Interventions to Improve HIV Viral Load Suppression among the Adolescents: Evidence of Improvement Science through a Quality Improvement Approach in Eastern Uganda

Introduction: Achieving viral load suppression among the adolescents living with HIV continues to hold back attainment of sustainable development goals. TASO Mbale realized a viral load suppression rate of 63.1% among the adolescents living with HIV in care in quarter 4 of 2016. We therefore, instituted a quality imrpovement project to improve Viral load suppression from 63.1% in quarter 4 2016 to 90% by the end of quarter 4 2017. Method: Baseline data from the Uganda viral load dashboard were analyzed, and fishbone diagram was utilized to provide root causes of low viral load suppression among the adolescents living with HIV at TASO Mbale. The identified barriers were Knowlegde gap, among the adolescents, on positive living, Missing clinic appointments, Sub-optimal adherence, Poorly planned adolescent HIV clinic, Inadequate follow-up and Low use of data for informed decisions. A plan-do-study-act (PDSA) model was applied to implement tested changes. Strategies that worked included introduction of appointment register to track appointment behaviour of the adolescents, generating lists of clients on appointment who were due for Viral Load bleeding, telephone calls for follow up, increasing the frequency of reviewing adolescents from once a month to twice a week, committing a dedicated team responsible for adolescent care. Results: The viral load suppression improved from 63.1% in quarter 4 of 2016 to 63.8% in the first quarter of 2017, to 87.5% in quarter 2 of 2017, 97.6% in the third quarter and 91.4% in quarter 4 of 2017. Conclusion: The use of quality improvement in addressing gaps in HIV service delivery is highly effective.

Evaluation of HIV Viral Load Activity at the Bacteriology-Virology Laboratory in the University Hospital Center of Brazzaville

Introduction: The bacteriology-virology laboratory of the teaching university hospital of Brazzaville, was equipped with a real-time PCR device like Miniopticon (Biorad? , France). The aim of this work was to do an evaluation of the HIV viral load activity, with a view to proposing some recommendations. Material and methods: Retrospective study, January 2013 to March 2015, in patients on first line ARV three-therapy, pre-inclusion therapy checkup in HIV positive patients, but again screening after sexual abuse in women or accident of exposure (AES). A blood sample on EDTA tube was made and RNA extraction with Qiagen kit. Ultrasensitive HIV-RNA quantification was performed using the Generic HIV real-time PCR assay (Biocentric?, Bandol, France). Results: 126 patients were included. The mean age was 37.63 years +/- 10.43 years, sex ratio F/H = 2.3. The HIV viral load was detectable in 94 cases (74.6%). Concerning patients with detectable viral load (copies/ml): 403 to 996 in 35 cases (37.23%), 1411 to 1812 in 41 cases (43.62%) and >1814 in 5 cases (5.32%) (therapeutic failure). Conclusion: This work reports success in the setting up of the molecular biology unit. Procedures that implement information and education actions on the risks associated with AES must be disclosed.

Evolution of Viral Load in Patients Infected with HIV-1 at Point G University Hospital

Introduction: HIV, the human immunodeficiency virus, is the etiological agent of acquired immunodeficiency syndrome (AIDS). The aim of this study was to assess the evolution of the viral load in patients under treatment. Methodology: This was a study carried out from July 2017 to June 2022 at the Point G University Hospital laboratory. The determination of the viral load of patients was carried out by PCR on the ABOTT M2000sp/rt platform. Results: A total of 129 patients infected with HIV-1, aged 19 to 72 years with a mean age of 40.05 years ± 10.71;all on antiretroviral chemotherapy. The female gender predominated among our patients. The most common treatment regimen was 2INTI + 1INNTI with 72.9% followed by 2INTI + 1INI with 13.2%. As for the combinations of molecules, the combination TDF + 3TC + EFV and TDF + 3TC + DTG predominated, respectively 65.1% and 13.2%. 89.9% of our patients had undetectable viremia after 12 months of treatment (p < 0.005) with an average viral load which had evolved from 681315.65 copies/ml ± 1616908.484 to M0 at 5742.36 copies /ml ± 35756.883 at M12 (p Conclusion: Generally speaking, antiretroviral treatment had contributed to controlling viral loads, however the therapeutic combination TDF + 3TC + DTG had made it possible to obtain more patients with undetectable viremia instead.

