Sylvie Ouédraogo

Missed Opportunities for Early Access to Care of HIV-Infected Infants in Burkina Faso

Objective The World Health Organization (WHO) has recommended a universal antiretroviral therapy (ART) for all HIV-infected children before the age of two since 2010, but this implies an early identification of these infants. We described the Prevention of Mother-to-Child HIV Transmission (PMTCT) cascade, the staffing and the quality of infrastructures in pediatric HIV care facilities, in Ouagadougou, Burkina Faso. Methods We conducted a cross-sectional survey in 2011 in all health care facilities involved in PMTCT and pediatric HIV care in Ouagadougou. We assessed them according to their coverage in pediatric HIV care and WHO standards, through a desk review of medical registers and a semi-structured questionnaire administered to health-care workers (HCW). Results In 2011, there was no offer of care in primary health care facilities for HIV-infected children in Ouagadougou. Six district hospitals and two university hospitals provided pediatric HIV care. Among the 67 592 pregnant women attending antenatal clinics in 2011, 85.9% were tested for HIV. The prevalence of HIV was 1.8% (95% Confidence Interval: 1.7%–1.9%). Among the 1 064 HIV-infected pregnant women attending antenatal clinics, 41.4% received a mother-to-child HIV transmission prevention intervention. Among the HIV-exposed infants, 313 (29.4%) had an early infant HIV test, and 306 (97.8%) of these infants tested received their result within a four-month period. Among the 40 children initially tested HIV-infected, 33 (82.5%) were referred to a health care facility, 3 (9.0%) were false positive, and 27 (90.0%) were initiated on ART. Although health care facilities were adequately supplied with HIV drugs, they were hindered by operational challenges such as shortage of infrastructures, laboratory reagents, and trained HCW. Conclusions The PMTCT cascade revealed bottle necks in PMTCT intervention and HIV early infant diagnosis. The staffing in HIV care and quality of health care infrastructures were also insufficient in 2011 in Ouagadougou.

Lung disease and HIV infection in children at the Charles de Gaulle university pediatric hospital center in Ouagadougou (Burkina Faso)

To compare the clinical and radiological aspects of lung diseases in HIV-positive and HIV-negative children, we conducted a retrospective case control study covering a 3-year period from January 2003 through December 2005 at Charles de Gaulle University Pediatric Hospital Center in Ouagadougou. HIV-positive patients hospitalised for lung disease were matched to HIV-negative patients controls, hospitalised for the same symptoms, by age and date of hospitalisation. The study included 186 patients (93 HIV-positive and 93 HIV-negative) and collected data on age, sex, clinical signs, radiological signs and short-term course. Of the 93 HIV-positive children suspected to have been contaminated by mother-to-child transmission, 92 had HIV1 and 1 had a double infection of HIV1 and 2. The mean age in both groups was 48 months. Clinically severe lung disease (44%) was more common in HIV-positive children. Radiology showed that interstitial syndrome was significantly more common in HIV-positive children (p=0001) with a sensitivity of 71% and a specificity of 60%. The case-fatality rate was 4.2% among HIV-positive children. This study allows us to remind paediatricians of the importance of lung disease in HIV-infected children. Moreover, the vertical transmission responsible for disease in all our patients shows the need to accelerate the scaling up of the program for prevention of mother-to-child HIV transmission in our country.

Pharmacokinetics of Efavirenz at a High Dose of 25 Milligrams per Kilogram per Day in Children 2 to 3 Years Old

ABSTRACT The MONOD ANRS 12206 trial was designated to assess simplification of a successful lopinavir (LPV)-based antiretroviral treatment in HIV-infected children younger than 3 years of age using efavirenz (EFV; 25 mg/kg of body weight/day) to preserve the class of protease inhibitors for children in that age group. In this substudy, EFV concentrations were measured to check the consistency of an EFV dose of 25 mg/kg and to compare it with the 2016 FDA recommended dose. Fifty-two children underwent blood sampling for pharmacokinetic study at 6 months and 12 months after switching to EFV. We applied a Bayesian approach to derive EFV pharmacokinetic parameters using the nonlinear mixed-effect modeling (NONMEM) program. The proportion of midinterval concentrations 12 h after drug intake (C12 h) corresponding to the EFV therapeutic pharmacokinetic thresholds (1 to 4 mg/liter) was assessed according to different dose regimens (25 mg/kg in the MONOD study versus the 2016 FDA recommended dose). With both the 25 mg/kg/day dose and the 2016 FDA recommended EFV dose, simulations showed that the majority of C12 h values were within the therapeutic range (62.6% versus 62.8%). However, there were more children underexposed with the 2016 FDA recommended dose (11.6% versus 1.2%). Conversely, there were more concentrations above the threshold of toxicity with the 25 mg/kg dose (36.2% versus 25.6%), with C12 h values of up to 15 mg/liter. Only 1 of 52 children was switched back to LPV because of persistent sleeping disorders, but his C12 h value was within therapeutic ranges. A high EFV dose of 25 mg/kg per day in children under 3 years old achieved satisfactory therapeutic effective levels. However, the 2016 FDA recommended EFV dose appeared to provide more acceptable safe therapeutic profiles. (This study has been registered at ClinicalTrials.gov under identifier NCT01127204.)

Febrile Convulsions in Infants at the Pediatrics University Hospital Center Charles de Gaulle of Ouagadougou (Burkina Faso)

Context: Seizures rank high among the commonest emergencies encountered in Pediatrics. As far as the etiologies are concerned, the most frequently confronted cause is infectious diseases. Therefore, particularly in the present work context, febrile seizures have been inadequately investigated. The study aimed at assessing the prevalence of febrile convulsions in our pediatrics department. Materials and Methods: This retrospective study was performed in the Pediatrics Medical Service Department of the Pediatrics University Hospital Charles de Gaulle of Ouagadougou in Burkina Faso (West Africa). Infants from one and thirty months of age, hospitalized between January 1, 2011 and December 31, 2012, were included in this study. Seizures are defined as those who accompany fevers above or equal to 38°C. However, the exclusions from the study included those infants recognized as epileptics; those with abnormal psychomotor development; those afflicted with encephalitis and meningitis; and children with hypoglycemia or dehydration with ionic disorders, as well as those infants who lacked lumbar puncture results. Data were analyzed using the Epi Info software version 3.5.1. Results: While the average age of the patients was 13 months, the average incidence of the febrile seizures was 2.5%. The seizures occurred all through the year, peaking in October (14.1%). The peak frequency (38.7%) was recorded in children from 12 to 24 months. About one-half of the patients (46.2%) registered a temperature from 38.5°C to 39.4°C. In 68.9% of the cases, the tonic convulsions were of the common type of convulsions. The number of convulsions was in the range of >2 episodes/24 h in 83.3% of the children. The pathologies commonly associated with tonic convulsions included acute gastroenteritis (29.4%), malaria (25.8%) and bronchopneumopathies (23.3%). The evolution was favorable in 95.3% of the cases. Conclusion: While this study confirms the benign character of the febrile convulsions, their recurrent quality necessitates the codification of a prospective study, for clearer identification and closer case monitoring.