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Increasing rate of TAMs and etravirine resistance in HIV-1-infected adults between 12 and 24 months of treatment: the VOLTART cohort study in Cote d'Ivoire, West Africa.

ABSTRACT: BACKGROUND:In sub-Saharan Africa, most HIV-infected patients receive antiretroviral therapy (ART) without virological monitoring. Longitudinal data on secondary resistance are rare. METHODS:We conducted a prospective cohort study of HIV-1-infected adults initiating ART in 3 clinics using computerized monitoring systems. Patients had plasma HIV-1 RNA viral load (VL) tests at months 12 (M12) and 24 (M24) after ART initiation and HIV-1 resistance genotype tests if VL was detectable (?300 copies/mL). RESULTS:Overall, 1573 patients initiated ART with stavudine/zidovudine plus lamivudine plus nevirapine/efavirenz. At M12 and M24, 944 and 844 patients, respectively, remained in active follow-up. Among them, 25% (M12) and 27% (M24) had detectable VLs and 12% (M12) and 19% (M24) had virus resistant to at least 1 antiretroviral drug, accounting for 54% (M12) and 75% (M24) of patients with detectable VLs. Among the resistant strains, 95% (M12) and 97% (M24) were resistant to lamivudine/emtricitabine, efavirenz, and/or nevirapine, the frequency of thymidine analog mutations increased from 8.1% (M12) to 14.7% (M24) and etravirine resistance increased from 13.5% (M12) to 24.5% (M24). CONCLUSIONS:Of the patients with detectable VLs at M24, 25% still did not harbor resistant virus. Preventing mutations from emerging with adherence reinforcement in patients with detectable VLs remains important beyond M24. Switching therapy early in patients with resistance to 3 TC/FTC and/or to nonnucleoside reverse transcriptase inhibitors to prevent extended resistance to nucleoside reverse transcriptase inhibitors and etravirine resistance from occurring is also a major challenge.

SUBMITTER: Messou E

PROVIDER: S-EPMC3834582 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Increasing rate of TAMs and etravirine resistance in HIV-1-infected adults between 12 and 24 months of treatment: the VOLTART cohort study in Côte d'Ivoire, West Africa.

Messou Eugène E Chaix Marie-Laure ML Gabillard Delphine D Yapo Vincent V Toni Thomas-d'Aquin TD Minga Albert A Kouakou Martial Guillaume MG Ouattara Eric E Rouzioux Christine C Danel Christine C Eholie Serge P SP Anglaret Xavier X

Journal of acquired immune deficiency syndromes (1999) 20131001 2

<h4>Background</h4>In sub-Saharan Africa, most HIV-infected patients receive antiretroviral therapy (ART) without virological monitoring. Longitudinal data on secondary resistance are rare.<h4>Methods</h4>We conducted a prospective cohort study of HIV-1-infected adults initiating ART in 3 clinics using computerized monitoring systems. Patients had plasma HIV-1 RNA viral load (VL) tests at months 12 (M12) and 24 (M24) after ART initiation and HIV-1 resistance genotype tests if VL was detectable ( ...[more]

PMID: 23797690

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Project description:BackgroundPopulations of vultures in Africa have experienced a rapid decline over recent decades, with some species suffering losses of more than 90%. Various forms of human pressures have been identified as the causes of this decline. However, very little is known about the complex interaction between cultural practises, traditional medicine and the vultures' natural environment. The purpose of this study was to analyse human pressures on vultures in relation with cultural attitudes such as their demand for magico-traditional medicine in Côte d'Ivoire, around the Comoé National Park (CNP), one of the last major refuges of these organisms in West Africa.MethodsEleven surrounding villages were visited to carry out ethno-ornithology surveys. One hundred and ten people were interviewed, at a rate of ten people per village, using a semi-structured questionnaire and informal discussions.ResultsThe findings showed that vultures are still being seen both in and around the CNP. The most common species indicated to be observed and indicated by the interviewees were the Hooded Vulture (Necrosyrtes monachus) and the White-headed Vulture (Trigonoceps occipitalis). Nevertheless, 98.2% of the interviewees indicated having observed a decrease in the abundance of vultures over the last few years in the study area, as well as a decline in the number of sightings of these organisms. Interviewees attributed this scarcity of vultures to (1) the limited availability of food resources, (2) pesticide and tobacco poisoning, (3) hunting, (4) rapid population growth, (5) annual bushfires and (6) habitat loss. The uses of the vulture or parts of vultures by the populations surrounding the CNP (traditional medicine, mystic practises, consumption as food, cultural heritage) were also highlighted as real threats to these organisms. And the vulture parts commonly used in this area are: feathers, legs, head, heart, stomach, brain and excrement. The Hooded Vulture (Necrosyrtes monachus) appears to be the most sought-after species and the most widely used for these practises in the study area.ConclusionAppropriate conservation and communication initiatives are required to ensure the survival of these raptors, crucial for ecosystem well-being, while also ensuring a respect of cultural practises.

