Zeitschrift für AIDS und klinische Forschung

Objective: The purpose of this study was to document the outcome of HIV-infected children receiving the Highly Active Antiretroviral Therapy (HAART) in Togo.

Patients and method: It was a retrospective and descriptive multicentric national survey based on records of HIV-infected children who started receiving the HAART before the 31 st of June 2010. The study was conducted in 14 sites throughout the country.

Results: 854 children (under 15 years old) out of 1257 monitored in Togo were included in the survey. During the study period, 715 (84%) of those children were stable patients, always watched over at selected sites. To be noted also, 56 deaths (6%), 69 follow-up lost (8%) and 14 transfers to other sites (2%). Death and follow-up losses rates were higher in children under one year with respective percentages 11.9% and 18.6%. The rate of death was 13.7% in the cohort of 2007, 10.8% in the cohort of 2008, 6.5% in the cohort of 2009 and finally 5% in the cohort of 2010. The survival rate at 12 months was greater than 90% in all the cohorts.

Conclusion: This study shows a gradual improvement in the survival rate of HIV-infected children receiving the HAAART from 2007 to nowadays. The survival rate of children receiving the HAART at 12 months is not different from that of adults. So, it is important to improve qualitative and quantitative care of HIV-infected children in public health programs in sub-Saharan Africa.

Background: Despite reports of an increasing incidence of asthma in HIV-infected children, exploration of pulmonary function by spirometry has never been reported in this population in the HAART era.

Objective: The aim of this study was to determine the prevalence of spirometric abnormalities in HIV-1 infected children. We conducted a cross-sectional study of pulmonary function tests (PFT) in HIV-1 vertically infected children.

Methods: Spirometric values were measured in 17 HIV-1 chronically infected children and compared to matched healthy children. In HIV-1 infected children, the correlations between PFT and the determination of the single breath carbon monoxide diffusing capacity of the lung (TL CO ) and immunological and virological values were assessed.

Results: Overall, 11 of the 17 PFT were normal. Four showed mild distal obstruction. Two were considered restrictive. When compared with matched healthy children, the only difference was the FEV1/FVC ratio that was significantly lower in the patients’ group (91.9% of predicted value versus 97.1%, p<0.0001). We found a positive correlation between TL CO and the CD4/CD8 T-cell ratio (p=0.012) and viral load (p=0.05). We observed that FEF 25-75 values increased with age and weight in healthy children (p= 0.006 and p=0.007 respectively), but not in infected patients.

Conclusions: Our results showed that chronic HIV-1 infection and/or continuous HAART exposure induce a specific response of the pulmonary immune system which may compromise its function with time. If confirmed, it may justify a careful follow-up of pulmonary function in vertically infected children

Background: As antiretroviral therapy (ART) becomes more available to the HIV infected population in rural areas in India, it is important to determine the prevalence of its long term complications. Therefore, it was proposed to find out the prevalence of lipodystrophy in patients receiving ART and compare the gender dif ferences.

Material and methods: In this cross sectional study, consenting HIV-infected patients on ART visiting Namakkal District Head Quarters Hospital, Tamil Nadu, India, were recruited. They were on generic first-line fixed dose combinations of ART. Sociodemographics, anthropometric measurements, ART regimens and duration of treatment were recorded. Patients’ self-perception of lipodystrophy was obtained using standardized questionnaires and clinically confirmed by the physician. An overnight fasting blood was drawn to determine serum lipids levels. Statistical analysis included Chi-square test, student t-test and Mann Whitney U test.

Results: There were 145 HIV-infected subjects (46.9% males, 53.1% females) receiving ART for a mean 29.4 months. Mean age of the males were 38.18 ± 8.85 and for the females, it was 33.34 ± 6.20. The mean body mass index (BMI) for the males was 21.95 ± 3.94 kg/m 2 while for the females it was 21.14 ± 3.54 kg/m 2 . The overall prevalence of lipodystrophy was 60.69%; 22.72% with lipohypertrophy, 51.14% with lipoatrophy, and 22.72% with mixed pattern. Women had a higher prevalence of lipodystrophy than men (p=0.004). Lipoatrophy was higher in females (p=0.015) and mixed pattern (p=0.015). There was a higher prevalence of facial atrophy, fat loss in arms, fat loss in legs and fat loss in buttocks among women compared to men. Women with lipodystrophy had higher BMI, CD4 counts, VLDL cholesterol and triglycerides.

Conclusion: Women had significantly higher rates of generalized lipodystrophy and particularly lipoatrophy when compared with men taking first-line antiretroviral regimen. Compared with women without lipodystrophy, those with lipodystrophy had lipid abnormalities.