Epidemiological and Virological Aspects of People Living with HIV-1 on Antiretroviral Therapy in Thierno Birahim NDAO Regional Hospital of Kaffrine, Senegal
Background: Human immunodeficiency virus infection remains a public health challenge, mostly in sub-Saharan Africa. This region accounts for 65% of those infected and contributes to 50% of new infections. WHO advocates for early antiretroviral therapy (ART) initiation for all newly diagnosed individuals. If monitoring viral load (VL) after ART initiation is increasingly common, baseline VL testing is under-utilized in resource-limited settings. This study intends to describe the epidemiological, virological, and therapeutic aspects of people living with HIV on antiretroviral therapy in Kaffrine Regional Hospital. Methods: We performed a retrospective analysis of data from an open cohort of PLWHIV followed at the Thierno Birahim NDAO Regional Hospital of Kaffrine who initiated antiretroviral therapy from 2020 to 2022. For diagnosis, a three-test HIV screening algorithm was used in accordance with the recommendations of the National AIDS Control Council (NACC). HIV RNA was quantified by using GeneXpert？ technology assay. Results: There were 257 PLWHIV included, women were the most representative gender group with 68.5%. The median age was 45 years at the inclusion and 99.6% (n = 256) of patients were infected with HIV-1 and 0.4% (n = 1) with HIV-1 and HIV-2 dually. The majority of people living with HIV (66.5%; n = 171) were diagnosed following medical care for various HIV-related conditions. All patients were on antiretroviral treatment and the most commonly used treatment was the combination Tenofovir + Lamivudine + Dolutegravir (98.44%; n = 253). Majority of people living with HIV (57.2%; n = 147) had an undetectable viral load. Distribution of viral load according to age group showed a significant pattern (p < 0.001), with higher viral loads observed in the 41 - 50 years age group. Among people living with HIV on antiretroviral therapy, 49 patients (19.1%) experienced virological failure. Conclusion: These results suggest the need to make new therapeutic classes available for first-line treatment and to promote actions improving retention in care.
References
[1]
ONUSIDA (2015) Recommandations pour le traitement du VIH. https://www.unaids.org/sites/default/files/media_asset/JC2484_treatment-2015_fr_1.pdf
[2]
UNAIDS (2017) Ending AIDS Progress Towards the 90-90-90 Targets. https://www.unaids.org/sites/default/files/media_asset/Global_AIDS_update_2017_en.pdf
[3]
ONUSIDA (2014) Accélérer la riposte: Mettre fin à l’épidémie de sida d’ici à 2030. https://www.unaids.org/sites/default/files/media_asset/JC2686_WAD2014report_fr.pdf. 2014
[4]
ONUSIDA (2021) Suivi mondial de la lutte contre le Sida. https://www.unaids.org/sites/default/files/media_asset/2021-global-aids-update_fr.pdf
[5]
WHO (2021) HIV/AIDS. https://www.who.int/data/gho/data/themes/hiv-aids
[6]
Ahmed, M., Merga, H. and Jarso, H. (2019) Predictors of Virological Treatment Failure among Adult HIV Patients on First-Line Antiretroviral Therapy in Woldia and Dessie Hospitals, Northeast Ethiopia: A Case-Control Study. BMCInfectiousDiseases, 19, Article No. 305. https://doi.org/10.1186/s12879-019-3924-4
[7]
UNAIDS (2019) Global HIV & AIDS Statistics—2019 Fact Sheet. https://www.unaids.org/en/resources/fact-sheet accessed 26 June 2021
[8]
Agegnehu, C.D., Merid, M.W. and Yenit, M.K. (2020) Incidence and Predictors of Virological Failure among Adult HIV Patients on First-Line Antiretroviral Therapy in Amhara Regional Referral Hospitals; Ethiopia: A Retrospective Follow-Up Study. BMC Infectious Diseases, 20, Article No. 460. https://doi.org/10.1186/s12879-020-05177-2
[9]
Ciaranello, A.L., Chang, Y., Margulis, A.V., Bernstein, A., Bassett, I.V., Losina, E., etal. (2009) Effectiveness of Pediatric Antiretroviral Therapy in Resource-Limited Settings: A Systematic Review and Meta-Analysis. Clinical Infectious Diseases, 49, 1915-1927. https://doi.org/10.1086/648079
[10]
Brhane, B.G., Nibret, E. and Abay, G.K. (2017) HIV/AIDS Treatment Failure and Its Determinant Factors among First Line HAART Patients at Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia. JournalofAIDS&ClinicalResearch, 8, Article 11. https://doi.org/10.4172/2155-6113.1000744
[11]
Bulage, L., Ssewanyana, I., Nankabirwa, V., Nsubuga, F., Kihembo, C., Pande, G., etal. (2017) Factors Associated with Virological Non-Suppression among HIV-Positive Patients on Antiretroviral Therapy in Uganda, August 2014-July 2015. BMC Infectious Diseases, 17, Article No. 326. https://doi.org/10.1186/s12879-017-2428-3
[12]
Conseil National de Lutte Contre le Sida au Sénégal (2022) Plan national stratégique de lutte contre le VIH au Sénégal 2018-2022. https://www.cnls-senegal.org/wp-content/uploads/2018/07/PSN-2018-2022.pdf
[13]
Essomba, N.E., Mbatchou Ngahane, B.H., Nida, M., Temfack, E., Mapoure Njankouo, Y., et al. (2015) Clinical and Immunological Profile of HIV-Infected Patients at the Initiation of Antiretroviral Therapy in Douala. Bulletin de la Societe de PathologieExotique, 108, 255-261.
