Back
 AID  Vol.9 No.3 , September 2019
Prevalence and Factors Associated with Virologic Failure among People Living with HIV (PLHIV) Monitored in a Decentralized Health Care Facility
Abstract: Introduction: In Senegal, the decentralization of Health Care Centers has contributed significantly to the intensification of antiretroviral treatment. However, Care providers are still facing the treatment optimizing challenge. Objectives: To determine the prevalence of virologic failures of PLHIV monitored in a decentralized Health care center and to determine associated factors. Patients and Methods: This is a cross-sectional descriptive and analytical study of PLHIV, aged 18 years and over, on first-line treatment, monitored onsite from February 1st to December 31st, 2018. A data collection form was completed from medical records (clinical, immuno-virologic and evolutionary). Any VL > 1000 cp/ml after 6 months of antiretroviral therapy (ART) was considered as virologic failure. Data were captured and analysed using the EPI INFO 2002software. Chi-square test and the Fisher test were used to compare the proportions; a value of p ≤ 0.05 was considered significant. Results: 331 patients were treated with HIV-1 profile in 89% of cases. A proportion of 55% was married and 97% came from rural areas. 80% were either not or poorly educated. The median of age was 44 ± 11 years with a F/M ratio of 3.4. At baseline, 56% were symptomatic at stage 3 or 4 of WHO. They had severe immunosuppression with a median CD4 count of 217 ± 187 cells/mm3, the viral load was detectable in half of the patients with a median VL of 97,000 cp/ml ± 70,569. The antiretroviral regimen combined 2 NRTIs with 1 NNRTI in 88% of cases. The median of follow-up was estimated at 60 ± 43 months. The prevalence of virologic failure was 19%. This prevalence was associated with age less than 25 years (p = 0.04), late diagnosis (CD4 at baseline less than 200 cel/mm3 (p = 0.002), stage 3 or 4 WHO (p = 0.04) High viral load greater than 10,000 (p = 0.04) at baseline. Conclusion: These results suggest making the new therapeutic classes accessible for first-line treatment.
Cite this paper: Ba, S. , Ba, N. , Sembene, L. , Dia, H. , Coulibaly, M. , Ndiaye, J. , Dia, N. and Ndour, C. (2019) Prevalence and Factors Associated with Virologic Failure among People Living with HIV (PLHIV) Monitored in a Decentralized Health Care Facility. Advances in Infectious Diseases, 9, 226-237. doi: 10.4236/aid.2019.93016.
References

[1]   Cain, L.E., Logan, R., Robins, J.M., et al. (2011) When to Initiate Combined Antiretroviral Therapy to Reduce Mortality and AIDS-Defining Illness in HIV-Infected Persons in Developed Countries: An Observational Study. Annals of Internal Medicine, 154, 509-515.
https://doi.org/10.7326/0003-4819-154-8-201104190-00001

[2]   Cohen, M.S., Chen, Y.Q., McCauley, M., et al. (2011) Prevention of HIV-1 Infection with Early Antiretroviral Therapy. The New England Journal of Medicine, 365, 493-505.
https://doi.org/10.1056/NEJMoa1105243

[3]   Eaton, J.W., Menzies, N.A., Stover, J., et al. (2014) Health Benefits, Costs, and Cost-Effectiveness of Earlier Eligibility for Adult Antiretroviral Therapy and Expanded Treatment Coverage: A Combined Analysis of 12 Mathematical Models. The Lancet Global Health, 2, 23-34.
https://doi.org/10.1016/S2214-109X(13)70172-4

[4]   Grarup, J., Rappoport, C., Engen, N.W., et al. (2015) Challenges, Successes and Patterns of Enrolment in the Insight Strategic Timing of Anti-Retroviral Treatment (START) Trial. HIV Medicine, 16, 14-23.
https://doi.org/10.1111/hiv.12229

[5]   Grinsztejn, B., Hosseinipour, M.C., Ribaudo, H.J., Swindells, S., Eron, J., Chen, Y.Q., et al. (2014) Effects of Early versus Delayed Initiation of Antiretroviral Treatment on Clinical Outcomes of HIV-1 Infection: Results from the Phase 3 HPTN 052 Randomised Controlled Trial. The Lancet Infectious Diseases, 14, 281-290.
https://doi.org/10.1016/S1473-3099(13)70692-3

[6]   Conseil National de Lutte contre le Sida au Sénégal (2015-2016) Rapport de situation sur la riposte nationale à l’épidémie du VIH/SIDA SENEGAL.