Factors Associated with HIV/Tuberculosis Coinfection among People Living with HIV after Initiation of Antiretroviral Treatment in Lingwala Health Zone from 2021 to 2023

Context and objective: Around 8% of incident cases of tuberculosis (TB) were reported among people living with HIV worldwide in 2022. Tuberculosis is the leading cause of death among people living with HIV. Africa accounts for the majority of co-infection episodes, with over 50% of cases in some parts of southern Africa. In the Democratic Republic of Congo (DRC), around 9% of persons living with HIV (PLHIV) develop TB and 11% of TB patients are infected with HIV. The DRC is one of the 30 countries in the world bearing the brunt of co-infection. Despite the efforts made by countries to improve access to antiretroviral traitement (ART), TB remains a major problem among people living with HIV. The Lingwala Health Zone in the provincial city of Kinshasa recorded a large number of cases of HIV/TB co-infection during the study period. The aim of this study was to determine the factors associated with HIV/TB co-infection among PLHIV on ART in the Lingwala health zone (HZ) in Kinshasa. Methods: This was a case-control study conducted in the state-run HIV care facilities in the Lingwala health district among PLHIV who had visited the health facilities during the period 2021-2023. Cases were coinfected patients and controls were PLHIV who had not developed tuberculosis during the study period. Results: A total of 281 PLHIV were enrolled in the study, with 70 cases and 211 controls. Factors associated with HIV/TB co-infection after multivariate analysis were viral load (OR = 5.34;95% CI;1.8-15.8, p = 0.005). History of tuberculosis (OR = 20.84;95% CI;8.6-50.3, p -85.0, p = 0.005) and BMI Conclusion: The results of this study indicate that the detection of these enumerated factors should prompt providers to actively search for tuberculosis with a view to organising early management.

凉山地区HIV/AIDS患者皮肤黏膜病变及流行病学特征分析

目的分析凉山地区HIV/AIDS患者皮肤黏膜病变及流行病学特征,以期为当地艾滋病防控工作提供参考。方法回顾性分析凉山地区某二级甲等综合医院2022年6月—2023年5月就诊的HIV/AIDS合并皮肤黏膜病变患者。检测其HIV病毒载量和CD4^(+)T淋巴细胞计数,收集性别、年龄以及HIV感染途径等一般资料。结果根据纳入标准,共纳入78例研究对象,男性48例(61.54%),女性30例(38.46%),中位年龄31岁(1~68岁)。婚姻状况中,以已婚为主(56例,71.80%)。艾滋病传播途径中,以异性性行为为主(58例,74.36%)。HIV病毒载量与CD4^(+)T淋巴细胞计数两者呈负相关(r=-0.328,P=0.012)。78例研究对象中,感染性皮肤黏膜病变32例(41.03%),以口腔念珠菌病和梅毒为主;非感染性皮肤黏膜病变46例(58.97%),以湿疹和脂溢性皮炎为主。随着CD4^(+)T淋巴细胞计数水平升高,皮肤黏膜病变发生率逐渐降低。当CD4^(+)T淋巴细胞计数<100 cells/μL时,皮肤黏膜病变发生率高,并常合并2种及以上皮肤黏膜病变。结论凉山地区HIV/AIDS患者皮肤黏膜病变表现复杂,合并疾病种类较多。因此,针对HIV/AIDS患者需进行详细的检查和诊断,及早发现罹患的皮肤黏膜病变。

