IntroductionLimited studies have reported the outcomes of lifelong antiretroviral therapy (ART) amongst adolescents living with HIV (ALWHIV) in resource-limited settings (RLS), thus classifying this population as underserved. We therefore aimed to ascertain the immunological and virological responses, and associated factors amongst Cameroonian ALWHIV.MethodA cross-sectional and observational study was conducted from January through May 2016 at the National Social Insurance Fund Health Centre in Yaoundé-Cameroon. Immunological and virological responses were evaluated using CD4 cell count and viral load respectively, with viral suppression (VS) defined as <50 copies/ml. Adherence was evaluated using self-reported missing doses during the past 14 days. Data were analyzed using R v.3.3.0, with p<0.05 considered statistically significant.ResultsOf the 145 ALWHIV on ART enrolled in the study, 52% were female, median age [interquartile (IQR)] was 13 [11–16] years, median [IQR] time-on-ART was 7 [5–10] years, 48% were orphans, 92% were on first-line ART and 36% were adherent to ART. Following ART response, 79% (114/145) had CD4 ≥500/mm3, 71.0% (103/145) were on VS of whom 52.4% (76/145) had a sustained VS. Duration of ART was associated with immune restoration (Odd Ratio 3.73 [1.26–12.21]) but not with virological response. Risks of poor adherence were greater in orphans of both parents (p = 0.078).ConclusionIn this urban setting of Cameroon, ALWHIV receiving ART show favorable immunological and virological response in a medium run. For long-term ART success, implementing a close monitoring of adherence and risks of viral rebound would be highly relevant, especially for orphans of both parents.

BackgroundEvidence of 24-months survival in the frame of prevention of mother-to-child transmission (PMTCT) cascade-care is scare from routine programs in sub-Saharan African (SSA) settings. Specifically, data on infant outcomes according to feeding options remain largely unknown by month-24, thus limiting its breath for public-health recommendations toward eliminating new pediatric HIV-1 infections and improving care. We sought to evaluate HIV-1 vertical transmission and infant survival rates according to feeding options.MethodsA retrospective cohort-study conducted in Yaounde from April 2008 through December 2013 among 1086 infants born to HIV-infected women and followed-up throughout the PMTCT cascade-care until 24-months. Infants with documented feeding option during their first 3 months of life (408 on Exclusive Breastfeeding [EBF], 663 Exclusive Replacement feeding [ERF], 15 mixed feeding [MF]) and known HIV-status were enrolled. HIV-1 vertical transmission, survival and feeding options were analyzed using Kaplan Meier Survival Estimate, Cox model and Schoenfeld residuals tests, at 5% statistical significance.ResultsOverall HIV-1 vertical transmission was 3.59% (39), and varied by feeding options: EBF (2.70%), ERF (3.77%), MF (20%), p = 0.002; without significance between EBF and ERF (p = 0.34). As expected, HIV-1 transmission also varied with PMTCT-interventions: 1.7% (10/566) from ART-group, 1.9% (8/411) from AZT-group, and 19.2% (21/109) from ARV-naïve group, p < 0.0001. Overall mortality was 2.58% (28), higher in HIV-infected (10.25%) vs. uninfected (2.29%) infants (p = 0.016); with a survival cumulative probability of 89.3% [79.9%–99.8%] vs. 96.4% [94.8%–97.9% respectively], p = 0.024. Mortality also varied by feeding option: ERF (2.41%), EBF (2.45%), MF (13.33%), p = 0.03; with a survival cumulative probability of 96% [94%–98%] in ERF, 96.4% [94.1%–98.8%] in EBF, and 86.67% [71.06%–100%] in MF, p = 0.04. Using Schoenfeld residuals test, only HIV status was a predictor of survival at 24 months (hazard ratio 0.23 [0.072–0.72], p = 0.01).ConclusionBesides using ART for PMTCT-interventions, practice of MF also drives HIV-1 vertical transmission and mortality among HIV-infected children. Thus, throughout PMTCT option B+ cascade-care, continuous counseling on safer feeding options would to further eliminating new MTCT, optimizing response to care, and improving the life expectancy of these children in high-priority countries.

