John Libbey Eurotext

Médecine et Santé Tropicales

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Outcome of HIV-positive children and adolescents treated with second-line antiretroviral agents in Congo Volume 28, issue 4, Octobre-Novembre-Décembre 2018

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Authors
Faculté des sciences de la santé, Université Marien Ngouabi, Brazzaville, Service de pédiatrie nourrissons, CHU de Brazzaville, BP : 32, Brazzaville, Congo
* Correspondance
  • Key words: HIV/AIDS, children, antiretroviral, therapeutic failure, Congo
  • DOI : 10.1684/mst.2018.0850
  • Page(s) : 413-8
  • Published in: 2018

Antiretroviral agents (ARVs) are the leading therapeutic weapon against HIV/AIDS infection. When first-line treatment fails, a second-line ARV is needed. Objective: To determine the prevalence of HIV-infected children treated with second-line ARVs, to assess their adherence and therapeutic response, and to identify factors of good adherence. Material and methods: A retrospective multicenter study covering the period from January 2015 to July 2016 in all centers providing care to children with HIV included all children treated with a second-line ARV. Results: A total of 71 children were identified, with a male to female ratio of 1.1 and a mean age of 14.2±3.2 years (range: 5 to 19). Mother-to-child transmission was observed for 97.2 %. In all, 64.8 % of the children had lost at least one parent, 29.6 % both of them. Family socioeconomic status was low for 15.5 % and middle for 74.6 %. Nearly half (46.5 %) were aware of their HIV status, and all received psychological support. The therapeutic regimen used for 54.9 % included ABC + DDI + LPV/r, and the treatment lasted for less than 2 years in 22.5 % and between 2 and 4 years in 38 %. Therapeutic adherence was good in 54.9 %, better in boys (p < 0.01) and in those aged 15 years and younger (p < 0.001). The therapeutic response was good in 89 % at 12 months and 86 % at 4 years, better in those aged 15 years and younger (p < 0.001). Conclusion: Despite the small proportion of good therapeutic adherence to second-line ARVs, the rate of good clinical and therapeutic response of 86 % in children and adolescents 4 years after being switched to them is an argument that should encourage prescribers to shift patients to second-line treatment as soon as there is an indication. However, challenges remain in improving the management of children and adolescents treated with a second-line ART.