HIV低病毒载量患者耐药检测的可行性及临床预后研究

目的评价人类免疫缺陷病毒(HIV)低病毒载量患者全血样本HIV前病毒DNA基因型耐药性检测(DNA GRT)与血浆HIV-RNA基因型耐药性检测(RNA GRT)的可行性,并分析HIV低病毒载量患者的临床预后。方法收集2018年1月至2021年12月云南省传染病医院低病毒载量(HIV RNA在200~1000 copy/mL)样本212份,进行RNA GRT。同时抽取40份样本分别进行DNA GRT。比较2种方法的扩增效果,以及2种方法检测40例样本的耐药结果;分析低病毒载量样本的耐药情况及低病毒载量对临床治疗效果的影响。结果进行RNA GRT的212份样本中扩增成功107份,扩增率为59.22%;进行DNA GRT的40份样本扩增成功24例,扩增率为60.0%。2种方法联合检测总扩增率为90%(36/40)。40份样本中采用两种方法共同获得耐药检测结果的有21份,其中2种方法检测结果完全一致的样本有10份(47.62%),蛋白酶类耐药突变位点不一致的样本有2份(9.52%),核苷类和非核苷类耐药突变位点不一致的样本有9份(42.86%)。107份RNA GRT扩增成功的样本中,持续性低病毒载量的耐药率为48.28%(14/29),一过性低病毒载量的耐药率为41.38%(12/29),基线低病毒载量的耐药率为6.25%(1/16)。29份持续性低病毒载量样本中,在后期12个月随访中有14例(48.28%)病毒载量<50 copy/mL,有2例(6.90%)病毒载量>1000 copy/mL。16例基线低病毒载量样本中,在后期12个月随访中有1例(6.25%)出现病毒载量>1000 copy/mL,其余病毒载量均<50 copy/mL。结论HIV低病毒载量患者进行耐药检测是可行的,应尽早识别耐药突变位点更换治疗方案,预防后期治疗失败。

HIV-1 Viral Load and CD4 Assessment in HIV-1 Infected Pregnant Women Supported as Part of PMTCT in N’Djamena, Chad

In Sub-Saharan Africa, HIV affects lots of women of childbearing age;without prevention they can transmit the virus to their child. A cross-sectional study was conducted in the center of Psycho Medico-Social Support (APMS) in N’Djamena, Chad from January 2014 to March 2015. Our sampling concerned HIV-1 infected pregnant women followed up for PMTCT and their newborn. CD4+ lymphocytes and HIV-1 viral load were tested respectively with PIMATM and Abbott m2000 Real Time in mothers. Early infant diagnosis of HIV-1 was done in Children using PCR tool (Abbott m2000 Real Time). Pregnant women included in the study had a median age of 25 years (IQR, 22 - 30 years). Most of them (75.6%) (34/45), were under combination ART (TDF + 3TC or FTC + EFV). The median duration on ART was 4 month (IQR [3 - 5 months]). Nevirapine syrup was administrated to newborns as prophylaxis at least for the first six weeks of life until EID was done. At ART initiation, mothers’ LTCD4+ median was 249 cells/mm3 (IQR: 95 - 674 cells/mm3). After a median duration of 4 months on ART, LTCD4+ median was 530 cells/mm3 (IQR [263 - 1220 cells/mm3]). Viral load assessment in mothers showed that 15.5% (7/45) were undetectable, 75.6% (34/45) were detectable with a VL < 3log copies/ml and 8.8% (4/45) at virologic failure (VL > 3log copies/ ml). Four (11.4%) of 35 children included were tested positive at EID for HIV-1. Antiretroviral treatment management in pregnant women can improve their health and reduce the risk of MTCT. Availability of virologic monitoring in routine is essential for pregnant women in resources limited setting for preventing HIV transmission to their new-born and keep them alive.

2004—2022年河南省平顶山市HIV/AIDS患者抗病毒治疗效果分析

目的通过分析平顶山市2004—2022年人类免疫缺陷病毒(HIV)/艾滋病(AIDS)患者抗病毒治疗情况,评估抗病毒治疗效果,为本区域的艾滋病防治工作提供科学依据。方法使用“中国疾病预防控制信息系统”,下载2004—2022年现地址在平顶山市,抗病毒治疗满6个月及以上的HIV/AIDS病例数据资料,检测CD4^(+)T淋巴细胞和病毒载量,分别作为抗病毒治疗效果的免疫学和病毒学评价指标。对数据统计分析采用SPSS 22.0。结果共纳入2186例患者,治疗前基线CD4^(+)T细胞计数均值为(286.32±189.81)个/μl,抗病毒治疗后最近一次随访检测CD4^(+)T细胞计数均值为(446.45±221.96)个/μl,抗病毒治疗前后CD4^(+)T细胞结果分布差异有统计学意义(χ^(2)=641.53,P<0.001)。患者最近一次随访检测VL<20 copies/ml有1875例(85.77%),构成比呈逐渐上升趋势(χ^(2)=16.970,P<0.001)。Spearman检验抗病毒治疗后CD4^(+)T细胞与VL结果呈负相关(r=-0.143,P<0.001)。结论平顶山市在治的抗病毒治疗HIV/AIDS患者,免疫重建和病毒抑制情况较好,应继续扩大检测、早发现、早治疗,加强患者服药依从性教育,坚持长期规范治疗,进一步提高抗病毒治疗质量。

