Acquired HIV drug resistance among adults living with HIV receiving first-line antiretroviral therapy in Rwanda: a cross-sectional nationally representative survey

BACKGROUND: We assessed the prevalence of acquired HIV drug resistance (HIVDR) and associated factors among patients receiving first-line antiretroviral therapy (ART) in Rwanda. METHODS: This cross-sectional study included 702 patients receiving first-line ART for at least 6 months with last viral load (VL) results >/=1000 copies/mL. Blood plasma samples were subjected to VL testing; specimens with unsuppressed VL were genotyped to identify HIVDR-associated mutations. Data were analysed using STATA/SE. RESULTS: Median time on ART was 86.4 months (interquartile range [IQR], 44.8-130.2 months), and median CD4 count at ART initiation was 311 cells/mm(3) (IQR, 197-484 cells/mm(3)). Of 414 (68.2%) samples with unsuppressed VL, 378 (88.3%) were genotyped. HIVDR included 347 (90.4%) non-nucleoside reverse transcriptase inhibitor- (NNRTI), 291 (75.5%) nucleoside reverse transcriptase inhibitor- (NRTI) and 13 (3.5%) protease inhibitor (PI) resistance-associated mutations. The most common HIVDR mutations were K65R (22.7%), M184V (15.4%) and D67N (9.8%) for NRTIs and K103N (34.4%) and Y181C/I/V/YC (7%) for NNRTIs. Independent predictors of acquired HIVDR included current ART regimen of zidovudine + lamivudine + nevirapine (adjusted odds ratio [aOR], 3.333 [95% confidence interval (CI): 1.022-10.870]; p = 0.046) for NRTI resistance and current ART regimen of tenofovir + emtricitabine + nevirapine (aOR, 0.148 [95% CI: 0.028-0.779]; p = 0.025), zidovudine + lamivudine + efavirenz (aOR, 0.105 [95% CI: 0.016-0.693]; p = 0.020) and zidovudine + lamivudine + nevirapine (aOR, 0.259 [95% CI: 0.084-0.793]; p = 0.019) for NNRTI resistance. History of ever switching ART regimen was associated with NRTI resistance (aOR, 2.53 [95% CI: 1.198-5.356]; p = 0.016) and NNRTI resistance (aOR, 3.23 [95% CI: 1.435-7.278], p = 0.005). CONCLUSION: The prevalence of acquired HIV drug resistance (HIVDR) was high among patient failing to re-suppress VL and was associated with current ART regimen and ever switching ART regimen. The findings of this study support the current WHO guidelines recommending that patients on an NNRTI-based regimen should be switched based on a single viral load test and suggests that national HIV VL monitoring of patients receiving ART has prevented long-term treatment failure that would result in the accumulation of TAMs and potential loss of efficacy of all NRTI used in second-line ART as the backbone in combination with either dolutegravir or boosted PIs

Geophagia In A Ten-Year-Old African Female With HIV Infection And Anemia

A very unusual case of geophagia in a 10 year old female patient, with a history of HIV and tuberculosis is reported. While the real prevalence and the pathogenesis of pica are unknown, the associated factors described in this case presentation are multiple. Association between geophagia and HIV or tuberculosis has not been documented. Case management consists of screening for soil-transmitted helminthes infection, anemia and iron depletion. Surgical complications can be serious but fortunately seldom occur.Un cas inhabituel de géophagie chez une jeune fille de 10 ans, souffrant du VIH associé à une tuberculose, est décrit. La pathogenèse de cette condition reste inconnue, tout comme sa prévalence, alors que les facteurs de risque associés sont nombreux. Une association de la géophagie avec le VIH et la tuberculose n\'est pas décrite. La prise en charge de la géophagie consiste essentiellement à rechercher les verminoses, l\'anémie et la déplétion en fer qui peuvent être associées. Les complications chirurgicales sont sérieuses mais surviennent rarement. Keywords: Géophagie, Sol - Helminthiase - Anémie - VIH.Clinics in Mother and Child Health Vol. 5 (2) 2008: pp. 933-93

