Virological Profile of People Living with HIV after 12 Months of Treatment with Dolutegravir in Kinshasa

Context: The evaluation of plasma Viral Load constitutes an indicator of the progression of the infection, the effectiveness and the tolerance of the treatment. Objective: The objective of this study is to present the virological profile of Patients Living with HIV (PLHIV) after 12 months of AntiRetro Viral Treatment (ART) based on Dolutegravir (DTG) in Kinshasa. Method: The present study is a cross-sectional view of the virological profile of the twelfth month of a prospective cohort of PLHIV at M12 of DTG-based ART in Kinshasa. During the M12 appointment, a blood sample was taken for Molecular Biology analyses from all PLHIV included. Result: During the M12 appointment, 28 patients were registered, including 16 (57.1%) women. Nine (9) patients (45.0%) had an undetectable Viral Load (VL). The median VL value was 3.18 log10 RNA copies/mL (1530 RNA copies/mL). The mutations K65R, T69P/N, K70R and M184V have been listed as mutations conferring resistance to Nucleotide Reverse Transcriptase Inhibitors. No mutations associated with Dolutegravir were observed at M12. Conclusion: After 12 months of AntiRetroViral Treatment based on Dolutegravir, half of the Patients on first-line ART are in a state of virological failure.

Profile of People Living with HIV after 24 Weeks of Treatment with Dolutegravir in Kinshasa

Introduction: The sixth month appointment (M6) is crucial because at the start of the ART course, it is an indicator of the prognosis of the evolution of care and decision-making on the continuity of treatment. Objective: The objective of this study is therefore to present the profile of People Living with HIV under treatment with Dolutegravir 6 months after starting ART in Kinshasa. Methods: The present study is a cross-sectional view at M6 of a prospective cohort to determine the profile of People Living with HIV (PLHIV) after 6 months of ARV Treatment (ART) in Kinshasa, DRC. During the M6 appointment, from April to August 2022, a sample of 5 ml of blood was taken for the various analyzes from all HIV patients included. The collection of sociodemographic data as well as biological and clinical data was carried out under the same conditions as at inclusion. The parameters recorded during M6 were: age, sex, and religion, level of study, marital status, profession, socio-economic level, height, weight, Body Mass Index (BMI), clinical profile, opportunistic infections as well as biochemical and molecular assessment. Results: In M6, 62 patients were registered including 38 women (61.3%), thus giving a sex ratio of 1.58 in favor of women. Fifty-seven (57) patients did not respond to the appointment, representing a loss rate of 47.89%. The most common age group is between 36 and 45 years old with 16 patients (26.7%). The mean age was 42.4 ± 13.3 years. The mean weight was 60.5 ± 15.4 kg with a mean BMI of 22.6 ± 5.8 kg/m2. Thirty-four (34) patients (61.82%) were in Clinical Stage 3. Thirty-six (36) patients (67.92%) had a normal clinical condition. The most common opportunistic infections among patients in M6 were: skin pruritus (25.8%), dermatitis (22.6%) and rash (21%). The mean values of biochemical parameters of patients in M6 were within normal ranges. The median VL value was 2.92 log10 RNA copies/ml with 17.75% of patients experiencing major failure of first-line treatment. Subtype A is dominant with 13 cases (20.98%);followed by CRF02_AG (16.13%) and C subtypes (14.52%). The mutations K65R (3 cases), T69P/N (6 cases), K70R (9 cases) and M184V (8 cases) were listed in M6. Conclusion: After 6 months of treatment, the majority of patients are in clinical stage 3 with a normal clinical state. Skin infections are the majority opportunistic infections. Certain biological parameters are considerably altered. A high virological failure rate with the presence of certain mutations associated with resistance to Lamivudine and Tenofovir.

Neurocognitive Profile of People Living with Human Immunodeficiency Virus Initiating Treatment in Kinshasa in the Dolutegravir Era, Democratic Republic of Congo

