Immunovirological Discordance and Associated Factors among People Living with HIV under Antiretroviral Treatment at Hôpital de Jour de Donka, Guinea

The antiretroviral treatment (ART) has significantly reduced the number of new HIV/AIDS infections and related deaths. However, cases of immunovirological discordance (IVD) are found in various locations. The objective of this study was to determine the profile of People living with HIV (PLHIV) with IVD and to identify associated factors. We conducted a cross-sectional study based on the records of PLHIV under ART for at least 6 months, followed at Hpital de Jour Donka from 2015 to 2017, and having both viral load (CV) and CD4 T-cell count. Prevalence of IVD was 34.57%, with 23.87% for immunological discordance (ID) and 10.7% for virological discordance (VD). Females were predominant (66.26%), and male gender influenced IVD with a statistically significant difference (p = 0.006) and was associated with VD (p = 0.007). The average age was 38.77 11.30 years. PLHIV were classified at WHO stages 3 and 4 (86.01%). The median initial haemoglobin level was 11.5 g/L [3.2 - 12]. The mean initial CD4 T-cell count was 272.84 cells/mm3 201.6. The median initial viral load (VL) was 147,337 copies/mL [1092 - 31,675,000]. The initial CD4 T-cell count 3 was associated with IVD with a statistically significant difference (p = 0.0009) and correlated with ID (p = 0.000). Prurigo was associated with IVD with a statistically significant difference (p = 0.003). Cerebral toxoplasmosis was not associated with IVD but was associated with ID (p = 0.04). This study allowed us to describe the profile of PLHIV with IVD. The main associated factors were male gender, initial CD4 T-cell count 3, toxoplasmosis, prurigo, and herpes zoster.

Self reported adherence to antiretroviral treatment and correlates in Hunan province,the Peoples Republic of China

Aims:This study aimed to describe the adherence level to antiretroviral therapy and its associated factors among people living with HIV in Hunan province,China.Methods:Across-sectional survey study was done at two major HIV treatment sites within Hunan province in China from July 2011 to Oct 2012 through face-to-face interviews.Adherence measures were captured using a 30-day visual analog scale(VAS).Results:A total of 418 participants consented and completed the questionnaires with the mean age being 38 years old.Based on VAS,28%of the participants had lower than 90%ART adherence level.The main reasons for missing drugs were;forgetting,being away from home,being busy and feeling worse after taking drugs.Logistic regression results showed that drug use(B=0.68,OR=2.11),time on ART(B=0.31,OR=0.72)and side effects(B=0.64,OR=1.82)were significantly associated with adherence to ART.Conclusion:Patients on ARVs in Hunan province are faced with adherence challenges notably drug abuse,drug regime scheduling challenges at the initial stages of therapy and drug side effects.It is therefore necessary to institute specific adherence interventions that target those who abuse drugs,ART naïve patients,and those experiencing side effects in order to achieve optimal ART adherence.

Identifications of drug resistance mutations among antiretroviral treatment naive HIV-1 patients in Peninsular Malaysia

Objective: To determine drug resistance mutations and the HIV-1 subtypes among antiretroviral treatment naive HIV-1 patients in Peninsular Malaysia,Methods: A total of 45 samples from four hospitals that provide HIV viral load services were subjected to the amplification of the protease and two third of reverse transcriptase regions of the pol gene by RT-PCR and Sanger sequencing,Drug resistance mutation(DRM) interpretation reports the presence of mutations related to protease inhibitors(PIs),Nucleoside reverse-transcriptase inhibitors(NRTI) and Non-nucleoside reverse-transcriptase inhibitors(NNRTI) based on analysis using Stanford HIV database program,Results: DRMs were identified in 35% of patients,among which 46.7% of them showed minor resistance to protease inhibitor with A71 V and L10 l were the commonest DRMs detected,About 21.4% and 50.0% of patients had mutations to NRTIs and NNRTIs,respectively,CRF01_AE was found to be the predominant HIV-1 subtype,Conclusions: These findings have served as an initial crucial data in determining the prevalence of transmitted HIV-1 drug resistance for the country,However,more samples from various parts of the country need to be accumulated and analyzed to provide overall HIV-1 drug resistance in the country.

