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.

A Cross-Sectional Study on the Impact of Operation Triple Zero (OTZ) Program on Viral Load Suppression amongst Members of the Adolescent Club in 68 Nigerian Army Reference Hospital Yaba Lagos, Nigeria

Background: In Nigeria, adolescents and young people (AYP) aged 10 - 24, comprise 22.3% of the population and with HIV prevalence of 3.5%. The AYP living with HIV enrolled at the 68 NARHY, Lagos reflects the national challenges with poor viral suppression. The OTZ program aligns with the UNAIDS 95-95-95 goals. It seeks to empower AYPLHIV to be in charge of their treatment and commit to triple zero outcomeszero missed appointments, zero missed drugs, and zero viral loads. The purpose of the study was to assess the impact of the OTZ program on viral load suppression among members of the adolescent club in 68 NARHY, Lagos. Method: A cross-sectional retrospective study to evaluate the impact of the OTZ program on the viral load of 53 AYP enrolled in the OTZ program between March 2019 to December 2019 was analyzed. The Percentage of viral load suppression before enrollment compared with 6 and 12 months after enrollment into the OTZ program. The AYP is grouped into 10 - 14, 15 - 19, and 20 - 24 years. Activities conducted were peer driven monthly meetings with the AYP during which the adolescents interacted on issues relating to improving their treatment outcomes, healthcare workers reviewed their clinical status, viral load result, provider peer counseling, and caregivers engagement to support adherence to medication and ARV refills. Results: Before OTZ, 81% aged 10 - 14 years, 75% aged 15 - 19 years, and 25% aged 20 - 24 years were virally suppressed (VL less than 1000 copies/ml). Six months after enrollment, 94% were virally suppressed95% aged 10 - 14 years, 96% aged 15 - 19 years, and 66% aged 20-24 years. Twelve months after enrollment, 96% of AYP were virally suppressed100% aged 10-14 years, 93% aged 15 - 19 years, and 100% aged 20 - 24 years. Males viral load (VL) suppression improved from 79% to 96% and 92%, while females VL suppression improved from 69% to 93% and 100% at 6 and 12 months respectively. Conclusion: The OTZ activities contributed to improved viral load suppression in the AYP of the facility.

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.

HCV-RNA positivity in peripheral blood mononuclear cells of patients with chronic HCV-infection: does it really mean viral replication?

AIM: To analyze the association of HCV-RNA with peripheral blood mononuclear cells (PBMC) and to answer the question whether HCV-RNA positivity in PBMC is due to viral replication. METHODS: HCV-RNA was monitored in serum and PBMC preparations from 15 patients with chronic HCV infection before, during and after an IFN-alpha therapy using a nested RT/PCR technique. In a second approach, PBMC from healthy donors were incubated in HCV positive plasma. RESULTS: In the IFN-alpha responding patients,HCV-RNA disappeared first from total RNA preparations of PBMC and then from serum. In contrast, in relapsing patients, HCV-RNA reappeared first in serum and then in PBMC. A quantitative analysis of the HCV-RNA concentration in serum was performed before and after transition from detectable to non detectable HCV-RNA in PBMC-RNA and vice versa. When HCV-RNA was detectable in PBMC preparations, the HCV concentration in serum was significantly higher than the serum HCV-RNA concentration when HCV-RNA in PBMC was not detectable. Furthermore, at no time during the observation period was HCV specific RNA observed in PBMC, if HCV-RNA in serum was under the detection limit. Incubation of PBMC from healthy donors with several dilutions of HCV positive plasma for two hours showed a concentration dependent PCR positivity for HCV-RNA in reisolated PBMC. CONCLUSION: The detectability of HCV-RNA in total RNA from PBMC seems to depend on the HCV concentration in serum. Contamination or passive adsorption by circulating virus could be the reason for detection of HCV-RNA in PBMC preparations of chronically infected patients.

