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Acquired Immunodeficiency Syndrome: HELP
Articles from Brussels
Based on 26 articles published since 2009

These are the 26 published articles about Acquired Immunodeficiency Syndrome that originated from Brussels during 2009-2019.
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life. 2018

Bamford, A / Turkova, A / Lyall, H / Foster, C / Klein, N / Bastiaans, D / Burger, D / Bernadi, S / Butler, K / Chiappini, E / Clayden, P / Della Negra, M / Giacomet, V / Giaquinto, C / Gibb, D / Galli, L / Hainaut, M / Koros, M / Marques, L / Nastouli, E / Niehues, T / Noguera-Julian, A / Rojo, P / Rudin, C / Scherpbier, H J / Tudor-Williams, G / Welch, S B / Anonymous6140819. ·Department of Paediatric Infectious Diseases and Immunology, Great Ormond Street Hospital NHS Trust, London, UK. · Medical Research Council Clinical Trials Unit, London, UK. · Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK. · Institute of Child Health, University College London, London, UK. · Radboud University Medical Center, Nijmegan, The Netherlands. · University Department of Immunology and Infectious Disease, Bambino Gesù Children's Hospital, Rome, Italy. · Our Lady's Children's Hospital Crumlin & University College Dublin, Dublin, Ireland. · Meyer University Hospital, Florence University, Florence, Italy. · HIV i-Base, London, UK. · Emilio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil. · Paediatric Infectious Disease Unit, Luigi Sacco Hospital, University of Milan, Milan, Italy. · Department of Paediatrics, University of Padua, Padua, Italy. · Department of Health Sciences, Pediatric Unit, University of Florence, Florence, Italy. · Department of Pediatrics, CHU Saint-Pierre, Free University of Brussels, Brussels, Belgium. · Portsmouth Hospitals NHS Trust, Portsmouth, UK. · Paediatric Infectious Diseases and Immunodeficiencies Unit, Pediatric Department, Porto Central Hospital, Porto, Portugal. · Department of Clinical Microbiology and Virology, University College London Hospitals, London, UK. · Centre for Pediatric and Adolescent Medicine, HELIOS Hospital Krefeld, Krefeld, Germany. · Infectious Diseases Unit, Pediatrics Department, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain. · 12th of October Hospital, Madrid, Spain. · University Children's Hospital, Basel, Switzerland. · Department of Paediatric Immunology and Infectious Diseases, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands. · Imperial College, London, UK. · Heartlands Hospital, Birmingham, UK. ·HIV Med · Pubmed #25649230.

ABSTRACT: The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV-1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short-term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long-term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first- and second-line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART 'pipeline' of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.

2 Editorial Monitoring treatment outcomes in patients with chronic disease: lessons from tuberculosis and HIV/AIDS care and treatment programmes. 2015

Harries, Anthony D / Kumar, Ajay M V / Karpati, Adam / Jahn, Andreas / Douglas, Gerald P / Gadabu, Oliver J / Chimbwandira, Frank / Zachariah, Rony. ·International Union against Tuberculosis and Lung Disease, Paris, France. · London School of Hygiene and Tropical Medicine, London, UK. · International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India. · International Union Against Tuberculosis and Lung Disease, North America Office, New York, NY, USA. · Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi. · ITECH, Malawi and University of Washington, Seattle, WA, USA. · Center for Health Informatics for the Underserved, University of Pittsburgh, Pittsburgh, PA, USA. · Baobab Health Trust, Lilongwe, Malawi. · Medecins sans Frontieres, Medical Department, Operational Research Unit, Brussels Operational Centre, Luxembourg, Luxembourg. ·Trop Med Int Health · Pubmed #25779103.

ABSTRACT: -- No abstract --

3 Review Eye examination for early diagnosis of disseminated tuberculosis in patients with AIDS. 2016

Heiden, David / Saranchuk, Peter / Keenan, Jeremy D / Ford, Nathan / Lowinger, Alan / Yen, Michael / McCune, Joseph / Rao, Narsing A. ·Seva Foundation, Berkeley, California, USA. Electronic address: dheidenpea@yahoo.com. · Southern Africa Medical Unit, Operational Centre Brussels, Médecins Sans Frontières, Cape Town, South Africa. · Francis I Proctor Foundation, University of California, San Francisco, CA, USA. · Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa. · Tufts University School of Medicine, Boston, MA, USA. · Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Division of Experimental Medicine, University of California, San Francisco, CA, USA. · Ophthalmic Pathology Laboratory and Uveitis Service, USC Eye Institute, Keck School of Medicine, University of Southern California, CA, USA. ·Lancet Infect Dis · Pubmed #26907735.

ABSTRACT: Choroidal tuberculosis is present in 5-20% of patients with disseminated tuberculosis, and point-of-care dilated binocular indirect ophthalmoscopy eye examination can provide immediate diagnosis. In geographical areas of high tuberculosis prevalence and in susceptible patients (CD4 counts less than 200 cells per μL) detection of choroidal granulomas should be accepted as evidence of disseminated tuberculosis. With training and proper support, eye screening can be done by HIV/AIDS clinicians, allowing early tuberculosis treatment. In regions with a high burden of tuberculosis, we recommend that eye screening be a standard part of the initial assessment of susceptible patients, including at a minimum all patients with HIV/AIDS with CD4 less than 100 cells per μL with or without eye symptoms, and with or without suspicion of disseminated tuberculosis.

4 Review A systematic review of missed opportunities for improving tuberculosis and HIV/AIDS control in Sub-saharan Africa: what is still missed by health experts? 2014

Keugoung, Basile / Fouelifack, Florent Ymele / Fotsing, Richard / Macq, Jean / Meli, Jean / Criel, Bart. ·Ministry of Public Health, Cameroon ; Research, Education, and Health Development Group (GARES-Falaise), Dschang, Cameroun. · Research, Education, and Health Development Group (GARES-Falaise), Dschang, Cameroun ; Yaoundé Central Hospital, Yaoundé, Cameroon. · Ministry of Public Health, Cameroon. · Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium. · Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon. · Public Health Department, Institute of Tropical Medicine, Nationalstraat Antwerp, Belgium. ·Pan Afr Med J · Pubmed #25478041.

