Immunological and Virologic Outcomes Within 10 Years of Combined Antiretroviral Therapy Initiated Before 1 Year of Age in Cameroonian Children With Perinatal HIV

Abstract

BACKGROUND: We reported immunological and virologic outcomes within 10 years of combined Antiretroviral Therapy (cART) initiated no later than age one year and associated factors in children with perinatal HIV in Cameroon. SETTING: This study was conducted in 3 referral hospitals in Cameroon. METHODS: We conducted a prospective cohort study, using time-to-event analysis. Probabilities of the following outcomes were assessed within the first 10 years of cART initiation: first Viral Suppression to <400 copies/mL (VS), maintaining first VS, Immunocompetence (IC) - stage 1, CDC Immunological Classification - and mortality. RESULTS: 190 children started cART before one year of age, at an average age of 4.3 months (Standard deviation: ±2.5 months), of whom 45.3% were immunocompetent; 66.8% on nevirapine (NVP)-based versus ritonavir-boosted lopinavir (LPV/r)-based regimens; 37.9% with running water at home. At 10 years of cART initiation, outcomes probabilities estimates were: 22.0% of death mostly in the first 2 years and mainly due to advanced HIV disease, 72.0% of first VS achieved; 70.0% and 50.4% of first VS maintained considering children with first VS achieved and all the study participants, respectively; immunocompetent children increased to 88.6%. Being immunocompetent at cART initiation and receiving LPV/r-based regimens (versus NVP-based ones) over time were significantly associated with maintaining VS. CONCLUSION: Long term efficacy of early cART in children with perinatal HIV was mainly impaired by high mortality during initial phase. Screening strategies, even community-based, for early detecting HIV in exposed infants before advanced HIV disease had set up, should be implemented.