210 out of the 529 files which were examined and which met the inclusion criteria were considered. The children’s average age was 6.90 years with extremes of 7 and 15 years. The sex ratio was 1.25. The orphans who had lost at least one parent (a motherless or fatherless child) were 37.6%. The children were living in town for 86.6% of the cases.

HIV1 was found in 204 children namely 94.61% and HIV2 in 6 children. The mothers who were alive at the moment when their child was being initiated to the antiretroviral treatment were all HIV positive (vertical transmission).

When they were admitted to hospital, there were 128 children out of the 210 who had benefitted from a dosage of TCD4 lymphocytes. In the last six months, 28 children had benefitted from a dosage of viral charge which was over 100,000 copies per cubic millimeter (mm³) in 23 among them (namely 82.15%). The other characteristics of the children are listed on Table 1.

^*L TCD4 = Lymphocytes TCD4. Acute malnutrition was noticeable in 38% of the children at the initiation of the antiretroviral treatment.

In our study, the children who were infected were placed on first line protocol of antiretroviral treatment. The therapeutic diagram was decided by an attending doctor after a pre-therapeutic assessment consisting at least of the dosage of the haemoglobin and lymphocytes TCD4 rate.

In our cohort, the therapeutic diagrams were composed of combinations as follows:

“Zidovudine + Lamivudine + Efavirenz” in 30.2 of the cases; “Stavudine + Lamivudine + Névirapine” in 27.30% of the cases; “Zidovudine + Lamivudine + Névirapine” in 13.37% of the cases; “Stavudine + Lamivudine + Névirapine” in 27.23% of the cases. In addition to the antiretroviral treatment (TARV), the children whose rate of TCD4 lymphocytes was lower than 25% received co-trimoxazole for the prevention of some opportunistic infections.

In 5 years of follow-up, 46 among the children, namely 20.4% were on a second line protocol and 164 among them were still on a first line protocol.

A part from the medical management, the children who suffer from acute malnutrition received a nutritional treatment based on a national treatment protocol. After hospitalization, they were followed as ambulatory patients and received an irregular nutritional assistance from the World Food Program essentially composed of cereals, oil, and milk.

The average age of our children was 6.9 years. This age can be compared to the one found by other authors [8] [16] . In Burkina Faso, the starting point of the Prevention of the Transmission Mother to Child of HIV came a little late in 2006. The children who had been followed at the Pediatrics University Hospital Charles De Gaulle since 2002 could not be screened very early and at times were recruited when they were at preschool level still very active.

However, these children’s mothers were HIV positive. It is therefore a vertical transmission to HIV which resulted in a gradual erosion of the child’s body reserves, a deep depression of his immunity (73.43%) at the moment when the antiretroviral treatment got started.

As was pointed out by some authors, this state of severe immune-depression tends to favour the sudden arrival of serious opportunistic infections such as tuberculosis [12] and certain impairment in the general state. So, the children who were infected are at times at a severe clinical stage (3 or 4 of WHO classification) when they were being initiated to the antiretroviral treatment [15] [12] .

This impairment of the clinical state is, after all, found out as being an important factor of mortality by some authors [10] [17] .

The protocol of the antiretroviral treatment (ART) in our study is respectful of the national protocol in Burkina Faso. This diagram took account of the clinical state of the child who is infected. The children whose weight was less than 15 kg and who were not suffering from anaemia (haemoglobin rate > 10g/dl) were treated on Zidovudine, Lamivudine, and Névirapine; those of them whose weight was over 15 kg received Efavirenz instead of Névirapine. The children who were anaemic (haemoglobin rate ˂ 10 g/dl) received the same protocol with stavudine instead of Zidovudine (until 2010 when Stavudine was no longer in use according to WHO’s recommendation).

These diagrams facilitate a regression of the viral replication. However, the non observance of the antiretroviral treatment by some children might have probably led to a persistent resistance of a positive viral charge. This probably led to starting a second line protocol of antiretroviral treatment in 46 among them with “Abacavir + Videx + Lopinavir/ritonavir”.

Severe acute malnutrition was 38.3% at admission to hospital in our study. Our results are consistent with those of Centeville et al. who found out 31.5% of severe acute malnutrition in 127 children infected with HIV [5] .

This form of malnutrition is related to a rapid ponderal loss. Indeed, the HIV-infected children are subject to anorexia, to digestive troubles especially repeated vomiting, and chronic diarrhea.

These troubles are aggravated by those of digestive absorption of food (by intestinal villous atrophy in some parasitic diarrheas), or opportunistic infections such as tuberculosis [10] [18] [19] .

A severe ponderal deficit occurs mainly in children uncontaminated by any antiretroviral treatment. This acute malnutrition is thus mentioned by some authors as being a predictive positive factor in the child’s HIV infection [7] [10] [20] -[23] . Others think that severe acute malnutrition might, in return, influence the immune response to the antiretroviral treatment [24] .

After the antiretroviral treatment has started, the ponderal growth rapidly evolved. It had a weight/height ratio that ranged from −1.62 Z-score at admission (M0) to 1.01 Z-score at the twelfth month (M12).

The catch up of the weight was obtained in our study for 81.2% of the children in the twelfth month. The same was observed by Nachman who found out in one of his studies on 192 HIV-infected children that the catch up of the children’s weight was being done in one year after the antiretroviral treatment has started, and in two years for that of their height [25] .

In South Africa, Feinstein found out, after a two years’ follow-up of HIV-infected children, a ponderal catch up in 81% among them against 64% for the catch up as regards height [12] .

Indeed, the antiretroviral treatment would lead to a rapid regression of the viral multiplication and therefore a reduction of the effects that are noxious to the ponderal growth.

The evolution of the average of the weight/height index yet shows stabilization from M12 to M60. That could be attributed to the insufficiency of predominant nutritious provisions in these children; more than a third of them were orphans.

Since the antiretroviral treatment has started, the improvement of the immunity, the regression of the opportunistic infections and that of the digestive troubles might lead to a rapid resumption of the ponderal growth. However, to keep up this growth, it is necessary to go through an adequate nutrition and a strict observance of the antiretroviral treatment in order to avoid taking up the viral replication again.

The number of children who have a positive viral charge during the last six months was 28 in our study. Thus, these children would all continue with an active viral replication which might influence their staturo-ponderal growth.

The rapid ponderal taking up after a M60 follow-up could be linked to the hormonal permeation in the children at their age of puberty. The proportion of these children who were over 10 was 18% in our study. The release of the anabolic hormones at this age might have an influence on this rapid growth.