was 6 years (IQR: 3.5-9) and children were at an advanced stage of HIV disease (46.6% and 20.3% presenting CDC stage B and CDC stage C, respectively). At baseline, the median HIV-DNA concentration was 3.4 log₁₀ copies/10(6) PBMCs (IQR: 3.1-3.6). Fifty-four children were initiated on ART during follow-up. After 24 months of ART, HIV-DNA load decreased by 0.32 (IQR: 0.08-0.57) log₁₀ copies/10(6) PBMCs. The only factor associated with the HIV-DNA decrease was a concomitant low HIV-RNA viral load result. Children with efficient ART had a 0.51 log₁₀ copies (IQR: 0.40-0.86) HIV-DNA decrease per million PBMCs. Conclusions HIV-DNA concentrations decreased following ART initiation in a large African paediatric cohort. This decline was exclusively associated with the decrease in ongoing replication level achieved. Our study points out that a strong adherence is needed for ART to be efficient on the viral reservoirs, and further reinforces that adherence support is also essential to diminish the reservoir.

Introduction : L’impact negatif de la stigmatisation sur la prevention du VIH et la prise en charge a ete documente. La stigmatisation a ete analysee au plan qualitatif au Burkina Faso, ou la prevalence VIH est faible (1 %). Des mesures quantitatives sont encore necessaires pour identifier les formes et manifestations majeures de la stigmatisation.Methodologie : Dans le cadre de l’etude MATCH (Multi-country African Study on Testing and Counselling for HIV), une etude transversale a ete conduite aupres de personnes ayant deja fait le test VIH. Les personnes seropositives ont ete interrogees sur les consequences du resultat VIH+. Leur vecu de la stigmatisation a ete evalue a travers 20 indicateurs de manifestations de la stigmatisation, regroupes en trois formes de stigmatisation/ discrimination.Resultats : Au total, 219 PVVIH ont ete recrutees. L’auto-stigmatisation est la forme majeure de stigmatisation. Elle est estimee dans cette etude a 46 % comparativement a la stigmatisation dans les relations interpersonnelles evaluee a 40 % et la stigmatisation dans les services de sante qui est de 11 %. L’experience de la stigmatisation dans les relations interpersonnelles est davantage rapportee par les PVVIH qui ont partage leur resultat, celles qui ont un faible niveau de scolarisation, les veufs/veuves ou separes, et les membres d’association. La stigmatisation dans les services de sante est rapportee plus souvent par les membres d’associations.Conclusion : Les programmes de prise en charge doivent, parallelement a l’extension des antiretroviraux, integrer un volet psychologique plus adapte aux besoins. Les activites d’appui psychosocial ciblant davantage l’individu doivent etre developpees, surtout au sein des associations.

Auteur(s) : Philippe Msellati* philippe.msellati@ird.fr * Philippe Mselatti, medecin epidemiologiste, UMI 233, IRD/UCAD/UM1/UY1, BP 1857 Yaounde, Cameroun ; UMI 233, IRD, 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France Voir version PDF.