Stroke and HIV: Correlation between Viral Load and Type of Stroke

Introduction: The role of immunosuppression of TCD4+ lymphocytes in the onset of stroke in people living with HIV has been reported in numerous studies examining the co-morbidity of stroke and HIV. Objective: To determine the correlation between the viral load and the type of stroke. Methodology: This was a 7-month cross-sectional descriptive study carried out in the Neurology Department of Loandjili General Hospital in Pointe-Noire. The study population consisted of patients living with HIV who had a stroke confirmed by brain scan. The sero-immunological investigation consisted of looking for T lymphocyte typing from two kits: a CD4+ T lymphocyte typing reagent kit (BD FACS Presto TM) and a GeneXpert kit for viral load (Xpert®HIV-1 Viral Load). The database was made from the 2010 version of Microsoft Excel. Results: We included 16 patients living with HIV, 56% of whom were women with a sex ration of 0.78. The mean age was 56.92 ± 11.21. The mean number of TCD4+ lymphocytes was 413.44 ± 677.95/mm3;minimum: 93/mm3;maximum: 2854/mm3. The mean viral load was 17,996.31 ± 20,982.22/mm3;minimum: 1002/mm3;maximum: 67,229/mm3. No significant difference between the viral load and the occurrence of the stroke (p = 0.13). Conclusion: Our study did not show a causal link between viral load, immunosuppression of TCD4+ lymphocytes and the onset of stroke.

Role of HIV-1 Viral Load in Initiating Antiretroviral Therapy

Purpose: For commencement of Antiretroviral Therapy (ART), CD4 count and/or WHO clinical staging is used as the guide in India. In western countries along with clinical and immunological criteria, HIV-1 viral load is also used to start the patient on treatment. The present study was conducted to determine the role of viral load in taking decision on ART commencement in HIV-1 infected treatment na?ve individuals. Method: A cross sectional study was carried out at the Integrated Counseling and Testing Centre (ICTC) in the Department of Microbiology at a Tertiary care teaching hospital after Institutional Ethics Committee approval. After obtaining written informed consent, HIV-1 infected patients who were clinically asymptomatic, ART na?ve, having CD4 count ? TaqMan? HIV-1 Test. Result: During the study period of one year, 8966 HIV-1 infected patients were referred for CD4 count estimation. Of these 1624 patients had CD4 count <250 cells/mm3 and 405 patients were treatment na?ve. Of these 96 (23.70%) patients were clinically asymptomatic and were enrolled. Of those enrolled, ten (10.41%) had viral load less than 5000 copies/ml. Conclusion: Decision to start patient on ART can be made judiciously when viral load is used along with CD4 count estimation.

Enhanced Adherence Counselling, Support Groups and Viral Load Suppression amongst HIV-Positive Adolescents in a Tertiary Health Care Facility in Cameroon

