[Impact of access to antiretroviral therapy in Côte d'Ivoire]. / Bilan de l'accès aux antirétroviraux en Côte d'Ivoire.

In 1998 UNAIDS implemented the national drug access initiative (DAI) in Côte d'Ivoire. The Ivorian government took the DAI over in 2000 with the support of the Global Fund and Presidential Emergency Program For AIDS Relief (PEPFAR). The ensuing affordability of antiretroviral therapy (ART), medical staff training, and healthcare equipment allowed Ministry of Health to improve HIV care throughout the country. Since 2008 ART and follow-up monitoring have been free of charge for people living with HIV/AIDS (PLWHA). In January 2009 a total of 57,833 PLWHA received ART and follow-up at 274 HIV care centers. Use of ART has improved the life expectancy of PLWHA. However morbidity and mortality remained high during the first year of ART implementation with respective frequencies of 5-10% person-year (PY) and 2-3% PY. Morbidity was mainly related to infectious disease (tuberculosis and bacteriaemia) and earlier onset of adverse events (AE). In most cases ART has been well tolerated. The main adverse effects have been anemia, neuropathy, skin toxicity and liver enzyme elevation. The incidence of stage 3/4 AE has been low (< 2 %PY). Although overall compliance has been good (<80%), data among children and adults suggest the need for further work to reinforce support mechanisms. Convincing results have been obtained in the management of PLWHA. Nevertheless greater funding and commitment must be given to management of opportunistic infections and side effects and to development of nutrition support services.

Bilan de l'acces aux antiretroviraux en Cote d'Ivoire

L'initiative nationale d'acces aux antiretroviraux en Cote d`Ivoire a debute en 1998 sous l'egide de l'ONUSIDA. Le relais a ete assure par le gouvernement ivoirien en 2000 avec le soutien du FondsMondial et du PEPFAR (President Emergency Program ForAids Reliefs). L'accessibilite financiere; la formation du personnel de soins et l'equipement des structures sanitaires ont permis la decentralisation de la prise en charge sur tout le territoire national. Depuis aout 2008; le traitement antiretroviral est gratuit de meme que le suivi biologique. Fin janvier 2009; l'on denombrait 57 833 patients sous antiretroviraux; suivis dans 274 centres de prise en charge. L'utilisation des multitherapies antiretrovirales a considerablement modifie le pronostic avec une amelioration de l'esperance de vie des patients infectes par le VIH. Cependant la morbidite et la mortalite restent encore preoccupantes au cours de la premiere annee suivant la mise en route du traitement avec des incidences respectives variant entre 5 et 10patients-annee (PA) et 2 et 3PA. La morbidite est principalement en rapport avec les infections (tuberculose; bacteriemies) et les effets secondaires precoces. Les traitements antiretroviraux sont globalement bien toleres; les principaux effets secondaires etant l'anemie; les neuropathies; les reactions cutanees et les hypertransaminasemies. Les effets secondaires de grade 3 et 4 ont une incidence faible (2PA). L'observance est bonne; estimee a 80; mais des donnees obtenues chez les enfants et sur certains sites de prise en charge incitent a renforcer les dispositifs d'appui a l'observance. Des resultats probants ont ete obtenus dans la prise en charge antiretrovirale des personnes vivant avec l eVIH .Aussi les efforts sont-ils a poursuivre pour le financement et la prise en charge des infections opportunistes et des effets secondaires et pour l'appui nutritionnel

Human immunodeficiency virus Type 1 (HIV-1) plasma virus load and markers of immune activation among HIV-infected female sex workers with sexually transmitted diseases in Abidjan, Côte d'Ivoire.

Plasma levels of human immunodeficiency virus type 1 (HIV-1) RNA and markers of immune activation were compared among HIV-1-infected female sex workers (FSWs) with (n=112) and without (n=88) sexually transmitted diseases (STDs) in Abidjan, Côte d'Ivoire. After adjustment for CD4+ T cells, the median virus load was 2.5-fold higher among HIV-seropositive FSWs with STDs than among those without an STD (P=.053). Median virus load was higher for FSWs with a genital ulcer (P=.052) or gonorrhoea (P=.058) than for FSWs without any STD. Median levels of markers of immune activation (CD38 and HLA-DR on CD8+ T cells, soluble tumor necrosis factor-alpha receptor II, and beta(2)-microglobulin) tended to be elevated, albeit nonsignificantly, among FSWs in the STD group. These findings have important public health implications in elaborating strategies for decreasing disease progression and transmission of HIV among FSWs.