IntroductionGender differences in antiretroviral therapy (ART) outcomes are critical in sub-Saharan Africa. We assessed the association between gender and virologic failure among adult patients treated in a public routine clinic (one of the largest in West Africa) in Burkina Faso.MethodsWe performed a case-control study between July and October 2012 among patients who had received ART at the Bobo Dioulasso Day Care Unit. Patients were eligible if they were 15 years or older, positive for HIV-1 or HIV-1+2, and on first-line ART for at least six months. Cases were all patients with two consecutive HIV loads >1000 copies/mL (Biocentric Generic or Abbott Real Time assays), or one HIV load >1000 copies/mL associated with immunologic or clinical failure criteria. Controls were all patients who only had HIV loads <300 copies/mL. The association between gender and virologic failure was assessed using a multivariate logistic regression, adjusted on age, level of education, baseline CD4+ T cell count, first and current antiretroviral regimens and time on ART.ResultsOf 2303 patients (74.2% women; median age: 40 years; median time on ART: 34 months), 172 had virologic failure and 2131 had virologic success. Among the former, 130 (75.6%) had confirmed virologic failure, 38 (22.1%) had viro-immunologic failure, and four (2.3%) had viro-clinical failure. The proportion of men was significantly higher among the cases than among the controls (37.2% vs. 24.9%; p<0.001). Compared to controls, cases were also younger, more immunodeficient at ART initiation, less likely to receive a protease inhibitor-based antiretroviral regimen and had spent a longer period of time on ART. After adjustment, male gender remained strongly associated with virologic failure (odds ratio 2.52, 95% CI: 1.77–3.60; p<0.001).ConclusionsMen on ART appeared more vulnerable to virologic failure than women. Additional studies are needed to confirm the poorer prognosis of men in this setting and to determine the causes for their vulnerability in order to optimize HIV care. From now on, efforts should be made to support the adherence of men to ART in the African setting.

Highly active antiretroviral therapy (HAART) has reduced morbidity and mortality of HIV but has led to an increasing metabolic cardiovascular risk. A cross-sectional study was conducted from May to September 2011 in Day Care Hospital for HIV-Patients of Bobo-Dioulasso. We included in this study 400 patients infected by HIVon antiretroviral therapy ≥ 6 months selected by a random draw. Metabolic syndrome was assessed according to the definitions of the IDF and ATP-III. The high risk of cardiovascular disease in 10 years was defined by a Framingham score ≥ 20%. The average age of our patients was 41.4 years [20-76]. 17% received an IP. The average duration of PI exposure was 35.5 months and 50.1 months for NNRTI. The prevalence of diabetes was 1.3% (95% CI: 0.5-3) and that of hypertension of 12.0 % (95% CI: 9.3-16). The prevalence of metabolic syndrome according to IDF was 10% (95% CI: 7.3-13.5) and the metabolic syndrome according to ATP-III 12.3% (95% CI: 9.3-16). The body mass index was higher (BMI 25.2 vs. 22.5 kg/m(2), p <10(-3) with ATPIII and BMI 26.6 vs. 22.4 kg/m(2), p <10(-3) with IDF), and duration exposure to ARVs longer in patients with metabolic syndrome regardless of the definition used (58.6 months vs 27.9 months). High cardiovascular risk was present in 1.8% (95% CI: 0.8 to 3.7) of our patients, all male more than half (n=4/7) of them were smoking. The choice of antiretroviral therapy must take into account its potential long-term toxicity. It should also strengthen supervision.

No abstract

No abstract

Background: In sub Saharan Africa, small size surveys have demonstrated early high mortality among infected patients on antiretroviral therapies (ART). Few studies have been conducted in large cohorts of HIV-patients in public health care system in West Africa. Objectives: Our study aims to determine mortality rate and its predictors in a cohort of patients on ART in a public daycare hospital in Burkina Faso. Methods: We have carried out a retrospective cohort study. All HIV-infected patients on ART between January 1st 2008 and December 31st 2011 were included in the study. Survival probability was estimated by the Kaplan-Meier method. Cox regression analysis was used to identify associated factors to mortality. Results: A total of 2243 HIV-infected patients were included in the study. During the follow-up, 218 patients representing 9.7% were lost. About 104 patients representing 4.6% were transferred and 1691 representing 75.4% were still in the therapeutic cohort. There were 230 death cases for a total of 4282 persons-years, (5.4 deaths for 100 persons-years; 95% CI: 4.8-6.3). The survival probabilities after 6 months, 1 year and 2 years were 92.6%, 91% and 88.9% respectively. For the multivariate analysis, the following factors were independently associated to death: male gender, BMI < 18.5 kg/m 2 , WHO stage 3 and 4, HIV-2, T-CD4 lymphocytes < 200/µl, haemoglobin rate < 8 g/dl and creatinine clearance < 60 ml/m 2. Conclusions: Our study provides for the first time mortality rates and its predictors among HIV-patients on antiretroviral treatment in a large cohort in public health sector in Burkina Faso. It highlights the importance of early HIV screening to limit ART initiation at advanced HIV infection stages.