Incidence and determinants of new AIDS-defining illnesses after HAART initiation in a Senegalese cohort.

BACKGROUND: Although a dramatic decrease in AIDS progression has been observed after Highly Active Anti Retroviral Therapy (HAART) in both low- and high-resource settings, few data support that fact in low-resource settings.This study describes the incidence of AIDS-defining illnesses (ADI) after HAART initiation and analyzes their risk factors in a low-resource setting. A focus was put on CD4 cell counts and viral load measurements. METHODS: 404 HIV-1-infected Senegalese adult patients were enrolled in a prospective observational cohort and data censored as of April 2008. A Poisson regression was used to model the incidence of ADIs over two periods and to assess its association with baseline variables, current CD4, current viral load, CD4 response, and virological response. RESULTS: ADI incidence declined from 20.5 ADIs per 100 person-years, 95% CI = [16.3;25.8] during the first year to 4.3, 95% CI = [2.3;8.1] during the fourth year but increased afterwards. Before 42 months, the decrease was greater in patients with clinical stage CDC-C at baseline and with a viral load remaining below 1000 cp/mL but was uniform across CD4 strata (p = 0.1). After 42 months, 293 patients were still at risk. The current CD4 and viral load were associated with ADI incidence (decrease of 21% per 50 CD4/mm3 and of 61% for patients with a viral load < 1000 cp/mL). CONCLUSIONS: During the first four years, a uniform decline of ADI incidence was observed even in patients with low CD4-cell counts at HAART initiation as long as the viral load remained undetectable. An increase was noted later in patients with immunologic and virological failures but also in patients with only virological failure.

Uptake, retention, and outcomes in a demonstration project of pre-exposure prophylaxis among female sex workers in public health centers in Senegal.

The Senegal pre-exposure prophylaxis (PrEP) Demonstration Project was an open-label cohort study assessing the delivery of daily oral PrEP to HIV-negative female sex workers (FSWs) in four Ministry of Health (MoH)-run clinics in Dakar, Senegal. We assessed uptake, retention in care, and adherence over up to 12 months of follow-up as well as HIV infection rates. Between July and November 2015, 350 individuals were approached and 324 (92.6%) were preliminarily eligible. Uptake was high, with 82.4% of eligible participants choosing to enroll and take PrEP. The mean age of those enrolled was 37.7 years (SD = 8.7), and approximately half had not attended school (41.2%). Among the 267 participants who were prescribed PrEP, 79.9 and 73.4% were retained in PrEP care at 6 and 12 months, respectively. Older age among FSWs was found to be the only significant predictor of lower discontinuation. We did not find significant differences in retention by site, education, condom use, or HIV risk perception. There were no new HIV infections at follow-up. Our results showed evidence of high interest in PrEP and very good PrEP retention rates among FSWs at 12-month follow-up when offered in MoH-run clinics, with older age as the only significant predictor of higher PrEP retention. This highlights the role that these clinics can play in expanding PrEP access nationwide.

Quantification de la Charge Virale et tests de résistance du VIH-1 aux ARV à partir d'échantillons DBS (Dried Blood Spots) chez des patients Guinéens sous traitement antirétroviral.

Quantification of Viral load and resistance tests of HIV-1 to ARVs from dried blood spots samples in Guinean patients undergoing antiretroviral treatment. Problem: As in several countries of the South, the virological monitoring of patients undergoing antiretroviral treatment (ARVT) in Guinea is low or non-existent in some locations. The aim of this study was to assess the technical and logistical feasibility of the use of (dried blood spots) DBSs in viral load (VL) and genotyping tests. Method: From September 2010 to October 2010, DBS were prepared from blood samples of adult patients under ARVT. The samples had to be sent to the reference laboratory within 30 days after the sample had been done at ambient temperature. The VL was quantified and the samples of patients with virological failure (CV ≥ 3 log10 copies/mL) were genotyped according to the ANRS protocol. The Stanford algorithm, version 6.0.8, was used to analyse and interpret the resistance mutations. Results: Amongst the 136 included patients, 129 and 7 were under first and second line treatment respectively, and monitored for an average of 35 months [IQR: 6-108]. Virological failure was noticed among 33 patients. Among them, 84.8% (n = 28/33) benefited from genotyping. The global resistance rate was 14% (n = 19/136). CRF02_AG was the most prevalent viral subtype (82%; n = 23). Conclusion: In addition to demonstrating the technical and logistic feasibility of VL and genotyping tests from DBSs, these results show the relevance of their use in the virological monitoring of patients under ARVT. Also, this study made it possible to provide information on virological failure, ARV resistance and the HIV-1 genetic diversity in Guinea.