Project description:BackgroundMany fungal species in tropical Africa are useful, with high added value, and play essential roles in the structure and dynamic of ecosystems. However, the diversity, distribution, and uses by local populations of these non-timber forest products (NTFPs) and their respective habitats are still very poorly understood in sub-Saharan Africa in general and more specifically in Côte d'Ivoire. This study aims at (i) inventorying the wild useful mushrooms of Côte d'Ivoire within its major protected areas and their respective surrounding sociolinguistical groups, according to climatic and phytogeographical gradients, and (ii) recording ethnomycological knowledge and considerations of these local people.MethodsField and ethnomycological surveys were conducted in the main and highest protected areas of Côte d'Ivoire (Comoé, Marahoué, and Taï national parks) and a set of their respective surrounding villages, along climatic and phytogeographical gradients. Standardized methods (permanent plots and opportunistic searches) were used for field surveys. In addition, a total 748 respondents belonging to 13 ethnic groups were interviewed at a rate of 300 interviewees during the preliminary investigations and 448 persons during the proper ethnomycological surveys.ResultsSixty-eight useful wild fungal species, belonging to 17 families and 23 genera, were listed and collected. Four categories of usage were reported by the rural people (food, medicinal, belief and recreational), with a dominance of food and medicinal uses. Fifty-six species were reported to be used as food and 16 species as medicinal fungi. These uses varied not only from one sociolinguistical group to another but also from a visited village to another. The high number (41) of the reported useful species was found in the Sudano-Guinean savanna zone while 28 species were collected in the forest zone and 22 species in the forest-savanna mosaic zone. These mushrooms were either saprotrophic or symbiotic (ectomycorrhizal or termitophilic). Auricularia sp3, Psathyrella tuberculata, and Termitomyces spp. were found as the most commonly used mushrooms.ConclusionsThese national scale field and ethnomycological surveys give one of the more complete but non-exhaustive list of useful mushrooms of Côte d'Ivoire. Mushrooms are relatively well known and used by the Ivorian people within the main phytogeographical zone of the country. These people also have an interest in all the functional groups with an important phytogeographical zone-fungal-specific used species. However, protected areas of the visited zones seem to represent the last sanctuaries of these organisms due to high rate of loss of natural habitats.

Project description:BACKGROUND:Immunization is one of the most cost-effective health intervention to halt the spread of childhood diseases, and improve child health. Yet, there is a substantial disparity in childhood immunization coverage. The overall objective of the study is to investigate the trends of within-country inequalities in childhood immunization coverage among children aged 12-23?months in Kenya, Ghana, and Côte d'Ivoire. The three countries included in this study are countries that are on the verge of entering the accelerated phase of the Gavi, the Vaccine Alliance's co-sharing of costs of vaccine and eventually assuming full costs of vaccines. Côte d'Ivoire is in the Gavi preparatory transition phase, entering the accelerated transition phase in 2020, with an expected transition to full self-financing in 2025. Ghana is expected to enter the accelerated transition phase in 2021 and to full self-financing in 2026 while Kenya will enter in 2022 and fully self-finance in 2027. We examine the pattern of inequality in childhood immunization coverage over time through an equity lens by mainly exploring the direction of inequality in coverage. METHODS:We use data from the Demographic Health Surveys and Multiple Indicator Cluster Surveys. The rate difference, rate ratio, and relative concentration index are used as measures of inequality. RESULTS:Results of the study suggest that in most years inequality in immunization coverage in the three countries persist over time, and it favors the most-advantaged households. However, there is a sharp decrease pattern in inequalities in childhood immunization coverage in Ghana over time. CONCLUSION:Policymakers could be more strategic in addressing pro-rich inequality in immunization coverage by designing health interventions through an equity lens. Using inequality data and putting disadvantaged households at the center of health intervention designs could increase the efficiency of the primary health care system and reduce the incidence of mortality and morbidity as a result of vaccine-preventable disease.

