PLoS One

BACKGROUND: In Cote d'Ivoire, people living with HIV (PLHIV) have free access to antiretroviral therapy (ART) and cotrimoxazole. Yet, they may use other medications to treat non-HIV diseases. Scarce data are available regarding the use of non-HIV medications in Africa. This study describes the use of non-HIV medications and identifies the factors associated with their use by PLHIV on ART in Cote d'Ivoire. METHODS: A cross-sectional study was conducted in six HIV clinics in 2016. HIV-1-infected adults receiving ART for at least one year were eligible. A standardized questionnaire was used to collect demographics, HIV characteristics and medication use data. Associated factors were identified using a multivariate adjusted Poisson regression. RESULTS: A total of 1,458 participants (74% women) were enrolled. The median age was 44 years, and the median duration of ART was 81 months. A total of 696 (48%) participants reported having used at least one non-HIV medication. Among the 1,519 non-HIV medications used, 550 (36%) had not been prescribed and 397 (26%) were from the nervous system class. Individuals who were more likely to report the use of at least one non-HIV medication included those who had been treated in an Abidjan HIV clinic, had a high school education level, had a monthly income between 152 and 304 euros, had a poor perceived health status, had WHO advanced clinical stage, had used traditional medicine products and had not used cotrimoxazole. CONCLUSION: Almost half PLHIV on ART reported using non-HIV medication. Further research is needed to assess whether the use of non-HIV medication is appropriate given about a third of those medications are not being prescribed

Epidémiologie, diagnostic et prise en charge de l'infection par le VIH-2 en Afrique de l'Ouest

Background : The holistic care of the one to two million HIV-2 infected individuals in West Africa remain a concern. The frequent misdiagnosis with rapid HIV tests, in addition to the intrinsic resistance of HIV-2 to non-nucleoside reverse transcriptase inhibitors, and its low susceptibility to some protease inhibitors, make the treatment of people living with HIV-2 very challenging. The lack of data on mortality and retention in care among people living with HIV-2, as well as the emergence of resistance to most ART drugs is a great concern for the West African ART program. Method : We relied on the WADA-HIV-2 cohort, its associated biobank and the ANRS 12294 FIT-2 trial, to describe challenges in diagnosis and treatment, as well as mortality and lost to follow up, among people living with HIV-2 in West Africa. Results : One quarter of HIV-2 or dually reactive individuals, according to the national algorithms for HIV diagnosis, were found infected by HIV-1 only, and the tests GenieIII® and ImmunoCombII® showed good performances for a more accurate algorithm. Considering treatment, HIV-2 patients often initiate boosted PI based regimen, with good immunologic and virologic response. A suboptimal response was obtained with either three NRTI based regimens and unboosted PI based regimen, however worse with the first one. HIV-2 infected individuals experienced early and relatively high mortality (5.2/100 person-years), that was associated with anemia and low CD4 count (<100/mm3) at ART initiation. The results of the ongoing ANRS 12294 FIT-2 trial are expected to identify the best strategy for the optimal use of available ART regimens in West African countries. Conclusion : Many questions remain unanswered regarding HIV-2. Epidemiologic, immunologic and genotypic resistances surveys will help improving the care of people living with HIV-2 the West African region.Contexte : L’infection par le VIH-2 touche un à deux millions de personnes en Afrique de l’Ouest et sa prise en charge se heurte à de nombreuses difficultés. En plus des erreurs diagnostiques observées avec les tests VIH, la résistance intrinsèque du VIH-2 aux Inhibiteurs non nucléosidiques de la transcriptase inverse et sa moindre sensibilité à certains inhibiteurs de protéase, rendent complexe le traitement de l’infection. A cela vient s’ajouter l’absence de données sur la mortalité et la rétention dans les soins,dans un contexte d’émergence de résistances aux différentes classes d’ARV. Méthode : Le présent travail de thèse, s’appuie sur la cohorte ouest africaine IeDEA-VIH-2 et la biothèque qui lui est rattachée, de même que l’essai ANRS 12294 FIT-2, pour décrire les modalités diagnostiques, explorer la réponse thérapeutique et décrire la mortalité et les perdus de vue, parmi les patients vivant avec le VIH-2 en Afrique de l’Ouest.Résultats : Un quart des patients VIH-2 ou doublement infectés, testés de novo avec les algorithmes nationaux, étaient en réalité monoinfectés par le VIH-1. Les tests GenieIII et ImmunoCombII se sont avérés être de bons candidats pour un algorithme d’identification des patients VIH-2. Pour ce qui est du traitement, les patients vivant avec le VIH-2 initiaient principalement des régimes ARV à base d’IP boostés, avec une bonne réponse immunologique et virologique. Les régimes à base de trois INTI produisaient une réponse inférieure à celles des IP, tandis que les régimes à base d’IPnon boosté produisaient une moins bonne réponse. Il existe chez les patients VIH-2,une mortalité sous traitement ARV qui était précoce et élevée (5,2 /100 patient-année),associée à l’anémie et à des CD4 bas (<100/mm3) à l’initiation des ARV. L’essai FIT-2 actuellement en cours permettra d’identifier les meilleures séquences d’initiation des régimes ARV disponibles dans les pays ouest africains. Conclusion De nombreuses questions restent encore en suspens concernant le VIH-2, les études épidémiologiques, immunologiques et génotypiques permettront d’améliorer la prise en charge des patients VIH-2 vivant en Afrique de l’Ouest

