From infanthood to adolescence across the globe : growing-up with HIV

This thesis is focusing on two extremes of the paediatric HIV spectrum in two different parts of the world. 1. If left untreated, HIV infection can be fatal in 50% of the children by the age of 2 years. Randomized controlled trials showed that early antiretroviral therapy can dramatically decrease mortality in infants. However, it has not been demonstrated in "real life" settings. In this thesis, we showed that early antiretroviral therapy was highly effective in a busy paediatric HIV state clinic in KwaZulu-Natal. Undetectable viral load was found in nearly 80% of the children who reached 18 months of treatment, their clinical, immunological conditions improved during the follow-up and the number of hospital admissions decreased. 2. The introduction of combination antiretroviral therapy has altered the course of HIV from what was once a fatal disease to a chronic one, with perinatally infected children now living well into adulthood. However there are few data on the health status of HIV-infected adolescents at the time of transfer to adult services. We showed that at CHU Sainte Justine, Montreal, more than 50% of 45 transferring adolescents were failing treatment which was manifested by detectable viral load, CD4 count < 200 and/or triple-class drug resistance. However, the most concerning patients were all treated with suboptimal therapy in the beginning of the pandemic when no other therapeutic option was available. We are expecting that the new generations, who received combination antiretroviral therapy from the start, will be in better health condition at the time of transfer. In summary, paediatric HIV has positively evolved. Due to the success of the prevention of mother-to-child transmission, new cases of perinatal infection are rare in high income countries and are decreasing in most of the endemic countries where huge effort are done to improve coverage and effectiveness of this strategy. If early diagnosed and treated, HIV infected children are surviving into adulthood with, in general, a good quality of life although some concerns exist about adherence, drug-related toxicities, drug resistance, social issues and reproductive health. Longer-term outcome of perinatally-infected children is still unclear and very scarce data exist about health status of those patients after transfer into adult services.(MED - Sciences médicales) -- UCL, 201