ABSTRACT
BACKGROUND: Non-communicable diseases (NCDs) represent the leading causes of death worldwide. HIV also increases the risk of developing NCDs including diabetes mellitus and hypertension. METHODS: A cross-sectional study, based on an analysis of the cohort database of the day hospital of the Souro Sanou teaching hospital in Bobo-Dioulasso (Burkina Faso). Diabetes mellitus was defined by the undergoing of anti-diabetic treatment or two successive measurements of fasting blood sugar above 7mmol/l and high blood pressure by the undergoing of antihypertensive treatment or two successive measurements of blood pressure above 140/90mmHg. Comparison of the frequency of diabetes and hypertension in the people living with HIV/AIDS (PLWHA) population on antiretroviral therapy (ART) with that of the general population of Burkina Faso was made by indirect standardization according to age and gender. RESULTS: A total of 4259 patients including 3148 women (73.9%) were included in this study. The median age of the patients was 45 years (IQR: 38-52); the median body mass index (BMI) was 19.6kg/m2 (IQR: 15.4 - 22.7) and 48.3% of patients had a BMI≥25kg/m2. The median CD4 count was 590 cells/mm3 (IQR: 417-785). The median ART duration was 8.2 years (IQR: 4.7-11.2). The majority of patients (82.9%) were on treatment combinations consisting in 2 INTI+1 NNRTI. Prevalence of hypertension was 39.8%; it was statistically higher in men than in women (45.8% versus 37.8%). Prevalence of hypertension was 87.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population. Prevalence of diabetes mellitus was 7.3%. Diabetes mellitus was more common in men than in women (10.1% versus 6.3%; P<10-3). Prevalence of diabetes mellitus was 36.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population. CONCLUSION: Prevalence of diabetes mellitus and hypertension was higher among PLHWA undergoing ART than in the general population. Care for the PLHWA population should more widely include NCD treatment.
Subject(s)
Diabetes Mellitus , HIV Infections , Hypertension , Adult , Burkina Faso/epidemiology , Cross-Sectional Studies , Diabetes Mellitus/epidemiology , Female , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Hospitals, University , Humans , Hypertension/epidemiology , Male , Middle AgedABSTRACT
BACKGROUND: We aimed to describe changes in hepatitis B screening practices over a 3-year period among HIV-infected patients in West Africa. METHODS: A medical chart review was conducted in urban HIV treatment centers in Ivory Coast (3 sites), Benin, Burkina Faso, Senegal, and Togo (1 site each). Among patients who started antiretroviral treatment between 2010 and 2012, 100 per year were randomly selected from each clinic. Demographic, clinical, and laboratory data was collected using a standardized questionnaire. We assessed changes in the proportion of patients screened over time and identified predictors of screening in a multivariable logistic regression. RESULTS: A total of 2097 patients were included (median age: 37 years, 65.4% of women). Overall, 313 (14.9%) patients had been screened for hepatitis B, with an increase from 10.6% in 2010 to 18.9% in 2012 (P<0.001) and substantial differences across countries. In multivariable analysis, being aged over 45 years (adjusted odds ratio: 1.34 [1.01-1.77]) and having an income-generating activity (adjusted odds ratio: 1.82 [1.09-3.03]) were associated with screening for hepatitis B infection. Overall, 62 HIV-infected patients (19.8%, 95% confidence interval: 15.5-24.7) were HBsAg-positive and 82.3% of them received a tenofovir-containing drug regimen. CONCLUSION: Hepatitis B screening among HIV-infected patients was low between 2010 and 2012. The increasing availability of HBsAg rapid tests and tenofovir in first-line antiretroviral regimen should improve the rates of hepatitis B screening.
Subject(s)
HIV Infections/complications , Hepatitis B/diagnosis , Mass Screening/trends , Adult , Africa, Western/epidemiology , Alanine Transaminase/blood , Anti-Retroviral Agents/administration & dosage , CD4 Lymphocyte Count , Female , HIV Infections/drug therapy , HIV-1/isolation & purification , HIV-2/isolation & purification , Hepatitis B/complications , Hepatitis B/epidemiology , Hepatitis B Surface Antigens/blood , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Factors , Surveys and QuestionnairesABSTRACT
OBJECTIVE: describe the sociodemographic, clinical, therapeutic, biological profile and the observance of treatment in cases of immuno-virologic dissociation response (IVDR) in HIV-1 patients at te 12 months of antiretroviral treatment (ARVT). METHODS: This was a historical cohort study with a descriptive and analytical focus from January 2008 to December 2012; covering the IVDR cases at the day hospital of Bobo Dioulasso. We collected the data during medical consultations by means of the ESOPE software and from medical records of the patients. RESULTS: Of 2078 patients on ARVT, 84 or 4% presented one IVDR, among which 56 women (66.7%) and 28 men (33.3%). The average age was 45 years [range: 45-55 years]. At the initiation of ARVT, most patients were in clinical stage 3 or 4 of the WHO classification (57.1%). The body mass index (BMI) average was 20.5kg/m2 [IQR = 18.5 and 23]. The average number of +CD4 T lymphocyte was 42 cells/mm3 [IQR = 12- 63]. During follow-up, the median gain in BMI was 3.2 kg/m2 [IQR = 1.2 to 4.3 kg/m2], the median gain was 76 cells/µl [IQR = 60 - 88]. The viral plasmatic load of the HIV-1 was undetectable with a rate of TCD4+ < 100 cells /µl in 12 months. Factors associated with IVDR were the age between 35 and 45 years (p = 0.0009), the number of +CD4 T cells (+CD4T≤50) at initiation of ARVT (p = 0.00045 ) and the WHO classification clinical stage 3. CONCLUSION: This study demonstrates the problem of IVDR management in Bobo-Dioulasso and reminds of the interest of care follow-up of people living with HIV-1 by viral load and not only by the rate of CD4+ T especially in the decentralized structures of coverage of HIV, where changes of therapeutic mechanisms operate disjointedly.