ABSTRACT: In sub-Saharan Africa, HIV/AIDS and tuberculosis are major public health problems. In 2010, 64% of the 34 million of people infected with HIV were reported to be living in sub-Saharan Africa. Only 41% of eligible HIV-positive people had access to antiretroviral therapy (ART). Regarding tuberculosis, in 2010, the region had 12% of the world's population but reported 26% of the 8.8 million incident cases and 254000 tuberculosis-related deaths. This paper aims to review missed opportunities for improving HIV/AIDS and tuberculosis prevention and care. We conducted a systematic review in PubMed using the terms 'missed'(Title) AND 'opportunities'(Title). We included systematic review and original research articles done in sub-Saharan Africa on missed opportunities in HIV/AIDS and/or tuberculosis care. Missed opportunities for improving HIV/AIDS and/or tuberculosis care can be classified into five categories: i) patient and community; ii) health professional; iii) health facility; iv) local health system; and v) vertical programme (HIV/AIDS and/or tuberculosis control programmes). None of the reviewed studies identified any missed opportunities related to health system strengthening. Opportunities that are missed hamper tuberculosis and/or HIV/AIDS care in sub-Saharan Africa where health systems remain weak. What is still missing in the analysis of health experts is the acknowledgement that opportunities that are missed to strengthen health systems also undermine tuberculosis and HIV/AIDS prevention and care. Studying why these opportunities are missed will help to understand the rationales behind the missed opportunities, and customize adequate strategies to seize them and for effective diseases control.

5 Review Epidemiology: clues to the pathogenesis of Burkitt lymphoma. 2012

Magrath, Ian. ·International Network for Cancer Treatment and Research, Rue Engeland 642, Brussels, Belgium. imagrath@inctr.be ·Br J Haematol · Pubmed #22260300.

ABSTRACT: The two major epidemiological clues to the pathogenesis of Burkitt lymphoma (BL) are the geographical association with malaria--BL incidence relates to the malaria transmission rate--and early infection by Epstein-Barr virus (EBV). Both agents cause B cell hyperplasia, which is almost certainly an essential component of lymphomagenesis in BL. The critical event in lymphomagenesis is the creation of a MYC translocation, bringing the MYC gene into juxtaposition with immunoglobulin genes and causing its ectopic expression, thereby driving the proliferation of BL cells. It is highly likely that such translocations are mediated by the activation-induced cytidine deaminase (AID) gene, which is responsible for hypervariable region mutations as well as class switching. Stimulation of the Toll-like receptor 9 by malaria-associated agonists induces AID, providing a mechanism whereby malaria could directly influence BL pathogenesis. EBV-containing cells must reach the memory cell compartment in order to survive throughout the life of the individual, which probably requires traversal of the germinal centre. Normally, cells that do not produce high affinity antibodies do not survive this passage, and are induced to undergo apoptosis. EBV, however, prevents this, and in doing so may also enhance the likelihood of survival of rare translocation-containing cells.

6 Review Lessons from clinical trials in African Burkitt lymphoma. 2009

Magrath, Ian. ·International Network for Cancer Treatment and Research, Brussels, Belgium. imagrath@inctr.be ·Curr Opin Oncol · Pubmed #19620863.

ABSTRACT: PURPOSE OF REVIEW: The center of gravity of the AIDS epidemic has moved - in 2007, 67% of all persons living with HIV infection and 72% of all deaths from AIDS occurred in Africa. The present review focuses on the treatment of an AIDS-defining malignancy, Burkitt lymphoma, since the discovery of the tumor in 1958 to provide a backdrop to the increasing necessity of dealing with AIDS-associated Burkitt lymphoma in Africa. RECENT FINDINGS: In Africa, it appears that AIDS-associated Burkitt lymphoma is increasing, but although treatment outcome is presently poor, the demonstration that highly active antiretroviral therapy permits the same treatment results to those in AIDS-unassociated Burkitt lymphoma provides hope for the future. SUMMARY: In the 1960s, the extraordinary response of Burkitt lymphoma to chemotherapy provided considerable encouragement to pioneer oncologists. Within little more than a decade, the most active drugs, the value of combination chemotherapy, and the need for intrathecal treatment, as well as the risk of tumor lysis syndrome had been demonstrated, providing a platform on which further advances could be made in resource-rich countries. Since that time, little progress has been made in Africa, but recent collaborative projects have shown that improved treatment outcome can be achieved at low cost. The impact of the HIV epidemic on the epidemiology and treatment of African Burkitt lymphoma will receive increasing focus in the coming years.

7 Article Long-term trends in mortality and AIDS-defining events after combination ART initiation among children and adolescents with perinatal HIV infection in 17 middle- and high-income countries in Europe and Thailand: A cohort study. 2018