Contexte. Selon l’Organisation mondiale de la sante (OMS), 80 % de la population africaine a deja eu recours au moins une fois a la medecine alternative pour des soins de sante primaire. Le Gabon est situe parmi les pays a prevalence elevee de l’infection a VIH, celle-la ayant ete estimee a 5,2 % en 2011. Globalement, 22 253 personnes vivant avec le VIH (PVVIH), adultes et enfants, sont actuellement suivies, dont 9 976 sont sous ARV. Objectif. Decrire l’impact des medecines alternatives sur la prise en charge des PVVIH au Gabon. Methodologie. Il s’agit d’une enquete transversale, descriptive, menee sur cinq mois en cumule entre mai 2009 et septembre 2010, (1) d’une part chez des personnes vivant avec le VIH, âgees de plus de 18 ans, frequentant certains centres de prise en charge et etant sous traitement ARV depuis au moins six mois, et ayant donne leur consentement ; (2) d’autre part aupres des medecins et soignants de ces centres. Nous avons procede par la methode d’echantillonnage aleatoire simple. Cette enquete s’est deroulee dans sept centres differents pour les PVVIH et les soignants, et huit centres distincts pour les medecins. Le recueil des donnees s’est fait avec le logiciel Epidata. Les analyses ont ete faites sur SAS. Resultats. Parmi les 5 752 patients sous ARV suivis dans les sept sites concernes par l’enquete en 2009/2010, 422 PVVIH (dont 58,3 % de femmes) ont ete enquetees : 284 a Libreville (67,29 %) et 138 en provinces (32,71 %). Parmi ces PVVIH enquetees, 90,5 % sont de confession chretienne, dont 21,5 % issues des Eglises chretiennes, 5,7 % etant musulmans. Les 4 % restants correspondent aux patients declarant qu’ils n’ont pas de religion. Il y a 12,5 % de medecins qui mettent leurs patients en relation avec des groupes spirituels ou religieux. Pour 29,2 % des PVVIH enquetes (IC 95 %, 24,6-33,8 %), les ARV font disparaitre le virus du sang (sans mesure de la charge virale) (p < 0,001). Les entretiens realises nous montrent que pour certaines PVVIH, les guerisseurs, par leurs pratiques, favorisent l’inobservance aux ARV. En outre, certaines PVVIH pronent une collaboration entre ces derniers et les medecins conventionnels. Conclusion. Notre etude a montre que la moitie des PVVIH ne connaissaient pas les procedures de mise sous traitement ARV. Les croyances sur l’infection par le VIH/sida etaient tres differentes selon que la PVVIH vit en province ou a la capitale. Enfin, le contexte culturel lie aux medecines alternatives, etait tres present dans les itineraires therapeutiques des PVVIH au Gabon. Ainsi, si les PVVIH doivent facilement acceder aux ARV, leur association avec des medecines alternatives organisees et controlees pourrait etre benefique.

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 (

BackgroundIn rural Africa, data on virologic effectiveness of antiretroviral treatment (ART) are not sufficient to assess the gap with the UNAIDS 90-90-90 treatment targets. We investigated the prevalences of unsuppressed viral load and antiretroviral drug resistance and the profile of genotypic resistance mutations among patients routinely treated in rural Cameroon.MethodsA cross-sectional study was performed in 2013–2014 among patients ≥15 years and on first-line ART for ≥6 months in a district hospital. Patients were offered free access to human immunodeficiency virus viral load testing. Genotypic drug resistance testing was done when the viral load was >1000 copies/mL. Multivariate logistic regression models were used to assess the relationship of unsuppressed viral load or antiretroviral drug resistance with sociodemographic and medical characteristics.ResultsOf 407 patients (women 74.9%, median age 41.8 years, median time on ART 29.2 months), 96 (23.6%; 95% confidence interval [CI], 19.5–28.0) had unsuppressed viral load and 74 (18.2%; 95% CI, 14.6–22.3) had antiretroviral drug resistance. The prevalences of unsuppressed viral load and resistance increased with time on ART, from 12.0% and 8.0% in the 6- to 12-month group to 31.3% and 27.1% in the >72-month group, respectively. All 74 patients with antiretroviral drug resistance were resistant to nonnucleoside reverse-transcriptase inhibitors, and 57 of them were also resistant to nucleoside reverse-transcriptase inhibitors.ConclusionsOur estimations were among the highest observed in the west and central African region. The proportion of patients with virologic failure should be divided at least by 2 to reach the UNAIDS 90-90-90 treatment targets.

Ebola virus disease (EVD) epidemic that spread in West Africa from the end of 2013 to early 2016 has reached more people than all past epidemics. Beyond care management of acute phase ill patients and measures for the control of the epidemic, the outcome of Ebola survivors became an important question as their number increased and raised new issues. A multidisciplinary prospective cohort of survivors in Guinea has been launched by IRD UMI 233 and Donka National Hospital, Conakry, Guinea, to assess the long-term clinical, psychological, sociological, immunological, and viral outcomes potentially related to EVD. This paper describes PostEboGui Programme, constraints and changes to the initial proposal, participants, first results, and new issues, 1 year after its start, in a descriptive and critical view. We started also to work on ethical aspects in the context of epidemics and of mass interventions with a risk of overinvestigation of patients.

