Background We described malnutrition and the effect of age at antiretroviral therapy (ART) initiation on catch-up growth over 24 months among HIV-infected children enrolled in the IeDEA West African paediatric cohort (pWADA). Methods Malnutrition was defined at ART initiation (baseline) by a Z-score <-2 SD, according to three anthropometric indicators: Weight-for-age (WAZ) for underweight, Height-for-age (HAZ) for stunting, and Weight-for-Height/BMI-for-age (WHZ/BAZ) for wasting. Kaplan-Meier estimates for catch-up growth (Z-score ≥-2 SD) on ART, adjusted for gender, immunodeficiency and malnutrition at ART initiation, ART regimen, time period and country, were compared by age at ART initiation. Cox proportional hazards regression models determined predictors of catch-up growth on ART over 24 months. Results Between 2001 and 2012, 2004 HIV-infected children < 10 years of age were included. At ART initiation, 51% were underweight, 48% were stunted and 33% were wasted. The 24-month adjusted estimates for catch-up growth were 69% (95% confidence interval [CI]: 57;80), 61% (95%CI: 47;70), and 90% (95%CI: 76;95) for WAZ, HAZ, and WHZ/BAZ, respectively. Adjusted catch-up growth was more likely for children <5 years of age at ART initiation compared to children ≥5 years for WAZ, HAZ (P<0.001), and for WHZ/BAZ (P = 0.026). Conclusions Malnutrition among these children is an additional burden that has to be urgently managed. Despite a significant growth improvement after 24 months on ART, especially in children <5 years, a substantial proportion of children still never achieved catch-up growth. Nutritional care should be part of the global healthcare of HIV-infected children in sub-Saharan Africa.

(grouped together into the 0-14 year age group) are specifi cally identifi ed in the NTP's quarterly reports. At the General Hospital (GH) in Cotonou, the economic capital, children are diagnosed and treated on the basis of information recorded in their personal medical fi les, but are never notifi ed to the NTP, for a variety of reasons. NTP data on children are therefore incomplete and cannot be used to estimate the true burden of childhood disease in Benin.The aim of the present study was to describe the burden of TB and characteristics and outcomes along children treated in Cotonou, Benin. Specifi c objectives were to determine: 1) the total number of TB cases recorded in the NTP TB registers, and of these, the number of children aged <15 years; 2) the incidence rate of notifi ed TB cases among children aged <15 years; 3) the number of children notifi ed with TB in the NTP TB register and the number of children recorded in the GH medical fi les (who are not notifi ed in the NTP TB register) and, in each of these groups, stratifi cation by sex, age, type of TB and human immunodefi ciency virus (HIV) status; and 4) the treatment outcomes among these children stratifi ed by place of treatment, sex, age, type of TB and HIV status, from 2009 to 2011. STUDY POPULATION, DESIGN AND METHODS Study designThis was a cross-sectional, retrospective cohort study of children with TB in Cotonou based on reviews of NTP TB registers and the medical fi les of the GH. SettingBenin is a small country in West Africa with a population of 9 million and a gross national income of US$780 per capita (http://data.worldbank.org/about/countryclassifi cations). The NTP notifi es about 3500 TB cases each year. The national incidence rate of notifi ed new TB cases has been stable over the last 10 years, at 41-46 per 100 000 population. The NTP follows the DOTS strategy and uses internationally recognised criteria for diagnosing and treating patients with TB. 6,7 The NTP has a central unit responsible for policy and strategy, while diagnosis, registration and care are decentralised to 57 public or private basic management units (BMUs) in the country.The present study was conducted in Cotonou and its suburbs, which has a population of about 1 million. There are fi ve BMUs in Cotonou, all of which have a TB register and use TB treatment cards. The GH has a Interna onal Union Against Tuberculosis and Lung DiseaseHealth solu ons for the poor by the NTP and 29 (16%) by the GH; the latter were not notified to the NTP. The incidence rate of notified TB cases was between 8 and 13 per 100 000 population, and was higher in children aged >5 years. Of 167 children tested, 29% were HIV-positive. Treatment success was 72% overall, with success rates of 86%, 62% and 74%, respectively, among sputum smear-positive, sputum smear-negative and extra-pulmonary patients. Treatment success rates were lower in children with sputum smear-negative TB (62%) and those with HIV infection (58%). Conclusion:The number of children being treated for TB is low, and younger ch...