Blood micronutrient, oxidative stress, and viral load in patients with chronic hepatitis C

AIM: To assess the extent of micronutrient and oxidative stress in blood and to examine their linkages with viral loads in chronic hepatitis C patients.METHODS: Hepatitis C virus (HCV)-RNA levels were quantified in the serum from 37 previously untreated patients with chronic hepatitis C. The plasma and erythrocyte micronutrients (zinc, selenium, copper, and iron) were estimated, and malondialdehyde (MDA)contents were determined as a marker to detect oxidative stress. Antioxidant enzymes, superoxide dismutase (SOD),glutathione peroxidase (GPX) and glutathione reductase (GR) activities in blood were also measured. The control group contained 31 healthy volunteers.RESULTS: The contents of zinc (Zn), and selenium (Se)in plasma and erythrocytes were significantly lower in hepatitis C patients than in the controls. On the contrary,copper (Cu) levels were significantly higher. Furthermore,plasma and erythrocyte MDA levels, and the SOD and GR activities in erythrocytes significantly increased in hepatitis C patients compared to the controls. However, the plasma GPX activity in patients was markedly lower. Plasma Se (r= -0.730, P<0.05), Cu (r = 0.635), and GPX (r = -0.675)demonstrated correlations with HCV-RNA loads. Significant correlation coefficients were also observed between HCV-RNA levels and erythrocyte Zn (r = -0.403), Se (r = -0.544), Cu (r = 0.701) and MDA (r = 0.629) and GR (r = 0.441).CONCLUSION: The levels of Zn, Se, Cu, and oxidative stress (MDA), as well as related anti-oxidative enzymes (GR and GPX) in blood have important impact on the viral factors in chronic hepatitis C. The distribution of these parameters might be significant biomarkers for HCV.

Association of core promoter mutations of hepatitis B virus and viral load is different in HBeAg(+) and HBeAg(-) patients

AIM:To identify the prevalence of hepatitis B e antigen (HBeAg) and to assess the association of hepatitis B virus (HBV) core promoter mutations and viral load in Indonesian patients.METHODS:Sixty-four patients with chronic hepatitis,65 with liver cirrhosis and 50 with hepatocellular carcinoma were included in this study.HBeAg and hepatitis B e antibody (HBeAb) tests were performed using enzyme-linked immunosorbent assay and the mutations were analyzed by sequencing.Viral load was measured by real-time polymerase chain reaction.RESULTS:Of 179 patients,108 (60.3%) were HBeAg(-) and 86 (79.6%) of these HBeAg(-) patients had been seroconverted.The A1896 mutation was not found in HBeAg(+) patients,however,this mutation was detected in 70.7% of HBeAg(-) patients.This mutation was frequently found when HBeAg was not expressed (87.7%),compared to that found in HBeAg seroconverted patients (65.1%).The A1899 mutation was also more prevalent in HBeAg(-) than in HBeAg(+) patients (P=0.004).The T1762/A1764 mutation was frequently found in both HBeAg(+) and HBeAg(-) patients,however,the prevalence of this mutation did not significantly differ among the two groups (P=0.054).In HBeAg(+) patients,the T1762/A1764 mutation was correlated with lower HBV DNA (P < 0.001).The A1899 mutation did not correlate with HBV DNA (P=0.609).In HBeAg(-) patients,the T1762/A1764 mutation alone was not correlated with HBV DNA (P=0.095),however,the presence of either the T1762/A1764 or A1896 mutations was associated with increased HBV DNA (P < 0.001).CONCLUSION:The percentage of HBeAg(-) patients is high in Indonesia,and most of the HBeAg(-) patients had been seroconverted.The A1896 mutation was most likely the major cause of HBeAg loss.The T1762/A1764 mutation alone was associated with lower viral loads in HBeAg(+) patients,but not in HBeAg(-) patients.

New combination test for hepatitis C virus genotype and viral load determination using Amplicor GT HCV MONITOR test v2.0

AIM: To develop a new sensitive and inexpensive hepatitis C virus (HCV) combination test (HCV Guideline test) that enables the determination of HCV genotypes 1, 2 and 3, and simultaneous determination of HCV viral load using commercial Amplicor GT HOV MONITOR test v2.0 (microwell version). METHODS: The HCV Guideline test used the PCR product generated in commercial Amplicor GT HCV Monitor test v2.0 for viral load measurement using microwell plate version of Amplicor HCV Monitor and also captured on separate plates containing capture probes and competitive oligonucleotide probes specific for HCV genotypes 1, 2 and 3, The HCV genotype was subsequently determined using the biotin-labeled PCR product and five biotin-labeled HCV-specific probes. RESULTS: The sensitivity of the HCV Guideline test was 0.5 KIU/mL. Specificity of the HCV Guideline test was confirmed by direct sequencing of HCV core region and molecular evolutionary analyses based on a panel of 31 samples. The comparison of the HCV Guideline test and an in-house HCV core genotyping assay using 252 samples from chronic hepatitis C patients indicated concordant results for 97.2% of samples (59.5% genotype 1, 33.7% genotype 2, 6.0% genotype 3, and 0.8% mixed genotypes). Similarly, the HCV Guideline test showed concordance with a serological test, and the serological test failed to assign any serotype in 12.7% of the samples, indicating a better sensitivity of the HCV Guideline test. CONCLUSION: Clinically, both viral load and genotypes (1, 2 and 3) have been found to be major predictors of antiviral therapy outcome regarding chronic hepatitis C based on guidelines and they are, in normal circumstances, performed as separate stand-alone assays. The HCV Guideline test is a useful method for screening large cohorts in a routine clinical setting for determining the treatment regimen and for predicting the outcome of antiviral therapy of chronic hepatitis C.