Background: Globally, HIV viral load suppression rate, which is an indirect measure of the efficacy of antiretroviral (ART) medication, is 47% and 52% in Africa. In Cameroon, the viral load (VL) suppression rate is 44.7% and poor adherence is widely documented as being responsible for the large gap in VL Suppression. Enhanced adherence counselling (EAC) sessions, and enrolment and participation in support groups are specific interventions to improve ART adherence and improve viral load suppression. Purpose: This study assesses the uptake and contribution of support groups and EAC sessions in the management of adolescents with unsuppressed VL results at Centre Hospitalier d’Essos, Yaounde. Methods: A retrospective correlational quantitative patient files review was conducted for 138 files of HIV positive adolescents aged between 10 - 19 years with HIV VL above 1000 copies/ml enrolled in care between January 2009 and December 2019. Data from the questionnaire was entered into CSPRO version 7.4. and analyzed by using SPSS version 25.0. Results: A total of 138 participants (75 females and 63 males) with a mean age of 15 ± 3 years were included in our study. Sixty-nine (50%) participants were in World Health Organization (WHO) stage I;32.6% were in Stage II;13.0% and 4.3% were in stages III and IV, respectively. Thirty (21.7%) had a history of tuberculosis and 76% of the adolescents were being cared for primarily by their parents. The charts of the adolescents revealed that there was an association between completion of EAC sessions in adolescents with unsuppressed VL and eventual VL suppression (R.R = 2.5;CI 0.848 - 6.162;p = 0.033). However, there was no significant association between support group enrolment and active participation, and eventual VL Suppression. Furthermore, combining EAC and support group interventions was strongly associated with eventual VL Suppression in this group of initially unsuppressed adolescents (R.R = 7.5;C.I 2.544 - 22.360;p Conclusion: Suppression rates were good after completion of EAC sessions and participation in support group enrolment for adolescents with a high VL. As we move towards having 95% of ART-treated adolescents achieve and maintain viral suppression, there is a need to reinforce EAC sessions and support group enrolment in ART clinics targeting this priority group.

江苏省2019年新报告HIV/AIDS患者病毒载量结果分析

目的病毒载量在艾滋病防治中重要性逐步提高,了解新报告HIV/AIDS患者治疗前病毒载量的基线情况,可为艾滋病防治工作提供依据。方法采用荧光定量PCR方法对2019年江苏省新报告HIV/AIDS患者样本进行HIV-1病毒载量检测,比较病毒载量在不同人口学特征下差异,分析高病毒载量影响因素。结果3098例江苏省新报告HIV/AIDS患者病毒载量对数均值为4.33±1.05 log/mL,病毒载量<5000拷贝/mL患者占比20.85%(646/3098)。不同性别患者的病毒载量差异有统计学意义(P<0.05),男性患者病毒载量水平较高。艾滋病病毒感染者与艾滋病患者病毒载量差异有统计学意义(P<0.05),疾病状态诊断为艾滋病患者其病毒载量值相对偏高;未婚和已婚有配偶较离异或丧偶更易出现高病毒载量的情况。基线病毒载量水平较高时,抗病毒治疗后病毒学失败率也较高。结论新报告HIV感染者/AIDS患者中病毒载量总体水平高,但存在一定比例的低病毒载量情况,提示在艾滋病防治工作中应加强对低病毒载量的随访;针对男性及未婚或已婚有配偶的人群加强干预措施,降低传播风险。

贵州省HIV/AIDS患者合并梅毒感染病毒载量与T淋巴细胞亚群相关性分析

目的分析贵州省近3年人类免疫缺陷病毒(HIV)/艾滋病(AIDS)患者合并梅毒感染病毒(HIV-RNA)载量与T淋巴细胞亚群之间的相关性。方法选取2019年1月1日—2021年12月31日在贵阳市公共卫生救治中心新确诊且未进行抗逆转录病毒治疗(ART)的HIV/AIDS患者2869例。根据患者梅毒检测结果,分为单纯HIV感染组2289例、HIV/梅毒现症感染组333例和HIV/梅毒既往感染组247例。比较3组患者一般人口学资料及实验室检测指标基线数据的差异,并分析HIV不同组间各自HIV-RNA载量与T淋巴细胞亚群的相关性。结果HIV/梅毒现症感染组的年龄小于单纯HIV感染组和HIV/梅毒既往感染组,男性占比高于单纯HIV感染组和HIV/梅毒既往感染组(P<0.05)。HIV/梅毒现症感染组的HIV-RNA载量低于单纯HIV感染组,CD4^(+)T细胞、CD8^(+)T细胞、CD3^(+)T细胞均高于单纯HIV感染组(P<0.05);HIV/梅毒既往感染组的HIV-RNA载量高于HIV/梅毒现症感染组,CD4^(+)T细胞、CD8^(+)T细胞、CD3^(+)T细胞均低于HIV/梅毒现症感染组(P<0.05);HIV不同组间CD4/CD8比值差异无统计学意义(P>0.05)。单纯HIV感染组和HIV/梅毒既往感染组Ⅰ级、Ⅱ级、Ⅲ级HIV-RNA载量均依次降低(P<0.05);HIV/梅毒现症感染组Ⅱ级、Ⅲ级HIV-RNA载量低于Ⅰ级(P<0.05)。3组患者HIV-RNA载量与T淋巴细胞亚群均呈负相关(P<0.01)。结论HIV/梅毒合并感染后T淋巴细胞亚群发生改变;随着HIV-RNA载量的变化,HIV/梅毒合并感染的T淋巴细胞亚群亦有所差异。

