Epidemiological, Clinical, Therapeutic and evolutionary Aspects of Children Living with HIV in Guédiawaye, Senegal

Abstract

Introduction: HIV infection in children is a major public health problem. The objective of this study carried out in the paediatric department of the Centre Hospitalier Roi Baudouin de Guédiawaye, was to evaluate the epidemiological, clinical, therapeutic and evolutionary aspects of a cohort of children with HIV over a 15-year period and to determine the factors associated with discontinuation of treatment and transition to second-line treatment. Patients and Methods: This was a descriptive and analytical cross-sectional study from August 2004 to December 2019 at the Centre Hospitalier Roi Baudouin de Guédiawaye. Through this study, age at diagnosis, current age, gender, orphan status, therapeutic aspects, status announcement and evolution were evaluated. A total of 129 patient records were studied over a 15-year period (2004-2019). HIV-positive children with profile I represented 93.8% and there was a male predominance with a sex ratio of 1.43. The current mean age of the children was 12.2 ± 4.5 and the median was 14 years. Fatherless and motherless children represented 24.0% and 20.2%, respectively, while both fatherless and motherless children represented 11.6%. The mean age at the start of ARV treatment was 7.6 ± 4.3 years and the median was 7.5 years. The mean age at the start of second-line treatment was 13.7 years with a standard deviation of 2.6 while the median was 13 years. AZT + 3TC + NVP was the most commonly used combination (29.5%) followed by TDF + FTC + NVP (26.2%). The mean age at treatment discontinuation was 13.3 ± 4.3 years while the median was 15 years. More than half of the children (57.0%) (N = 69) were aware of their status. Factors associated with discontinuation were gender (p value = 0.025 and OR = 3.2), orphan status (p value = 0.027 and OR = 3.0) and follow-up time greater than 10 years (p value = 0.013 and OR = 5.6). The mortality rate was 3.9%. Factors associated with transition to second-line treatment were year of inclusion (p value = 0.001 and OR = 15.6), age group (p value = 0.001 and OR = 19.2), orphan status (p value = 0.040 and OR = 2.6), treatment regimen (p value = 0.019 and OR = 5.7), duration of ARV treatment (p value Conclusion The cohort of HIV-infected children followed up in Guédiawaye remains dominated by adolescents. Orphan status, announcement of status and duration of follow-up are associated with transition to second-line treatment and treatment discontinuation.