Alarming rates of virological failure and HIV-1 drug resistance amongst adolescents living with perinatal HIV in both urban and rural settings: evidence from the EDCTP READY-study in Cameroon.

OBJECTIVES: Adolescents living with perinatal HIV infection (ALPHI) experience persistently high mortality rates, particularly in resource-limited settings. It is therefore clinically important for us to understand the therapeutic response, acquired HIV drug resistance (HIVDR) and associated factors among ALPHI, according to geographical location. METHODS: A study was conducted among consenting ALPHI in two urban and two rural health facilities in the Centre Region of Cameroon. World Health Organization (WHO) clinical staging, self-reported adherence, HIVDR early warning indicators (EWIs), immunological status (CD4 count) and plasma viral load (VL) were assessed. For those experiencing virological failure (VF, VL ≥ 1000 copies/mL), HIVDR testing was performed and interpreted using the Stanford HIV Drug Resistance Database v.8.9-1. RESULTS: Of the 270 participants, most were on nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens (61.7% urban vs. 82.2% rural), and about one-third were poorly adherent (30.1% vs. 35.1%). Clinical failure rates (WHO-stage III/IV) in both settings were < 15%. In urban settings, the immunological failure (IF) rate (CD4  < 250 cells/µL) was 15.8%, statistically associated with late adolescence, female gender and poor adherence. The VF rate was 34.2%, statistically associated with poor adherence and NNRTI-based antiretroviral therapy. In the rural context, the IF rate was 26.9% and the VF rate was 52.7%, both statistically associated with advanced clinical stages. HIVDR rate was over 90% in both settings. EWIs were delayed drug pick-up, drug stock-outs and suboptimal viral suppression. CONCLUSIONS: Poor adherence, late adolescent age, female gender and advanced clinical staging worsen IF. The VF rate is high and consistent with the presence of HIVDR in both settings, driven by poor adherence, NNRTI-based regimen and advanced clinical staging.

[Early ENT manifestations of HIV infection/AIDS. An analysis of 76 cases observed in Africa]. / Manifestations Oto-Rhino-Laryngologiques inaugurales de l'infection à VIH/SIDA. Analyse de 76 cas observés en milieu africain.

OBJECTIVE: The aim of this work is to describe the ENT clinical manifestations by which HIV positive patients inaugurate their AIDS-illness and to classify these manifestations in respect to the biological state of the infection. MATERIAL AND METHOD: It was a multicenter, prospective study carried out in the ENT services of Yaounde (Cameroon), between the period of September 2000 and June 2002. Included in this study were HIV patients who started their AIDS with an ENT illness. The stage of evolution of the HIV infection was evaluated using the CD4 and CD8 T lymphocyte counts. This was carried out using the Flux cytometric technique of Fascount/Becton. RESULTS: We thereafter recruited 76 patients. The incidence rate of ENT early manifestations in HIV positive patients was 11.5%. Pharyngeal and oral candidosis represented the most observed manifestation (30.60%), followed by peripheral facial paralysis (11.13%) and rhino-sinusitis (10.58%). Parotid gland hypertrophy represented 8.23% of the affections. Persistant cervical lymphadenopathy was observed in 7.05% of cases. Kaposi sarcoma and cervical lymph node tuberculosis represented each 3.53% of cases of the sample. The correlation of lymphocytic count and initial ENT manifestations showed that these manifestations were observed in all the biological states of the HIV/AIDS infection. CONCLUSION: The above mentioned ENT manifestations in the patient should motivate the request of the HIV screening tests.