Disclosure of HIV-serostatus remains a way to avoid sexual transmission of HIV because it allows partners to take the necessary protective measures, e.g. use of condoms. Disclosure is nevertheless difficult due to the discrimination associated with HIV. The objective of this study was to analyze factors leading to self-disclosure of HIV-positive status within a sample of persons of both sexes attending different healthcare services in Burkina Faso. Methodology Cross-sectional study conducted by interviewing 740 patients in 26 healthcare services. Univariate (Chi2 test) and multivariate (logistic regression) analyses were performed. The significance level was 5%. Qualitative data on factors associated with self-disclosure of HIV-positive status were analyzed. Results The majority of the patients (81.4%) informed at least one person who was very often a close relative (descendant, ascendant and sibling) or the partner. At multivariate analysis, HIV-serostatus was associated with using antiretroviral treatment, (OR = 0.40, 95% CI: 0.3–0.7, P

Access to antiretroviral therapy (ART) and routine laboratory monitoring are limited for HIV-1-infected children from sub-Saharan Africa. This trial conducted in Bobo-Dioulasso, Burkina Faso, aimed to describe the biological efficacy, tolerance, and adherence of the combination of didanosine, lamivudine, efavirenz in once-daily administration among eligible HIV-1-infected children. From February 2006 to November 2007, 51 HIV-1-infected children aged from 30 months to 15 years and eligible for ART were enrolled in a phase II open clinical trial with follow-up visits every 3 months. HIV-1 genotype testing was performed in children with plasma viral load (PVL) > 1000 copies per milliliter after ART initiation. Children were followed for a median of 13.4 months [interquartile range (IQR) 12.8-14.2]. At enrollment, median CD4 count was 8% (IQR = 4.5-12). PVL was 341,032 (IQR = 127,838-761,539) copies per milliliter. At 12 months, median CD4 increased significantly by +15% (P < 10(-3)), and median PVL decreases significantly by 2290,500 copies per milliliter (P < 10(-4)). Hemoglobin and platelets counts increased significantly by +1.05 g/dL (P < 10(-5)) and 108,500 cells per milliliter (P < 10(-3)), respectively. Based on pill count, mean yearly adherence was 97.3%, and 48% of the children had an adherence rate >= 95% at the four quarterly visits. Adherence was better for girls than for boys independently of other sociodemographic variables or markers of HIV disease progression. Drug-resistant mutations were found in 11 children (21.6%). This once-daily drug combination is associated with excellent virological efficacy, immune reconstitution, and good adherence. However, the high prevalence of drug resistance mutations is a matter of concern.

OBJECTIVE To describe lipid levels in antiretroviral (ARV)-naive HIV-infected Ivorian children and assess their evolution after ARV-treatment initiation. METHODS Lipid concentrations were assessed at baseline and at least 6 months later in 93 children. Fifty-six children initiated ARV treatment at baseline, and 37 remained untreated. RESULTS At baseline, 65, 92 and 84% of the children had low levels of total cholesterol, HDL and APOA1, respectively, whereas 75 and 70% had triglycerides and APOB levels in the normal range. At baseline, low level of HDL cholesterol and high level of triglycerides were associated with high viral load and low levels of CD4 cell count. Levels of total, HDL cholesterol and APOA1 increased over time, and treatment was associated with a higher increase whereas levels of triglycerides and APOB decreased in treated children and remained stable in untreated group. CONCLUSIONS The initiation of antiretroviral treatment was associated with a normalization of the infection-related lipid profile.

BACKGROUND: Previously HIV epidemic models have used a double Weibull curve to represent high initial and late mortality of HIV-infected children without distinguishing timing of infection (peri- or post-natally). With more data on timing of infection which may be associated with disease progression a separate representation of children infected early and late was proposed. METHODS: Paediatric survival post-HIV infection without anti-retroviral treatment was calculated using pooled data from 12 studies with known timing of HIV infection. Children were grouped into perinatally or post-natally infected. Net mortality was calculated using cause-deleted life tables to give survival as if HIV was the only competing cause of death. To extend the curve beyond the available data children surviving beyond 2.5 years post infection were assumed to have the same survival as young adults. Double Weibull curves were fitted to both extended survival curves to represent survival of children infected perinatally or through breastfeeding. RESULTS: Those children infected perinatally had a much higher risk of dying than those infected through breastfeeding even allowing for background mortality. The final-fitted double Weibull curves gave 75% survival at 5 months after infection for perinatally infected and 1.1 years for post-natally infected children. An estimated 25% of the early infected children would still be alive at 10.6 years compared with 16.9 years for those infected through breastfeeding. CONCLUSIONS: The increase in available data has enabled separation of child mortality patterns by timing of infection allowing improvement and more flexibility in modelling of paediatric HIV infection and survival.