Acute Malnutrition and Infection with the Human Immuno-Deficiency Virus (HIV) in Children Followed up at the Pediatrics University Hospital Charles de Gaulle: Evolution of Anthropometric Parameters on Antiretroviral Treatment

Burkina Faso, a country with very scarce resources, undertook to fight against HIV infection. In 2013, according to UNAIDS, 110,000 persons were living in this country with HIV infection. 18,000 children among these persons were under 15. We conducted a retrospective study from January 2003 to December 2012 at the Pediatrics University Hospital Charles De Gaulle, Ouagadougou (CHUP CDG), Burkina Faso. The study aimed at assessing the children’s ponderal growth when under antiretroviral treatment. The children who were under 15 and who had been on antiretroviral treatment for at least 5 years were included in the study. Acute malnutrition concerned children whose height/weight ratio (H/W) was lower at -2 width type (or Z score) of the median of reference regarding age according to WHO. Two categories of malnutrition were outstanding in our study: moderate acute malnutrition, (-3 Z-score ≤ H/W -2 Z-score) and severe acute malnutrition (W/H -3 Z-score). The clinical and paraclinical data recorded during previous consultations were extracted from the ESOPE (Monitoring and follow-up of patients) data basis and exported to the ENA software and SPSS for their analysis. In total, 210 out of 529 children’s cases were considered. These children’s average age was 6.9 years. There were 55.7% of male and 44.3% of female children. HIV1 was found in 97.6% of the children against 2.4% for HIV2. In a 5 year follow-up, 46 among the children, namely 20.4% were on a second line protocol of antiretroviral treatment and 164 among them were still on a first line protocol of antiretroviral treatment. When they were admitted at hospital, 38% of the children showed characteristics of acute malnutrition. 17.8% of these children presented characteristics of severe form of acute malnutrition. During this 5-year follow-up, the average of the W/H index of the children gradually rised from -1.62 Z-score when being admitted to -0.18 Z-score at after a 60-month antiretroviral treatment. Our study showed an effective ponderal catch-up with an average of the W/H index at -1.02 Z-score after a 12-month antiretroviral treatment. This study completed by the search for nutritious factors is likely to influence the infected children’s ponderal growth.

Survival of Antiretroviral Therapy Patients at the Outpatient Treatment Centre of the Community University Hospital of Bangui from 2015 to 2020

Background: The advent of antiretroviral treatment has considerably increased the life expectancy of people living with HIV in recent years. The Central African Republic, despite challenges related to the socio-political context, is committed to achieving the UNAIDS 90-90-90 targets and to the elimination of AIDS by 2030 advocated by the WHO. Objective: To analyze survival among HIV-positive adult patients on antiretroviral therapy from 2015 to 2020. Methods: This was a history-based cohort study of patients started on ART. The main variable was survival. The Kaplan-Meier method was used to describe the survival curve since inclusion in the cohort and a multivariate Cox model was used to investigate factors associated with mortality on ART. Results: A total of 145 naive patients started ART at the Outpatient Treatment Centre (OTC) in 2015. A female predominance was observed in our study with 78.08% of cases. The analysis of the patients’ fate at the time of point of treatment showed that 58.62% of them were still in active care and 13.10% died. The probability of survival at 5 years was 0.82 and mortality was significantly associated with very advanced disease (WHO stage IV) (p = 0.047) and anemia (p = 0.039). Conclusion: The majority of patients were still in care at the endpoint and mortality was significantly related to advanced disease and anemia. Early management of people living with HIV combined with better quality of care would improve their survival.

Overview of antiretroviral treatment in China： advancement and challenges

As the severity of the HIV epidemic in China grew, National Free Antiretroviral Treatment （ART） Program was announced since 2003. Even though there still were many difficulties, China had obtained great achievements in fighting against HIV.Over 52 000 adult patients had received first-line HAART thus far and the mortality of AIDS in China decreased significantly. This paper presents an overview of the HIV/AIDS epidemic in China; the status of national free ART program,the difficulties suffered and the achievements made since the initiation of program and the challenges ahead for continued progress for China. This paper also provides suggestions to overcome these challenges.

Improving China＇s antiretroviral treatment program： assessing current and future performance using the principals of ethics

The global commitment to providing antiretroviral therapy （ART） to people living with human immunodeficiency virus/acquired immunodeficiency syndrome （HIV/AIDS） in low-income countries has raised hope that the increasing momentum in the fight against the worldwide HIV/AIDS pandemic will be sufficient to control it. However, improved availability of subsidized antiretroviral （ARV） treatments in low-income .countries raises complex ethical issues. In many resource-constrained countries the number of individuals infected with HIV in need of treatment far exceeds the supply of ARV medication. Resource allocation decisions can be made on the basis of many epidemiological, ethical, or preferential treatment priority criteria. Healthcare systems and funding in low-income countries are limited, requiring a step-by-step approach to scaling- up programs to reach their stated aims.