BackgroundThere are limited data on protease inhibitor (PI)-based antiretroviral therapy (ART) amongst children in resource-limited settings, for informing on optimal paediatric regimens.ObjectiveTo evaluate therapeutic response to PI-based ART amongst HIV-infected Cameroonian children.MethodsA retrospective study was conducted amongst children aged 2–18 years receiving a PI-based ART at the Essos Hospital Centre (EHC), Yaounde, Cameroon. Primary end points were therapeutic success on PI-based ART, defined as clinical success (WHO I/II clinical stage), immunological success (CD4 ≥ 500/mm3) and viral suppression (viral load [VL]<1000 copies/ml). Factors associated with therapeutic success were assessed in uni- and multivariate analysis using SPSS software v.2.0; with p<0.05 considered statistically significant.ResultsA total of 71 eligible children on PI-based ART were enrolled (42 on initial and 29 on substituted regimens), with a median age of 8 [IQR: 5–12] years and mean duration on ART of 7 years. Following therapeutic responses, all (100%) experienced clinical success, 95.2% experienced immunological success (91.7% on initial and 97.2% on substituted PI/r-based regimens) and 74.7% viral suppression. In univariate analysis, viral suppression was associated with: younger age (p<0.0001), living with parents as opposed to guardians (p = 0.049), and the educational level (p<0.0001). In multivariate analysis, only the age ranges of 10–14 years (OR: 0.22 [0.07–0.73]) and 15–18 years (OR: 0.08 [0.02–0.57]), were determinants of poor viral suppression.ConclusionAmong these Cameroonian children, PI-based ART confers favourable clinical and immunological outcomes. The poor rate of viral suppression was mainly attributed to adolescence (10–18 years).

Introduction: Respiratory pathologies are top listed amongst neonatal morbidities. Our objective was to describe the clinical features, causes and treatment of respiratory distress (RD) in full and post term neonates in a tertiary health center in Yaoundé, the Essos Hospital Centre (EHC). Patients and Method: This was a retrospective study. Full/post term neonates with RD from January 2017-December 2018 were included. Main parameters: incidence of RD, etiologies, risk factors for severity and mortality. Results: We included 186 neonates among 2312 newborn babies. The RD prevalence rate was 8%. Sex ratio of 2.15 was favoring male, median gestational age of 38 weeks. Clinical signs of RD were dominated by a Silverman score above 4/10 in 64%. Main etiologies were pneumonia (44%), followed by transient tachypnea (35.4). Perinatal asphyxia (OR = 9.412, P = 0.005) and cyanosis (OR = 6.509; P < 0.001) were worsening RD, while caesarian section was protective (OR = 0.412; P = 0.050). Mortality rate (MR) was 10.4%. Therapeutic measures briefly consisted in oxygen therapy for 98.9% of patients and probabilistic antibiotic therapy. Conclusion: Neonatal pneumonia was the preeminent etiology of RD in this population; the MR was high.

Introduction. Vaccination is very often delayed in premature and low birth weight infants. However, timely vaccination is even more important in the latter because of their increased susceptibility to infection.Objective. To assess immunization practice and factors associated with vaccine promptness and completeness in former preterm and low-birth-weight infants.Methods. We conducted a retrospective analytical cross-sectional study (January 2017 to February 2019). Main measurement : Promptness and completeness at each contact, Statistical analysis was performed using R software version 3.6.2, logistic regression was used to estimate the Odds Ratio (OR) and their 95% Confidence Interval (CI).Results. We recruited 310 children aged 12 to 36 months born before 37 weeks with low birth weight, 163 (52.6%) of whom were female. Two hundred and fifty-three had received the vaccines at the indicated age, with promptness rate of 81.6%, and 97.7% had completed routine immunization at 9 months. The mean age at vaccination initiation was 6 days ±11 and the mean weight at vaccination initiation was 2233g ±494. High prematurity and very low birth weight were associated with a high rate of vaccine delay: 61.5% [OR: 15.56; (CI: 3.22-118.52; p=0.002)] and 66.7% [OR: 19.19; (CI: 4.67-92.52; p<0.001)] respectively. Distance > 5 km with HEC [OR: 3.48; (CI: 1.68-7.47; p=0.001)] was associated with poor vaccination. Women in common-law unions had the lowest vaccine readiness rate (60.6%), (OR: 3.36; CI: 1.006-10.70; p=0.038). The frequency of occurrence of post immunization adverse events was 24.5%, with fever type in 94.7%.Conclusion. Nearly all premature and/or low-birth-weight children hospitalized at Essos Hospital Center had completed routine immunization at 9 months, and the majority had received the vaccines in a timely manner. Similar study is needed in rural area.