AIDS Res Hum Retroviruses

Immunorecovery could be attenuated in HIV-hepatitis B virus (HBV) co-infection versus HIV mono-infection during antiretroviral therapy (ART), yet whether it also occurs in individuals from Sub-Saharan Africa without severe co-morbidities is unknown. In this study, 808 HIV-infected patients in Cote d'Ivoire initiating continuous ART were included. Six-month CD4+ count trajectories and the proportion reaching CD4+ T-cell counts >350/mm3, HIV-RNA 104 copies/mL). Co-infected patients with high HBV-DNA replication initiated ART with significantly lower median CD4+ T-cell counts (216/mm3, IQR=150-286) compared to co-infection with low HBV-DNA replication (268/mm3, IQR=178-375) or HIV mono-infection (257/mm3, IQR=194-329) (p=0.003). These patients had significantly faster rates of CD4+ cell count increase from baseline after adjusting for baseline age, WHO stage III/IV and CD4+ cell counts (p=0.04), yet were not more likely to exhibit optimal immunorecovery (82.5% versus 80.0% and 77.9%, respectively) (p=0.8). In conclusion, change in CD4+ cell counts after ART-initiation was accelerated in co-infected patients with high HBV DNA viral loads, but this did not lead to increased rates of optimal immunorecovery

Hepatitis B surface antigen quantification as a predictor of seroclearance during treatment in HIV-hepatitis B virus coinfected patients from Sub-Saharan Africa

International audienceAbstractBackground and AimIn Sub-Saharan Africa, seroclearance of hepatitis B surface antigen (HBsAg) and hepatitis B “e” antigen (HBeAg), including their quantifiable markers, have rarely been evaluated during long-term antiviral treatment among patients coinfected with HIV and hepatitis B virus (HBV).MethodsIn this prospective cohort study from two randomized-control trials in Côte d'Ivoire, 161 antiretroviral-naïve HIV-HBV coinfected patients starting lamivudine (n = 76) or tenofovir/emtricitabine (n = 85) containing antiretroviral therapy were included. HBV DNA was quantified using an in-house assay (detection limit = 12 copies/mL) and HBsAg quantification (qHBsAg) using the Elecsys assay.ResultsOverall, 33 (20.5%) patients were HBeAg positive, 121 (75.2%) had detectable HBV DNA, and 92/93 (98.9%) harbored HBV genotype E. Median treatment duration was 35.5 months (interquartile range: 24.3–36.4). Among HBeAg-positive patients, cumulative proportion with HBeAg seroclearance was 46.3% (n = 14). Overall, cumulative proportion of HBsAg seroclearance was 6.6% (n = 10). Lower baseline qHBsAg levels and strong 12-month declines in qHBsAg were significantly associated with HBsAg seroclearance for both HBeAg-negative and HBeAg-positive patients. When taken at certain levels, these determinants provided moderate sensitivity (Se) and specificity (Sp) in predicting HBsAg seroclearance at month 36 (≤ 1000 IU/mL at baseline, Se = 0.80, Sp = 0.80; ≥ 1.0 log10 IU/mL drop at month 12, Se = 0.57, Sp = 1.00). Instead, qHBsAg levels ≤ 100 or ≤ 10 IU/mL at month 12 were optimal (both Se = 0.90 and Sp = 1.00). Detectable HBV-DNA provided fairly high Se and Sp when evaluated at baseline (Se = 1.00, Sp = 0.80), but not at month 12 (Se = 0.80, Sp = 0.40).ConclusionsHBsAg seroclearance rates are not common in patients from Sub-Saharan Africa treated with anti-HBV containing antiretroviral therapy. qHBsAg levels at 12 months of treatment may accurately predict HBsAg seroclearance

Ending AIDS as a public health threat by 2030: Scientific Developments from the 2016 INTEREST Conference in Yaoundé, Cameroon.

The underpinning theme of the 2016 INTEREST Conference held in Yaoundé, Cameroon, 3-6 May 2016 was ending AIDS as a public health threat by 2030. Focused primarily on HIV treatment, pathogenesis and prevention research in resource-limited settings, the conference attracted 369 active delegates from 34 countries, of which 22 were in Africa. Presentations on treatment optimization, acquired drug resistance, care of children and adolescents, laboratory monitoring and diagnostics, implementation challenges, HIV prevention, key populations, vaccine and cure, hepatitis C, mHealth, financing the HIV response and emerging pathogens, were accompanied by oral, mini-oral and poster presentations. Spirited plenary debates on the UNAIDS 90-90-90 treatment cascade goal and on antiretroviral pre-exposure prophylaxis took place. Joep Lange career guidance sessions and grantspersonship sessions attracted early career researchers. At the closing ceremony, the Yaoundé Declaration called on African governments; UNAIDS; development, bilateral, and multilateral partners; and civil society to adopt urgent and sustained approaches to end HIV by 2030

Dissection aortique anévrismale chez un adulte infecté par le VIH-1 dans le cadre d’un syndrome de reconstitution immune avec tuberculose