Anonymous1050986 / Judd, Ali / Chappell, Elizabeth / Turkova, Anna / Le Coeur, Sophie / Noguera-Julian, Antoni / Goetghebuer, Tessa / Doerholt, Katja / Galli, Luisa / Pajkrt, Dasja / Marques, Laura / Collins, Intira J / Gibb, Diana M / González Tome, Maria Isabel / Navarro, Marisa / Warszawski, Josiane / Königs, Christoph / Spoulou, Vana / Prata, Filipa / Chiappini, Elena / Naver, Lars / Giaquinto, Carlo / Thorne, Claire / Marczynska, Magdalena / Okhonskaia, Liubov / Posfay-Barbe, Klara / Ounchanum, Pradthana / Techakunakorn, Pornchai / Kiseleva, Galina / Malyuta, Ruslan / Volokha, Alla / Ene, Luminita / Goodall, Ruth. ·MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom. · Institut National d'Etude Demographique (INED), Mortality, Health and Epidemiology Unit, Paris, France. · Institut de Recherche pour le Developpement (IRD), UMI 174/PHPT, Chiang Mai, Thailand. · Unitat d'Infectologia, Servei de Pediatria, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain. · Hopital St Pierre, Brussels, Belgium. · St George's Healthcare NHS Trust, London, United Kingdom. · Department of Health Sciences, Pediatric Unit, University of Florence, Florence, Italy. · Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands. · Centro Hospitalar do Porto, Porto, Portugal. · Hospital Doce de Octubre, Madrid, Spain. · Hospital General Universitario "Gregorio Marañón", Madrid, Spain. · Institut National de la Santé et de la Recherche (INSERM), Paris, France. · University Hospital Frankfurt, Department of Paediatrics, Goethe University, Frankfurt, Germany. · University of Athens Medical School, Athens, Greece. · Hospital de Santa Maria, Lisbon, Portugal. · Karolinska University Hospital, Stockholm, Sweden. · Paediatric European Network for the Treatment of AIDS (PENTA), Padova, Italy. · UCL Great Ormond Street Institute of Child Health, London, United Kingdom. · Medical University of Warsaw, Hospital of Infectious Diseases, Warsaw, Poland. · Republican Hospital of Infectious Diseases, St Petersburg, Russia. · Hopitaux Universitaires de Genève, Genève, Switzerland. · Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand. · Department of Pediatrics, Phayao Provincial Hospital, Phayao, Thailand. · Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine. · Perinatal Prevention of AIDS Initiative, Odessa, Ukraine. · Victor Babes Hospital, Bucharest, Romania. ·PLoS Med · Pubmed #29381702.

ABSTRACT: BACKGROUND: Published estimates of mortality and progression to AIDS as children with HIV approach adulthood are limited. We describe rates and risk factors for death and AIDS-defining events in children and adolescents after initiation of combination antiretroviral therapy (cART) in 17 middle- and high-income countries, including some in Western and Central Europe (W&CE), Eastern Europe (Russia and Ukraine), and Thailand. METHODS AND FINDINGS: Children with perinatal HIV aged <18 years initiating cART were followed until their 21st birthday, transfer to adult care, death, loss to follow-up, or last visit up until 31 December 2013. Rates of death and first AIDS-defining events were calculated. Baseline and time-updated risk factors for early/late (≤/>6 months of cART) death and progression to AIDS were assessed. Of 3,526 children included, 32% were from the United Kingdom or Ireland, 30% from elsewhere in W&CE, 18% from Russia or Ukraine, and 20% from Thailand. At cART initiation, median age was 5.2 (IQR 1.4-9.3) years; 35% of children aged <5 years had a CD4 lymphocyte percentage <15% in 1997-2003, which fell to 15% of children in 2011 onwards (p < 0.001). Similarly, 53% and 18% of children ≥5 years had a CD4 count <200 cells/mm3 in 1997-2003 and in 2011 onwards, respectively (p < 0.001). Median follow-up was 5.6 (2.9-8.7) years. Of 94 deaths and 237 first AIDS-defining events, 43 (46%) and 100 (42%) were within 6 months of initiating cART, respectively. Multivariable predictors of early death were: being in the first year of life; residence in Russia, Ukraine, or Thailand; AIDS at cART start; initiating cART on a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen; severe immune suppression; and low BMI-for-age z-score. Current severe immune suppression, low current BMI-for-age z-score, and current viral load >400 c/mL predicted late death. Predictors of early and late progression to AIDS were similar. Study limitations include incomplete recording of US Centers for Disease Control (CDC) disease stage B events and serious adverse events in some countries; events that were distributed over a long time period, and that we lacked power to analyse trends in patterns and causes of death over time. CONCLUSIONS: In our study, 3,526 children and adolescents with perinatal HIV infection initiated antiretroviral therapy (ART) in countries in Europe and Thailand. We observed that over 40% of deaths occurred ≤6 months after cART initiation. Greater early mortality risk in infants, as compared to older children, and in Russia, Ukraine, or Thailand as compared to W&CE, raises concern. Current severe immune suppression, being underweight, and unsuppressed viral load were associated with a higher risk of death at >6 months after initiation of cART.


Arrey, Agnes Ebotabe / Bilsen, Johan / Lacor, Patrick / Deschepper, Reginald. ·*Mental Health and Wellbeing Research Group,Department of Public Health,Vrije Universiteit Brussel,Brussels,Belgium. · †Department of Internal Medicine and Infectious Diseases-AIDS Reference Centre,Universitair Ziekenhuis Brussel,Brussels,Belgium. ·J Biosoc Sci · Pubmed #27692006.

ABSTRACT: Stigma and discrimination within health care settings remain a public health challenge across diverse cultural environments and may have deleterious effects on mental and physical health. This study explores the causes, forms and consequences of HIV-related stigma and discrimination among migrant sub-Saharan African women living with HIV in Belgium. A qualitative study was conducted with 44 HIV-positive sub-Saharan African migrant women between April 2013 and December 2014 in health care settings in Belgium. Data were analysed using thematic content analysis. Twenty-five of the women reported overt stigma and discrimination and fifteen reported witnessing behaviours that they perceived to be stigmatizing and discriminatory in health care settings. The themes that emerged as to the causes of stigma and discrimination were: public perceptions of migrants and HIV, fear of contamination and institutional policies on HIV management. Reported forms of stigma and discrimination included: delayed or denied care, excessive precautions, blame and humiliation. The consequences of stigma and discrimination were: emotional stress, inconsistent health-care-seeking behaviour and non-disclosure to non-HIV treating personnel. Stigma and discrimination in health care settings towards people with HIV, and more specifically towards HIV-positive sub-Saharan African migrant women, impedes sustainable preventive measures. Specialized education and training programmes for non-HIV health care providers require in-depth investigation.