重庆市初治HIV感染者基线病毒载量、CD4^(+)T细胞水平在新型冠状病毒感染疫情下的变化

目的分析近3年重庆市初治HIV感染者人口学特征,明确基线病毒载量、CD4^(+)T细胞免疫水平及相关影响因素,了解新型冠状病毒感染疫情下上述指标是否发生变化。方法收集2019年1月—2021年12月确诊HIV感染且在重庆市公共卫生医疗救治中心初始启动抗病毒治疗患者的人口学信息及临床数据,以年份分组,用SPSS 25.0软件对比分析。结果共纳入HIV初治患者3573例,男性2814例(78.8%),年龄中位数45.9岁,同性性传播总占比28.4%(1016例),呈逐年降低趋势,从2019年30.9%下降到2021年25.2%(P<0.05)。基线HIV RNA中位数5.1 log_(10)拷贝/mL,1887例(52.8%)≥5.0 log_(10)拷贝/mL,呈逐年增高趋势,从2019年5.0 log_(10)拷贝/mL上升到2021年5.2 log_(10)拷贝/mL,且HIV RNA≥5.0 log_(10)拷贝/mL占比也逐年递增(P均<0.05)。CD4^(+)T细胞中位数158个/μL,2205例(61.7%)≤200个/μL,年度间未见显著差异。HIV RNA≥5.0 log_(10)拷贝/mL组较<5.0 log_(10)拷贝/mL组男性占比更高,年龄更大(P均<0.05),异性性传播占比更高,且CD4^(+)T细胞中位数95.0个/μL,显著低于非高病毒载组210.5个/μL(P<0.05)。结论重庆市HIV初治患者普遍存在基线高病毒载量与极低CD4^(+)T细胞免疫水平,尤其易发生在老年、男性、异性性传播感染者,且新型冠状病毒感染疫情下基线病毒载量有增高趋势,需加大对该群体的宣教力度,早筛查、早诊断、早治疗。

Study of HIV-1 Drug Resistance in Patients Receiving Free Antiretroviral Therapy in China

To investigate the prevalence of drug-resistance mutations,resistance to antiretroviral drugs,and the subsequent virological response to therapy in treatment-naive and antiretroviral-treated patients infected with HIV/AIDS in Henan,China,a total of 431 plasma samples were collected in Queshan county between 2003 and 2004,from patients undergoing the antiretroviral regimen Zidovudine + Didanosine + Nevirapine(Azt+Ddi+Nvp).Personal information was collected by face to face interview.Viral load and genotypic drug resistance were tested.Drug resistance mutation data were obtained by analyzing patient-derived sequences through the HIVdb Program(http://hivdb.stanford.edu).Overall,38.5% of treatment-naive patients had undetectable plasma viral load(VL),the rate significantly increased to 61.9% in 0 to 6 months treatment patients(mean 3 months)(P<0.005)but again significantly decrease to 38.6% in 6 to 12 months treatment patients(mean 9 months)(P<0.001)and 40.0% in patients receiving more than 12 months treatment(mean 16 months)(P<0.005).The prevalence of drug resistance in patients who had a detectable VL and available sequences were 7.0%,48.6%,70.8%,72.3% in treatment-na?ve,0 to 6 months treatment,6 to 12 months treatment,and treatment for greater than 12 months patients,respectively.No mutation associated with resistance to Protease inhibitor(PI)was detected in this study.Nucleoside RT inhibitor(NRTI)mutations always emerged after non-nucleoside RT inhibitor(NNRTI)mutations,and were only found in patients treated for more than 6 months,with a frequency less than 5%,with the exception of mutation T215Y(12.8%,6/47)which occurred in patients treated for more than 12 months.NNRTI mutations emerged quickly after therapy begun,and increased significantly in patients treated for more than 6 months(P<0.005),and the most frequent mutations were K103N,V106A,Y181C,G190A.There had been optimal viral suppression in patients undergoing treatment for less than 6 months in Queshan,Henan.The drug resistance strains were highly prevalent in antiretroviral-treated patients,and increased with the continuation of therapy,with many patients encountering virological failure after 6 months therapy.