Four-week pegylated interferon a-2a monotherapy for chronic hepatitis C with genotype 2 and low viral load:A pilot,randomized study

AIM:To assess the efficacy and advantages of 4-wk pegylated interferon a-2a(peg-IFN-a2a) monotherapy for chronic hepatitis C patients with strong predictors of sustained virologic response(SVR).METHODS:Patients(n = 33) with genotype 2 and low viral load(< 100 KIU/mL),who became HCV RNA negative after 1 wk of IFN treatment,were randomly allocated to receive a 4-or 12-wk treatment course at a ratio of 2:1,respectively,with a subsequent 24-wk follow-up period.Peg-IFN-a2a was administered subcutaneously at a dose of 180 μg or 90 μg once weekly.SVR was defined as absence of serum HCV RNA at the end of the follow-up period.RESULTS:All patients completed the treatment schedule,and more than half were symptom-free during the treatment.In the 4-wk treatment group,20 of 22(91%) patients achieved SVR.Two patients relapsed,but achieved SVR following re-treatment with peg-IFN-a2a alone.In the 12-wk treatment group,11 of 11(100%) patients attained SVR.CONCLUSION:Our results show that a 4-wk course of peg-IFN-a2a monotherapy can achieve a high SVR rate in "IFN-sensitive" patients,without negatively affecting outcome.

Effects of Duck Tembusu Virus on Serum Biochemical Indexes, Cytokines and Viral Replication of Ducklings

In order to understand the pathogenicity of duck Tembusu virus （DTMUV）, it was injected into muscle of 5-d-old Cherry Valley ducklings according to the dosage of 1×104 EID50. Then, the biochemical indexes of duckling serum samples were determined by kits, and the changes in detoxification, tissue viral load and cytokines were detected by using fluorescence quantitative PCR. The results showed that DTMUV had serious damage to the liver, kidney, heart and muscle of ducklings; DTMUV could proliferate in the liver, spleen, lung and brain; the virus levels in the liver and brain reached the peaks on day 5 after the inoculation and those in the lung and spleen reached the peaks on day 9; the virus content was highest in the brain, liver and spleen; and DTMUV induced the overexpression of IFN-γ, IFN-α, IL-6, IFN-β, IL-1β, TLR-7,IL-2, major histocompatibility complex type I （MHC-I） andmajor histocompatibility complex type II （MHC-II） in the spleen on day 1 and the overexpression of IL-6 and IL-2 in the brain on days 1, 2 and 3.

Human bocavirus infection in children hospitalized with lower respiratory tract infections:Does viral load affect disease course?

Objective:To examine the effects of human bocavirus type 1(HBoV1)on the course of lower respiratory tract infections in cases of monoinfection and coinfection,and the effects of HBoV1 viral load on the disease in children under six years old hospitalized with a diagnosis of HBoV1-associated lower respiratory tract infections.Methods:Children under six years of age,who were hospitalized with the diagnosis of lower respiratory tract infection due to HBoV1 between 1 January 2021 and 1 January 2022 were included in the study.Laboratory confirmation of the respiratory pathogens was performed using polymerase chain reaction(PCR).Results:Fifty-four(16.4%)children with HBoV1 among 329 children whose PCR was positive with bacterial/viral agent in nasopharyngeal swab samples were included in the study.There were 28(51.9%)males and 26(48.1%)females with a median age 23.4 months[interquartile range(IQR):13.2,30.0 months](min-max:1 month-68 months).HBoV1 was detected as a monoinfecton in 26(48.1%)children,and as a coinfection with other respiratory agents in 28 children(51.9%).In multiple regression analysis,coinfection(P=0.032)was associated with the length of hospitalization(P<0.001;R^(2)=0.166).There was a negative correlation(r=−0.281,P=0.040)between cough and cycle threshold.Fever was found to be positively correlated with C-reactive protein(r=0.568,P<0.001)and procalcitonin(r=0.472;P=0.001).Conclusions:Although we found a higher HBoV1 viral load in children with more cough symptoms in our study,it had no effect on the severity of the disease,such as length of hospital stay and need for intensive care.Coinfection was found to affect the length of hospitalization.