L’objectif est de determiner la prevalence des caries et des gingivites chez des enfants ivoiriens infectes par le VIH et d’etudier leur association avec la severite de la maladie et son traitement. Une etude transversale a ete conduite en 2004 dans une structure de recherche a Abidjan. Parmi 83 enfants examines, l’âge median etait de 6,8 ans, le taux de CD4 median de 20,1 % et 34 % etaient sous antiretroviraux; 11 % presentaient une gingivite et 76 % des caries dont 3 traites. L’âge etait le principal facteur associe a la presence de caries (rapport de cote de prevalence ajuste [RCPA] : 1,3, intervalle de confiance [IC] a 95 % : 1,1-1,7), alors que la gingivite etait plus frequente chez les enfants presentant une immunosupression severe (RCPA : 7,9, CI : 1,7-36,3). Depistage des caries et traitement de la gingivite devraient etre recommandes chez les enfants infectes par le VIH.

Access to antiretroviral (ARV) treatment remains a crucial problem for patients living with HIV/AIDS (PLWHA) in limited-resources countries. Some African countries have adopted the principle of providing ARV free of charge, but Burkina Faso opted for a direct out-of-pocket payment at the point of care delivery, with subsidized payments and mechanisms for the poorest populations to receive these services free of charge. Our objectives were to determine the proportion of PLWHA who pay for ARV and to identify the factors associated with ARV access in Burkina Faso. A cross-sectional study was performed in 13 public health facilities, 10 Nongovernmental Organizations and association health facilities, and three faith-based health facilities. In each facility, 20 outpatients receiving ARV were interviewed during a routine clinic visit. A multivariate analysis by logistic regression was performed. Among the expected 520 patients receiving ARV, 499 (96.0%) were surveyed. The majority of patients (79%) did not pay for their ARV treatment, thereby limiting cost recovery from patient payments. In a multivariate analysis, level of education and income were associated with free access to ARV. Patients with no education more frequently received free ARV than those who had received some level of education (OR 2.7, 95% CI [1.3-5.6]). Patients without any income or with less than US$10 per month were more likely to receive free ARV (OR 2.6 [95% CI 1.3-5.2]) than those who earned more than US$10 per month. However, 16% of patients without any income and 21% of those without employment paid for ARV, and the costs of drugs for opportunistic infections, food, and transport remained a burden for 85%, 91%, and 74%, respectively, of those who did not pay for ARV. Free access to a minimum care package for every PLWHA would enhance access to ARV.

We aimed in this study to describe lamivudine concentration-time courses in treatment-naïve children after once-daily administration, to study the effects of body weight and age on lamivudine pharmacokinetics, and to simulate an optimized administration scheme. For this purpose, lamivudine concentrations were measured in 49 children after at least 2 weeks of didanosine-lamivudine-efavirenz treatment. A total of 148 plasma lamivudine concentrations were measured, and a population pharmacokinetic model was developed with NONMEM. The influence of individual characteristics was tested using a likelihood ratio test. Children were divided into two groups, according to their pharmacokinetic parameters, thanks to tree regression analysis. For each patient, the area under the curve was derived from estimated individual pharmacokinetic parameters. Different once-daily doses were simulated in each group, to obtain the same exposure in children as the mean effective exposure in adults (8.9 mg/liter·h). A two-compartment model in which the slope of distribution is assumed to be equal to the absorption rate constant adequately described the data. Parameter estimates were standardized for a mean standard body weight using an allometric model. Children were then divided into 2 groups according to body weight: CL/Fwas significantly higher in children weighing less than 17 kg (1.12 liters/h/kg) than in children over 17 kg (0.95 liters/h/kg;P= 0.01). The target mean AUC of 8.9 mg/liters·h was obtained with a 10-mg/kg once-daily lamivudine (3TC) dose for children below 17 kg; the recommended dose of 8 mg/kg seems to be sufficient in children weighing more than 17 kg. These assumptions should be prospectively confirmed.