: J Public Health Afr

Little is known on the impact of HIV-2 infection on HCV viral replication. The aim of the study was to compare HCV prevalence and viral replication based on HIV types in West Africa. A cross-sectional survey was conducted within the IeDEA HIV-2 West Africa cohort from March to December 2012. All HIVinfected adult patients who attended participating HIV clinics during the study period were included. Blood samples were collected and re-tested for HIV type discrimination, HCV serology and viral load. A total of 767 patients were enrolled: 186 HIV-1, 431 HIV-2 and 150 HIV-1&2 dually reactive. At time of sampling, 531 (69.2%) were on ART and median CD4+ cell count was 472/mm(3). Thirty (3.9%, 95% CI 2.7-5.5) patients were anti-HCV positive (4.3% in HIV-1, 4.0% in HIV-1&2 dually reactive and 3.7% in HIV-2; p=0.91). Detectable HCV RNA was identified in 21 (70.0%) patients (100% in HIV-1 and HIV- 1&2 dually reactive vs. 43.8% in HIV-2; p=0.003). Systematic screening should be promoted and performed in this population, since HCV is now potentially curable in sub- Saharan Africa

Changes in HIV-Related Cervical Cancer Over a Decade in Cote d'Ivoire

PURPOSE: Major improvements have occurred in access to invasive cervical cancer (ICC) screening in HIV-infected women over the past decade in sub-Saharan Africa. However, there is limited information on changes in the burden of HIV-related ICC at a population level. Our objective was to compare HIV-related ICC over a decade and document factors associated with HIV infection in women with ICC in Côte d'Ivoire. METHODS: A repeated cross-sectional study was conducted in referral hospitals of Abidjan, Côte d'Ivoire, through the 2009-2011 and 2018-2020 periods. Women diagnosed with ICC were systematically tested for HIV. Demographics, ICC risk factors, cancer stage (International Federation of Gynecology and Obstetrics), and HIV characteristics were collected through questionnaires. Characteristics of HIV-related ICC were compared between the periods, and factors associated with HIV in women diagnosed with ICC in 2018-2020 were documented through a multivariable logistic model. RESULTS: During the 2009-2011 and 2018-2020 periods, 147 and 297 women with ICC were diagnosed with estimated HIV prevalence of 24.5% and 21.9% (P = .53), respectively. In HIV-infected women, access to antiretroviral treatment increased from 2.8% to 73.8% (P < 10(-4)) and median CD4 cell count from 285 (IQR, 250-441) to 492 (IQR, 377-833) cells/mm(3) (P = .03). In women diagnosed with ICC during the 2018-2020 period, HIV infection was associated with a less advanced clinical stage (International Federation of Gynecology and Obstetrics I or II stage) (adjusted OR, 2.2 [95% CI, 1.1 to 4.4]) and with ICC diagnosis through a systematic screening (adjusted OR, 10.5 [95% CI, 2.5 to 45.5]). CONCLUSION: Despite a persistently high proportion of HIV-related ICC over time in Côte d'Ivoire, HIV was associated with less advanced clinical stage at ICC diagnosis. Recent improvements in ICC screening services across HIV clinics might explain this association and support their implementation across non-HIV health facilities

Chronic viral hepatitis, HIV infection and Non-Hodgkin Lymphomas in West Africa, a case-control study

Non-Hodgkin Lymphomas (NHL) are underestimated causes of cancer in West Africa where chronic viral hepatitis and HIV are endemic. While the association with HIV infection has already been characterized, limited information is available on the association between chronic viral hepatitis and NHL in sub-Saharan Africa A case-control study was conducted in referral hospitals of Abidjan (Cote d'Ivoire) and Dakar (Senegal). Cases of NHL were matched with controls on age, gender and participating site. The diagnosis of NHL relied on local pathological examination completed with immunohistochemistry. HIV, HBV and HCV serology tests were systematically performed. A conditional logistic regression model estimated the associations by the Odds Ratio (OR) with their 95% confidence interval (CI). A total of 117 NHL cases (Abidjan n=97, Dakar n=20) and their 234 matched controls were enrolled. Cases were predominantly men (68.4%) and had a median age of 50 years (IQR 37 - 57). While Diffuse Large B-cell lymphoma were the most reported morphological type (n=35) among mature B-cell NHL, the proportion mature T-cell NHL (30%) was high. The prevalence figures of HBV, HCV and HIV infection were 12.8%, 7.7% and 14.5%, respectively among cases of NHL. In multivariate analysis, HBV, HCV and HIV were independently associated with NHL with OR of 2.23 (CI 1.05-4.75), 4.82 (CI 1.52-15.29) and 3.32 (CI 1.54-7.16), respectively. Chronic viral hepatitis B and C were significantly associated with NHL in West Africa. Timely preventive measures against HBV infection and access to curative anti-HCV treatment might prevent a significant number of NHL