[7]   Conseil National de Lutte contre le Sida au Sénégal (2018) Plan national stratégique de lutte contre le VIH au Sénégal 2018-2021.

[8]   De Beaudrap, P., Thiam, M., Diouf, A., Toure-Kane, C., Ngom-Gueye, N.F., Vidal, N., et al. (2013) Risk of Virological Failure and Drug Resistance during First and Second-Line Antiretroviral Therapy in a 10-Year Cohort in Senegal: Results from the ANRS 1215 Cohort. JAIDS Journal of Acquired Immune Deficiency Syndromes, 62, 381-387.
https://doi.org/10.1097/QAI.0b013e31827a2a7a

[9]   Diouara, A.A.M., Diop Ndiaye, H., Guindo, I., Bangoura, N., Cisse, M., Edmond, T., et al. (2014) Antiretroviral Treatment Outcome in HIV-1-Infected Patients Routinely Followed up in Capital Cities and Remote Areas of Senegal, Mali and Guinea-Conakry. Journal of the International AIDS Society, 17, 19315.
https://doi.org/10.7448/IAS.17.1.19315

[10]   Cissé, A.M., Laborde-Balen, G., Kébé-Fall, K., Dramé, A., Diop, H., Diop, K., et al. (2019) High Level of Treatment Failure and Drug Resistance to First-Line Antiretroviral Therapies among HIV-Infected Children Receiving Decentralized Care in Senegal. BMC Pediatrics, 19, 47.

[11]   Lawson, A.T.D., Lakhe, N.A., Dione, H., Toure, P.S., Ba, M., Niang, N., et al. (2018) Evaluation of Early Warning Indicators of ARV Resistance to HIV in the Hospital of Tivaouane from 2008 to 2016. Advances in Infectious Diseases, 8, 54-63.
https://doi.org/10.4236/aid.2018.82007

[12]   Kazooba, P., Mayanja, B.N., Levin, J., Masiira, B. and Kaleebu, P. (2018) Virological Failure on First-Line Antiretroviral Therapy; Associated Factors and a Pragmatic Approach for Switching to Second Line Therapy-Evidence from a Prospective Cohort Study in Rural South-Western Uganda, 2004-2011. Pan African Medical Journal, 29, 191.
https://doi.org/10.11604/pamj.2018.29.191.11940

[13]   Idindili, B., Jullu, B., Mugusi, F. and Tanner, M. (2012) A Case-Control Study of Factors Associated with Non-Adherence to Antiretroviral Therapy among HIV Infected People in Pwani Region, Eastern Tanzania. Tanzania Journal of Health Research, 14, 194-203.
https://doi.org/10.4314/thrb.v14i3.6

[14]   Meriki, H.D., Tufon, K.A., Afegenwi, M.H., Nyindem, B.A., Atanga, P.N. and Anong, D.N. (2014) Immuno-Haematologic and Virologic Responses and Predictors of Virologic Failure in HIV-1 Infected Adults on First-Line Antiretroviral Therapy in Cameroon. Infectious Diseases of Poverty, 3, 5.
https://doi.org/10.1186/2049-9957-3-5

[15]   Ka, D., Manga, N.M., Ngom-Guéye, N.F., Ndiaga, D., Diop, M., Cisse-Diallo, V.M.P., et al. (2017) Factors Associated with Immunovirologic Dissociation in HIV-1-Infected Patients under Highly Active Antiretroviral Therapy in the Ambulatory Treatment Center (ATC) in Dakar. Pan African Medical Journal, 27, 16.
https://doi.org/10.1684/mst.2017.0717

[16]   OMS (2007) Guide du conseil et du dépistage du VIH à l’initiative du soignant dans les établissements de santé.
http://www.who.int/publications/list/9789242595568/fr

[17]   Konou, A.A., Dagnra, A.Y., Vidal, N., et al. (2015) Alarming Rates of Virological Failure and Drug Resistance in Patients on Long-Term Antiretroviral Treatment in Routine HIV Clinics in Togo. AIDS, 29, 2527-2530.
https://doi.org/10.1097/QAD.0000000000000906

[18]   Penot, P., Héma, A., Bado, G., Kaboré, F., Sore, I., Sombie, D., et al. (2014) The Vulnerability of Men to Virologic Failure during Antiretroviral Therapy in Public Routine Clinic in Burkina Faso. Journal of the International AIDS Society, 17, 18646.
https://doi.org/10.7448/IAS.17.1.18646

