Ismael Diallo

HIV drug resistance pattern among HAART-exposed patients with suboptimal virological response in Ouagadougou Burkina Faso.

Objective:Determine the pattern of drug resistance among HIV infected drug exposed patients failing therapy in Ouagadougou, Burkina Faso. Methods:The protease (PR) and reverse transcriptase (RT) of 87 samples from 75 treatment exposed HIV infected patients failing therapy were PCR amplified, sequenced, subtyped and analyzed for the presence of drug resistance mutations. Results:The most common drugs used were 3TC, AZT (or d4T) and EFV. The dominant subtypes were CRF06_cpx (48%) and CRF02_AG (40%). The prevalence of resistance mutations among patients failing therapy was: PR inhibitors (PI), 40%; non-nucleoside RT-inhibitors (NNRTI), 76% and nucleoside RT-inhibitors (NRTI), 85%. Dominant mutations included M46I (37%), 154V (26%), V82A/T/F (30%) in PR; K103N (44%), G190A/S (16%) and T215F/Y (48%) (NRTIs) in RT. Some resistance mutations, notably D67N/G, K70R and L210W (thymidine analogue mutations-TAMs); K101E, V179E in RT, 154V, V82A/T/F and L90M in PR were significantly higher among CRF06_cpx than CRF02_AG strains (P < 0.05). Although not significant, other TAMs (M41L, T215F/Y, K219Q/E) also occurred more frequently among CRF06_cpx strains as well. Conclusion:There is a high prevalence of drug resistance mutations among ARV exposed patients in Burkina Faso with an unexpected subtype-specific difference. Validation of this result will require larger sample sizes and in vitro drug susceptibility studies with CRF06_cpx strains.

Low prevalence of detectable HIV plasma viremia in patients treated with antiretroviral therapy in Burkina Faso and Mali.

Background:Sub-Saharan Africa has seen dramatic increases in the numbers of people treated with antiretroviral therapy (ART). Although standard ART regimens are now universally applied, viral load measurement is not currently part of standard monitoring protocols in sub-Saharan Africa. Methods:We describe the prevalence of inadequate virological response (IVR) to ART (viral load ≥ 500 copies/mL) and identify factors associated with this outcome in 606 HIV-positive patients treated for at least 6 months. Recruitment took place in 7 hospitals and community-based sites in Bamako and Ouagadougou, and information was collected using medical charts and interviews. Results:The overall prevalence of IVR in treatment-naive patients was 12.3% and 24.4% for pretreated patients. There were no differences in rates of IVR according to ART delivery sites and time on treatment. Patients living farther away [odds ratio (OR) = 2.48; 95% confidence interval (CI) 1.40 to 4.39], those on protease inhibitor or nucleoside reverse transcriptase inhibitor regimens (OR = 3.23; 95% CI 1.79 to 5.82) and those reporting treatment interruptions (OR = 2.36; 95% CI 1.35 to 4.15), had increased odds of IVR. Immune suppression (OR = 3.32, 95% CI 1.94 to 5.70) and poor self-rated health (OR = 2.00; 95% CI 1.17 to 3.41) were also associated with IVR. Conclusions:Sufficient expertise and dedication exist in public hospital and community-based programs to achieve rates of treatment success comparable to better-resourced settings.

Features of Metabolic Syndrome and Its Associated Factors during Highly Active Antiretroviral Therapy in Ouagadougou (Burkina Faso)

Background: To study the features of metabolic syndrome (MS) and its associated factors during highly active antiretroviral therapy (HAART), in Ouagadougou. Methods: It was a cross-sectional study from March to November 2011 in Yalgado Ouédraogo hospital. A nonprobability sample of adults receiving antiretroviral drugs for at least 6 months was studied. Pregnancy, ascites, or abdominal mass were noninclusion criteria. Metabolic syndrome met the criteria of International Diabetes Federation 2005. Results: The authors studied 300 patients. Metabolic syndrome was diagnosed in 54 (18%) patients: mean age 44.8 ± 7.4 years, sex ratio 0.17, and mean duration of HAART 71 ± 30.9 months. The current anomaly of MS was low high-density lipoprotein (HDL)-cholesterol in 37 patients (68.5%), and the common profile of MS was high waist circumference + low HDL-cholesterol + abnormal blood pressure (29.6%). Associated factors were protease inhibitor regimens (P = .000), female gender (P = .004), age > 42 years (P = .001), and lipodystrophy (P = .01). Conclusion: Cardiovascular risks should be regarded during the care of HIV-infected patients.