9 Article 1970s and 'Patient 0' HIV-1 genomes illuminate early HIV/AIDS history in North America. 2016

Worobey, Michael / Watts, Thomas D / McKay, Richard A / Suchard, Marc A / Granade, Timothy / Teuwen, Dirk E / Koblin, Beryl A / Heneine, Walid / Lemey, Philippe / Jaffe, Harold W. ·Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, Arizona 85721, USA. · Department of History and Philosophy of Science, University of Cambridge, Cambridge CB2 3RH, UK. · Departments of Biomathematics, Biostatistics and Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, USA. · Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. · UCB, Brussels BE-1070, Belgium. · Laboratory of Infectious Disease Prevention, The New York Blood Center, New York, New York 10065, USA. · Department of Microbiology and Immunology, Rega Institute, KU Leuven-University of Leuven, Minderbroedersstaat 10, 3000 Leuven, Belgium. ·Nature · Pubmed #27783600.

ABSTRACT: The emergence of HIV-1 group M subtype B in North American men who have sex with men was a key turning point in the HIV/AIDS pandemic. Phylogenetic studies have suggested cryptic subtype B circulation in the United States (US) throughout the 1970s and an even older presence in the Caribbean. However, these temporal and geographical inferences, based upon partial HIV-1 genomes that postdate the recognition of AIDS in 1981, remain contentious and the earliest movements of the virus within the US are unknown. We serologically screened >2,000 1970s serum samples and developed a highly sensitive approach for recovering viral RNA from degraded archival samples. Here, we report eight coding-complete genomes from US serum samples from 1978-1979-eight of the nine oldest HIV-1 group M genomes to date. This early, full-genome 'snapshot' reveals that the US HIV-1 epidemic exhibited extensive genetic diversity in the 1970s but also provides strong evidence for its emergence from a pre-existing Caribbean epidemic. Bayesian phylogenetic analyses estimate the jump to the US at around 1970 and place the ancestral US virus in New York City with 0.99 posterior probability support, strongly suggesting this was the crucial hub of early US HIV/AIDS diversification. Logistic growth coalescent models reveal epidemic doubling times of 0.86 and 1.12 years for the US and Caribbean, respectively, suggesting rapid early expansion in each location. Comparisons with more recent data reveal many of these insights to be unattainable without archival, full-genome sequences. We also recovered the HIV-1 genome from the individual known as 'Patient 0' (ref. 5) and found neither biological nor historical evidence that he was the primary case in the US or for subtype B as a whole. We discuss the genesis and persistence of this belief in the light of these evolutionary insights.

10 Article Spirituality/Religiosity: A Cultural and Psychological Resource among Sub-Saharan African Migrant Women with HIV/AIDS in Belgium. 2016

Arrey, Agnes Ebotabe / Bilsen, Johan / Lacor, Patrick / Deschepper, Reginald. ·Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium. · Department of Internal Medicine and Infectious Diseases-AIDS Reference Center, Universitair Ziekenhuis Brussel, Brussels, Belgium. ·PLoS One · Pubmed #27447487.

ABSTRACT: Spirituality/religion serves important roles in coping, survival and maintaining overall wellbeing within African cultures and communities, especially when diagnosed with a chronic disease like HIV/AIDS that can have a profound effect on physical and mental health. However, spirituality/religion can be problematic to some patients and cause caregiving difficulties. The objective of this paper was to examine the role of spirituality/religion as a source of strength, resilience and wellbeing among sub-Saharan African (SSA) migrant women with HIV/AIDS. A qualitative study of SSA migrant women was conducted between April 2013 and December 2014. Participants were recruited through purposive sampling and snowball techniques from AIDS Reference Centres and AIDS workshops in Belgium, if they were 18 years and older, French or English speaking, and diagnosed HIV positive more than 3 months beforehand. We conducted semi-structured interviews with patients and did observations during consultations and support groups attendances. Thematic analysis was used to analyse the data. 44 women were interviewed, of whom 42 were Christians and 2 Muslims. None reported religious/spiritual alienation, though at some point in time many had felt the need to question their relationship with God by asking "why me?" A majority reported being more spiritual/religious since being diagnosed HIV positive. Participants believed that prayer, meditation, regular church services and religious activities were the main spiritual/religious resources for achieving connectedness with God. They strongly believed in the power of God in their HIV/AIDS treatment and wellbeing. Spiritual/religious resources including prayer, meditation, church services, religious activities and believing in the power of God helped them cope with HIV/AIDS. These findings highlight the importance of spirituality in physical and mental health and wellbeing among SSA women with HIV/AIDS that should be taken into consideration in providing a caring and healthy environment.

11 Article HIV-Helicobacter pylori Co-Infection: Antibiotic Resistance, Prevalence, and Risk Factors. 2015

Nkuize, Marcel / De Wit, Stéphane / Muls, Vinciane / Delforge, Marc / Miendje Deyi, Véronique Y / Cadière, Guy B / Buset, Michel. ·Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium. · Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium. · Department of Microbiology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium. · Department of Digestive Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium. ·PLoS One · Pubmed #26691198.

ABSTRACT: BACKGROUND: Patients infected with human immunodeficiency virus (HIV) are living longer due to the availability of more potent treatments. However, prescription of antibiotics to treat or prevent infections in these patients may increase the likelihood of co-infection with antibiotic-resistant species. AIM: To compare antimicrobial susceptibility of Helicobacter pylori (H. pylori) in HIV-positive and HIV-negative patients and assess risk-factors for resistance. METHODS: We prospectively collected data from consecutive HIV-positive and HIV-negative patients undergoing upper gastrointestinal endoscopy. Patients with H. pylori-positive gastric biopsies who had never received H. pylori treatment were included. RESULTS: Of the 353 patients included, 93 were HIV-positive and 260 HIV-negative. Among the HIV-positive patients, 56 (60%) had been infected for <10 years, the median CD4+ count was 493 cells/μl and median viral load was 61 copies/mL; 66 (71%) were receiving antiretroviral therapy. HIV-positive patients were more often male (p = 0.009), had a lower body mass index (p<0.0001), and had less frequently received antibiotics during the 12-months prior to the endoscopy (p<0.0001) than HIV-negative patients. HIV-positive patients were more likely to have H. pylori resistant to levofloxacin (p = 0.0004), metronidazole (p = 0.01), or multiple antibiotics (p = 0.006). HIV-positive Black Africans were more likely to have resistant strains than were HIV-negative Black Africans (p = 0.04). Ethnicity and HIV status were independent risk factors for H. pylori resistance in all patients and acquired immune deficiency syndrome (AIDS) and sex were risk factors in HIV-positive patients. CONCLUSIONS: There was a higher prevalence of primary H. pylori-resistant strains in HIV-positive than in HIV-negative patients. AIDS and sex were predictors of H. pylori resistance in HIV-positive patients.

