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Obstetrical, maternal characteristics and outcome of HIV-infected rapid progressor infants at Yaounde: a
Félicitée Nguefack1, Roger Dongmo1, Carole Leïla Touffic Othman1
11 Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Cameroon ; 2 Gynaeco-Obstetric and Paediatric Hospital, P.o. Box 4362, Yaoundé, Cameroon ; 3 District Hospital Efoulan PO. Box 1113-Yaoundé, Cameroon ; 4 Mother and Child Centre of the Chantal Biya Foundation, P.O. Box 1444, Yaoundé, Cameroon.
Background:
Rapid progressors are exposed to HIV infection at an early stage of life, and the prognosis is poor without treatment. Reducing the proportion of infants who are rapid progressors, require strengthening strategies to achieve the highest level of performance for the PMTCT program.
Methods:
This was a retrospective study carried out on HIV infected infants aged less than 12 months, clinically classified stage 4 (WHO) or having CD4 count <25%. We described maternal and obstetrical characteristics of HIV-infected rapid progressors using univariate and bivariate analysis. Patients' survival was monitored from the inclusion time to the end of the study. We then estimated their probability of survival with or without anti-retroviral (ARV) treatment from birth using the Kaplan-Meier method.
Results:
The characteristics of the mothers of the 150 rapid progressors infants we included were: low level of education (OR=3.87; P=0.016), CD4 count less than 200/mm(3) (OR=43.3; P=0.000), absence of ARV prophylaxis (OR=6.02; P=0.043), or treatment with HAART (OR=5.74; P=0.000) during pregnancy. In the children, the most important findings were lack of co-trimoxazole prophylaxis (OR=11.61; P=0.000) and antiretroviral prophylaxis (OR=2.70; P=0.0344). The survival rate was 84.3% in infants who were receiving HAART as opposed to 43.3% in those who were not (P<0.05).
Conclusions:
HIV infected women who are eligible should start antiretroviral treatment prior to a pregnancy, in order to improve their immunological status. This measure associated to cotrimoxazole prophylaxis and ART could improve their survival.