Factors Associated with the Unsuppressed Viral Load of Children on Antiretroviral Therapy Followed Up in the GbêkêRegion (Côte d’Ivoire)

Introduction: Unsuppressed viral load (VL) in immunocompromised children on antiretroviral therapy (ART) increases the risk of child morbidity and death. The aim of the study was to identify factors associated with unsuppressed viral load in children on ART for the improvement of prognosis. Patients and Methods: this is a retrospective, descriptive and analytical study carried out from July 2015 to December 2019 in the 28 pediatric HIV/AIDS treatment centers supervised by the NGO IRAA in the region of Gbêkê. It Included children from 0 to 15 years who were HIV positive, on ART for at least 6 months with at least one viral load. The variables studied were socio-demographic, diagnostic and evolutionary. Data analysis was descriptive and analytical with a significance level of p < 0.05. Results: out of 329 children included, 118 (62 boys, 53 girls) had a non-suppressed VL, i.e. a prevalence of 36%. The mean age at diagnosis was 61 months. The mother was a small trader (36.4%), illiterate (45.8%). Unsuppressed viral load was significantly associated with poor nutritional status at the start of treatment (p < 0.001), non-compliance with treatment (p < 0.001), poor maternal education (p = 0.011) and the lack of follow-up of the mother in the context of PMTCT (p = 0.03). Conclusion: Unsuppressed viral load is common in children on ART in the Gbêkê region. It mainly concerns the child who did not comply with ART, and whose mother was not followed within the framework of PMTCT. Strengthening early detection, early initiation of ART, PMTCT and increased therapeutic education strategies would improve the prognosis of children infected with HIV.

Virologic Response among Children and Adults in an Antiretroviral Therapy Programme in Northern Nigeria: A Cross-Sectional Descriptive Study

Introduction: Viral load suppression is a key determinant of successful anti-retroviral therapy. The study aimed to determine virologic response to Antiretroviral therapy in the large cohort of children and adults living with Human Immune deficiency Virus. Materials and Methods: Viral Load results from the HIV Ribonucleic Acid Polymerase Chain Reaction register of 10,887 children and adults on cART in 4 states in Northern Nigeria between 2017 and 2019 were retrieved and analyzed in the PCR Molecular Laboratory of the Federal Teaching Hospital, Gombe. Results: 10,887 children and adults were analyzed. Males were 28.4% (3094) and 71.6% (7793) females. 2.9% (311);3.5% (386);7.3% (797);65.2% (7098);14.5% (1583);5.2% (562) and 1.3% (150) were aged 0 - 9 years, 11 - 18 years;19 - 25 years, 26 - 45 years;46 - 55 years;56 - 65 years and 10 years. The most recent CD4count before viral load request was ≥1000/μL in 7.4% (810/10887);500 -999/μL in 39.0% (4240);350 - 499 μL in 22.7% (2466) and 1000 c/mL in 26.5% (821/3094) males and 24.1% (1876/7793) females. Viral load was significantly lower among females (p-value 0.007). 50.5% (157/311);52.1% (201/386);28.5% (227/797);23.5% (1670/7098);19.9% (315/1583);17.8% (100/562) and 18.0% (27/150) aged 0 - 9 years, 11 - 18 years;19 - 25 years, 26 - 45 years;46 - 55 years;56 - 65 years and 1000 c/mL respectively. Viral load was >1000 c/mL in 28.2% (229/811) for those on HAART for 6 months - 1 year and 23.6% (1243/5275) after receiving Highly Active Antiretroviral Therapy (HAART) for 1 - 5 years. 26.3% (1072/4075) and 21.1% (153/726) had viral load > 1000 c/mL after receiving HAART for 6 - 10 and >10 years respectively (p-value 0.001). Conclusion: HIV viral suppression was below the WHO recommended threshold.