12 Article The development of a national HIV Plan in Belgium: Achieving consensus despite institutional complexity. 2015

Schweikardt, Christoph / Coppieters, Yves. ·Université Libre de Bruxelles, School of Public Health, CR2: Research Centre 2: Epidemiology, Biostatistics, and Clinical Research, CR3: Research Centre 3: Health Systems and Policies - International Health, Campus Erasme, bâtiment A, CP594, route de Lennik 808, 1070 Brussels, Belgium. Electronic address: christoph.schweikardt@ulb.ac.be. · Université Libre de Bruxelles, School of Public Health, CR2: Research Centre 2: Epidemiology, Biostatistics, and Clinical Research, CR3: Research Centre 3: Health Systems and Policies - International Health, Campus Erasme, bâtiment A, CP594, route de Lennik 808, 1070 Brussels, Belgium. Electronic address: yves.coppieters@ulb.ac.be. ·Health Policy · Pubmed #26143584.

ABSTRACT: BACKGROUND: The development of a national HIV Plan poses serious challenges to countries with a complex distribution of legal powers such as Belgium. This article explores how the Belgian national HIV Plan 2014-2019 was developed. METHODS: Applying the policy streams model of John Kingdon, the analysis of the HIV Plan development process was based on published government statements, parliamentary documents, and websites of stakeholders. RESULTS: The Federal Ministry of Health initiative to achieve the HIV Plan was characterized by a coordinating role with a participatory approach towards the other Belgian governments and stakeholders. The 2013 protocol agreement of the Belgian governments committed them to principles, actions, and cooperation, but not to budgets, priorities, or target figures. DISCUSSION: The Federal government followed a successful strategy to create momentum and commitment to a common national vision on HIV/AIDS. The window of opportunity was not sufficient to create an implementation plan prior to the 2014 elections, and major challenges were left to the subsequent governments, including financing. CONCLUSION: The country of Belgium represents an example of a consensus strategy to achieve a national HIV Plan with its achievements and limits within institutional complexity and limited Federal legal powers.

13 Article Acute myocardial infarction following thalidomide treatment for AIDS-related ulcers. 2015

Dauby, Nicolas / Coussement, Julien / Karakike, Eleni / Ungureanu, Claudiu / De Wit, Stéphane / Payen, Marie-Christine. ·aDepartment of Infectious Diseases bDepartment of Cardiology, CHU Saint-Pierre, Brussels, Belgium. ·AIDS · Pubmed #26125145.

ABSTRACT: -- No abstract --

14 Article "It's my secret": fear of disclosure among sub-Saharan African migrant women living with HIV/AIDS in Belgium. 2015

Arrey, Agnes Ebotabe / Bilsen, Johan / Lacor, Patrick / Deschepper, Reginald. ·Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium. · Department of Internal Medicine and Infectious Diseases-AIDS Reference Center, Universitair Ziekenhuis Brussel, Brussels, Belgium. ·PLoS One · Pubmed #25781906.

ABSTRACT: Patients with HIV not only have to deal with the challenges of living with an incurable disease but also with the dilemma of whether or not to disclose their status to their partners, families and friends. This study explores the extent to which sub-Saharan African (SSA) migrant women in Belgium disclose their HIV positive status, reasons for disclosure/non-disclosure and how they deal with HIV disclosure. A qualitative study consisting of interviews with twenty-eight SSA women with HIV/AIDS was conducted. Thematic content analysis was employed to identify themes as they emerged. Our study reveals that these women usually only disclose their status to healthcare professionals because of the treatment and care they need. This selective disclosure is mainly due to the taboo of HIV disease in SSA culture. Stigma, notably self-stigma, greatly impedes HIV disclosure. Techniques to systematically incorporate HIV disclosure into post-test counseling and primary care services are highly recommended.

15 Article [Qualitative analysis of the integration of sex education for young people in audio-visual media in Kinshasa Democratic Republic of Congo]. 2015

Nsakala, Gabriel V / Coppieters, Yves / Kayembe, Patrick K. ·Ecole de santé publique, Université Libre de Bruxelles (ULB), Bruxelles, Belgique Département d'épidémiologie et biostatistique, Ecole de santé publique, Université de Kinshasa, Kinshasa, République Démocratique du Congo gabysak@yahoo.fr. · Ecole de santé publique, Université Libre de Bruxelles (ULB), Bruxelles, Belgique. · Département d'épidémiologie et biostatistique, Ecole de santé publique, Université de Kinshasa, Kinshasa, République Démocratique du Congo. ·Glob Health Promot · Pubmed #24938512.

ABSTRACT: -- No abstract --

16 Article Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. 2014

Smith, Colette J / Ryom, Lene / Weber, Rainer / Morlat, Philippe / Pradier, Christian / Reiss, Peter / Kowalska, Justyna D / de Wit, Stephane / Law, Matthew / el Sadr, Wafaa / Kirk, Ole / Friis-Moller, Nina / Monforte, Antonella d'Arminio / Phillips, Andrew N / Sabin, Caroline A / Lundgren, Jens D / Anonymous7090800. ·Research Department of Infection and Population Health, University College London, London, UK. Electronic address: c.smith@ucl.ac.uk. · CHIP, Department of Infectious Diseases (2100), Rigshospitalet, University of Copenhagen, Denmark. · Division of Infectious Diseases, University Hospital Zurich, University of Zurich, Zurich Switzerland. · Service de Medecine Intern et Maladies Infectieuses, CHU de Bordeaux, Universite Bordeaux Segalen, Bordeaux, France. · Department of Public Health, Nice University Hospital, Nice, France. · Academic Medical Center, University of Amsterdam, and Stichting HIV Monitoring, Netherlands. · Department of Adult's Infectious Diseases, Medical University of Warsaw, Poland. · Department of Infectious Diseases, St Pierre University Hospital, Brussels, Belgium. · The Kirby Institute, University of New South Wales, Sydney, NSW, Australia. · Mailman School of Public Health, Columbia University, New York, USA. · Department of Infectious Diseases, Odense University Hospital, Denmark. · Department of Health Sciences, San Paolo University Hospital, Milan, Italy. · Research Department of Infection and Population Health, University College London, London, UK. ·Lancet · Pubmed #25042234.