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.

HIV Viral Suppression in Children in a Subnational Antiretroviral Treatment Programme in Nigeria

Background: Despite years of Paediatric Antiretroviral therapy in Nigeria, the National implementation plan for the scale up of viral load testing was only rece ntly launched. Viral load determination is the most important indicator of ART response. Material & methods: First viral load samples were collected from 663 children living with HIV between December 2017-Decemb er 2019 aged 0 - 18 years on highly active antiretroviral therapy from 4 states within Nigeria. Samples were analyzed at a Polymerase Chain Reaction laboratory of the Federal Teaching Hospital Gombe. Results: Males were 311 (46.9%) and 352 (53.1%) female. Children aged 0 - 9 years constituted 44.9% (298);55.1% (365) were aged 10 - 18 years. This first viral load was primarily routine in 94 .2% (625);2.9% (19) of children respectively had suspected clinical or immunological failure. ART combination was AZT/3TC/NVP in 78.1% (518/663) of CLHIV;TDF/3TC/EFV in 21.2% (141);AZT/3TC/LPV/rtv in 4 (0.6%). Prior to initiation of routine viral load testing $0.55 (366/663) CLHI V had received HAART for 1 - 5 years;7.8% (52/663) for 6 months but < 1 year;32.8% (218/663) 6 - 10 years and 4.1% (27) for >10 years. The most recent CD4 count before viral load request was ≥1000/μL in 24.7% (164) of CLHIV;500 - 999/μL in 42.9% (285);350 - 499 μL in 11% (73) and <350 μL in 21.3% (141) of children. Viral load was ≥1000 c/ml in 51.3% (340/663) of children. Viral load was >1000 c/ml in 59.9% (174/311) males and 47.2% (166/352) females. Viral load was significantly lower among females (P-value 0.02). Of children aged 0 - 9 years 50.3% (150/298) had viral load > 1000 c/ml and 10 - 18 years 52.1% (190/365) (P value 0.660). Viral load was >1000 c/ml in 38.5% (20/52) of children on HAART for 6 months - 1 year and 52.2% (191/366) after receiving HAART for 1 - 5 years. 52.3% (114/218) and 55.6% (15/27) CLHIV had viral load > 1000 c/ml after receiving HAART for 6 - 10 and >10 years respectively (P value 0.29). Conclusion: About half of children on HAART have viral load > 1000 c/ml after more than 1 - 5 years on HAART. Longer duration of ART and use of AZT/3TC/NVP are associated with viral load > 1000 c/ml. Key considerations are poor adherence and/or viral drug resistance. Optimizing ART adherence and resistance monitoring remain key strategies for ART programmes.

APRI as a predictor of early viral response in chronic hepatitis C patients

AIM:To evaluate the aspartate aminotransferase(AST) to platelet ratio index(APRI) as a predictive factor of early viral response in chronic hepatitis C naive patients.METHODS:We performed an ambispective case-control study.We enrolled chronic hepatitis C naive patients who were evaluated to start therapy with PEGylated interferon α-2b(1.5 μg/kg per week) and ribavirin(>75 kg:1200mg and <75kg:1000mg).Patients were allocated into two groups,group 1:Hepatitis C patients with early viral response(EVR),group 2:Patients without EVR.Odds ratio(OR) and 95% confi dence interval(CI) were calculated to assess the relationship between each risk factor and the EVR in both groups.RESULTS:During the study,80 patients were analyzed,45 retrospectively and 35 prospectively.The mean ± SD age of our subjects was 42.9 ± 12 years;weight 70 kg(±11.19),AST 64.6 IU/mL(±48.74),alanine aminotransferase(ALT) 76.3 IU/mL(±63.08) and platelets 209000 mill/mm3(±84 429).Fifty-five(68.8%) were genotype 1 and 25(31.3%) were genotype 2 or 3;the mean hepatitis C virus RNA viral load was 2 269 061 IU/mL(±7220266).In the univariate analysis,APRI was not associated with EVR [OR 0.61(95% CI 0.229-1.655,P=0.33)],and the absence of EVR was only associated with genotype 1 [OR 0.28(95% CI 0.08-0.94,P=0.034)].After adjustment in a logistic regression model,genotype 1 remains signifi cant.CONCLUSION:APRI was not a predictor of EVR in chronic hepatitis C;Genotype 1 was the only predictive factor associated with the absence of EVR in our patients.