[19]   Rupérez, M., Pou, C., Maculuve, S., Cedeño, S., Luis, L., Rodríguez, J., et al. (2015) Determinants of Virological Failure and Antiretroviral Drug Resistance in Mozambique. Journal of Antimicrobial Chemotherapy, 70, 2639-2647.
https://doi.org/10.1093/jac/dkv143

[20]   Sabin, C.A., Cooper, D.A., Collins, S. and Schechter, M. (2013) Rating Evidence in Treatment Guidelines: A Case Example of When to Initiate Combination Antiretroviral Therapy (cART) in HIV-Positive Asymptomatic Persons. AIDS, 27, 1839-1846.
https://doi.org/10.1097/QAD.0b013e328360d546

[21]   Manga, N.M., Diop, S.A., Ndour, C.T., Dia, N.-M., Mendy, A., Coudec, M., et al. (2009) Dépistage tardif de l’infection à VIH à la clinique des maladies infectieuses de Fann, Dakar: Circonstances de diagnostic, itinéraire thérapeutique des patients et facteurs déterminants. Médecine et maladies infectieuses, 39, 95-100.
https://doi.org/10.1016/j.medmal.2008.09.021

[22]   Harklerode, R., Waruiru, W., Humwa, F., Waruru, A., Kellogg, T., Muthoni, L., Macharia, J. and Zielinski-Gutierrez, E. (2019) Epidemiological Profile of Individuals Diagnosed with HIV: Results from the Preliminary Phase of Case-Based Surveillance in Kenya. AIDS Care, 1-7.
https://doi.org/10.1080/09540121.2019.1612021

[23]   WHO (2013) Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Recommendations for a Public Health Approach.
http://www.who.int/hiv/pub/arv/arv-2016/en

[24]   Ayele, G., Tessema, B., Amsalu, A., Ferede, G. and Yismaw, G. (2018) Prevalence and Associated Factors of Treatment Failure among HIV/AIDS Patients on HAART Attending University of Gondar Referral Hospital Northwest Ethiopia. BMC Immunology, 19, 37.
https://doi.org/10.1186/s12865-018-0278-4

[25]   Rawizza, H.E., Chaplin, B., Meloni, S.T., Eisen, G., Rao, T., Sankalé, J.L., et al. (2011) Immunologic Criteria Are Poor Predictors of Virologic Outcome: Implications for HIV Treatment Monitoring in Resource-Limited Settings. Clinical Infectious Diseases, 53, 1283-1290.
https://doi.org/10.1093/cid/cir729

[26]   Mutevedzi, P.C., Lessells, R.J., Rodger, A.J. and Newell, M.L. (2011) Association of Age with Mortality and Virological and Immunological Response to Antiretroviral Therapy in Rural South African Adults. PLoS ONE, 6, e21795.
https://doi.org/10.1371/journal.pone.0021795

[27]   Kamya, M.R., Mayanja-Kizza, H., Kambugu, A., Bakeera-Kitaka, S., Semitala, F., Mwebaze-Songa, P., et al. (2007) Predictors of Long-Term Viral Failure among Ugandan Children and Adults Treated with Antiretroviral Therapy. Journal of Acquired Immune Deficiency Syndromes, 46, 187-193.
https://doi.org/10.1097/QAI.0b013e31814278c0

[28]   Mosha, F., Muchunguzi, V., Matee, M., Sangeda, R.Z., Vercauteren, J., Nsubuga, P., et al. (2013) Gender Differences in HIV Disease Progression and Treatment Outcomes among HIV Patients One Year after Starting Antiretroviral Treatment (ART) in Dar es Salaam, Tanzania. BMC Public Health, 13, 38.
https://doi.org/10.1186/1471-2458-13-38

[29]   Kipp, W., Alibhai, A., Saunders, L.D., Senthilselvan, A., Kaler, A., Konde-Lule, J., et al. (2010) Gender Differences in Antiretroviral Treatment Outcomes of HIV Patients in Rural Uganda. AIDS Care, 22, 271-278.
https://doi.org/10.1080/09540120903193625

[30]   Gandhi, M., Aweeka, F., Greenblatt, R.M. and Blaschke, T.F. (2004) Sex Differences in Pharmacokinetics and Pharmacodynamics. Annual Review of Pharmacology and Toxicology, 44, 499-523.
https://doi.org/10.1146/annurev.pharmtox.44.101802.121453