ABSTRACT: BACKGROUND: With the advent of effective antiretroviral treatment, the life expectancy for people with HIV is now approaching that seen in the general population. Consequently, the relative importance of other traditionally non-AIDS-related morbidities has increased. We investigated trends over time in all-cause mortality and for specific causes of death in people with HIV from 1999 to 2011. METHODS: Individuals from the Data collection on Adverse events of anti-HIV Drugs (D:A:D) study were followed up from March, 1999, until death, loss to follow-up, or Feb 1, 2011, whichever occurred first. The D:A:D study is a collaboration of 11 cohort studies following HIV-1-positive individuals receiving care at 212 clinics in Europe, USA, and Australia. All fatal events were centrally validated at the D:A:D coordinating centre using coding causes of death in HIV (CoDe) methodology. We calculated relative rates using Poisson regression. FINDINGS: 3909 of the 49,731 D:A:D study participants died during the 308,719 person-years of follow-up (crude incidence mortality rate, 12.7 per 1000 person-years [95% CI 12.3-13.1]). Leading underlying causes were: AIDS-related (1123 [29%] deaths), non-AIDS-defining cancers (590 [15%] deaths), liver disease (515 [13%] deaths), and cardiovascular disease (436 [11%] deaths). Rates of all-cause death per 1000 person-years decreased from 17.5 in 1999-2000 to 9.1 in 2009-11; we saw similar decreases in death rates per 1000 person-years over the same period for AIDS-related deaths (5.9 to 2.0), deaths from liver disease (2.7 to 0.9), and cardiovascular disease deaths (1.8 to 0.9). However, non-AIDS cancers increased slightly from 1.6 per 1000 person-years in 1999-2000 to 2.1 in 2009-11 (p=0.58). After adjustment for factors that changed over time, including CD4 cell count, we detected no decreases in AIDS-related death rates (relative rate for 2009-11 vs 1999-2000: 0.92 [0.70-1.22]). However, all-cause (0.72 [0.61-0.83]), liver disease (0.48 [0.32-0.74]), and cardiovascular disease (0.33 [0.20-0.53) death rates still decreased over time. The percentage of all deaths that were AIDS-related (87/256 [34%] in 1999-2000 and 141/627 [22%] in 2009-11) and liver-related (40/256 [16%] in 1999-2000 and 64/627 [10%] in 2009-11) decreased over time, whereas non-AIDS cancers increased (24/256 [9%] in 1999-2000 to 142/627 [23%] in 2009-11). INTERPRETATION: Recent reductions in rates of AIDS-related deaths are linked with continued improvement in CD4 cell count. We hypothesise that the substantially reduced rates of liver disease and cardiovascular disease deaths over time could be explained by improved use of non-HIV-specific preventive interventions. Non-AIDS cancer is now the leading non-AIDS cause and without any evidence of improvement. FUNDING: Oversight Committee for the Evaluation of Metabolic Complications of HAART, with representatives from academia, patient community, US Food and Drug Administration, European Medicines Agency and consortium of AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, ViiV Healthcare, Merck, Pfizer, F Hoffmann-La Roche, and Janssen Pharmaceuticals.

17 Article Divergences in trends in child and adult mortality in sub-Saharan Africa: survey evidence on the survival of children and siblings. 2014

Masquelier, Bruno / Reniers, Georges / Pison, Gilles. ·a Université Catholique de Louvain. ·Popul Stud (Camb) · Pubmed #24303913.

ABSTRACT: This paper provides an overview of trends in mortality in children aged under 5 and adults between the ages of 15 and 60 in sub-Saharan Africa, using data on the survival of the children and siblings collected in Demographic and Health Surveys. If conspicuous stalls in the 1990s are disregarded, child mortality levels have generally declined and converged over the last 30-40 years. In contrast, adult mortality in many East and Southern African countries has increased markedly, echoing earlier increases in the incidence of HIV. In recent years, adult mortality levels have begun to decline once again in East Africa, in some instances before the large-scale expansion of antiretroviral therapy programmes. More surprising is the lack of sustained improvements in adult survival in some countries that have not experienced severe HIV epidemics. Because trends in child and adult mortality do not always evolve in tandem, we argue that model-based estimates, inferred by matching indices of child survival onto standard mortality schedules, can be very misleading.

18 Article Drug-induced uveitis in aids patients: two case reports. 2011

Bazewicz, M / Fikri, J / Martin, C H / Libois, A / Meunier, A / Frippiat, F / Caspers, L / Willermain, F. ·Dept of Ophthalmology CHU Saint-Pierre and Brugmann, Brussels, Belgium. m-bazewic@ulb.ac.be ·Bull Soc Belge Ophtalmol · Pubmed #22003760.

ABSTRACT: Patients with acquired immunodeficiency syndrome (AIDS) can develop severe uveitis. Although infectious and autoimmune causes must always be considered, drug induced uveitis is also an important etiology. Herein, we present two case reports illustrating the classical presentation of rifabutin and cidofovir induced uveitis. The first case was a 33 year old woman with AIDS treated with anti-protease and anti-tuberculosis drugs (including rifabutin). She presented with a red painful right eye. There was a strong anterior segment inflammation with fibrinous exudates and a dense vitritis. Rifabutin was stopped and topical steroids and mydriatics were given. Intraocular inflammation and symptoms rapidly resolved. The second patient was a 36 year old woman who presented with a painful decrease of vision in her left eye. She was followed for bilateral CMV retinitis in the setting of AIDS and had recently received 2 systemic injections of cidofovir. Anterior segment inflammation with posterior synechiae in both eyes and folds of Descemet membrane in the left eye were noted. Intraocular pressure was 0 mmHg in the left eye and 10 mmHg in the right eye. Fundus examination disclosed CMV retinitis scars in the right eye and choroidal folds in the macula of the left eye. Cidofovir was discontinued and topical steroids and mydriatics started. Progressively the inflammation decreased and the intraocular pressure returned to normal levels. In conclusion, rifabutin and cidofovir are classical examples of drug induced uveitis with distinct characteristic clinical presentation. Recognition of those entities in AIDS patients can avoid useless and potentially invasive interventions in those fragile people.