Our objective was to study didanosine pharmacokinetics in children after the administration of tablets, the only formulation available in Burkina Faso for which data are missing, and to establish relationships between doses, plasma drug concentrations, and treatment effects (efficacy/toxicity). Didanosine concentrations were measured for 40 children after 2 weeks and for 9 children after 2 to 5 months of treatment with a didanosine-lamivudine-efavirenz combination. A population pharmacokinetic model was developed with NONMEM. The link between the maximal concentration of the drug in plasma (Cmax), the area under the concentration-time curve (AUC), and the decrease in human immunodeficiency virus (HIV) type 1 RNA levels after 12 months of treatment was evaluated. The threshold AUC that improved efficacy was determined by the use of a Wilcoxon test for HIV RNA, and an optimized dosing schedule was simulated. Didanosine pharmacokinetics was best described by a one-compartment model with first-order absorption and elimination. The apparent clearance and volume of distribution were higher for tablets, probably due to a lower bioavailability with tablets than with pediatric powder. The decrease in the viral load after 12 months of treatment was significantly correlated with the didanosine AUC andCmax(P≤ 0.02) during the first weeks of treatment. An AUC of >0.60 mg/liter·h was significantly linked to a greater decrease in the viral load (a decrease of 3 log10versus 2.4 log10copies/ml;P= 0.03) than that with a lower AUC. A didanosine dose of 360 mg/m2administered as tablets should be a more appropriate dose than 240 mg/m2to improve efficacy for these children. However, data on adverse events with this dosage are missing.

Objective: To analyze the determinants of CD4 change in children during 3 periods: before highly active antiretroviral therapy (HAART), during the first year after HAART initiation, and past I year after HAART initiation. Methods: One hundred seventy-seven children enrolled in it prospective cohort in Abidjan received HAART during a mean follow-up of 30 months. A linear mixed-effects model was used for the first period, a mixed-effects piecewise model for the second period, and all asymptotic mixed-effects model for long-term CD4 dynamics. Results: Before HAART initiation, CD4 percentage decreased along time [beta = -0.59 (-0.92 to -0.26)] was positively associated with body mass index for age [beta = 0.47 (0.22 to 0.72)] and negatively associated with vital load [beta = -1.01 (-1.90 to -0.13)]. During the first year of treatment, the CD4 decrease reverted to a steep increase that vas negatively associated with age at HAART initiation [beta = -0.24 (-0.4 to -0.07)] and with the mean viral load Under HAART [beta = -1.51 (-2.21 to -0.81)]. The long-term CD4 percentage was also negatively associated with the mean viral load under HAART beta = -4.97 (-6.22 to -3.72)] and age at HAART initiation [beta = -0.82 (-1.12 to -0.51)]. Conclusions: Before HAART initiation, the CD4 cell percentage was associated with growth indicators whereas, after HAART, all early increase and a long-term plateau were negatively associated with the viral load and age at HAART initiation.

In order to adapt African programs for antiretroviral treatment (ART) to children's needs, a good understanding of the unique features of pediatric HIV in Africa and realistic expectations of the results of such programs are crucial. We compared pediatric HIV in African settings to pediatric HIV in Western settings and to adult HIV in African settings. As an illustration, we also compared baseline characteristics and ART-outcomes from 15 African pediatric studies, 11 Western pediatric studies and 15 studies of African adults. Several differences in diagnostic, clinical, immunological and virological characteristics were identified, as well as variations in the most influential factors for disease progression and response to ART. Environmental factors may influence disease progression, mortality, loss to follow-up, adherence and the need to adapt the regimen. Many of the responses to ART are two-phased, the first phase taking longer in children than in adults. The selected African pediatric programs recorded a higher increase in median CD4-percent than the selected Western pediatric programs and a higher increase in CD4-count than the selected African adult programs. Compared to the adult programs, the African pediatric programs had lower drop-out rates, higher reported adherence levels and comparable mortality rates. The Western pediatric programs, however, had the lowest mortality rates. While several challenges complicate comparisons between ART-programs, increased knowledge of the unique features of pediatric HIV in Africa may greatly assist in improving pediatric HIV care on a global level.