[31]   Bulage, L., Ssewanyana, I., Nankabirwa, V., Nsubuga, F., Kihembo, C., Pande, G., et al. (2017) Factors Associated with Virological Non-Suppression among HIV-Positive Patients on Antiretroviral Therapy in Uganda, August 2014-July 2015. BMC Infectious Diseases, 17, 326.
https://doi.org/10.1186/s12879-017-2428-3

[32]   Anude, C.J., Eze, E., Onyegbutulem, H.C., Charurat, M., Etiebet, M.-A., Ajayi, S., et al. (2013) Immuno-Virologic Outcomes and Immuno-Virologic Discordance among Adults Alive and on Anti-Retroviral Therapy at 12 Months in Nigeria. BMC Infectious Diseases, 13, 113.
https://doi.org/10.1186/1471-2334-13-113

[33]   Penda, C.I., Bebey, F.S., Mangamba, D.K., Moukoko, E.C.E., Ngwa, V., Makouet, N., et al. (2013) échecs thérapeutiques chez les enfants infectés par le VIH en suivi de routine dans un contexte à ressources limitées au Cameroun. Pan African Medical Journal, 15, 80.
https://doi.org/10.11604/pamj.2013.15.80.2754

[34]   Ouedraogo, S.M., Zoungrana, J., Sondo, K.A., Barro, M., Kyélèm, C.G. and Konaté, I. (2015) Etude des facteurs associes a l’echec therapeutique au cours du suivi des enfants infecte par le vih1 sous traitement antiretroviral au CHU sanou souro de bobo-dioulasso (2007-2013). Le Mali médical, 30, 26-31.

[35]   Ndahimana, J.A., Riedel, D.J., Mwumvaneza, M., Sebuhoro, D., Uwimbabazi, J.C., Kubwimana, M., et al. (2016) Drug Resistance Mutations after the First 12 Months Onantiretroviral Therapy and Determinants of Virological Failure in Rwanda. Tropical Medicine and International Health, 21, 928-935.
https://doi.org/10.1111/tmi.12717

[36]   Stellbrink, H.J., Reynes, J., Lazzarin, A., Voronin, E., Pulido, F., Felizarta, F., Almond, S., et al. (2013) Dolutegravir in Antiretroviral-Naive Adults with HIV-1: 96-Week Results from a Randomized Dose-Ranging Study. AIDS, 27, 1771-1778.
https://doi.org/10.1097/QAD.0b013e3283612419

[37]   Rutherford, G.W. and Horvath, H. (2016) Dolutegravir plus Two Nucleoside Reverse Transcriptase Inhibitors versus Efavirenz plus Two Nucleoside Reverse Transcriptase Inhibitors as Initial Antiretroviral Therapy for People with HIV: A Systematic Review. PLoS ONE, 11, e0162775.
https://doi.org/10.1371/journal.pone.0162775

[38]   Clotet, B., Feinberg, J., van Lunzen, J., Khuong-Josses, M.A., Antinori, A., Dumitru, I., et al. (2014) Once-Daily Dolutegravir versus Darunavir plus Ritonavir in Antiretroviral-Naive Adults with HIV-1 Infection (FLAMINGO): 48 Week Results from the Randomised Open-Label Phase 3b Study. The Lancet, 383, 2222-2231.

[39]   Ba, S., Raugi, D.N., Smith, R.A., Sall, F., Faye, K., Hawes, S.E., et al. (2018) A Trial of a Single-Tablet Regimen of Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Disoproxil Fumarate for the Initial Treatment of Human Immunodeficiency Virus Type 2 Infection in a Resource-Limited Setting: 48-Week Results from Senegal, West Africa. Clinical Infectious Diseases, 67, 1588-1594.
https://doi.org/10.1093/cid/ciy324

[40]   WHO (2018) Updated Recommendations on First-Line and Second-Line Antiretroviral Regimens and Post-Exposure Prophylaxis and Recommendations on Early Infant Diagnosis of HIV: Interim Guidance. World Health Organization, Geneva.

[41]   UNAIDS (2017) Une nouvelle thérapie antirétrovirale de haute qualité sera lancée en Afrique du Sud, au Kenya et dans plus de 90pays à revenu faible et à revenu intermédiaire, pour un prix réduit UNAIDS.
http://www.unaids.org/fr/resources/presscentre/pressreleaseandstatementarchive/2017/
september/20170921_TLD


[42]   Ministère de la Sante et de l’Action Sociale du Sénégal: Division de Lutte contre le Sida et les IST. Plan de transition au Tenofovir/Lamivudine/Dolutégravir pour l’optimisation du Traitement Antiretroviral.

 
 
Top