HIV drug resistance and hepatitis co-infections in HIV-infected adults and children initiating antiretroviral therapy in Rwanda

Abstract

Since the roll-out of antiretroviral therapy (ART), few data have been generated on outcomes and outcome predictors of ART in adults and children in Rwanda. Equally, the extent of chronic hepatitis virus infections and their impact on the ART outcomes in the country are not known. This information is crucial to inform the choice of empiric first- and second-line ART regimen, ensure adequate clinical management of opportunistic infections and improve the overall performance of the ART programme. We assessed clinical, immunological, and virological outcomes including risk factors for developing HIV drug resistance (HIVDR) in HIV -infected adults and children initiating ART in Rwanda. The burden of the hepatitis B and C infection among the two populations was also explored. The main findings can be summarized as follows: - The limitation of clinico-immunological criteria to detect virological failure are confirmed, highlighting the need for better access to viral load testing to reduce acquired HIVDR. - Rates of baseline and transmitted HIVDR are low. However an increase in the distribution of A/C recombinant viruses warrants additional investigations on the transmissibility and drug susceptibility of this emerging strain. - Treatment outcomes among children are less favorable than among adults, suggesting needed adjustment of pediatric HIV care. - Relatively high prevalence of Hepatitis B and C among HIV patients justifies the systematic identification, treatment and prevention of these diseases whenever possible. Studies included in this thesis were funded by NWO-WOTRO and conducted as part of the Infectious Disease Network for Treatment and Research in Africa (INTERACT) programme