From access to adherence: the challenges of antiretroviral treatment

This book is a testament to the early treatment successes and the hidden challenges of antiretroviral therapy （ART） in resource-poor settings. It is also a wake-up call to the risk of treatment failure and the development of widespread ARV resistance unless all patients are given the continuing support they need to achieve full adherence to ARVs. AIDS is particularly challenging because it requires very high （at least 95%） levels of adherence to prevent treatment failure and the generation of ARV-resistant virus.

A Qualitative Look at Decreasing Barriers to Receiving Uninterrupted Care for People Living with HIV in Rural Southern Georgia

Early linkage to antiretroviral therapy (ART) after HIV diagnosis extends life. Low socioeconomic populations with HIV face regional concerns that inhibit early treatment. Barriers include religious-based stigma, lack of local treatment facilities, fear of discovery and purposeful secrecy fostering increased HIV transmission and decreased ART adherence. This ethnographic qualitative study employed semi-structured interviews with 10 health care providers (HCP) and 10 people living with HIV (PLWH) to discover methods to streamline care and increase medication adherence. Clients perceive enhanced care when they are active participants in treatment. HCPs reported positive health outcomes when there was active multidisciplinary communication. Obstacles included a lack of consistent medication assistance programs, homelessness, and limited access to specialized services. There is a need for further investigation on how to provide individualized, holistic treatment to a population of patients with extremely limited federal funding in a geographic region where religious stigma surrounding HIV is widespread.

Factors Associated with Non-Adherence to Antiretroviral Therapy among HIV-Infected Adolescents at Pediatric Department of Yopougon University Hospital, Côte d’Ivoire

Context: The consequences of non-adherence to antiretroviral therapy (ART) are harmful in terms of morbidity and mortality among HIV-infected adolescents. There is a little data in this population in West Africa, about non-adherence to ART. Objective: To identify factors associated with non-adherence to ART in adolescents at the Pediatric Ambulatory Treatment Center (PATC) of the pediatric department of Yopougon University Hospital. Materials and Methods: A cross-sectional study was conducted from May to July 2017 among adolescents aged 10 to 19 years old at PATC of pediatrics department of Yopougon University Hospital. We have considered that adolescent was not adherent to ART when he affirm that he have not taking ART at least once in the week before the survey. A logistic regression model was used to identify factors associated with non-adherence to ART. Results: Overall 166 adolescents were included. The median age was 15 years old [IQI = 13 - 17 years]. They had a detectable viral load greater than 1000 copies/ml in 41.8% of cases. The rate of non-adherence to ART was 40.4%. The factors associated with non-adherence to ART were male [OR = 2.5 (CI = 1.1 - 10.0)], having parent widowed [OR = 7.8 (CI = 1.6 - 39.3)] or divorced [RC= 3.7 (IC=1.1 - 13.5)], CD4 inclusion rate ≥ 500 cells/ml [OR = 8.5 (CI = 1.6 - 45.5)] and duration on ART ≥ 10 years [OR = 8.9 (CI = 1.6 - 50)]. Conclusion: A rigorous therapeutic education taking into account associated factors in this study is necessary to reduce the rate of non-adherence among adolescents at PATC.

Human immunodeficiency virus patients with low CD4 counts are more likely to have precancerous polyps identified during index colonoscopy

BACKGROUND Antiretroviral treatment(ART)has improved the life expectancy of patients living with human immunodeficiency virus(HIV).As these patients age,they are at increased risk for developing non-acquired immunodeficiency syndrome defining malignancies(NADMs)such as colon cancers.AIM To determine which factors are associated with the development of precancerous polyps on screening colonoscopy in patients with HIV and to investigate whether HIV disease status,measured by viral load and CD4 count,might influence precancerous polyp development.METHODS A retrospective review of records at two urban academic medical centers was performed for HIV patients who had a screening colonoscopy between 2005-2015.Patients with a history of colorectal cancer or polyps,poor bowel preparation,or inflammatory bowel disease were excluded.Demographic data such as sex,age,race,and body mass index(BMI)as well as information regarding the HIV disease status such as CD4 count,viral load,and medication regimen were collected.Well-controlled patients were defined as those that had viral load<50 copies,and poorly-controlled patients were those with viral load≥50.Patients were also stratified based on their CD4 count,comparing those with a low CD4 count to those with a high CD4 count.Using colonoscopy reports in the medical record,the size,histology,and number of polyps were recorded for each patient.Precancerous polyps included adenomas and proximal serrated polyps.Data was analyzed using Fisher’s exact tests and logistic regression through SAS 3.8 software.RESULTS Two hundred and seven patients met our inclusion criteria.The mean age was 56.13 years,and 58%were males.There were no significant differences in terms of age,race or ethnicity,insurance,and smoking status between patients with CD4 counts above or below 500.BMI was lower in patients with CD4 count<500 as compared to those with count>500(P=0.0276).In patients with CD4>500,53.85%of patients were female,and 70.87%of patients with CD4<500 were male(P=0.0004).Only 1.92%of patients with CD4≥500 had precancerous polyps vs 10.68%of patients with CD4<500(P=0.0102).When controlled for sex,BMI,and ART use,patients with CD4<500 were 9.01 times more likely to have precancerous polyps[95%confidence interval(CI):1.69-47.97;P=0.0100].Patients taking non-nucleoside reverse transcriptase inhibitors were also found to be 10.23 times more likely to have precancerous polyps(95%CI:1.08-97.15;P=0.0428).There was not a significant difference noted in precancerous polyps between those that had viral loads greater or less than 50 copies.CONCLUSION Patients with low CD4 counts were more likely to have precancerous polyps on their screening colonoscopy although the etiology for this association is unclear.We also found an increased risk of precancerous polyps in patients taking non-nucleoside reverse transcriptase inhibitors,which is contradictory to prior literature showing ART has decreased the risk of development of NADMs.However,there have not been studies looking at colorectal cancer and ART by drug class,to our knowledge.Further prospective studies are needed to determine the effect of HIV control and therapies on polyp development.

