Introduction: Access to antiretroviral treatment (ART) in resource-limited countries has increased signif-icantly but scaling up ART into rural areas is more recent and information on treatment outcome in rural areas ...Introduction: Access to antiretroviral treatment (ART) in resource-limited countries has increased signif-icantly but scaling up ART into rural areas is more recent and information on treatment outcome in rural areas is still very limited. We reported here virological outcome and drug resistance in ART in rural settings in Togo. Methods: HIV-1 infected adults (≥18 years) and infants were enrolled in routine medical visit at 12 on first-line ART in three HIV care centers. Epidemiological and demographic information and data on ART history were collected. Viral load (VL) was determined and genotypic drug resistance testing was performed on all samples with viral load above 1000 copies/ml. Results: 102 adult patients and 27 infants were consecutively enrolled. Virological failure was observed in 28 (21.5%) patients. For 25/28 patients, sequencing was successful and drug resistance mutations were observed in 23 (92%) of them. The global prevalence of drug resistance in the study population was thus at least 17.8% (23/129), with 7 (6.9%) patients infected with HIV strains that are resistant to two of the three first-line antiretroviral (ARVs) drugs and 9 (8.3%) to all three first-line ARVs. As expected, the observed drug resistance mutations were mainly associated with the drugs used in first line regimens, zidovudine, lamivudine and effavirenz/nevirapine but several patients accumulated high numbers of mutations and developed also cross-resistance to abacavir, didanosine or the new non-nucleoside reverse transcriptase inhibitor drugs, like etravirine and rilpivirine. Conclusion: The observations on ART treatment outcome from ART clinics in rural areas are the same as observed in previous observations in Lomé, the capital city. Although access to viral load will improve treatment outcome, better programme management and implementation of actions to improve factors as patient adherence, drugs stock-outs and lost to follow-up are also essential.展开更多
Background: In Togo, the HIV/AIDS epidemic is characterized by the circulation of the 2 subtypes of HIV. Thus, patients infected with HIV-2 are diagnosed and monitored in the care centers. Objective: To document the t...Background: In Togo, the HIV/AIDS epidemic is characterized by the circulation of the 2 subtypes of HIV. Thus, patients infected with HIV-2 are diagnosed and monitored in the care centers. Objective: To document the trend of HIV-2 prevalence over a decade of activities of the National Reference Center for HIV tests and screening (CNR-VIH). Methods: A cross sectional study was carried out from the screening data archived from January 2005 to December 2014 at the CNR-VIH, a laboratory located in the Sylvanus Olympio University Hospital (CHU SO) Lome. The sampling consisted of adults and children outpatients or those who were hospitalized in CHU SO, subjects presenting for voluntary testing, pregnant women and patients or samples referred for HIV confirmation. All samples were tested for HIV-1 and HIV-2 infections by combining ELISA and rapid diagnostic tests. Result: During the decade, 34,077 subjects were screened for HIV infection. The overall prevalence of HIV infection was 20.70% (7055/34077). In 10 years, the prevalence of HIV infection in CNR-VIH decreased significantly from 35.40% CI95% [34.50% - 36.20%] in 2005 to 14.20% CI95% [13.60% - 14.70%] in 2014 (p = 0.03). The prevalence of HIV-1, HIV-2 and dual HIV1&HIV-2 was respectively 20.40%, 0.23% and 0.07%, with annual prevalence of HIV-2 between 0.07% and 0.39%. The differences between the HIV-2 prevalence over the decade were not statistically significant (p > 0.15). A 4-year-old child from mother-to-child HIV-2 transmission was diagnosed. Sixty-five percent of adult patients were over 40 years of age with an average age of 43.5 ± 11.3 years. Conclusion: Data from the National Reference Center for HIV Tests in Togo over the last ten years confirm the existence of a weak epidemic of HIV- 2 infection with a tendency towards stability.展开更多
According to WHO, the rates of smear-negative and extra-pulmonary pulmonary tuberculosis are increasing in high prevalence HIV epidemic areas. Delays in diagnosis of tuberculosis can lead to large excess of mortality....According to WHO, the rates of smear-negative and extra-pulmonary pulmonary tuberculosis are increasing in high prevalence HIV epidemic areas. Delays in diagnosis of tuberculosis can lead to large excess of mortality. It is extremely important to provide a strong diagnosis tool of tuberculosis if we want to reduce mortality due particularly to TB co-infection in HIV infected people in low-income countries such as Togo. This study aims to assess the performance of Determine? TB LAM Antigen, a rapid diagnostic test (RDT) for tuberculosis. It was an evaluation study, conducted at the National Reference Laboratory for Mycobacteria located at the Sylvanus Olympio University Teaching Hospital in Lomé, Togo from 01 July to 15 November 2017. We performed the assessment onto 100 urine specimens collected from 100 subjects (HIV-infected or not). The test allows qualitative detection of the Lipo Arabinno Mannan (LAM) antigen of Mycobacteria in the urine. Bacilloscopy was chosen as gold standard. Overall, the test Determine? TB LAM presented a sensitivity of 31.25% and a specificity of 95%. In contrast, the sensitivity and specificity of the test were respectively 82.35% and 66.67% in the group of HIV-infected subjects. In HIV non-infected subjects, the sensitivity was 17.46% and the specificity was 100%. Determine? TB LAM Antigen test can help detect TB in HIV-infected people unable to expectorate in our settings.展开更多