The aim of this study, conducted in Ivory Coast, was to evaluate the prevalence and evolution of viral hepatitis in children coinfected with human immunodeficiency virus type 1 (HIV-1).Hepatitis B virus (HBV) and hepatitis C virus (HCV) markers were retrospectively and longitudinally assessed among 280 HIV-1-infected children enrolled in the Agence Nationale de Recherches sur le SIDA et les Hépatites Virales B et C 1244/1278 cohort. Among these, 173 (61.8%) received highly active antiretroviral therapy (HAART), including lamivudine (3TC) for 122 children. Detection of the hepatitis B s antigen (HBsAg) was performed on specimens collected at inclusion and 6 months later. If results of both tests were positive, hepatitis B e antigen (HBeAg)/hepatitis B e antibody (HBeAb) and HBV DNA levels were measured at inclusion and during follow-up. A fourth-generation HCV enzyme immunoassay was used for HCV screening at inclusion.In our pediatric cohort, no patients were infected with HCV, but the prevalence of HBsAg at inclusion was 12.1% (34 of 280; 95% confidence interval [CI], 8.6-16.6). Among the HBV-HIV-1-coinfected children, a high rate of positive HBeAg chronic hepatitis B (CHB) was noted at inclusion (82.4% [ 28 of 34]; 95% CI, 65.5%-93.2%) and after a median follow-up of 18 months (78.3%; 95% CI, 45.5%-92.7%), with no significant difference between children treated with HAART (with or without 3TC) and untreated ones. These children showed high HBV DNA levels (usually8.0 log(10) copies/mL) and viral population consisting of nearly exclusively wild-type HBeAg-positive HBV strains, strongly suggesting that most of them were in the initial immunotolerant phase of chronic hepatitis B.In sub-Saharan Africa, children with chronic hepatitis B and who are treated with 3TC-based HAART are at risk of developing 3TC resistance. Further studies are required to guide the management of HBV-HIV-1-coinfected children.

Summary: The high genetic diversity of HIV-1 has a major impact on the quantification of plasma HIV-1 RNA, representing an increasingly difficult challenge. A total of 898 plasma specimens positive for HIV-1 RNA by commercial assays (Amplicor v1.5; Roche Diagnostic Systems, Alameda, CA or Versant v3.0; Bayer Diagnostics, Emeryville, CA) were tested using the Agence Nationale de Recherches sur le SIDA second-generation (G2) real-time reverse transcriptase polymerase chain reaction (RT-PCR) test: 518 samples containing HIV-1 of known subtype, including 88 from 2 subtype panels and 430 harboring B (n = 266) and non-B (n = 164) group M HIV-1 subtypes from patients followed up in 2002 through 2005 at Necker Hospital (Paris, France), and 380 samples from 10 different countries (Argentina, Cambodia, Cameroon, Central African Republic, France, Ivory Coast, Madagascar, Morocco, Thailand, and Zimbabwe). HIV-1 RNA values obtained by G2 real-time PCR were highly correlated with those obtained by the Amplicor v1.5 for B and non-B subtypes (R2 = 0.892 and 0.892, respectively) and for samples from diverse countries (R2 = 0.867 and 0.893 for real-time PCR vs. Amplicor v1.5 and real-time PCR vs. Versant v3.0, respectively). Approximately 30% of specimens harboring non-B subtypes were underquantified by at least −0.51 log10 in Amplicor v1.5 versus 5% underquantified in G2 real-time PCR. Discrepant results were also obtained with subtype B samples (14% underquantified by Amplicor v1.5 vs. 7% by G2 real-time PCR). Similar percentages were observed when comparing results obtained with the G2 real-time PCR assay with those obtained using the Versant assay. Addressing HIV-1 diversity, continual monitoring of HIV-1 RNA assays, together with molecular epidemiology studies, is required to improve the accuracy of all HIV RNA assays.