Immunovirological long-term outcome of HIV-infected children living in a resource limited-setting of South Africa : implication of an early treatment initiation

Since 2010, the World Health Organization has successively recommended initiating antiretroviral therapy in all infants, children and finally adults with the human immunodeficiency virus. These treatments, administered for life and sometimes since birth, present many challenges in terms of adherence, side effects and resistance for patients, families and caregivers. The main objective of this thesis is to compare the long-term immunovirological evolutions of two cohorts of South African children who initiated their antiretroviral treatments before the age of one and after the age of two respectively. Our results allow us to conclude that patients who initiated their treatments earlier in life show better immunological results but more resistance mutations for some classes of antiretrovirals (NRTI and NNRTI). The introduction of resistance monitoring in clinical practice and access to new antiretrovirals should be considered in order to contain the HIV epidemic by 2030 and to respect the objectives of UNAIDS.