1例出境人员HIV抗体WB不确定结果分析及口岸防控思考

目的分析1例出境人员HIV抗体蛋白印迹试验(WB)不确定结果,提出艾滋病相关口岸防控思考。方法按照《全国艾滋病检测技术规范》检测要求,回顾性分析1例HIV抗体WB不确定样本检测流程。结果筛查试验:第一次和第二次体检初筛结果均为有反应,第一次和第二次体检两种抗体试剂复检结果均为有反应,第一次体检随访筛查两种抗体试剂检测结果为一有一无反应;确证试验:第一次体检、第一次随访及第二次体检WB检测条带分别为p24和gp160、gp160、gp160,结果均为HIV-1不确定;核酸检测:第一次随访及第二次体检病毒核酸载量检测结果均为“未检出”。结论针对HIV抗体不确定现状,建议尽快将HIV抗体确证试验和核酸检测作为补充实验在实际工作中联合使用。就此提出口岸艾滋病防控的思考:织牢疫情监测预警网络;完善国际旅行健康服务体系;强化实验室建设;建立联防联控体系,统筹协调口岸新冠疫情与艾滋病防控,做好“多病共防”。

Immunovirologic Evaluation of Triomune (Lamivudine, Stavudine and Nevirapine) Antiretroviral Therapy in First Line HIV-1 Adult Patients in N’Djamena, Chad

Contexte:?The fight against HIV/AIDS epidemics is one of the greatest challenges of this century. The epidemic affects generally under-developed countries, and Sub-Saharan Africa are the most concerned. The combined marketed form known as Triomune was used as first-line treatment in several sub-Saharan African Countries (60% of VIH infected people), including Chad. However, no evaluation has been done for that treatment in the country. Objective: To evaluate the efficacy and safety immuno-virological of Triomune at the General Hospital in N’Djamena/Chad. Methods: 48 HIV-1 positive patients eligible for ARV treatment were enrolled in our study, and they have been then followed for 8 months. We have measured in these patients the CD4 cell count before treatment and at the 8th month of treatment. After 8 months of treatment, we have also evaluated the Lymphocyte T CD4 and the plasma viral load (VL). Comparisons of means of CD4 lymphocytes and plasma CV (≥1000 copies/ml) were used to define treatment failure.?Results:?48 patients were under Triomune regime. The average CD4 count was decreased from 462 ± 179.22 [56 - 981] cells/mm3?before treatment to 327.23 ± 153.77 [10 - 1008] cells/mm3?at the 8th month of treatment. The mean plasma viral load for patients was 66008.62 copies/ml. The failure rate to Triomune was 43.75% (21/48).?Conclusion:?Aside from the side effects already described for Triomune, our study reveals a high treatment failure rate. Hence, there is the need of regular revisions of therapeutic regime administer in the first intention.

北京市MSM人群HIV感染者合并HCV与梅毒感染的状况及相应免疫指标与病毒载量的变化

目的 了解北京市男男性接触者（MSM）的艾滋病病毒（HIV）感染及宿主的免疫状态。方法 2005年7～12月对招募的MSM进行HIV感染检测，采集阳性感染者的外周血，对分离毒株进行鉴定，并对阳性感染者的免疫状态包括CD4^＋、CD8^＋T细胞的数量，以及感染者体内病毒载量进行了分析。结果在招募的526名MSM中，HIV感染的主要流行亚型为欧美B亚型，1例为CRF01-AE重组亚型，后者主要为异性间HIV感染的流行亚型。HIV感染者中合并HCV或者梅毒的感染率分别为17．65％与35．29％，合并感染者的CD4^＋、CD8^＋T淋巴细胞数量明显降低，病毒载量明显升高。结论 MSM人群中HIV感染者合并STD感染，明显降低宿主免疫系统控制病毒复制的能力，同时存在着MSM人群与其他高危人之间通过性途径相互传播HIV的趋势。