Impact of antiretroviral therapy on the biological profile of HIV infected children in Cameroon

Background: HIV infection in children is a public health problem in ressource-constrained settings. Despite the support of the international community, meeting the cost of treatment and biological follow up remains a challenge in Cameroon and the developing world as a whole. The aim of this study was to evaluate the impact of antiretroviral therapy on the biological profile of HIV infected children followed up at the University Teaching Hospital of Yaounde (UTHY) in Cameroon. Methods & Materials: We carried out a retrospective study from May 2003 to December 2012 at the paediatric service of the UTHY. 116 files of HIV infected children were studied. Data on the socio demographic characteristics, family history in relation to HIV, biological investigations and the treatment outcome were collected. We compared the results of biological investigations performed before and six months after the initiation of antiretroviral therapy. Data analysis was performed using EPI info and SPSS statistical software. The study was approved by the Cameroon ethics committee. Results: The mean age was 54.02±46.34 months. The sex ratio was 0.96 in favor of males. This cohort was characterized by a late diagnosis (49.95±45 months) as well as a late initiation of antiretroviral therapy (8.52±14.17months). Patients consulted when the clinical and immunologic state was well advanced (74.2% and 83.3% respectively). Only 36 out of 116 children (31%) were able to meet the cost of biological investigations before and six months after the initiation of therapy. We noticed a significant increase in the following biological parameters after six months of therapy: blood glucose levels of 0.09 g/L (0.75-0.84; p= 0.007), percentage of CD4 in children below 5 years of age of 4.62% (20.12-24.75; p=0.022), absolute value of CD4 in children above 5 years of 294 cells/mm3 (151.18-445.18; p=0.011), CD4/CD8 ratio of 0.35 (0.55-0.90; p=0.000). Interestingly, after six months of therapy, there was a decrease in viral load of 3.90 log 10 copies/ml (5.85-1.95; p=0.006). Conclusion: This study demonstrated that immune restoration and virologic suppression in children were obtained after six months of therapy. Therefore, making biological follow up affordable to this vulnerable group is essential in our quest for a good therapeutic outcome.