19 Article The HIV/AIDS epidemic in sub-Saharan Africa: thinking ahead on programmatic tasks and related operational research. 2011

Zachariah, Rony / Van Damme, Wim / Arendt, Vic / Schmit, Jean Claude / Harries, Anthony D. ·Médecins sans Frontières, Operational Centre Brussels, Medical Department, MSF- Luxemburg, Luxemburg. zachariah@internet.lu ·J Int AIDS Soc · Pubmed #21967983.

ABSTRACT: Until now, we have all been desperately trying to run behind the HIV/AIDS epidemic and catch up with it, but despite all our efforts, the epidemic remains well ahead of us. In 2010, the antiretroviral treatment (ART) gap was about 60%, AIDS-related deaths were almost two million a year, and on top of these figures, for every one person started on ART, there were two new HIV infections. What is needed to change this situation is to think ahead of the epidemic in terms of the programmatic tasks we will be faced with and try to act boldly in trying to implement those tasks. From a programmatic perspective, we: a) highlight what needs to fundamentally change in our thinking and overall approach to the epidemic; and b) outline a number of key task areas for implementation and related operational research.

20 Article Gender differences in retention and survival on antiretroviral therapy of HIV-1 infected adults in Malawi. 2010

Taylor-Smith, Katie / Tweya, Hannock / Harries, Anthony / Schoutene, Erik / Jahn, Andreas. ·Medecins sans Frontieres, Medical Department (Operational Research), Brussels Operational Center, Brussels, Belgium. ·Malawi Med J · Pubmed #21614882.

ABSTRACT: METHODS: Using data from the national ART monitoring and evaluation system, a survival analysis of all healthcare workers, teachers, and police/army personnel who accessed ART in Malawi by June, September and December 2006 respectively, was undertaken. Gender differences in survival were analysed using Kaplan-Meier estimates and rate ratios were derived from Poisson regression adjusting for confounding. RESULTS: 4670 ART patients (49.8% female) were followed up for a median of 8.7 months after starting ART. Probability of death was significantly higher for men than women (p < 0.001). Controlling for age, WHO clinical stage and occupation, men experienced nearly 2 times the mortality of women RR 1.90 [95% CI: 1.57-2.29]. A higher proportion of men initiated ART in WHO stage 4 (p < 0.001). CONCLUSION: Among healthcare workers, teachers, police/army personnel, men have higher mortality on ART than women. Possible reasons are unclear but could be biological or because men present for ART at a later clinical stage or have poorer adherence to therapy. Improving early access to ART may reduce mortality, especially among men. A gender difference in adherence to therapy needs further investigation.

21 Article [The struggle against AIDS: between new paradigms and inertia]. 2010

Clumeck, N. ·Service des maladies infectieuses, C.H.U. - Hôpital St-Pierre, Bruxelles. ·Bull Mem Acad R Med Belg · Pubmed #21171242.

ABSTRACT: Recent statistics on the global HIV epidemic illustrate that HIV incidence continues to increase and provide stark reminders of the urgent need for new and more effective HIV prevention tools. The new paradigm of HIV prevention strategies consists on a biomedical approach including circumcision, vaginal microbicides, pre and post exposure prophylaxis and the treatment of the infected individual. The goal of the ARV therapy is to reach level of plasma HIV indetectability. At less than 20c/ml the risk of sexual transmission is equal to zero. A mathematical model shows that by universal testing associated with immediate therapy the epidemic could be driven towards elimination by the year 2020. It is anticipated that there will be substantial barriers to making biomedical HIV prevention tools available to individuals who are the highest risk of infection. Operationalizing biomedical approaches will require tight links between HIV testing and treatment programs, as HIV testing will be the common entry point for people to receive either biomedical prevention tools or treatment.

22 Article Upper gastrointestinal endoscopic findings in the era of highly active antiretroviral therapy. 2010

Nkuize, M / De Wit, S / Muls, V / Arvanitakis, M / Buset, M. ·Clinic of Hepato-gastroenterology, CHU Saint Pierre, Brussels, Belgium. ·HIV Med · Pubmed #20146733.

ABSTRACT: BACKGROUND: The current literature suggests that there has been a decrease in opportunistic diseases among HIV-infected patients since the widespread introduction of highly active antiretroviral therapy (HAART) in 1995. OBJECTIVES: The aim of the study was to investigate the impact of HAART and CD4 lymphocyte count on diseases of the upper gastrointestinal (UGI) tract, digestive symptoms, and endoscopic and histological observations. METHODS: A review of 706 HIV-infected patients who underwent GI endoscopy was undertaken. The cohort was divided into three groups: group 1 (G1), pre-HAART, consisting of 239 patients who underwent endoscopy between January 1991 and December 1994; group 2 (G2), early HAART, consisting of 238 patients who underwent endoscopy between January 1999 and December 2002; and group 3 (G3), recent HAART, consisting of 229 patients who underwent endoscopy between January 2005 and December 2008. Parameters studied included age, gender, opportunistic chemoprophylaxis, antiretroviral therapies, CD4 cell counts, symptoms, observations at the first UGI endoscopy and histology. RESULTS: When G1, G2 and G3 were compared, significant increases were seen over time in the following parameters: the percentage of women, the mean CD4 cell count, and the frequencies of reflux symptoms, gastroesophageal reflux disease (GERD), inflammatory gastropathy, gastric ulcer and Helicobacter pylori (HP) infection. Significant decreases were seen in the frequencies of the administration of anti-opportunistic infection prophylaxis, odynophagia/dysphagia, acute/chronic diarrhoea, candida oesophagitis, nonspecific oesophageal ulcer and Kaposi sarcoma. No significant change was observed in the other parameters, i.e. digestive bleeding, duodenal ulcer and inflammatory duodenopathy. CONCLUSION: These results suggest a correlation between the improvement of immunity as a result of more efficient antiviral therapy and the decrease in the frequency of digestive diseases in AIDS, mainly opportunistic pathologies. However, HP infection, reflux symptoms and GERD have increased in the HAART era.