Micronutrients and T-cell subsets: a comparison between HIV-infected and uninfected, severely malnourished Rwandan children

Objective: To determine the levels of CD4+ cells and micronutrients in HIV-infected and uninfected severely malnourished children. Design: Cross-sectional study in two centres. Setting: Children admitted to the malnutrition units in Kigali and Butare, Rwanda. Patients: A total of 112 children aged 2 months to 5 years presenting with severe malnutrition (weight for height Z-score -3 SD +/- oedema). Fifty-two (46.4%) were HIV-infected. Methods: CD4+ counts, selenium, zinc and copper levels were measured. The percentage of CD4 cells was calculated as a proportion of total lymphocyte count. Results: The mean age of the 52 HIV-infected children (18 months) was lower than of the 60 uninfected children (26 months) (p=0.01). Six (11.5%) of the HIV-infected had oedematous malnutrition compared with 50% of the uninfected group. The mean (SD) CD4+ count was 1054 (780) in the HIV-infected and 1579 (721) in the uninfected group (p=0.001). The CD4+ count was also significantly lower in the HIV-infected group than in the uninfected group for the ages 36 mths (p=0.001). In HIV-infected children, 17% had severe immunosuppression (25%) compared with 9%, 12% and 80% in the HIV-uninfected group, respectively (p<0.001). Approximately one-third in both groups had low levels of selenium and zinc and 77% had raised levels of copper. In multivariate analysis there was significant correlation between selenium and CD4+ (r=0.36, p<0.001) in HIV-infected children and no correlation of zinc and copper to CD4+%. In HIV uninfected children, CD4+% was related to selenium (r=0.282, p=0.03) and to zinc (r=0.264, p=0.047) but not to copper. Conclusions: In severely malnourished children with HIV infection, low CD4+ levels are associated mainly with HIV infection. There was no significant difference in levels of selenium, zinc and copper between HIV-infected and uninfected children

Assessing The Accuracy Of The Jm-102 Transcutaneous Bilirubin Measurement In Dark Skin Jaundiced Neonates: Case Of University Teaching Hospital, Rwanda