Background Viral load and CD4% are often not available in resource-limited settings for monitoring children's responses to antiretroviral treatment (ART). We aimed to construct normative curves for weight gain at six-, twelve-, eighteen-, and twenty-four-month post initiation of ART in children, and to assess the association between poor weight gain and subsequent responses to ART. Design Analysis of data from HIV-infected children <10 years old from African and Asian clinics participating in the International epidemiologic Databases to Evaluate AIDS (IeDEA). Methods The generalized additive model for location, scale and shape was used to construct normative percentile curves for weight gain at six, twelve, eighteen, and twenty-four months following ART initiation. Cox proportional models were used to assess the association between lower percentiles (<50th) of weight gain distribution at the different time points and subsequent death, virological suppression, and virological failure. Results Among 7173 children from five regions of the world, 45% were underweight at baseline. Weight gain below the 50th percentile at six-, twelve-, eighteen-, and twenty-four months of ART was associated with increased risk of death, independent of baseline characteristics. Poor weight gain was not associated with increased hazards of virological suppression or virological failure. Conclusions Monitoring weight gain on ART using age- and sex-specific normative curves specifically developed for HIV-infected children on ART is a simple, rapid, sustainable tool that can aid in the identification of children who are at increased risk of death in the first year of ART.

IntroductionCurrent knowledge on morbidity and mortality in HIV-infected children comes from data collected in specific research programmes, which may offer a different standard of care compared to routine care. We described hospitalization data within a large observational cohort of HIV-infected children in West Africa (IeDEA West Africa collaboration).MethodsWe performed a six-month prospective multicentre survey from April to October 2010 in five HIV-specialized paediatric hospital wards in Ouagadougou, Accra, Cotonou, Dakar and Bamako. Baseline and follow-up data during hospitalization were recorded using a standardized clinical form, and extracted from hospitalization files and local databases. Event validation committees reviewed diagnoses within each centre. HIV-related events were defined according to the WHO definitions.ResultsFrom April to October 2010, 155 HIV-infected children were hospitalized; median age was 3 years [1–8]. Among them, 90 (58%) were confirmed for HIV infection during their stay; 138 (89%) were already receiving cotrimoxazole prophylaxis and 64 children (40%) had initiated antiretroviral therapy (ART). The median length of stay was 13 days (IQR: 7–23); 25 children (16%) died during hospitalization and four (3%) were transferred out. The leading causes of hospitalization were WHO stage 3 opportunistic infections (37%), non-AIDS-defining events (28%), cachexia and other WHO stage 4 events (25%).ConclusionsOverall, most causes of hospitalizations were HIV related but one hospitalization in three was caused by a non-AIDS-defining event, mostly in children on ART. HIV-related fatality is also high despite the scaling-up of access to ART in resource-limited settings.

Setting Drug resistance threatens tuberculosis (TB) control, particularly among HIV-infected persons. Objective We surveyed antiretroviral therapy (ART) programs from lower-income countries on prevention and management of drug-resistant TB. Design We used online questionnaires to collect program-level data in 47 ART programs in Southern Africa (14), East Africa (8), West Africa (7), Central Africa (5), Latin America (7) and Asia-Pacific (6 programs) in 2012. Patient-level data were collected on 1,002 adult TB patients seen at 40 of the participating ART programs. Results Phenotypic drug susceptibility testing was available at 36 (77%) ART programs, but only used for 22% of all TB patients. Molecular drug resistance testing was available at 33 (70%) programs and used for 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the whole treatment, 16 (34%) during intensive phase only and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line TB regimens; 18 (38%) reported TB drug shortages. Conclusions Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower income countries. DOT was not always implemented and drug supply was regularly interrupted, which may contribute to the global emergence of drug resistance.