Un homme de 35 ans, VIH-1, sans antécédents médicaux et chirurgicaux particuliers, a été hospitalisé à Abidjan, Côte d'Ivoire, dans un contexte fébrile, toux, dyspnée, douleurs thoraciques et à la radiographie pulmonaire, un déroulement de la crosse de l'aorte une semaine après avoir débuté les antirétroviraux (ARV). Les scanners angiothoraciques réalisés ont mis en évidence une ectasie aortique globale étendue avec thrombus mural. Une échocardiographie transoesophagienne conclut à une dissection aortique, type A de Stanford. Le diagnostic de tuberculose a été confirmé par l'isolation en culture de Mycobacterium Tuberculosis. Huit ans après, le patient est encore vivant, sans intervention chirurgicale et se plaint de douleurs thoraciques intermittentes. Sa pression artérielle est stable et a une insuffisance rénale modérée. Nous rapportons un cas rare de dissection aortique anévrismale chez un adulte infecté par le VIH-1 dans le cadre d'un syndrome de reconstitution immune avec tuberculose pulmonaire

Manifestations thromboemboliques chez 36 patients Ouest Africains infectés par le VIH

Chez les patients infectés par le VIH, la maladie thromboembolique est une complication dont le risque est accru. En Côte d'Ivoire, dans le servicede référence de prise en charge médicale des personnes atteintes du VIH/SIDA, aucune étude n'a été menée sur la question. L'objectif de notreétude est de décrire les manifestations thromboemboliques colligées dans le Service des Maladies Infectieuses et Tropicales (SMIT) chez les patientsinfectés par le VIH, traités ou non par les antirétroviraux. Il s'est agi d'une étude rétrospective des dossiers de patients infectés par le VIH, hospitalisés,et présentant une thrombose veineuse profonde (TVP), artérielle et/ou une embolie pulmonaire de la période de janvier 2005 à juillet 2015. Lediagnostic a été posé par l'écho-Doppler des vaisseaux et/ou l'angioscanner thoracique. L'analyse a porté sur les aspects diagnostiques,thérapeutiques et évolutifs. Les dossiers de 36 patients dont 23 femmes (64%), sex-ratio H/F à 0,57, et âge moyen de 43±12 ans ont été retenus.Les thromboses veineuses profondes (TVP) ont été retrouvées chez 26 (72,2%) patients, des embolies pulmonaires (EP) chez neuf (25%) patients,une thrombose artérielle chez un patient (2,8%). La TVP était unilatérale dans 81% des cas et plus située à gauche (77%). L'EP était unilatérale età droite dans 100% des cas et la thrombose artérielle était bilatérale dans 2,7% des cas. Chez les patients atteints de TVP, la veine fémorale (39%)et la veine poplitée (35%) étaient les sièges plus fréquents de thrombose. L'EP concernait les artères pulmonaires dans 77,8% des cas et la thromboseartérielle concernait les carotides internes gauche et droite. La majorité des patients était sous traitement antirétroviral (69%). Les infectionsopportunistes fréquemment associées étaient les candidoses orales (31%) et la tuberculose (33%). L'évolution a été marquée par neuf décès (25%).Cette étude rapporte une fréquence élevée des TVP au cours de l'infection à VIH. D'autres études s'avèrent nécessaires pour mieux appréhender lerôle du VIH dans la survenue de la maladie thromboembolique

High correlation between Framingham equations with BMI and with lipids to estimate cardiovascular risks score at baseline in HIV-infected adults in the Temprano trial, ANRS 12136 in Côte d’Ivoire

<div><p>Context</p><p>Data on cardiovascular risk (CVR) score among HIV-infected patients in sub-Saharan Africa are scarce. Our first objective was to compare the CVR score of Framingham utilizing BMI and lipids at baseline, and secondary to assess evolution of CVR score over time at Month 30 in the Temprano trial.</p><p>Methods</p><p>HIV-infected adults with CD4 <800/mm³ without criteria for initiating ART were included and followed for 30 months in the Temprano trial, which assessed the benefits and risks of early antiretroviral treatment (ART) vs deferred ART. CVR score was estimated at baseline and Month-30 using Framingham equations with either BMI or lipids and classified as high (>20%), moderate (10–20%), and low risk (<10%). At baseline, we compare these two estimations utilizing the Pearson correlation test and analyze the increasing CV risk score over time by Proportional odds cumulative logit models for people attending the Month-30 (M30) visit.</p><p>Results</p><p>Among the 2056 patients, 78% were women, median age was 35 years, and median CD4 count was 464/mm³, 6.8% were obese, 6.3% had hypertension, 7.8% were smokers (1.8% women, 26.8% men), 19% had Total Cholesterol (TC) >5mmol/L, and 1% diabetes at baseline. At baseline the concordance between the two Framingham equations was excellent (r = 0.95; p<0.0001). Among the 1700 patients who attended M30 visit and with available data, 1.3% had a high CV risk score at baseline and 3.1% at M30 visit using Framingham equation with BMI. Adjusted odds ratio (aOR) of being at a higher CV risk score at M30 visit compared to a higher CV risk score at M0 visit was 1.35 (CI 95% 1.17–1.57). Stratified by sex, the increasing CV risk score was OR 1.73 (CI 95%: 1.30–2.29) for women and OR 1.24 (CI 95%: 1.02–1.50) for men. Early ART was not associated with an increasing CV risk score (p = 0.88). Results for the 1422 patients with Framingham equation using lipids were similar.</p><p>Conclusion</p><p>In a large trial evaluating early ART for HIV infection in Côte d’Ivoire, Framingham equation with BMI and lipids were highly correlated and CV risk score increases over time. Early ART was not significantly associated with this increasing CV risk score.</p></div

Evolution of the CV risk score with Framingham equation using BMI between M0 and M30.

<p>Proportional odds cumulative logit model, N = 1700.</p