OBJECTIF: décrire le profil sociodémographique, clinique, thérapeutique, biologique et l'observance du traitement des cas de réponse immuno-virologique dissociée (DIV) chez les patients VIH-1 à 12 mois de traitement antirétroviral (ARV). MÉTHODES: Il s'agissait d'une étude de cohorte historique à visée descriptive et analytique de janvier 2008 à décembre 2012, portant sur les DIV suivis à l'hôpital de jour (HDJ) de Bobo- Dioulasso. Nous avons recueilli les données au cours des consultations médicales à l'aide du logiciel ESOPE et à partir du dossier médical des patients. RÉSULTATS: Sur 2078 patients sous ARV, 84 soit 4% présentaient une dissociation immuno-virologique (DIV), dont 56 femmes (66,7%) et 28 hommes (33,3%). L'âge médian était de 45 ans [EIQ = 45 55 ans]. A l'initiation du traitement ARV, la plupart des patients étaient aux stades cliniques 3 ou 4 de l'OMS (57,1%). La médiane de l'IMC était à 20,5kg/m2 [EIQ=18,5 et 23 ans]. La médiane du nombre de lymphocyte TCD4+ était de 42 cellules/mm3 [EIQ= 12 63]. Au cours du suivi, le gain médian en indice de masse corporelle était de 3,2 kg/m2 [EIQ=1,24,3 kg/m2], le gain médian en TCD4+ était de 76 cellules/µl [EIQ=60 88]. La charge virale plasmatique du VIH-1 était indétectable chez tous avec un taux de TCD4+ < 100 cellules/µl à 12 mois. Les facteurs associés à la réponse immunovirologique dissociée étaient l'âge compris entre 35 à 45 ans (p = 0,0009), un nombre de lymphocytes T CD4 (CD4≤50) à l'initiation du traitement ARV (p=0,00045) et le stade clinique OMS 3. CONCLUSION: Cette étude prouve la problématique de la gestion de la réponse immuno-virologique dissociée à Bobo-Dioulasso, et rappel tout l'intérêt du suivi des PvVIH par la charge virale et non seulement par le taux de TCD4+ surtout dans les structures déconcentrées de prise en charge du VIH, où des changements de régime thérapeutique s'opèrent à tord.
ABSTRACT
The objective of this study was to evaluate the effectiveness and the clinical tolerance of a combination containing TDF/FTC/EFV in the treatment of HIV infection. This was a retrospective and descriptive study which included 196 adults infected by HIV-1 and treated by a combination containing TDF/FTC/EFV during 29 months in the daily hospital of Bobo Dioulasso. The median duration of follow-up was 7 months IQR [5-14 month]. The median age was 37 years IQR [31-45].With the initiation of treatment ARV, the median of the index of body mass was of 19 IQR [17-22]. The median of the lymphocytes TCD4 was 201/µl IQR [74-298/µl]. During the follow-up, we reported 25 deaths (12.8%). HIV-1 RNA plasma viral load was undetectable in 91.9% of the patients (124/135) at six months of treatment. The majority of the adverse effects of the treatment were of a neurosensory nature (40.5%). The TDF/FTC/EFV combination showed a good effectiveness in the treatment of the infection with HIV-1 in the first intention just as a good clinical tolerance.
Subject(s)
Adenine/analogs & derivatives , Anti-Retroviral Agents/therapeutic use , Deoxycytidine/analogs & derivatives , HIV Infections/drug therapy , Organophosphonates/therapeutic use , Oxazines/therapeutic use , Adenine/therapeutic use , Adult , Burkina Faso , Deoxycytidine/therapeutic use , Drug Combinations , Drug-Related Side Effects and Adverse Reactions/epidemiology , Efavirenz, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination , Female , HIV Infections/epidemiology , HIV-1 , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: The authors had for aim to assess the prevalence of hepatitis B co-infection in a cohort of HIV-infected patients, routinely followed-up at the Day Care Unit of the Bobo Dioulasso Sanou Souro University Hospital, Burkina Faso. PATIENTS AND METHODS: The Elisa technique was used to dose HBs antigen (AgHBs), antibodies anti-HBs and anti-HBc in all the patients followed by the biological laboratory, from October to December 2008. RESULTS: The AgHBs prevalence was 12.7% [CI at 95%: 10.7-15.0%] and men were slightly more likely to be positive for AgHBs than women (16.5% [12.0-21.9%] versus 11.6% [9.4-14.1%]; P=0.047); 83.3% of the patients [80.8-85.6%] were positive for hepatitis B core antibody, and 32.6% [29.7-35.6%] for hepatitis B surface antibody; 29.9% of the patients [27.1-32.8%] had a complete profile of former hepatitis B infection, 41.3% [38.2-44.4%] expressed core antibodies only; 13.8% [11.7-16.0%] had a negative serological test, and 2.3% [1.5-3.4%] presented a vaccinal immunity. CONCLUSION: These results stress the usefulness of screening for hepatitis B in all HIV-infected patients, along with the initial biological tests. This would help adapt HIV treatment to co-infected patients and to build an expanded program of vaccination for non-immune patients.