DNA-guided hepatitis B treatment:Viral load is insufficient with few exceptions

In DNA-guided hepatitis B treatment, viral load is insufficient, and requires other viral markers for treatment of hepatitis B patients as in patients with acute exacerbation of chronic hepatitis B, end-stage renal disease on dialysis, human immunodeficiency virus co-infected patients. There are exceptions to this rule： a residual level hepatitis B virus （HBV） DNA at 24 wk predicts beneficial outcome and reduced resistance at i year. The genotypic viral resistance to antiviral agents and occult HBV infection can be determined by HBV-DNA levels.

Co-relation of SARS-CoV-2 related 30-d mortality with HRCT score and RT-PCR Ct value-based viral load in patients with solid malignancy

BACKGROUND Coronavirus disease 2019(COVID-19)patients with malignancy are published worldwide but are lacking in data from India.AIM To characterize COVID-19 related mortality outcomes within 30 d of diagnosis with HRCT score and RT-PCR Ct value-based viral load in various solid malignancies.METHODS Patients included in this study were with an active or previous malignancy and with confirmed severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection from the institute database.We collected data on demographic details,baseline clinical conditions,medications,cancer diagnosis,treatment and the COVID-19 disease course.The primary endpoint was the association between the mortality outcome and the potential prognostic variables,specially,HRCT score,RT-PCR Ct value-based viral load,etc.using logistic regression analyses treatment received in 30 d.RESULTS Out of 131 patients,123 met inclusion criteria for our analysis.The median age was 57 years(interquartile range=19-82)while 7(5.7%)were aged 75 years or older.The most prevalent malignancies were of GUT origin 49(39.8%),hepatopancreatobiliary(HPB)40(32.5%).109(88.6%)patients were on active anticancer treatment,115(93.5%)had active(measurable)cancer.At analysis on May 20,2021,26(21.1%)patients had died.In logistic regression analysis,independent factors associated with an increased 30-d mortality were in patients with the symptomatic presentation.Chemotherapy in the last 4 wk,number of comorbidities(≥2 vs none:3.43,1.08-8.56).The univariate analysis showed that the risk of death was significantly associated with the HRCT score:for moderate(8-15)[odds ratio(OR):3.44;95%confidence interval(CI):1.3-9.12;P=0.0132],severe(>15)(OR:7.44;95%CI:1.58-35.1;P=0.0112).CONCLUSION To the best of our knowledge,this is the first study from India reporting the association of HRCT score and RT-PCR Ct value-based 30-d mortality outcomes in SARS-CoV-2 infected cancer patients.

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.

SARS-CoV-2 viral load in the upper respiratory tract and disease severity in COVID-19 patients

Due to the disease's broad clinical spectrum,it is currently unclear how to predict the future prognosis of patients at the time of diagnosis of coronavirus disease 2019(COVID-19).Real-time reverse transcription-polymerase chain reaction(RTPCR)is the gold standard molecular technique for diagnosing COVID-19.The number of amplification cycles necessary for the target genes to surpass a threshold level is represented by the RT-PCR cycle threshold(Ct)values.Ct values were thought to be an adequate proxy for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)viral load.A body of evidence suggests that SARS-CoV-2 viral load is a possible predictor of COVID-19 severity.The link between SARS-CoV-2 viral load and the likelihood of severe disease development in COVID-19 patients is not clearly elucidated.In this review,we describe the scientific data as well as the important findings from many clinical studies globally,emphasizing how viral load may be related to disease severity in COVID-19 patients.Most of the evidence points to the association of SARS-CoV-2 viral load and disease severity in these patients,and early anti-viral treatment will reduce the severe clinical outcomes.

Profiling Hepatitis B Viral Load: Treatment and Epidemiological Implications in a West African Hospital

