<strong>Introduction</strong> In Central-African Republic, according to UNAIDS in 2019, out of approximately 100,000 people living with HIV, 70% (72,000) knew their HIV status and 47,000 (46%) were on ARV ...<strong>Introduction</strong> In Central-African Republic, according to UNAIDS in 2019, out of approximately 100,000 people living with HIV, 70% (72,000) knew their HIV status and 47,000 (46%) were on ARV therapy;however, there is a paucity of data on viral load suppression in people on ARV therapy. The objective of this study was to assess the third 90 of the UNAIDS strategy for the years 2019 and 2020 in the CAR. <strong>Methods</strong> We analyzed the available viral load data extracted from the data base of the medical analysis laboratory (SYSLAM) of the Institut Pasteur of Bangui for the years 2019 and 2020. The viral loads were determined based on plasma collected in an EDTA tube with Cepheid’s GeneXpert<sup><span style="white-space:nowrap;">®</span></sup> 16-module controllers. Viral load data were extracted from SYSLAM, converted to Excel format, and analyzed with STATA version 14 software. The significance threshold for the statistical tests was set at 5%. <strong>Results</strong> This study included 22,895 patients, of who 72% were female. The average age was 40.82 years, and the majority of the patients (80%) came from the city of Bangui. Regarding the virological parameters associated with this study, 66% of the patients had significant viral load suppression according to the WHO recommendations and 34% were in virological failure. Patients over 50 years of age (71.85%) and age group 40 - 49 years (69.25%) recorded significant levels of viral load suppression. On the other hand, 63.45% of patients under 18 years of age had virological failure. All of these results were statistically significant (p < 0.005). <strong>Conclusion</strong> There should be a concerted effort, to make viral load accessible and available to all patients receiving ARV treatment in the CAR and the management of HIV/AIDS infection of children and adolescents should be given special attention.展开更多
Background:Over 90%of Human Immunodeficiency Virus(HIV)infected individuals will be on treatment by 2020under UNAIDS 90-90-90 global targets.Under World Health Organisation(WHO)"Treat All"approach,this numbe...Background:Over 90%of Human Immunodeficiency Virus(HIV)infected individuals will be on treatment by 2020under UNAIDS 90-90-90 global targets.Under World Health Organisation(WHO)"Treat All"approach,this number will be approximately 36.4 million people with over 98%in low-income countries(LICs).Main body:Pretreatment drug resistance(PDR)largely driven by frequently use of non-nucleoside reverse transcriptase inhibitors(NNRTIs),efavirenz and nevirapine,has been increasing with roll-out of combined antiretroviral therapy(cART)with 29%annual increase in some LICs countries.PDR has exceeded 10%in most LICs which warrants change of first line regimen to more robust classes under WHO recommendations.If no change in regimens is enforced in LICs,it’s estimated that over 16%of total deaths,9%of new infections,and 8%of total cART costs will be contributed by HIV drug resistance by 2030.Less than optimal adherence,and adverse side effects associated with currently available drug regimens,all pose a great threat to achievement of 90%viral suppression and elimination of AIDS as a public health threat by 2030.This calls for urgent introduction of policies that advocate for voluntary and compulsory drug licensing of new more potent drugs which should also emphasize universal access of these drugs to all individuals worldwide.Conclusions:The achievement of United Nations Programme on HIV and AIDS 2020 and 2030 targets in LICs depends on access to active cART with higher genetic barrier to drug resistance,better safety,and tolerability profiles.It’s also imperative to strengthen quality service delivery in terms of retention of patients to treatment,support for adherence to cART,patient follow up and adequate drug stocks to help achieve a free AIDS generation.展开更多
Background:Recent studies have shown that early antiretroviral therapy(ART)initiation results in significant HIV transmission reduction.This is the rationale behind the“test and treat”policy of the World Health Orga...Background:Recent studies have shown that early antiretroviral therapy(ART)initiation results in significant HIV transmission reduction.This is the rationale behind the“test and treat”policy of the World Health Organization(WHO).Implementation of this policy will lead to an increased incidence of ART-related adverse effects,especially in sub-Saharan Africa(SSA).Is the region yet ready to cope with such a challenging issue?Main body:The introduction and widespread use of ART have drastically changed the natural history of HIV/AIDS,but exposure to ART leads to serious medication-related adverse effects mainly explained by mitochondrial toxicities,and the situation will get worse in the near future.Indeed,ART is associated with an increased risk of developing cardiovascular disease,lipodystrophy,prediabetes and overt diabetes,insulin resistance and hyperlactatemia/lactic acidosis.The prevalence of these disorders is already high in SSA,and the situation will be exacerbated by the implementation of the new WHO recommendations.Most SSA countries are characterized by(extreme)poverty,very weak health systems,inadequate and low quality of health services,inaccessibility to existing health facilities,lack of(qualified)health personnel,lack of adequate equipment,inaccessibility and unaffordability of medicines,and heavy workload in a context of a double burden of disease.Additionally,there is dearth of data on the incidence and predictive factors of ART-related adverse effects in SSA,to anticipate on strategies that should be put in place to prevent the occurrence of these conditions or properly estimate the upcoming burden and prepare an adequate response plan.These are required if we are to anticipate and effectively prevent this upcoming burden.Conclusion:While SSA would be the first region to experience the huge benefits of implementing the“test and treat”policy of the WHO,the region is not yet prepared to manage the consequential increased burden of ART-related toxic and metabolic complications.Urgent measures should be taken to fill the lacunae if SSA is not to become over-burdened by the consequences of the“test and treat”policy.展开更多