[14]
Mouhari-Toure, A., Patassi, A., Nabroulaba, K.T., Djadou, K.E., Edou, K., Nyametso, D., et al. (2011) Biological Profile of Adult Patients Infected with HIV at Initiation of Antiretroviral Therapy in Togo. Medical Malpractice and Infection, 41, 229-234.
[15]
Chas, J., Hema, A., Slama, L., Kabore, N.F., Lescure, F., Fontaine, C., et al. (2015) The Day-Hospital of the University Hospital, Bobo Dioulasso: An Example of Optimized HIV Management in Southern Burkina Faso. PLOS ONE, 10, e0125588. https://doi.org/10.1371/journal.pone.0125588
[16]
Oripelaye, M., Umar, A., Olanrewaju, F., Onayemi, O., Olasode, O. and Oninla, O. (2020) Determinants of Discordant Immune Response in a Cohort of Human Immunodeficiency Virus-Infected Patients Initiating Antiretroviral Therapy. Sahel Medical Journal, 23, 22-28. https://doi.org/10.4103/smj.smj_1_19
[17]
Gemechu, A., Mihret, A., Atire, F.A., Aseffa, A., Howe, R., Seyoum, B., et al. (2023) Virological Non-Suppression among Newly Diagnosed HIV-Positive Individuals on Dolutegravir-Based Antiretroviral Treatment in Eastern Ethiopia: Follow-Up Study. Tropical Medicine and Infectious Disease, 8, Article 391. https://doi.org/10.3390/tropicalmed8080391
[18]
UNAIDS (2024) Global Data on HIV Epidemiology and Response. https://crossroads.unaids.org/wp-content/uploads/2024/09/UNAIDS-GLOBAL-REPORT-EXECUTIVE-SUMMARY-French.pdf
[19]
Kharsany, A.B.M. and Karim, Q.A. (2016) HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities. The Open AIDS Journal, 10, 34-48. https://doi.org/10.2174/1874613601610010034
[20]
Dunkle, K.L. and Decker, M.R. (2012) Gender-Based Violence and hiv: Reviewing the Evidence for Links and Causal Pathways in the General Population and High-Risk Groups. American Journal of Reproductive Immunology, 69, 20-26. https://doi.org/10.1111/aji.12039
[21]
Balestre, E., Lokossoue, A., Eholié, S.P., Dabis, F., Ekouevi, D.K. and Thiébaut, R. (2010) Comparaison de deux méthodes classiques d’analyse de la réponse immunologique des patients adultes infectés par le VIH, traités par thérapie antirétrovirale (TAR) et suivis dans une cohorte internationale en Afrique de l’Ouest. Revue d’Épidémiologie et de Santé Publique, 58, S96. https://doi.org/10.1016/j.respe.2010.06.155
[22]
Ayelola, K. and Balogou, A. (2016) Prévalence de l’infection à VIH chez les patients victimes d’accident vasculaire cérébral au CHU Campus de Lomé. RevueNeurologique, 172, A65. https://doi.org/10.1016/j.neurol.2016.01.153
[23]
Maguette, S.N., Rena, D., Babacar, M., et al. (2017) Profiles of Peripheral CD4+T Cells Count during Antiretroviral Treatment in Senegalese Adults Infected by HIV: Impact of Therapeutic Associations. Journal of Immunology and Infectious Diseases, 2, 2-10.
[24]
Deguenonvo, L.F., Manga, N.M., Diop, S.A., et al. (2011) Current Profile of HIV-Infected Patients Hospitalized in Dakar (Senegal). Bulletin de la Societe de PathologieExotique, 10, 366-370.
[25]
Abrogoua, D.P., Aulagner, G., Kablan, B.J. and Petit, C. (2010) Study of Meta-Trajectories of CD4 Cells Count from Taxonomy in the Antiretroviral Response of Efavirenz-Based Regimen with Naive Symptomatic Patients in Abidjan. Annales PharmaceutiquesFrancaises, 69, 7-21.
