APOL1 Renal Risk Variants and Kidney Function in HIV-1-Infected People From Sub-Saharan Africa.

Introduction: APOL1 G1 and G2 alleles have been associated with kidney-related outcomes in people living with HIV (PLHIV) of Black African origin. No APOL1-related kidney risk data have yet been reported in PLHIV in West Africa, where high APOL1 allele frequencies have been observed. Methods: We collected clinical data from PLHIV followed in Burkina Faso (N = 413) and in the ANRS-12169/2LADY trial (Cameroon, Senegal, Burkina Faso, N = 369). APOL1 G1 and G2 risk variants were genotyped using TaqMan assays, and APOL1 high-risk (HR) genotype was defined by the carriage of 2 risk alleles. Results: In West Africa (Burkina Faso and Senegal), the G1 and G2 allele frequencies were 13.3% and 10.7%, respectively. In Cameroon (Central Africa), G1 and G2 frequencies were 8.7% and 8.9%, respectively. APOL1 HR prevalence was 4.9% in West Africa and 3.4% in Cameroon. We found no direct association between APOL1 HR and estimated glomerular filtration rate (eGFR) change over time. Nevertheless, among the 2LADY cohort participants, those with both APOL1 HR and high baseline viral load had a faster eGFR progression (ß = -3.9[-7.7 to -0.1] ml/min per 1.73 m2 per year, P < 0.05) than those with low-risk (LR) genotype and low viral load. Conclusion: Overall, the APOL1 risk allele frequencies in PLHIV were higher in the West African countries than in Cameroon, but much lower than previously reported in some Nigeria ethnic groups, which strongly advocates for further investigation in the African continent. This study suggested that the virological status could modulate the APOL1 impact on kidney function, hence reinforcing the need for early therapeutic interventions.

Mesures visant à renforcer l'observance pour les antirétroviraux : perceptions et expérience des PVVIH au Burkina Faso.

INTRODUCTION: Adherence to antiretroviral therapy is a major obstacle to achieving WHO target 3. In West Africa, however, there is a lack of evidence on the most feasible, acceptable and effective adherence reinforcement measures and users' perceptions of these measures. The purpose of this article is to analyze the perceptions of PLHIV (people living with HIV) on ART reinforcement measures in Burkina Faso. METHOD: In Ouagadougou and Bobo-Dioulasso care centers, THILAO Research Project (ANRS 12269) enrolled PLHIV experiencing therapeutic failure on 2nd line antiretroviral treatment, and offered to them adherence reinforcement measures. We conducted a qualitative socio-anthropological study to explore their perceptions. Data were collected through repeated individual interviews with 37 PLHIV. RESULTS: The 31 participants who completed interviews were relatively satisfied with the measures to support adherence. Three measures (pill organizer, weekly phone calls by a member of the team, cellphone alarm reminders) were perceived as simple, effective, discreet, adapted to both illiterate and educated people. Three other measures (home visits, involvement of a member of the family and SMS) were not highly appreciated as they expose to the disclosure of HIV+ status and /or stigmatization. Two measures (support group, frequent visits to the care center) were less selected because considered tedious. CONCLUSION: PLHIV chosed and used the most appropriate adherence measures for their profile / context. The most feasible and acceptable measures identified could be offered to PLHIV at risk of non-compliance in West African ART programs.

Chronic kidney disease and HIV in the era of antiretroviral treatment: findings from a 10-year cohort study in a west African setting.