文摘<strong>Introduction</strong> In Central-African Republic, according to UNAIDS in 2019, out of approximately 100,000 people living with HIV, 70% (72,000) knew their HIV status and 47,000 (46%) were on ARV therapy;however, there is a paucity of data on viral load suppression in people on ARV therapy. The objective of this study was to assess the third 90 of the UNAIDS strategy for the years 2019 and 2020 in the CAR. <strong>Methods</strong> We analyzed the available viral load data extracted from the data base of the medical analysis laboratory (SYSLAM) of the Institut Pasteur of Bangui for the years 2019 and 2020. The viral loads were determined based on plasma collected in an EDTA tube with Cepheid’s GeneXpert<sup><span style="white-space:nowrap;">®</span></sup> 16-module controllers. Viral load data were extracted from SYSLAM, converted to Excel format, and analyzed with STATA version 14 software. The significance threshold for the statistical tests was set at 5%. <strong>Results</strong> This study included 22,895 patients, of who 72% were female. The average age was 40.82 years, and the majority of the patients (80%) came from the city of Bangui. Regarding the virological parameters associated with this study, 66% of the patients had significant viral load suppression according to the WHO recommendations and 34% were in virological failure. Patients over 50 years of age (71.85%) and age group 40 - 49 years (69.25%) recorded significant levels of viral load suppression. On the other hand, 63.45% of patients under 18 years of age had virological failure. All of these results were statistically significant (p < 0.005). <strong>Conclusion</strong> There should be a concerted effort, to make viral load accessible and available to all patients receiving ARV treatment in the CAR and the management of HIV/AIDS infection of children and adolescents should be given special attention.
文摘Background:Over 90%of Human Immunodeficiency Virus(HIV)infected individuals will be on treatment by 2020under UNAIDS 90-90-90 global targets.Under World Health Organisation(WHO)"Treat All"approach,this number will be approximately 36.4 million people with over 98%in low-income countries(LICs).Main body:Pretreatment drug resistance(PDR)largely driven by frequently use of non-nucleoside reverse transcriptase inhibitors(NNRTIs),efavirenz and nevirapine,has been increasing with roll-out of combined antiretroviral therapy(cART)with 29%annual increase in some LICs countries.PDR has exceeded 10%in most LICs which warrants change of first line regimen to more robust classes under WHO recommendations.If no change in regimens is enforced in LICs,it’s estimated that over 16%of total deaths,9%of new infections,and 8%of total cART costs will be contributed by HIV drug resistance by 2030.Less than optimal adherence,and adverse side effects associated with currently available drug regimens,all pose a great threat to achievement of 90%viral suppression and elimination of AIDS as a public health threat by 2030.This calls for urgent introduction of policies that advocate for voluntary and compulsory drug licensing of new more potent drugs which should also emphasize universal access of these drugs to all individuals worldwide.Conclusions:The achievement of United Nations Programme on HIV and AIDS 2020 and 2030 targets in LICs depends on access to active cART with higher genetic barrier to drug resistance,better safety,and tolerability profiles.It’s also imperative to strengthen quality service delivery in terms of retention of patients to treatment,support for adherence to cART,patient follow up and adequate drug stocks to help achieve a free AIDS generation.
文摘Background:Recent studies have shown that early antiretroviral therapy(ART)initiation results in significant HIV transmission reduction.This is the rationale behind the“test and treat”policy of the World Health Organization(WHO).Implementation of this policy will lead to an increased incidence of ART-related adverse effects,especially in sub-Saharan Africa(SSA).Is the region yet ready to cope with such a challenging issue?Main body:The introduction and widespread use of ART have drastically changed the natural history of HIV/AIDS,but exposure to ART leads to serious medication-related adverse effects mainly explained by mitochondrial toxicities,and the situation will get worse in the near future.Indeed,ART is associated with an increased risk of developing cardiovascular disease,lipodystrophy,prediabetes and overt diabetes,insulin resistance and hyperlactatemia/lactic acidosis.The prevalence of these disorders is already high in SSA,and the situation will be exacerbated by the implementation of the new WHO recommendations.Most SSA countries are characterized by(extreme)poverty,very weak health systems,inadequate and low quality of health services,inaccessibility to existing health facilities,lack of(qualified)health personnel,lack of adequate equipment,inaccessibility and unaffordability of medicines,and heavy workload in a context of a double burden of disease.Additionally,there is dearth of data on the incidence and predictive factors of ART-related adverse effects in SSA,to anticipate on strategies that should be put in place to prevent the occurrence of these conditions or properly estimate the upcoming burden and prepare an adequate response plan.These are required if we are to anticipate and effectively prevent this upcoming burden.Conclusion:While SSA would be the first region to experience the huge benefits of implementing the“test and treat”policy of the WHO,the region is not yet prepared to manage the consequential increased burden of ART-related toxic and metabolic complications.Urgent measures should be taken to fill the lacunae if SSA is not to become over-burdened by the consequences of the“test and treat”policy.