Prevention of Mother-to-Child Transmission of HIV: Experience of a Level 2 Health Center in Senegal

The elimination of vertical transmission of HIV from mother to child is a major global goal. In Senegal, the transmission rate was estimated at 3.2% in 2017. To reduce or even eliminate this transmission, Senegal has implemented various strategies and programs adopted and applied nationally. Thus access to services for the prevention of mother-to-child transmission of HIV has been extended to the level of the health post (the lowest level of the country’s health pyramid) with a delegation of tasks to paramedical staff (nurse, midwife) in the diagnosis and therapeutic management. Objectives: To describe the epidemiological profile of HIV (Human Immunodeficiency Virus)-positive mothers, to assess the care of children born to HIV-positive mothers, to determine the rate of HIV transmission from mother to child. Patients and Method: We carried out a retrospective, cross-sectional and descriptive study of all live newborns of HIV-positive mothers who gave birth at the Gaspard Kamara Health Center (a level 2 health center in Dakar, Senegal) between January 1, 2015 and December 31, 2018. The data were collected from prevention of mother-to-child transmission (PMTCT) prenatal follow-up registers and files, delivery files and registers, and neonatology and pediatric follow-up files, and exploited using the Epi info 7 software. Results: There were 98 children of seropositive mothers. The epidemiological profile of the HIV-positive woman was that of a young woman aged between 16 and 43 with an average of 31.31 years, pauciparous (>65% of cases) from Dakar center (>75% of cases), housewife with a low socio-economic level (63.1% of cases), married in almost all cases, with HIV profile (in almost all cases) and diagnosed before pregnancy (51.02%). The analysis of the children’s data revealed a predominance of girls (52.04%) with a good birth weight (2964g on average) and a pregnancy carried to term in more than 95% of cases. ARV prophylaxis was almost entirely respected with triple therapy (AZT + 3TC + NVP) in a fixed combination as protocol. Protected breastfeeding (80.21%), including 6 months of exclusive protected breastfeeding, was the rule for the mode of feeding. Three children were diagnosed positive with PCR1 as with serology (3.06%). Discussion and Conclusion: the initiatives and strategies put in place in Senegal have enabled a significant reduction in mother-to-child transmission of HIV and deserve to be supported by insisting on primary prevention, programming and good follow-up of pregnancies, and a good support for HIV-positive women.

Drug Resistance Mutations and Genetic Diversity in Patients Treated for HIV Type 1 Infection in Rural Care Centers in Togo

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.

Profile of the Blood Count among People Living with HIV Monitored at the Institute of Social Hygiene and the Aristide Le Dantec Hospital in Dakar