Context: Antiretroviral therapies improve the prognosis of NeuroAIDS contrasting with a high frequency of Minor Neurocognitive Disorders (MND) even in aviremic subjects. Objective: The objective of this study is to present the neurological and cognitive profile of People Living with HIV (PLHIV) initiating antiretroviral treatment in Kinshasa in the era of Dolutegravir (DTG). Methods: This is a multicenter, cross-sectional study with a descriptive aim carried out in 16 HIV Outpatient Treatment Centers (OTC) in Kinshasa from October 4, 2021 to February 15, 2022. The International HIV Dementia Scale (IHDS) correlated with the Activities of Daily Living (IADL) scale facilitated the categorization of NeuroCognitive Disorders (NCD) of PLHIV evaluated after carrying out a summary neurological examination. Results: Of the 96 patients recruited, 56.3% were women with a sex ratio of 0.68. The average age was 40.1 ± 12.1 years. The secondary education level was the majority at 64.6%. Malaria (44.8%) and tuberculosis (32.3%) were more common as opportunistic infections. They were alcoholics in (30.2%). Their history was heart disease (15.6%), high blood pressure (18.8%);drug abuse (10.4%). The IHDS score was light in 55.2% of cases. The correlation between IHDS/IADL watches asymptomatic neurocognitive impairments (ANI) in 77.1%, almost all of subjects are found with normal overall functioning (94.8%) and a disturbed neurological examination in 53.1% of cases with a predominance of motor impairments in 79.1%. Conclusion: In view of these results, early and systematic screening of NCD and associated factors remains necessary in our context. .

Virological and Molecular Profile of People Living with the Human Immunodeficiency Virus Starting Dolutegravir Based Antiretroviral Treatment in Kinshasa, Democratic Republic of Congo

Context: Despite the new recommendations “Test and Treat”, the virological and molecular parameters remain important information for Antiretroviral Treatment and adequate for monitoring of patients infected with HIV/AIDS. Objective: the Objective of this study is to present the virological and molecular profile of People Living with HIV starting Antiretroviral Therapy in Kinshasa in the era of the Dolutegravir. Methods: This was a transversal study to determine virological and molecular profile of People Living with HIV (PLHIV) starting an ARV Treatment. The patient’s inclusion period was from October 04, 2021 to February 15, 2022. A sample of 5 ml of blood was taken in a tube with EDTA anticoagulant for Molecular Biology analyzes (Viral Load and Sequencing) in all HIV patients, after reading and signing informed consent. The population was made up of adult patients over the age of 18, infected with HIV and starting ART. Results: 119 patients (56.3% of women) were included in this study, thus a sex-ratio of 1.29. The average age of patients included was 39.87 ± 12.36 years. The most represented age group is that of 36 to 45 with 37 patients (31.9%) followed by that from 26 to 35 years with 24 patients (20.7%). Out of 119 patients, 21 patients had an undetectable Viral Load (VL). The median value of VL was 4.16 log10 RNA copies/ml. 114 samples were successfully amplified. Subtype A was dominant with 23 cases (20.2%);followed by the subtype C and CRF02_AG each with 14.0%, and D (10.5 %). K65R (1.8%), T69P/N (4.4%), K70R (7.9%) and M184V (7.0%) mutations were listed as existing mutations for Nucleotide Transcriptase Inhibitors. Conclusion: 38 patients (31.93%) started the TARV with a positive virological prognosis. The subtype A remains dominant in Kinshasa with 23 cases (20.2%);followed by the subtype C and CRF02_AG each with 14.0%. For Inhibitors of Transcriptase Reverse Nucleotide;K65R, T69P/N, K70E/R and M184V mutations were found in patients’ naive of ARV Treatment.

Biological Profile of People Living with Human Immunodeficiency Virus Starting Treatment in Kinshasa, Democratic Republic of the Congo

Context: The biochemical assessment is a real-time indicator of the state and evolution of an infection. Among other things, it makes it possible to determine the right moment when it becomes necessary to start or change a treatment. Objective: The objective of this study is to present the Biological profile of People Living with HIV starting AntiRetroViral treatment in Kinshasa in the era of Dolutegravir. Methods: The present study is a descriptive cross-sectional to determine the biological profile of People Living with HIV (PLHIV) starting AntiRetroViral Treatment (ART). The patient inclusion period was from October 4, 2021 to February 15, 2022. Sixteen centers were included. A sample of 5 ml of blood was taken in a tube with EDTA. Patients were randomly included consecutively in the centers during consultations. The population was made up of adults aged over 18, infected with HIV and starting ART. The parameters of interest retained for the present study were: sex, age, hemoglobin level, blood sugar, urea, creatinine, transaminases, total cholesterol, triglycerides, proteins total, as well as amylase. Results: 119 patients were included in this study in accordance with the inclusion criteria;67 (56.3%) are female, giving a sex ratio of 1.29 in favor of women. The average age of the patients is 39.87 ± 12.36 years. The most represented age group is that of 36 to 45 years with 37 patients (31.9%). The mean values of the biological parameters of the patients at the start of ART are as follows: 31.61 ± 20.71 IU/L for ALT/SGPT, 25.81 ± 19.96 IU/L for AST/SGOT, 79.35 ± 49.49 IU/L for Amylase, 108.13 ± 62.17 mg/dl for Total Cholesterol, 2.77 ± 1.27 mg/dl for Creatinine, 72.53 ±22.23 mg/dl for Glycaemia, 10.30 ± 2.33 g/dl for Hemoglobin, 7.91 ± 1.75 g/dl for Total Protein, 131.23 ± 68.80 mg/dl for Triglycerides, and 33.61 ± 26.27 mg/dl for Urea. Conclusion: Mean values of PLHIV are, for the most part, within the normal range. The average creatinine is higher than the normal average value while the average total cholesterol is below the limit values.

