High efficacy of first-line ART in a West African cohort, assessed by dried blood spot virological and pharmacological measurements.

OBJECTIVES: The objectives of this study were to determine the rate of viral success in HIV-infected patients on first-line ART by the assessment of dried blood spot (DBS) viral load (VL) and to assess the performance of DBS sampling for VL measurement, genotypic resistance and antiretroviral concentration determinations. METHODS: HIV-infected patients treated for >1 year with first-line ART in Niamey, Niger were included. VL based on nucleic acid sequence-based amplification (NASBA) assay (limit of quantification <800 copies/mL) was measured on DBS capillary samples. Resistance genotype was assessed for all detectable VLs (limit of detection >100 copies/mL); antiretroviral concentrations were interpreted using standard plasma cut-offs after extrapolation of blood to plasma results. Median (IQR) results are presented. RESULTS: Two hundred and eighteen patients (61% women), aged 41 (34-46) years, with 138 (56-235) CD4 cells/mm3 at baseline were included. After 4 (2-6) years of follow-up under therapy, CD4 gain was +197 (98-372) cells/mm3; 81% had VL <800 copies/mL. Antiretroviral concentrations were adequate in 87% of patients and nevirapine/efavirenz concentrations were related to viral success (P < 0.001). DBS genotypic resistance amplification succeeded in 71% of failing patients: NRTI drug resistance mutations were identified in 73% including resistance to lamivudine/emtricitabine (67%), abacavir (30%) and tenofovir (21%); and NNRTI drug resistance mutations were identified in 82% including resistance to rilpivirine (39%) and etravirine (15%). CONCLUSIONS: This study demonstrated a good response after 4 years of first-line ART in Niger. Adherence was high, according to antiretroviral concentrations, and the majority of failures were explained by selection of drug resistance mutations detected in the DBS genotype. Using DBS might improve the assessment of ART failure in HIV-infected patients in low-income countries.

[Smoking and related factors among college students in Dixinn, Guinea]. / Tabagisme et facteurs associés chez les collégiens de Dixinn en Guinée.

INTRODUCTION: Very few published studies are available on smoking in schools In Guinea. This investigation was designed to determine the extent of smoking in Guinean urban schools. METHODS: This cross-sectional study was conducted from April to june 2012. Students from four public schools in the municipality of Dixinn were anonymously interviewed by self-administered questionnaire concerning their smoking habits. The questionnaires were then analysed by SPSS 20 software RESULTS: The prevalence of smoking, always in the form of cigarettes, was 13.4% (C/95%: 10.6-16.1) among college students. Early initiation of smoking was observed (13.9 years) and smokers frequently expressed the prospect of withdrawal. The most common predisposing factor was the imitation of the environment (32.9%). The influence of fashion and advertising (45.6%) and imitation of the per group (32.9%) were the factors most frequently cited to promote smoking. Male gender [odd ratio= 7.9 (95% confidence interval3.8 to 16.9)], having a close friend who smoked [1.7 (1.1-2.8)], and frequently seeing other students smoking {3 8 (2.3 to 6.2)] were associated with smoking. CONCLUSION: Smoking is common among college students in Conakry, Guinea. The authorities, including educational authorities, should be more actively involved in the fight against this growing scourge in developing countries.