文摘Introduction: Access to antiretroviral treatment (ART) in resource-limited countries has increased signif-icantly but scaling up ART into rural areas is more recent and information on treatment outcome in rural areas is still very limited. We reported here virological outcome and drug resistance in ART in rural settings in Togo. Methods: HIV-1 infected adults (≥18 years) and infants were enrolled in routine medical visit at 12 on first-line ART in three HIV care centers. Epidemiological and demographic information and data on ART history were collected. Viral load (VL) was determined and genotypic drug resistance testing was performed on all samples with viral load above 1000 copies/ml. Results: 102 adult patients and 27 infants were consecutively enrolled. Virological failure was observed in 28 (21.5%) patients. For 25/28 patients, sequencing was successful and drug resistance mutations were observed in 23 (92%) of them. The global prevalence of drug resistance in the study population was thus at least 17.8% (23/129), with 7 (6.9%) patients infected with HIV strains that are resistant to two of the three first-line antiretroviral (ARVs) drugs and 9 (8.3%) to all three first-line ARVs. As expected, the observed drug resistance mutations were mainly associated with the drugs used in first line regimens, zidovudine, lamivudine and effavirenz/nevirapine but several patients accumulated high numbers of mutations and developed also cross-resistance to abacavir, didanosine or the new non-nucleoside reverse transcriptase inhibitor drugs, like etravirine and rilpivirine. Conclusion: The observations on ART treatment outcome from ART clinics in rural areas are the same as observed in previous observations in Lomé, the capital city. Although access to viral load will improve treatment outcome, better programme management and implementation of actions to improve factors as patient adherence, drugs stock-outs and lost to follow-up are also essential.
文摘Background: In Togo, the HIV/AIDS epidemic is characterized by the circulation of the 2 subtypes of HIV. Thus, patients infected with HIV-2 are diagnosed and monitored in the care centers. Objective: To document the trend of HIV-2 prevalence over a decade of activities of the National Reference Center for HIV tests and screening (CNR-VIH). Methods: A cross sectional study was carried out from the screening data archived from January 2005 to December 2014 at the CNR-VIH, a laboratory located in the Sylvanus Olympio University Hospital (CHU SO) Lome. The sampling consisted of adults and children outpatients or those who were hospitalized in CHU SO, subjects presenting for voluntary testing, pregnant women and patients or samples referred for HIV confirmation. All samples were tested for HIV-1 and HIV-2 infections by combining ELISA and rapid diagnostic tests. Result: During the decade, 34,077 subjects were screened for HIV infection. The overall prevalence of HIV infection was 20.70% (7055/34077). In 10 years, the prevalence of HIV infection in CNR-VIH decreased significantly from 35.40% CI95% [34.50% - 36.20%] in 2005 to 14.20% CI95% [13.60% - 14.70%] in 2014 (p = 0.03). The prevalence of HIV-1, HIV-2 and dual HIV1&HIV-2 was respectively 20.40%, 0.23% and 0.07%, with annual prevalence of HIV-2 between 0.07% and 0.39%. The differences between the HIV-2 prevalence over the decade were not statistically significant (p > 0.15). A 4-year-old child from mother-to-child HIV-2 transmission was diagnosed. Sixty-five percent of adult patients were over 40 years of age with an average age of 43.5 ± 11.3 years. Conclusion: Data from the National Reference Center for HIV Tests in Togo over the last ten years confirm the existence of a weak epidemic of HIV- 2 infection with a tendency towards stability.
文摘According to WHO, the rates of smear-negative and extra-pulmonary pulmonary tuberculosis are increasing in high prevalence HIV epidemic areas. Delays in diagnosis of tuberculosis can lead to large excess of mortality. It is extremely important to provide a strong diagnosis tool of tuberculosis if we want to reduce mortality due particularly to TB co-infection in HIV infected people in low-income countries such as Togo. This study aims to assess the performance of Determine? TB LAM Antigen, a rapid diagnostic test (RDT) for tuberculosis. It was an evaluation study, conducted at the National Reference Laboratory for Mycobacteria located at the Sylvanus Olympio University Teaching Hospital in Lomé, Togo from 01 July to 15 November 2017. We performed the assessment onto 100 urine specimens collected from 100 subjects (HIV-infected or not). The test allows qualitative detection of the Lipo Arabinno Mannan (LAM) antigen of Mycobacteria in the urine. Bacilloscopy was chosen as gold standard. Overall, the test Determine? TB LAM presented a sensitivity of 31.25% and a specificity of 95%. In contrast, the sensitivity and specificity of the test were respectively 82.35% and 66.67% in the group of HIV-infected subjects. In HIV non-infected subjects, the sensitivity was 17.46% and the specificity was 100%. Determine? TB LAM Antigen test can help detect TB in HIV-infected people unable to expectorate in our settings.
