Feasibility of Early Infant Diagnosis of HIV in Resource-Limited Settings: The ANRS 12140-PEDIACAM Study in Cameroon

BACKGROUND: Early infant diagnosis (EID) of HIV is a key-point for the implementation of early HAART associated with lower mortality in HIV-infected infants. We evaluated the EID process of HIV according to national recommendations in urban areas of Cameroon. METHODS/FINDINGS: The ANRS12140-PEDIACAM study is a multisite cohort in which infants born to HIV-infected mothers were included before the 8(th) day of life and followed. Collection of samples for HIV DNA/RNA-PCR was planned at 6 weeks together with routine vaccination. The HIV test result was expected to be available at 10 weeks. A positive or indeterminate test result was confirmed by a second test on a different sample. Systematic HAART was offered to HIV-infected infants identified. The EID process was considered complete if infants were tested and HIV results provided to mothers/family before 7 months of age. During 2007-2009 1587 mother-infant pairs were included in three referral hospitals; most infants (n = 1423 89.7%) were tested for HIV at a median age of 1.5 months (IQR 1.4-1.6). Among them 51 (3.6%) were HIV-infected. Overall 1331 (83.9%) completed the process by returning for the result before 7 months (median age: 2.5 months (IQR 2.4-3.0)). Incomplete process that is test not performed or result of test not provided or provided late to the family was independently associated with late HIV diagnosis during pregnancy (adjusted odds ratio (aOR) = 1.8 95%CI: 1.1 to 2.9 p = 0.01) absence of PMTCT prophylaxis (aOR = 2.4 95%CI: 1.4 to 4.3 p = 0.002) and emergency caesarean section (aOR = 2.5 95%CI: 1.5 to 4.3 p = 0.001). CONCLUSIONS: In urban areas of Cameroon HIV-infected women diagnosed sufficiently early during pregnancy opt to benefit from EID whatever their socio-economic marital or disclosure status. Reduction of non optimal diagnosis process should focus on women with late HIV diagnosis during pregnancy especially if they did not receive any PMTCT or if complications occurred at delivery.