Background: Clinical assessment of neonatal jaundice is inaccurate and results in a significant number of blood tests in otherwise well babies. The number of these blood tests could be reduced, with benefit to the neonates and potential cost savings by using a noninvasive transcutaneous bilirubinometer. Objective: The aim of our study was to evaluate the accuracy of one of the birubinometer JM-102(Minolta/Hill-Rom Air-Shields ® JM-102), in dark skin term and preterm neonates old less than two weeks compared to the gold standard which is the measurement of serum bilirubin (SBR) and to identify the most informative value of transcutaneous bilirubinometer (TcB) in terms of sensitivity and specificity. Methods: The study included 275 jaundiced neonates who were less than 14 days and consulted neonatology unit of University teaching hospital during the study period. Neonates with severe conditions (hypothermia, respiratory distress, cardiovascular disorders, and neurological disorders) and/or with previous history of phototherapy were excluded from the study. On these 275 newborns, the Minolta/Hill-Rom Air-Shields ® JM-102 was used to measure the transcutaneous bilirubin and SRB sampling was performed within 30 minutes. All newborns were black skin. Results: The correlation of the gold standard and the measurements of the TcB Minolta/Hill-Rom Air-Shields ® JM-102 was 74.5 %. Comparing the gold standard with measurements of the TcB Minolta/Hill-Rom Air-Shields ® JM-102, we estimated the area under the Receiver Operating Curve(ROC) to be 0.887 classified as good and a p value of < 0.001 suggesting that the TcB measurement is far better than guessing. Conclusion: The correlation between TcB measurement and the serum bilirubin measurement was good for the population studied. The TcB measurement using the Minolta/Hill-Rom Air Shields ® JM-102 was found to be useful in detecting infant with hyperbilirubinaemia in dark skin jaundiced neonates.The Minolta JM-102 device could be used as a screening instrument, leading to the avoidance of invasive blood samplings for term and preterm neonates. TcB measurements with the JM-102 bilirubinometer should obviate the need for serum bilirubin levels in dark skin jaundiced newborns, although serum bilirubin measurements are still required when treatment with phototherapy or exchange transfusion is being considered.Introduction: L’évaluation visuelle de l’ictère néonatal est imprécise et conduit aux prélèvements sanguins inutiles pour dosage de la bilirubine chez les nouveau-nés qui de part ailleurs sont en bon état général. Le nombre et le coût de ces prélèvements pourraient être réduits par l’utilisation non invasive du bilirubinomètre transcutané. Objectif: Le but de notre étude était d’évaluer l’utilité du bilirubinomètre JM-102(Minolta/Hill-Rom Air-Shields ® JM-102) chez les nouveau-nés à peau foncée âgés de moins de deux semaines de vie présentant un ictère néonatal. Les mesures fournis par le bilirubinomètre ont été comparés au gold standard qui est le dosage sérique de la bilirubine. Méthodes: L’étude a enrôlé 241 nouveau-nés âgés de moins de 2 semaines présentant un ictère néonatal et 34 nouveau-nés non ictériques. Les nouveau-nés qui étaient en mauvais état général (hypothermique, en détresse respiratoire, présentant des troubles hémodynamiques ou des troubles neurologiques) ou qui avaient été sous photothérapie ont été exclus de l’étude. Le bilirubinomètre transcutané JM-102(Minolta/Hill-Rom Air-Protections ® JM-102) a été appliqué au niveau frontal et sternal et le sang pour dosage de la bilirubine sérique a été prélevé dans les 30 minutes suivant la mesure transcutanée. Tous les nouveau-nés enrôlés dans l’étude étaient à peau foncée. Résultats: La corrélation des résultats fournis par le bilirubinomètre transcutané et ceux obtenus par le dosage sérique de la bilirubine était de 74,5%. L’aire en dessous de la courbe ROC (Receiver Operating Cuve) était de 0,887 avec une valeur p <0,001 suggérant que l’évaluation de l’ictère néonatal par le bilirubinomètre transcutané était de loin meilleur que l’évaluation visuelle. Conclusion: La corrélation entre les résultats fournis par le bilirubinometre transcutané JM 102 et le dosage de la bilirubine sérique était bonne sur la population étudiée. Le bilirubinomètre Minolta JM-102 pourrait être utilisé pour identifier les nouveau-nés ictériques chez lesquels le dosage de la bilirubine sérique devrait être fait en vue d’une photothérapie ou exsanguino-transfusion éventuelle

Diarrhoeagenic microbes by real-time PCR in Rwandan children under 5\ua0years of age with acute gastroenteritis.

Acute gastroenteritis is a main cause of disease and death among children in low-income countries. The causality rates and pathogenic characteristics of putative aetiological agents remain insufficiently known. We used real-time PCR targeting 16 diarrhoeagenic agents to analyse stool samples from children ≤5.0\ua0years old with acute diarrhoea in Rwanda. Among the 880 children (median age 14.2\ua0months; 41% female) at least one pathogen was detected in 92% and two or more agents in 63% of cases. Rotavirus was detected in 36.9%, adenovirus in 39.7%, enterotoxigenic Escherichia coli (ETEC) with genes for labile (eltB) or stable (estA) toxin in 31.3% and 19.0%, E.\ua0coli with eae or bfpA genes in 25.2% and 14.2%, Shigella in 17.5% and Cryptosporidium in 7.8%. Rotavirus and ETEC-estA were associated with more severe dehydration than diarrhoea due to other causes. Shigella was associated with bloody stools and higher CRP. Microbial loads (Ct values) of rotavirus, ETEC-estA and Shigella were associated with severity of symptoms. Rotavirus, ETEC-estA and E.\ua0coli with bfpA were associated with younger age, Shigella with older age. Antibiotic treatment was given to 42% and was associated with dehydration, fever and CRP, but not with pathogen. We conclude that rotavirus and ETEC-estA were the most important causes of diarrhoea with dehydration, that Shigella caused bloody diarrhoea but less severe dehydration, that microbial loads of rotavirus, ETEC-estA and Shigella were associated with severity of symptoms, and that antibiotic use was frequent and in poor agreement with microbiological findings