Profiles of Elderly People Infected with HIV and Response to Antiretroviral Treatment in Burkina Faso: A Retrospective Cohort Study

Background: In sub-Saharan Africa, few studies exist on elderly HIV-positive populations. Therefore, we aimed to examine the profiles of elderly people living with HIV (PLHIV) in Burkina Faso and their response to antiretroviral therapy (ART). Methods: We reviewed the monitoring and treatment of PLHIV over the age of 50 years and then compared with the monitoring and treatment of PLHIV under 50 years. Results: A total of 3367 patients were included. The median age of elderly people was 54.5 years and of young people was 34.9 years (P = .03). In both the groups, screening was performed following clinical suspicion (64.9% in elderly versus 56% in young people; P < .001). Cardiovascular risk factors were generally more significant in the elderly people. The risk of death while on ART was 2.3 times higher in elderly people (P < .001). Conclusion: HIV infection in older people occurs in those who already have some cardiovascular risk factors. Particular attention should be given to multidisciplinary care for the elderly individuals.

Residual mother-to-child transmission of HIV in Burkina Faso

Background: Burkina Faso is one of the countries in West Africa most affected by the HIV/AIDS pandemic, despite the implementation of a mother-to-child HIV transmission prevention program as a strategy to reduce the risk of vertical transmission of the disease. Objective: To assess the current risk of mother-to-child transmission of HIV in Burkina Faso. Materials and methods: A prospective study was conducted between December 2014 and July 2016, in the 13 health regions of Burkina Faso. Women who were screened HIV-positive during a prenatal consultation were followed until delivery. Their babies received dry blood spot (DBS) at birth, at week 6 and at 1year, to screen for HIV. Results: Overall, 186 pregnant women were included in the study, with a mean age of 29.17±6.13 years. Of their children, 430 DBS actually received a PCR test, giving a 91.1% PCR implementation rate. After analyses, 6 (1.3%) babies were identified as carriers of HIV1. The newborn’s serological status was associated with delivery pattern (p=0.000), the administration of antiretroviral drugs to the mother after delivery (p=0.0064), the administration of Nevirapine to the newborn at birth (p=0.022), the use of contraceptive methods after delivery (p=0.028) and the presence of breast affections/infections since delivery (p=0.013). Conclusion: The results of our study are encouraging and demonstrate the effectiveness of interventions in the mother-tochild prevention program (PMTCT) for HIV-positive pregnant women can be improved through early initiation of triple therapy in early pregnancy and improved adherence to antiretroviral (ARV) therapy. Keywords: Burkina Faso, HIV/AIDS, mother-to-child transmission, antiretroviral drugs, pregnant women

Characteristics and Follow-up of Newly Managed HIV-Infected Patients in the National Referral Center in Ouagadougou, Burkina Faso

Background: In sub-Saharan countries, HIV testing and treatment facilities are available, especially at subsidized rates for the past few years. Methods: A prospective and descriptive review was conducted at Yalgado Ouédraogo Teaching Hospital Internal Medicine department in Ouagadougou, using personal case report forms, between June 2009 and August 2010 in all newly diagnosed adults with positive HIV antibody. Results: The study participants consisted of 191 patients at a median age of 37 years (range, 18-65 years) and sex ratio (men/women): 0.66. In all, 110 (57.6%) patients were symptomatic. Fourteen patients were lost to follow-up. Of the 177 patients, 144 had CD4 count <350 cells/mm3 and all have been treated. At the ninth month, weight gain and immune restoration were significant (P < .01); only 79 of the 144 patients had viral load measurement, and 76 of the 79 were undetectable. Mortality rate of treated patients was 6.25%. Conclusion: Laboratory tests and highly active antiretroviral therapy make the management of patients easier, but a majority of them still presented late and were still lost to follow-up. Nevertheless, we have excellent treatment success.

