Alarming rates of virological failure and drug resistance in patients on long-term antiretroviral treatment in routine HIV clinics in Togo

Konou, Abla A.; Dagnra, Anoumou; Vidal, Nicole; Salou, Mounérou; Adam, Zakillatou; Singo-Tokofaï, Assétina; Delaporte, Eric; Prince-David, Mireille; Peeters, Martine

doi:10.1097/qad.0000000000000906

Cited by 17 publications

(16 citation statements)

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“…Virological failure in our series was 19%. This prevalence is like the one described by Boender (20) in countries with limited resources, and lower than those described in the sub-region precisely in Togo [21] and Burkina-Faso [22].…”

Section: Discussionsupporting

confidence: 78%

Factors Associated with Adverse Therapeutic Outcomes in People Living with HIV (PLHIV) Monitored in Roi Baudouin Health Care Center, Dakar, Senegal

Ba¹,

Ba²,

Sembene³

et al. 2020

WJA

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Background: Optimizing antiretroviral therapy is an essential step to reach the 90 -90 -90 targets. Despite tremendous progress made for antiretroviral treatment (ART) to be accessible in countries with limited resources, health care providers continue to face challenges due to the under-optimization of ART due to therapeutic failures and poor retention. Objectives: To determine the prevalence of adverse therapeutic outcomes in a decentralized health care center and to determine associated factors. Patients and Methods: This is a cross-sectional descriptive and analytical study targeting PLHIV, aged 18 years and over, on first line antiretroviral treatment (ART), monitored onsite from February 1st to December 31st, 2018. A data collection form was completed from medical records (clinical, immuno-virological, therapeutic and evolutionary). Data were also collected from interviews with patients for additional socio-demographic information including the level of HIV knowledge. Data were captured and analyzed using EPI 2002 and R software. Proportions were compared using the chi -square and Fisher tests and logistic regression. A value of p < 0.05 was considered significant. Results: 331 patients were enrolled with HIV-1 profile in 89% of the cases. A proportion of 55% was married and 98% came from the rural area. 80% were either not or poorly educated. The median of age was 44 ± 11 years with a F/M ratio of 3.5. 30% that had not shared their HIV status, and more than half had a low knowledge of HIV transmission. At baseline, 56% were symp-How to cite this paper: Baat WHO stage 3 or 4. They had severe immunosuppression with a median CD4 count of 217 ± 187 cells/mm 3 ; the viral load was detectable in half of the patients with a median viral load (VL) of 97,000 ± 70,569 cp/ml. The antiretroviral regimens combined 2 nucleoside reverse transcriptase inhibitor (NRTI) with 1 no nucleoside reverse transcriptase inhibitor (NNRTI) in 88% of the cases. The median duration of follow-up was estimated at 60 ± 43 months. The prevalence of adverse therapeutic outcomes was 36% (119 patients). The proportion of virological failure was 19%, lost follow up was 20% and the mortality was 4%. The adverse therapeutic outcomes were associated with the age less than 25 years (p = 0.007) and with a late diagnosis (CD4 T cells at baseline less than 200 cell/mm 3 , p = 0.02). Conclusion: These results suggest the need to make new therapeutic classes available for first-line treatment and to promote actions improving retention in care.

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Section: Discussionsupporting

confidence: 78%

Factors Associated with Adverse Therapeutic Outcomes in People Living with HIV (PLHIV) Monitored in Roi Baudouin Health Care Center, Dakar, Senegal

Ba¹,

Ba²,

Sembene³

et al. 2020

WJA

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“…Virologically, viral load quantification was used to evaluate the antiretroviral response [23] and a virological failure prevalence of 19% was determined. This prevalence was lower than those in the subregion, namely in Togo [17], Burkina…”

Section: Evolutionary Aspectsmentioning

confidence: 54%

Prevalence and Factors Associated with Virologic Failure among People Living with HIV (PLHIV) Monitored in a Decentralized Health Care Facility