23 Article Acceptance of HIV-infected patients in assisted reproductive technique protocols. 2010

Manigart, Y / Autin, C / Rozenberg, S / Barlow, P / Hainaut, M / Gustin, M-L / Gerard, M / Delvigne, A. ·Fertility Clinic, CHU Saint-Pierre, Université Libre de Buxelles, 322 rue Haute, 1000 Brussels, Belgium. ·Maturitas · Pubmed #19945235.

ABSTRACT: OBJECTIVE: To assess the adequacy of a multidisciplinary approach providing information to couples affected by HIV before ART. DESIGN: Prospective observational study. SETTING: RT centre and infectious disease clinic, public university hospital. PATIENTS: 50 couples with at least one HIV-infected partner. INTERVENTIONS: Multidisciplinary approach towards ART by various intervening physicians (specialist in fertility, infectious diseases, paediatrics, obstetrics, psychiatry). MAIN OUTCOME MEASURED: We analysed specifically the cases in which the staff did not accept and the patient's compliance to the counselling procedures. RESULTS: Among the 150 couples, 30 did not complete the procedure and were lost to follow-up. The remaining 120 couples were evaluated: 89 couples were accepted, 5 were temporarily refused and 26 were refused definitively. The major reasons for refusal were medical reasons (n=13). CONCLUSION: Because of the high refusal rate and the drop of rate, a multidisciplinary approach is mandatory before initiating ART in seropositive couples.

24 Article HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. 2009

Delobelle, Peter / Rawlinson, Jakes L / Ntuli, Sam / Malatsi, Inah / Decock, Rika / Depoorter, Anne Marie. ·Department of Public Health, Vrije Universiteit Brussel, Belgium. pdelobel@vub.ac.be ·J Adv Nurs · Pubmed #19399982.

ABSTRACT: AIM: This paper is a report of a study exploring HIV/AIDS-related knowledge, attitudes, practices and perceptions of nurses in the largely black and rural Limpopo Province of South Africa. BACKGROUND: Studies of HIV/AIDS knowledge, attitudes and practices among healthcare workers in developing countries have shown gaps in knowledge and fear of contagion, coupled with ambivalent attitudes in caring for patients with HIV/AIDS and inconsistent universal precautions adherence. METHOD: A cross-sectional study of a random sample of primary health care (PHC) (n = 71) and hospital nurses (n = 69) was carried out in 2005, using a questionnaire, focus groups and in-depth interviews. FINDINGS: Hospital nurses reported a higher frequency of care for patients with HIV/AIDS (P < 0.05), but less HIV/AIDS training when compared to PHC nurses (P < 0.001). HIV/AIDS knowledge was moderately adequate and associated with professional rank, frequency of care and training (P < 0.001). Attitudes towards patients with HIV/AIDS were mainly positive and were statistically significantly correlated with HIV/AIDS knowledge (P < 0.01) and training (P < 0.05). Three out of four nurses reported that they practised universal precautions (76.1%), but fear of occupational HIV transmission and lack of injection safety was found. Seven in 10 nurses reported previous needlestick injuries, but postexposure prophylaxis was not available in all healthcare facilities. Participants reported a higher workload because of HIV/AIDS, lack of training impacting negatively on their work, and stigma and shared confidentiality affecting them emotionally. CONCLUSION: There is a need for accelerated HIV/AIDS training of rural nurses and for wider implementation of universal precautions and postexposure prophylaxis availability in public health facilities in southern Africa.

25 Article Effect of early antiretroviral therapy on the risk of AIDS/death in HIV-infected infants. 2009

Goetghebuer, Tessa / Haelterman, Edwige / Le Chenadec, Jerome / Dollfus, Catherine / Gibb, Diana / Judd, Ali / Green, Hannah / Galli, Luisa / Ramos, Jose Tomas / Giaquinto, Carlo / Warszawski, Josiane / Levy, Jack / Anonymous201055. ·Pediatric Department, CHU St Pierre, Brussels 1000, Belgium. ·AIDS · Pubmed #19194272.

ABSTRACT: OBJECTIVE: In the absence of treatment, rapid progression to AIDS occurs in approximately 20% of HIV-1-infected infants over the first year of life. The prognosis of these children has considerably improved with highly active antiretroviral therapy. As data from well resourced countries are lacking, the objective of this collaborative study was to evaluate the impact of early treatment in vertically infected infants. DESIGN: Children born to HIV-infected mothers between 1 September 1996 and 31 December 2004, who were diagnosed with HIV and free of AIDS before 3 months, were eligible. Demographics and pregnancy data, details of antiretroviral therapy, and clinical outcome were collected from 11 European countries. METHODS: The risk of AIDS or death, by whether or not an infant started treatment before 3 months of age, was estimated by Kaplan-Meier survival analysis and Cox proportional hazards models. RESULTS: Among 210 children, 21 developed AIDS and three died. Baseline characteristics of the 124 infants treated before 3 months were similar to those of the 86 infants treated later. The risk of developing AIDS/death at 1 year was 1.6 and 11.7% in the two groups, respectively (P < 0.001). Deferring treatment was associated with increased risk of progression [crude hazard ratio 5.0; 95% confidence interval (CI) 2.0-12.6; P = 0.001] that persisted after adjusting for cohort in multivariate models (adjusted hazard ratio 3.0; 95% CI 1.2-7.9; P = 0.021). CONCLUSION: In HIV-1 vertically infected infants, starting antiretroviral therapy before the age of 3 months is associated with a significant reduction in progression to AIDS and death.