Risk Factors for Early Mortality on Antiretroviral Treatment of Elderly People Infected with HIV in Burkina Faso

Background: Age is a key determinant of mortality due to diseases including HIV infection. Methods: A retrospective and descriptive cohort study used a computerized database to compare HIV-infected patients diagnosed in late adulthood to a group of patients diagnosed before their 49 years of age, without matching the characteristics of HIV infection. The study included patients who visited the day hospital (outpatient clinic) of the Sanou Souro Teaching Hospital of Bobo-Dioulasso, in Burkina Faso, from January 2007 to December 2011. Older adults were defined as those aged 50 years and more. Results: Participants in the study consisted of 2572 patients (265 older adults and 2307 young patients living with HIV. Based on Markov chain method, 32.1% of the older adults living with HIV were found to be seroconvert at 50 years or older. The median follow-up time on antiretroviral treatment (ART) was 32.7 months (range 0.03-65.4 months). Two hundred and ninety-five (11.5%) patients died, including 21.1% of older adults and 10.4% of young (P < .01). World Health Organization stage 3 or 4 and the lowest CD4 count reached <200 cells/mm3 were the factors associated with early mortality of older adults on ART. Conclusion: Mortality rate of older adult patients living with HIV in Burkina Faso is high. Early diagnosis, early treatment, and primary prevention of HIV infection in the older adults are the main keys that could help reduce such mortality.

Clinical outcomes and mortality associated factors in patients infected with HIV receiving a presumptive anti-tuberculosis treatment in a tertiary level hospital in Burkina Faso

Introduction: Tuberculosis is the leading cause of death among people living with HIV/AIDS (PLHIV) in sub-Saharan Africa. In PLHIV, Smear-Negative Pulmonary Tuberculosis (SNPTB) and Extrapulmonary Tuberculosis (EPTB) are predominant. Presumptive anti-tuberculosis (anti-TB) treatment is often delayed leading to a high mortality rate. Objectives: To investigate the clinical outcomes of presumptive anti-TB treatment in HIV patients suspected of having TB and to determine the factors associated with patients’ death. Methods: We conducted a retrospective descriptive study from 1 January 2007 to 31 December 2008 in the Department of Internal Medicine of the Hospital Yalgado Ouédraogo on patients infected with HIV who received a presumptive anti-TB treatment. Defining patients with SNPTB or EPTB was based on the 2007 WHOs diagnostic algorithm of SNPTB and EPTB. Results: One hundred and sixteen patients of the 383 (30.2%) HIV patients hospitalized in this period were suspected of having TB. The average CD4 count was 86.1 cells/µl (SD = 42.3). A SNPTB was diagnosed in 67 patients (57.8%) and a EPTB in 49 patients (42.2%). The median length of hospitalization duration was 23.5 days. The average time of initiation of anti-TB treatment after admission was 22 days (SD = 9.2 days). Evolution during the hospital stay was favorable for 65 patients (56.0%), unfavorable for 48 patients (41.4% or 12.5% of all hospitalized patients), and 3 patients (2.6%) were treatment defaulters. In a multivariate analysis, hospitalization duration longer than 15 days and a delay of anti-TB treatment initiation of more than 30 days are independent factors associated with patients’ deaths. Conclusion: An urgent access to TB-diagnostic tools and a revision of the International algorithm for the diagnosis and treatment of SNPTB and EPTB in the context of HIV could help to reduce the delay of anti-TB treatment initiation and the mortality rate of PLHIV in sub-Saharan Africa.

Characteristics and Factors Associated with the Clinical Forms of Lipoatrophy during Highly Active Antiretroviral Therapy in Ouagadougou, Burkina Faso

Background: We aimed to study the factors associated with clinical forms of lipoatrophy in patients receiving highly active antiretroviral therapy (HAART) in Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso. Methods: This cross-sectional review from March 10 to November 10, 2011, included a nonprobability sample of HIV-infected adults receiving antiretroviral (ARV) medications for at least 6 months and monitored in the internal medicine department. The diagnosis of lipoatrophy was clinical. Results: Three hundred patients were included. The sex ratio was 0.4 and the mean age was 42.1 ± 8.5 years. The mean duration of HAART was 73.2 ± 30.9 months. In all, 97 (32.3%) patients had lipoatrophy: 75 (25%) isolated and 22 (7.3%) mixed syndrome. Facial lipoatrophy was frequent (61.8%). Isolated lipoatrophy was associated with male sex (P = .002) and body mass index ≤25 (P < .05). Mixed syndrome was associated with female sex (P = .002), age >42 years (P < .05), physical activity (P = .003), smoking (P = .001), stavudine (d4T; P = .0001), or protease inhibitors (P = .01). Conclusion: Prevention of lipoatrophy associated with HAART requires the exclusion of modifiable risk factors that we identified.