gms | German Medical Science

Introduction: In Cameroon, the number of HIV infected children on ARV increased over the last 5 years thanks to national treatment recommendations and financial support by the Global Fund. We analyzed a paediatric HIV treatment cohort in rural Cameroon to identify the challenges of successful implementation of treatment recommendations.

Methods: All consecutive HIV infected children starting ARV received a complete clinical assessment and a baseline laboratory workup. The decision to start ARV was taken by a therapeutic committee according to national guidelines. EPI DATA was used to create an electronic data base.

Results: A total of 338 children was initiated on ARV between March 2003 and December 2008 of whom 166 males and 172 females. The ages ranged between 0,2 and 15,3 years with an average of 5,4 years. Most live within Bamenda and environs but some come from rural areas as far as 400 km away on difficult road. The median time between diagnosis and initiation of ART was 35 days (IQR 14–128). Transmission was mainly vertical with 79% of mothers known to be HIV positive, and 19% of mothers with unknown HIV status. Seven cases (2%) of horizontal transmission with HIV negative mothers occurred (2 blood transfusions, 2 scarifications, 1 treatment for extensive burns, 2 of unknown transmission risk; mean age: 9,8 years, SD 3,7). The caregivers were parents in 66%, grandparents in 13%, aunts in 17%, and siblings in 2%.Ten of these children entered HIV care through PMTCT programs, 5 of them in 2008 when PCR testing for early infant diagnosis became available in Cameroon. WHO stage at initiation of ARV was stage I in 2%, stage II in 8%, stage III in 72% and stage IV in 18%. All patients were severely immunosuppressed according to the WHO classification of 2006 (median CD4 count for children <12 months: 19%, 12–35 months: 11%, 36–59 months: 13%, >5years: 7%). The most frequently used combinations were AZT+3TC+NVP in 38%, d4t+3TC+NVP in 38%, AZT+3TC+EFV in 14% and d4t+3TC+EFV in 8%. Six percent of children received concomitant TB treatment at initiation of HAART.

Conclusion: Despite the availability of free ARV for HIV infected children, deferred diagnosis of HIV infection and delayed initiation of ARV remain significant problems due to lack of parental care and distance to specialized treatment centres. Most children were infected vertically, but the possibility of horizontal HIV transmission also exists in this rural African cohort.