Impact of a modified directly administered antiretroviral treatment intervention on virological outcome in HIV-infected patients treated in Burkina Faso and Mali.

OBJECTIVE: This study explores whether viral load measurements can be used in resource-limited settings to target those in need of adherence assistance. It was hypothesized that high plasma viral loads (pVLs) (>/=500 HIV-1 RNA copies/mL) were the result of poor antiretroviral therapy adherence and amenable to improvement with adherence assistance. DESIGN: A single-arm, multicentre pilot study was conducted from November 2003 to March 2004 on 606 treatment-experienced patients who had initiated an antiretroviral regimen in Mali and Burkina Faso >/=6 months before study enrolment. In these patients, those whose pVL was >/=500 copies/mL were offered 1 month of modified directly administered antiretroviral treatment (mDAART) with weekly follow-up visits from pharmacists or adherence counsellors. METHODS: An adherence questionnaire was given to all cohort patients and viral load was used to screen for patients with >/=500 copies/mL. mDAART participants included cohort patients with >/=500 copies/mL, who completed the adherence questionnaire. Genotypic analyses were conducted on samples taken prior to and after the intervention. The intervention was considered effective when there was a decrease of >/=1 log(10) in pVL. RESULTS: mDAART was effective in over one-third of the intervention participants, while in two-thirds no decrease in pVL was observed. The majority of mDAART participants had major resistance mutations. CONCLUSIONS: pVL measurement was useful to identify patients who needed adherence assistance. However, because it was performed >/=6 months after starting treatment, mDAART came too late for most participants, as they had already developed important resistance mutations that might have been avoided with better laboratory monitoring.

Incidence of tuberculosis after HAART initiation in a cohort of HIV-positive patients in Burkina Faso.

OBJECTIVE: To determine the incidence rates of tuberculosis (TB) after the initiation of highly active antiretroviral treatment (HAART). METHODS: We conducted a retrospective cohort study on four human immunodeficiency virus (HIV) treatment centres in Ouagadougou, Burkina Faso. TB incidence was measured at different intervals after HAART initiation. Cox regression models were used to identify factors associated with TB incidence. RESULTS: We analysed a cohort of 2383 subjects with a mean follow-up period of 836 days (standard deviation +/- 443.4). TB incidence rate was highest during the first trimester of HAART; after 3 months of treatment, the total TB case incidence dropped by 60% from 5.77/100 person-years (py) to 2.23/100 py. World Health Organization clinical Stage III or IV, CD4+ T-cell count < 50 cells/microl and body mass index (BMI) < 18.5 were associated with increased risk of TB on univariate analysis. In the Cox regression, BMI < 18.5 and CD4+ T-cell count < 50 cells/microl at HAART initiation were independently associated with a two-fold higher risk of TB. CONCLUSIONS: Delaying HAART initiation until the CD4+ T-cell count drops to <50 cells/microl significantly increases TB incidence in the first 3 months after HAART initiation. Active case finding for TB is an essential element of standard clinical care in HIV-positive patients during the initial period of HAART.

Gender-related factors influencing HIV serostatus disclosure in patients receiving HAART in West Africa.

Disclosure of HIV serostatus remains an important tool for the prevention of new infections and early initiation of treatment for HIV-positive individuals' regular sexual partners. Our aim is to identify factors associated with disclosure to partner in patients taking antiretroviral treatment, with a gender- and sex-based approach. In this study conducted in Mali and Burkina Faso, men (154) and women (164) who reported being in a marital or cohabitating relationship were included. Sex-specific bivariate analyses and multivariate logistic regression were performed to identify determinants of disclosure. Disclosure to partner was 72.1% in men and 79.9% in women. Results of bivariate and multivariate analyses indicated that cohabiting with partner was strongly associated with disclosure in both men and women. In men only, older age, literacy and having good communication with the treating doctor were significantly associated with disclosure. Among women, disclosure was associated with having children and high self-reported importance of religion. Future research and interventions promoting disclosure should take into account these differences reflecting the social construction of gender roles in these settings.

[Aftercare and rehabilitation of HIV patients in Western Africa]. / Nachsorge und Rehabilitation bei HIV-Patienten in Westafrika.

Thanks to the modern therapy protocols, terminal prognosis of Aids disease is no longer certainty. It has now been updated to a chronic disease with good survival rates demanding follow-up and rehabilitative measures. Rehabilitative care in Western Africa is still rare. The care for Aids patients mainly concentrates on psychosocial activities offered by non-governmental Aids associations. The care is mainly outpatient; the objective is to improve the patients' compliance. Compared to western countries, African HIV-infected patients suffer even more from discrimination and are outcast from their family. Hospital-based rehabilitation is being established. Objectives are primarily to improve compliance and, secondly, to restore physical and mental efficiency as well. Favourable patient compliance is considered to be a good prognostic factor resulting in preventing recurrences and expensive therapy.