BACKGROUND: It has been reported that people living with HIV in West Africa exhibited the highest risks for chronic kidney disease (CKD) in the world. Here, we aimed at determining the CKD frequency and changes in kidney function during antiretroviral treatment (ART) in a large cohort of HIV-patients followed in Burkina Faso. METHODS: We included ART-naive adults who initiated ART at the Day Care Unit of the Souro Sanou University Hospital between 01/01/2007 and 12/31/2016. We assessed the estimated glomerular filtration rate (eGFR) by serum creatinine using the Modification of Diet in Renal Disease (MDRD) equation. Following the K/DOQI recommendations, CKD was defined as eGFR < 60 ml/min/1.73m2 at two consecutive measurements at least 3 months apart. The factors associated with eGFR decline or CKD were identified by mixed linear regression and Cox regression, respectively. RESULTS: Three thousand, one hundred and thirty-eight patients (72% women) were followed for a median (IQR) of 4.5(2.2-6.9) years. At baseline, median eGFR (IQR) was 110.7(94.4-128.4) ml/min/1.73m2 and 93 (3%) patients exhibited eGFR < 60 ml/min/1.73m2. The lowest-performing progressions of eGFR during the first year of ART were observed in patients with 40-49 yr. age range (- 8.3[- 11.7;-5.0] ml/min/1.73m2, p < 0.001), age ≥ 50 yr. (- 6.2[- 10.7;-1.8] ml/min/1.73m2, p = 0.006) and high blood pressure (HBP) (- 28.4[- 46.9;-9.9] ml/min/1.73m2, p = 0.003) at ART initiation. Regarding the ART exposure in patients with normal baseline eGFR, zidovudine (AZT) with protease inhibitor (PI) (- 4.7[- 7.7;-1.6] ml/min/1.73m2, p = 0.002), tenofovir (TDF) + PI (- 13.1[- 17.4;-8.7] ml/min/1.73m2, p < 0.001), TDF without PI (- 3.2[- 5.0;-1.4] ml/min/1.73m2, p < 0.001), stavudine (d4T) + PI (- 8.5[- 14.6-2.4] ml/min/1.73m2, p = 0.006) and d4T without PI (- 5.0[- 7.6-2.4] ml/min/1.73m2, p < 0.001) were associated with poorer eGFR progression. The prevalence of CKD was 0.5% and the incidence was 1.9 [1.3; 2.7] cases/1000 person-years. The risk of CKD was higher in patients with HBP (4.3[1.8;9.9], p = 0.001), 40-49 yr. patients (4.2[1.6;11.2], p = 0.004), ≥50 yr. patients (4.5[1.5;14.1], p = 0.009) and patients exposed to abacavir (ABC) or didanosine (ddI) based ART (13.1[4.0;42.9], p < 0.001). CONCLUSIONS: Our findings do not confirm the high risk of CKD reported in previous studies of West Africans with HIV, but support the recommendations for early initiation of ART and close kidney function monitoring in patients with HBP or aged ≥40 yr.

[Adherence reinforcement for antiretroviral therapy: PLHIV's perceptions and experience in Burkina Faso]. / Mesures visant à renforcer l'observance pour les antirétroviraux : perceptions et expérience des PVVIH au Burkina Faso.

INTRODUCTION: Adherence to antiretroviral therapy is a major obstacle to achieving WHO target 3. In West Africa, however, there is a lack of evidence on the most feasible, acceptable and effective adherence reinforcement measures and users' perceptions of these measures. The purpose of this article is to analyze the perceptions of PLHIV (people living with HIV) on ART reinforcement measures in Burkina Faso. METHOD: In Ouagadougou and Bobo-Dioulasso care centers, THILAO Research Project (ANRS 12269) enrolled PLHIV experiencing therapeutic failure on 2nd line antiretroviral treatment, and offered to them adherence reinforcement measures. We conducted a qualitative socio-anthropological study to explore their perceptions. Data were collected through repeated individual interviews with 37 PLHIV. RESULTS: The 31 participants who completed interviews were relatively satisfied with the measures to support adherence. Three measures (pill organizer, weekly phone calls by a member of the team, cellphone alarm reminders) were perceived as simple, effective, discreet, adapted to both illiterate and educated people. Three other measures (home visits, involvement of a member of the family and SMS) were not highly appreciated as they expose to the disclosure of HIV+ status and /or stigmatization. Two measures (support group, frequent visits to the care center) were less selected because considered tedious. CONCLUSION: PLHIV chosed and used the most appropriate adherence measures for their profile / context. The most feasible and acceptable measures identified could be offered to PLHIV at risk of non-compliance in West African ART programs.

Risk Factors for Early Mortality on Antiretroviral Treatment of Elderly People Infected with HIV in Burkina Faso.

BACKGROUND: Age is a key determinant of mortality due to diseases including HIV infection. METHODS: A retrospective and descriptive cohort study used a computerized database to compare HIV-infected patients diagnosed in late adulthood to a group of patients diagnosed before their 49 years of age, without matching the characteristics of HIV infection. The study included patients who visited the day hospital (outpatient clinic) of the Sanou Souro Teaching Hospital of Bobo-Dioulasso, in Burkina Faso, from January 2007 to December 2011. Older adults were defined as those aged 50 years and more. RESULTS: Participants in the study consisted of 2572 patients (265 older adults and 2307 young patients living with HIV. Based on Markov chain method, 32.1% of the older adults living with HIV were found to be seroconvert at 50 years or older. The median follow-up time on antiretroviral treatment (ART) was 32.7 months (range 0.03-65.4 months). Two hundred and ninety-five (11.5%) patients died, including 21.1% of older adults and 10.4% of young (P < .01). World Health Organization stage 3 or 4 and the lowest CD4 count reached <200 cells/mm(3) were the factors associated with early mortality of older adults on ART. CONCLUSION: Mortality rate of older adult patients living with HIV in Burkina Faso is high. Early diagnosis, early treatment, and primary prevention of HIV infection in the older adults are the main keys that could help reduce such mortality.