Introduction: The human immunodeficiency virus (HIV) is a pandemic of concern to the World Health Organization. It is all the more worrisome because if not properly managed, it can be responsible for several complications, including abnormal blood counts. These abnormalities may also be related to treatment. Objectives: The main objective of this study is to show that adequate antiretroviral therapy can correct various abnormalities exerted by HIV on patients’ blood counts. The specific objective is to determine all the abnormalities we can see in blood count before and during HIV treatment. Materials and Methods: Our study was conducted in the hematology laboratory and the dermatology departments of the Aristide Le Dantec Hospital and the Institute of Social Hygiene. It took place from December 2009 to October 2011. It is a retrospective descriptive and analytical study involving HIV-positive patients (HIV 1 and 2) and under antiretroviral treatment (at least six months of treatment). We included 110 patients in the study. Blood counts were performed at the hematology laboratory of the Aristide le Dantec hospital using a KX21 automaton. Each patient received three blood counts during the first six months of treatment (M0, M3 and M6). A univariate analysis was performed to determine the profile of the abnormalities of the blood count and the chi 2 test was used and a threshold of p 0.05 was considered significant. Results: The mean age of the patients was 38.6 ± 8.6 years (extremes of 18 and 64 years) with a sex ratio of 0.42 (77 females and 33 males). The prevalence of anemia was 80% (n = 88) at M0, 53, 63% at M3 (n = 59), and 38.20% at M6 (n = 42) (p = 0.02). We noted a favorable evolution with treatment. For the other abnormalities, the evolution was favorable for leukopenia (p = 0.011) and thrombocytopenia (p = 0.007). Conclusion: Our study showed a correction of blood count abnormalities in PLHIV with antiretroviral treatment.

Sensitive detection of HIV-1 resistance to Zidovudine and impact on treatment outcomes in low-to middle-income countries

Background:Thymidine analogs,namely AZT(Zidovudine or Retrovir^(TM))and d4T(Stavudine or Zerit^(TM))are antiretroviral drugs still employed in over 75%of first line combination antiretroviral therapy(cART)in Kampala,Uganda despite aversion to prescribing these drugs for cART in high income countries due in part to adverse events.For this study,we explored how the continued use of these thymidine analogs in cART could impact emergence of drug resistance and impact on future treatment success in Uganda,a low-income country.Methods:We examined the drug resistance genotypes by Sanger sequencing of 262 HIV-infected patients failing a first line combined antiretroviral treatment containing either AZT or d4T,which represents approximately 5%of the patients at the Joint Clinical Research Center receiving a AZT or d4T containing treatment.Next generation sequencing(DEEPGEN^(TM)HIV)and multiplex oligonucleotide ligation assays(AfriPOLA)were then performed on a subset of patient samples to detect low frequency drug resistant mutations.CD4 cell counts,viral RNA loads,and treatment changes were analyzed in a cohort of treatment success and failures.Results:Over 80%of patients failing first line AZT/d4T-containing cART had predicted drug resistance to 3TC(Lamivudine)and non-nucleoside RT inhibitors(NNRTIs)in the treatment regimen but only 45%had resistance AZT/d4T associated resistance mutations(TAMs).TAMs were however detected at low frequency within the patients HIV quasispecies(1-20%)in 21 of 34 individuals who were failing first-line AZT-containing cART and lacked TAMs by Sanger.Due to lack of TAMs by Sanger,AZT was typically maintained in second-line therapies and these patients had a low frequency of subsequent virologic success.Conclusions:Our findings suggest that continued use of AZT and d4T in first-line treatment in low-to-middle income countries may lead to misdiagnosis of HIV-1 drug resistance and possibly enhance a succession of second-and third-line treatment failures.

The Prevalence and Related Effects of HIV Drug-Resistant Strains Against Antiretroviral Therapy in China

Anti-human immunodeficiency virus(HIV)treatment resistance surveillance has been going on for nearly 18 years in China.In this paper,we review the prevalence in China of resistance to reverse transcriptase and protease inhibitors in the HIV-infected population receiving antiretroviral therapy(ART)and the population that stopped ART in recent years.Drug resistance is an important factor affecting the death of patients with acquired immune deficiency syndrome(AIDS).With the extension of the duration of ART and the expansion of the population receiving ART,especially the widespread promotion of preventive drugs before and after exposure,it is important to obtain insight into the prevalence and types of drug-resistant strains and their impact on the overall AIDS prevention and treatment effect.

Factors Associated with the Size of HIV DNA Reservoir

Objective： To review the recent literatures related to the factors associated with the size of the HIV reservoir and their clinical significance. Data Sources： Literatures related to the size of HIV DNA was collected from PubMed published from 1999 to June 2016. Study Selection： All relevant articles on the HIV DNA and reservoir were collected and reviewed, with no limitation of study design. Results： The composition and development of the HIV- 1 DNA reservoir in either treated or untreated patients is determined by integrated mechanism comprising viral characteristics, immune system, and treatment strategies. The HIV DNA reservoir is a combination of latency and activity. The residual viremia from the stochastic activation of the reservoir acts as the fuse, continuing to stimulate the immune system to maintain the activated microenvironment for the rebound of competent virus once treatment with antiretroviral therapy is discontinued. Conclusion： The size of the HIV-1 DNA pool and its composition has great significance in clinical treatment and disease progression.