[26]
Lewden, C., Chêne, G., Morlat, P., Raffi, F., Dupon, M., Dellamonica, P., et al. (2007) HIV-Infected Adults with a CD4 Cell Count Greater than 500 Cells/mm3 on Long-Term Combination Antiretroviral Therapy Reach Same Mortality Rates as the General Population. Journal of Acquired Immune Deficiency Syndromes, 46, 72-77. https://doi.org/10.1097/qai.0b013e318134257a
[27]
Marlink, R. (1996) Lessons from the Second AIDS Virus, HIV-2. AIDS, 10, 689-700. https://doi.org/10.1097/00002030-199606001-00002
[28]
WHO (2018) Updated Recommendations on First-Line and Second-Line Antiretroviral Regimens and Post-Exposure Prophylaxis and Recommendations on Early Infant Diagnosis of HIV: Interim Guidance. https://www.who.int/publications/i/item/WHO-CDS-HIV-18.51
[29]
NAMSAL ANRS 12313 Study Group, Kouanfack, C., Mpoudi-Etame, M., Omgba Bassega, P., Eymard-Duvernay, S., Leroy, S., et al. (2019) Dolutegravir-Based or Low-Dose Efavirenz-Based Regimen for the Treatment of HIV-1. NewEnglandJournalofMedicine, 381, 816-826. https://doi.org/10.1056/nejmoa1904340
[30]
Abstract Supplement Oral Abstracts from the 23rd International AIDS Conference, 6-10 July 2020 (2020). Journal of the International AIDS Society, 23, e25547.
[31]
Gebremedhin, T., Aynalem, M., Adem, M., Geremew, D., Aleka, Y. and Kiflie, A. (2024) Dolutegravir Based Therapy Showed CD4+ T Cell Count Recovery and Viral Load Suppression among ART Naïve People Living with HIV AIDS: A Pilot Evaluation. Scientific Reports, 14, Article No. 3297. https://doi.org/10.1038/s41598-024-53282-y
[32]
Addo, M.M. and Altfeld, M. (2014) Sex-Based Differences in HIV Type 1 Pathogenesis. Journal of Infectious Diseases, 209, S86-S92. https://doi.org/10.1093/infdis/jiu175
[33]
Ziegler, S. and Altfeld, M. (2016) Sex Differences in Hiv-1-Mediated Immunopathology. Current Opinion in HIV and AIDS, 11, 209-215. https://doi.org/10.1097/coh.0000000000000237
[34]
Farzadegan, H., Hoover, D.R., Astemborski, J., Lyles, C.M., Margolick, J.B., Markham, R.B., et al. (1998) Sex Differences in HIV-1 Viral Load and Progression to Aids. The Lancet, 352, 1510-1514. https://doi.org/10.1016/s0140-6736(98)02372-1
[35]
Meier, A., Chang, J.J., Chan, E.S., Pollard, R.B., Sidhu, H.K., Kulkarni, S., et al. (2009) Sex Differences in the Toll-Like Receptor-Mediated Response of Plasmacytoid Dendritic Cells to HIV-1. Nature Medicine, 15, 955-959. https://doi.org/10.1038/nm.2004
[36]
Boender, T.S., Sigaloff, K.C.E., McMahon, J.H., Kiertiburanakul, S., Jordan, M.R., Barcarolo, J., et al. (2015) Long-Term Virological Outcomes of First-Line Antiretroviral Therapy for HIV-1 in Low-and Middle-Income Countries: A Systematic Review and Meta-Analysis. Clinical Infectious Diseases, 61, 1453-1461. https://doi.org/10.1093/cid/civ556
[37]
Ba, S., Ba, N.D., Sembene, L., Anne, T.S.B., Dia, H., Ndiaye, J.L., et al. (2020) Factors Associated with Adverse Therapeutic Outcomes in People Living with HIV (PLHIV) Monitored in Roi Baudouin Health Care Center, Dakar, Senegal. World Journal of AIDS, 10, 23-35. https://doi.org/10.4236/wja.2020.101003
[38]
Konou, A.A., Dagnra, A.Y., Vidal, N., Salou, M., Adam, Z., Singo-Tokofai, A., et al. (2015) Alarming Rates of Virological Failure and Drug Resistance in Patients on Long-Term Antiretroviral Treatment in Routine HIV Clinics in Togo. AIDS, 29, 2527-2530. https://doi.org/10.1097/qad.0000000000000906
[39]
Penot, P., Héma, A., Bado, G., Kaboré, F., Soré, I., Sombié, D., et al. (2014) The Vulnerability of Men to Virologic Failure during Antiretroviral Therapy in a Public Routine Clinic in Burkina Faso. Journal of the International AIDS Society, 17, Article 18646. https://doi.org/10.7448/ias.17.1.18646