Project description:ObjectivesDespite the increasing number of interventions aiming to integrate cervical cancer screening into HIV clinics in sub-Saharan Africa, Women living with HIV (WLHIV) still have a high risk of developing cervical cancer. The aim of this study was to estimate the coverage of cervical cancer screening and associated factors among WLHIV in Abidjan, Côte d'Ivoire.DesignCross-sectional survey conducted from May to August 2017.SettingsOutpatient setting in the four highest volume urban HIV clinics of government's or non-governmental organisation's sector in Côte d'Ivoire.ParticipantsAll WLHIV, aged 25-55 years, followed since at least 1?year, selected through a systematic sampling procedure.InterventionA standardised questionnaire administered to each participant by trained healthcare workers.OutcomeCervical cancer screening uptake.ResultsA total of 1991 WLHIV were included in the study, aged in median 42 years (IQR 37-47), and a median CD4 count (last known) of 563 (378-773) cells/mm3. Among the participants, 1913 (96.1%) had ever heard about cervical cancer, 1444 (72.5%) had been offered cervical cancer screening, mainly in the HIV clinic for 1284 (88.9%), and 1188 reported a personal history of cervical cancer screening for an overall coverage of 59.7% (95% CI 57.6 to 62.0). In multivariable analysis, university level (adjusted OR (aOR) 2.1; 95% CI 1.4 to 3.1, p<0.001), being informed on cervical cancer at the HIV clinic (aOR 1.5; 95% CI 1.1 to 2.0, p=0.017), receiving information self-perceived as 'clear and understood' on cervical cancer (aOR 1.7; 95% CI 1.4 to 2.2, p<0.001), identifying HIV as a risk factor for cervical cancer (aOR 1.4; 95% CI 1.1 to 1.8, p=0.002) and being proposed cervical cancer screening in the HIV clinic (aOR 10.1; 95% CI 7.6 to 13.5, p<0.001), were associated with cervical cancer screening uptake.ConclusionInitiatives to support cervical cancer screening in HIV care programmes resulted in effective access to more than half of the WLHIV in Abidjan. Efforts are still needed to provide universal access to cervical cancer screening, especially among socioeconomically disadvantaged WLHIV.

Project description:IntroductionThe long-term prognosis of HIV-2-infected patients receiving antiretroviral therapy (ART) is still challenging, due to the intrinsic resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI) and the suboptimal response to some protease inhibitors (PI). The objective was to describe the 5-years outcomes among HIV-2 patients harboring drug-resistant viruses.MethodsA clinic-based cohort of HIV-2-patients experiencing virologic failure, with at least one drug resistance mutation was followed from January 2012 to August 2017 in Côte d'Ivoire. Follow-up data included death, lost to follow-up (LTFU), immuno-virological responses. The Kaplan-Meier curve was used to estimate survival rates.ResultsA total of 31 HIV-2 patients with virologic failure and with at least one drug resistance mutation were included. Two-third of them were men, 28(90.3%) were on PI-based ART-regimen at enrolment and the median age was 50 years (IQR = 46-54). The median baseline CD4 count and viral load were 456 cells/mm3 and 3.7 log10 c/mL respectively, and the participants have been followed-up in median 57 months (IQR = 24-60). During this period, 21 (67.7%) patients switched at least one antiretroviral drug, including two (6.5%) and three (9.7%) who switched to a PI-based and an integrase inhibitor-based regimen respectively. A total of 10(32.3%) patients died and 4(12.9%) were LTFU. The 36 and 60-months survival rates were 68.5% and 64.9%, respectively. Among the 17 patients remaining in care, six(35.3%) had an undetectable viral load (<50 c/mL) and for the 11 others, the viral load ranged from 2.8 to 5.6 log10 c/mL. Twelve patients were receiving lopinavir at the time of first genotype, five(42%) had a genotypic susceptibility score (GSS) ≤1 and 4(33%) a GSS >2.ConclusionsThe 36-months survival rate among ART-experienced HIV-2 patients with drug-resistant viruses is below 70%,lower than in HIV-1. There is urgent need to improve access to second-line ART for patients living with HIV-2 in West Africa.