Ba¹,

Ba²,

Sembene³

et al. 2019

AID

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Introduction: In Senegal, the decentralization of Health Care Centers has contributed significantly to the intensification of antiretroviral treatment. However, Care providers are still facing the treatment optimizing challenge. Objectives: To determine the prevalence of virologic failures of PLHIV monitored in a decentralized Health care center and to determine associated factors. Patients and Methods: This is a cross-sectional descriptive and analytical study of PLHIV, aged 18 years and over, on first-line treatment, monitored onsite from February 1st to December 31st, 2018. A data collection form was completed from medical records (clinical, immuno-virologic and evolutionary). Any VL > 1000 cp/ml after 6 months of antiretroviral therapy (ART) was considered as virologic failure. Data were captured and analysed using the EPI INFO 2002software. Chi-square test and the Fisher test were used to compare the proportions; a value of p ≤ 0.05 was considered significant. Results: 331 patients were treated with HIV-1 profile in 89% of cases. A proportion of 55% was married and 97% came from rural areas. 80% were either not or poorly educated. The median of age was 44 ± 11 years with a F/M ratio of 3.4. At baseline, 56% were symptomatic at stage 3 or 4 of WHO. They had severe immunosuppression with a median CD4 count of 217 ± 187 cells/mm 3 , the viral load was detectable in half of the patients with a median VL of 97,000 cp/ml ± 70,569. The antiretroviral regimen combined 2 NRTIs with 1 NNRTI in 88% of cases.

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“…However, despite this treatment, there is a strong immunosuppression, indicating either a poor ARV intake or failure of the ARV therapy because of resistance. In Togo, for the whole population of HIV infected patients under ARV, Dagran observes in 2011 a rate of resistance on drugs used in the first line therapy of 24.5% [10] and a Konou fund in 2015 a resistance rate on protease inhibitors used in the second line therapy of 17% [11]. It's good to remember that in the years 2007 to 2008 in Togo, There have been many breaks in the supply of ARVs.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal Meningitis of the HIV-Infected Person in Lomé: About 102 Cases over 10 Years

Wateba¹,

Balaka²,

Bawe³

et al. 2017

WJA

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Objective: To describe the clinical, epidemiological and evolutionary aspects of cryptococcal meningitis. Methods: This was a retrospective descriptive study on all HIV-infected patients who had been hospitalized for cryptococcal meningitis between 2006 and 2016 in the principal structures for the care of HIV infected person in Lomé. The diagnosis of meningitis was clinical and confirmed by the presence of cryptococci on Chinese ink or the detection of CSFsoluble antigens. All patients have made the CD4 rate assay and received an antifungal treatment based on fluconazole or Amphotericin B, followed later by antiretroviral triple therapy. Results: A total of 102 patients infected with cryptococcal meningitis (62 men for 40 women) were found. The sex ratio was 1.55. The median age was 34 years with extremes of 15 to 49 years. Clinically, headache was the symptomatic symptom in 100% of cases, prone to long runs and weight loss respectively in the proportions of 45% and 65%. The mean CD4 cell count was 65 ± 22 cells per mm 3 . The duration of hospital stay was short (less than 7 days) for the deceased. A total of 62 patients were able to receive treatment, 40 of them with fluconazole and 22 with Amphotericin B. The mortality was very high (65%), 25% were lost to follow-up, and 9.5% still in live 3 months after admission to the hospital. Conclusion: Cryptococcal meningitis has a very reserved prognosis. It is to be feared in cases of severe immunosuppression, hence the early detection of HIV for optimal management is important.

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Alarming rates of virological failure and drug resistance in patients on long-term antiretroviral treatment in routine HIV clinics in Togo

Cited by 17 publications

References 9 publications

Factors Associated with Adverse Therapeutic Outcomes in People Living with HIV (PLHIV) Monitored in Roi Baudouin Health Care Center, Dakar, Senegal

Factors Associated with Adverse Therapeutic Outcomes in People Living with HIV (PLHIV) Monitored in Roi Baudouin Health Care Center, Dakar, Senegal

Prevalence and Factors Associated with Virologic Failure among People Living with HIV (PLHIV) Monitored in a Decentralized Health Care Facility

Cryptococcal Meningitis of the HIV-Infected Person in Lomé: About 102 Cases over 10 Years

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Alarming rates of virological failure and drug resistance in patients on long-term antiretroviral treatment in routine HIV clinics in Togo

Cited by 17 publications

References 9 publications

Factors Associated with Adverse Therapeutic Outcomes in People Living with HIV (PLHIV) Monitored in Roi Baudouin Health Care Center, Dakar, Senegal

Factors Associated with Adverse Therapeutic Outcomes in People Living with HIV (PLHIV) Monitored in Roi Baudouin Health Care Center, Dakar, Senegal

Prevalence and Factors Associated with Virologic Failure among People Living with HIV (PLHIV) Monitored in a Decentralized Health Care Facility

Cryptococcal Meningitis of the HIV-Infected Person in Lom&#233;: About 102 Cases over 10 Years

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Cryptococcal Meningitis of the HIV-Infected Person in Lomé: About 102 Cases over 10 Years