Blood Safety in the Democratic Republic of the Congo: Literature Review

Background: The Democratic Republic of the Congo (DRC) faces severe malaria, postpartum haemorrhage, malnutrition and sickle cell disease that require transfusion. The latter poses immunological, infectious, metabolic and hemodynamic risks to recipients. Objective: To present transfusion safety in the DRC through data from the literature. Methods: This review consists of listing the various articles and abstracts published online and presented in scientific conferences having as a subject of interest transfusion safety in the DRC. Results: The review is dominated by articles from eastern DRC and blood mobilization is around 0.5% of the general population. All screening tests are serological with a proven residual risk. The prevalence of HIV, HBV, HCV and syphilis infections is documented at more than 80% and represents respectively 1.9%, 2.96%, 1.89% and 1.21%. The prevalence of other pathogens, the immunological and haemodynamic risk are very poorly documented (12.5% to 25%). The prevalence of Parvovirus B19 infection is 5.3% and that of bacterial contamination at 1.4%, that of malaria infestations between 0.3% and 28.3%, that of trypanosomiasis at 1.3%, that of babebiosis at 0.17% in blood donors. Allo-immunization represents 47.8%, adverse reactions 3.4%, iron deficiency 63.2, iron deficiency anemia 25.9% and anemia 36.5%. Pediatrics is the biggest user of this blood. Conclusion: The prevalence of HIV, HBV, HCV and Syphilis infections is within the range of sub-Saharan African countries. The serological test is systematic and involves the residual risk, it is necessary to introduce the molecular tests. The prevalence of other pathogens (emerging viruses, bacteria and hemoparasites), the immunological and metabolic risk is poorly documented. The search for these pathogens, irregular antibodies and the determination of ferritin in blood donations is not systematic.

Evaluation of Rational Use of Antiretrovirals before the Dolutegravir Transition in Kinshasa, Democratic Republic of Congo

Background: The ultimate goal of AntiRetroViral Treatments (ART) is to achieve complete immune restoration and lasting viral suppression in the infected patient. In order to ensure the efficacy, safety and accessibility of antiretroviral drugs (ARVs), it is recommended that they should be prescribed according to national guidelines;which are evolving with the various recommendations of the World Health Organization (WHO) and the arrival of newer, more effective and safer molecules. Objective: The objective of this study was to assess the rational use of Antiretrovirals in patients treated in Kinshasa before the use of Dolutegravir within the national program in order to assess the correct use of these molecules. Methods: This work is a descriptive cross-sectional study to assess the rational use of first-line ARVs among People Living with HIV (PLHIV) in different Centers of Treatment (ATCs) in Kinshasa before the introduction of Dolutegravir. The records of patients on ARVs were randomly and rationally selected in 12 different ATCs for HIV in Kinshasa according to three centers per district in the period from June to September 2018. Information on use and consumption of ARVs, compliance with guidelines, change of therapeutic combination as well as their reasons were consulted for the present study. Results: 507 files of PLHIV were collected in the various ATCs. 274 (54.1%) were from female patients. The most represented age group was 26 to 35 years with 192 patients (37.9%). The mean duration of first-line treatment for all patients included was 16.30 ± 5.85 months. The most widely used combination of ARVs overall was TDF + 3TC + EFV at 45.4%. 305 (60.2%) PLHIV kept the same first-line treatment molecule throughout the treatment period with an average treatment duration of 12.9 ± 2.77 months. The most common combination found in this population was TDF + 3TC + EFV (69.2%). 202 (39.8%) PLHIV changed treatment molecule yet respecting the first-line combinations. The average duration of treatment for those who changed molecules was 21.43 ± 7.25 months. Before the change, 112 (55.5%) of these patients were using the ZDV + 3TC + EFV combination. After switching, 105 (52%) of the patients used the TDF + 3TC + NVP combination. The first reason for changing molecules was its unavailability (53.3%) in the ATCs. Conclusion: Although some banned molecules are still available in some treatment centers, the guidelines on first-line treatments are respected in different centers in Kinshasa.