Project description:BACKGROUND:Lymphatic filariasis (LF) is widely endemic in Côte d'Ivoire, and elimination as public health problem (EPHP) is based on annual mass drug administration (MDA) using ivermectin and albendazole. To guide EPHP efforts, we evaluated Wuchereria bancrofti infection indices among humans, and mosquito vectors after four rounds of MDA in four cross-border health districts of Côte d'Ivoire. METHODOLOGY:We monitored people and mosquitoes for W. bancrofti infections in the cross-border health districts of Aboisso, Bloléquin, Odienné and Ouangolodougou, Côte d'Ivoire. W. bancrofti circulating filarial antigen (CFA) was identified using filariasis test strips, and antigen-positive individuals were screened for microfilaremia. Moreover, filarial mosquito vectors were sampled using window exit traps and pyrethrum sprays, and identified morphologically at species level. Anopheles gambiae s.l. and Culex quinquefasciatus females were analyzed for W. bancrofti infection using polymerase chain reaction (PCR) technique. PRINCIPAL FINDINGS:Overall, we found a substantial decline in W. bancrofti infection indices after four rounds of MDA compared to pre-MDA baseline data. CFA prevalence fell from 3.38-5.50% during pre-MDA to 0.00-1.53% after MDA interventions. No subjects had detectable levels of CFA in Ouangolodougou. Moreover, post-MDA CFA prevalence was very low, and below the 1% elimination threshold in Aboisso (0.19%) and Odienné (0.49%). Conversely, CFA prevalence remained above 1% in Bloléquin (1.53%). W. bancrofti microfilariae (Mf) were not found in Aboisso, Bloléquin, and Ouangolodougou, except for Odienné with low prevalence (0.16%; n = 613) and microfilaremia of 32.0 Mf/mL. No An. gambiae s.l. and Cx. quinquefasciatus pools were infected with W. bancrofti in Bloléquin and Ouangolodougou, while they exhibited low infection rates in Aboisso (1% and 0.07%), and Odienné (0.08% and 0.08%), respectively. CONCLUSIONS:In cross-border areas of Côte d'Ivoire, LF infection indices in humans and mosquito vectors substantially declined after four rounds of MDA. CFA prevalence fell under the World Health Organization (WHO)-established threshold (1%) in Aboisso, Ouangolodougou and Odienné. Moreover, W. bancrofti prevalence in mosquitoes was lower than WHO-established threshold (2%) in all areas. This might suggest the interruption of W. bancrofti transmission, and possible MDA cessation. However, a formal transmission assessment survey (TAS) and molecular xenomonitoring in mosquito vectors should be implemented before eventual MDA cessation. However, MDA should pursue in Bloléquin where W. bancrofti infection prevalence remained above 1%. Our results provided important ramifications for LF control efforts towards EPHP in Côte d'Ivoire.

Dataset Information

Increasing rate of TAMs and etravirine resistance in HIV-1-infected adults between 12 and 24 months of treatment: the VOLTART cohort study in Cote d'Ivoire, West Africa.

Publications

Increasing rate of TAMs and etravirine resistance in HIV-1-infected adults between 12 and 24 months of treatment: the VOLTART cohort study in Côte d'Ivoire, West Africa.

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