Background: Chronic hepatitis B virus (HBV) infection is one of the largest public health problems with nearly 350 million chronic carriers and 500,000 deaths each year. These deaths are most often associated with disease progression to cirrhosis or hepatocellular carcinoma, which some studies have shown is associated with long-term viral replication in chronic carriers. Viral load quantification, a key element of disease management, is expensive and difficult to access. Viral load plays a crucial role in patient classification and treatment initiation. Four years after the implementation of viral load platform, the objective of this study was to assess viral load profile in HBs chronic carriers in a sub-Saharan Hospital and to determine the potential impact of this distribution on preventive and therapeutic strategies against hepatitis B infection. Materials and Method: The study was carried out between April 2016 and October 2020 in the laboratory of the PRINCIPAL Hospital in Dakar. All patients referred for HBV DNA viral load testing following a positive AgHBs test were included. Incomplete medical records were excluded from the study. Only the first quantification test performed on each patient is recorded. DNA extraction was performed with COBAS AmpliPrep (Roche Molecular Systems, Inc., Branchburg, NJ, USA). Amplification was performed using COBAS TaqMan48 (Roche Molecular Systems, Inc., Branchburg, NJ, USA). Data were collected from the laboratory’s computer system and entered into Microsoft Excel (2007). Statistical analyzes were performed using Epi-Info 7 software. Results: A total of 3002 patients, 76.1% (2285/3002) men and 33.9% (717/3002) women, were included in the study. Young adults were most represented among the subjects (23.2%) and (20.1%) in the age groups 25 - 30 and 30 - 35. The majority (52.7%) of patients had viral loads between 20 and 2000 IU. Patients with undetectable viral loads and patients with viral loads below 20 IU comprised 14.6% and 7.53% of the study population, respectively. Patients with viral loads between 2000 and 20,000 IU/ml and those with viral loads greater than 20,000 IU/ml represented 16.3% and 8.89% of the study population, respectively. Viral load was higher in males than females, with corresponding median and interquartile ranges of 2.7 log IU (2.2, 2.75) and 2.23 log IU (2.1, 2.4) (p Conclusion: This study shows a successful implementation of virus quantification in the context of resource-constrained countries. The second finding of this study is the high prevalence of adolescents with high plasma viral loads, indicating the need for additional investigations to initiate therapy. The large population with a low HBV replication rate points to the problem of financing follow-up care for chronically infected people. Studying this population in the context of an unknown genomic profile indicates the need to deepen virological laboratory testing through a sequencing platform. Finally, regular viral load reporting in major hospital cities could be a powerful and accessible management tool for hepatitis B programs in resource-constrained countries.

Viral Suppression in Adult Nigerians in a Regional Antiretroviral Therapy Programme: A Cross Sectional Descriptive Study

Background: The adult ART (antiretroviral therapy) programme started in Nigeria in 2002. After many years of ART in the country, the National implementation plan for the scale up of viral load testing was launched in 2016. Viral load estimation is the most important indicator of ART response. Aim: To describe viral suppression in adults on the HIV ART programme Material & methods: Viral load blood samples of 9450 adults on highly active antiretroviral therapy living with HIV from 4 states within Nigeria were analyzed for HIV RNA in Polymerase Chain Reaction laboratory of the Federal Teaching Hospital, Gombe between December 2017 and December 2019. Results: Males were 2577/9450 (27.3%) and 6873 (72.7%) females. Adults aged 26 - 45 years constituted 69.5% (6572). Viral load test was primarily routine in 96.3% (9098). ART was AZT/3TC/NVP in 52.5% (4962);TDF/3TC/EFV in 46.3% (4375). 48.3% (4568/9450) adults had received HAART for 1 - 5 years;7.4% (699) for 6 months but <1 year;37.6% (3551) 6 - 10 years and 6.7% (632) for >10 years. The most recent CD4 count before viral load request was ≥1000/μL in 6.5% (612) of adults;500 - 999/μL in 38.6% (3651);350 - 499 μL in 23.2% (2195) and <350 μL in 31.7% (2992). Viral load was ≥1000 c/ml in 22.9% (2167/9450) of adults. Viral load was >1000 c/ml in 22.8% (587/2577) males and 23.0% (1580/6873) females. Of adults aged 19 - 25 years, 28.4% (211/743) had viral load >1000 c/ml;23.5% (1544/6572);20.0% (294/1473);17.8% (93/523) and 18.0% (25/139) aged 26 - 45 years, 46 - 55 years;56 - 65 years and >65 years also had viral load >1000 c/ml (p value < 0.001) Viral load was >1000 c/ml in 26.0% (182/699) of adults on HAART for 6 months - 1 year and 21.3% (975/4568) after receiving HAART for 1 - 5 years. 24.9% (885/3551) and 19.8% (125/632) adults had viral load > 1000 c/ml after receiving HAART for 6 - 10 and >10 years respectively. (p value < 0.001) Conclusion: Over all viral suppression of 77% in our study is high but fell below the WHO threshold of 90%. ART programme in Nigeria requires strengthening.

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.