ObjectiveTo examine how patient characteristics combined with ART eligibility expansions affect the initiation of antiretroviral therapy (ART) among eligible patients attending a referral center in Senegal from 1998 to 2015.MethodsThis is a retrospective observational study carried out at the outpatient treatment Centre (Centre de Traitement Ambulatoire) in Dakar, Senegal, based on computerized medical records, gathered from 1998 to 2015, of ART-naïve patients over 15 years of age. ART eligibility was defined as (CD4 count below 200) or as (WHO stage 4) or as (WHO stage 3 with (CD4 count below 350 or with unavailable CD4 count)) in 1998–2010; as (CD4 count below 350) or as (WHO stage 3 or 4) in 2011–2013; as (CD4 count below 500) or as (WHO stage 3 or 4) in 2014–2015. Four periods were defined according to ART eligibility expansions and Senegal’s HIV care history: 1998–2003 (P 1), 2004–2010 (P 2), 2011–2013 (P3), and 2014–2015 (P4). Patients were expected to participate financially in their treatment during the first period (P1).ResultsA total of 3651 patient records were included. The median patient age was 40 years (IQR: 32–48). Women represented 56% of the population. The median CD4 count was 183 cells/mm3. Overall, 53% of patients had CD4 < 200 cells/mm3 at entry. This proportion reached 45% in 2014–2015. 2535 patients (69%) were eligible for therapy, including 1503 (41%) who started ART. The proportion of treated patients among those who were eligible at entry or later increased steadily from 25%, 47%, 75% to 82% in the four periods, respectively. The median time to treatment decreased from 5.6 months (IQR: 3–11) in P1 to 0.8 months (IQR: 0–2) in P4. Eligible patients with more advanced disease (CD4<200 cells/mm3 and/or clinical stage 3 or 4) were more likely to be ART initiated than those with CD4≥200 cells/mm3 and/or clinical stage 1 or 2 at each stage of ART eligibility expansion.ConclusionART eligibility expansions were marked by a sharp increase in the proportion of eligible patients initiating treatment. These results show that in terms of management, the target of "Test and Treat" can be easily reached but that HIV testing will remain a key element to improve treatment success, as illustrated by the high proportion of people with advanced stage of infection at the time of ART initiation.

Introduction: Over the past years, efforts have been made to expand access to antiretroviral combinations (cART) in low-income countries. However, major concerns are noted with drug resistance emergence, as treatment failure result and need to introduce a second line treatment, more expensive and difficult to implement. The objective was to study the incidence of switch to second line, reasons for switch and risk factors using a cohort of people living with HIV in an Ambulatory Treatment Center in Dakar. Methodology: This was a cohort study of people living with HIV under cART from January 2004 to December 2013. Naive patients monitored for at least six months, regardless of their profile and regimen with baseline CD4 counts < 350 cells/mm 3 were included in this study. Results: The median age of the 827 patients included was 44 [IQR = 18-78]. The switch to second-line treatment was observed in 72 patients (8.7%) after an average of 38.5 months of follow-up. The overall incidence rate of switch to second line of antiretroviral treatment was 1.59 per 100 persons-years. Most of changes in first-line treatment were motivated by virological failures (n = 60, 83.3%) under treatment with AZT/3TC/NVP (n = 25, 34.7%) or AZT/3TC/EFV21 (29.2%). 9.7% of switch occurred after immunological failure, 1.4% after clinical failure, 4.2% after severe toxicity and 1.4% was not documented. Predictive factors identifying failures at the end of the multivariate analysis were age < 44 years and CD4 counts below 100 cells/mm 3. Conclusions: In total, CTA identified a low incidence rate of treatment failure of the first line of treatment. Associated risk factors were age < 44 years, CD4 counts below 100 cells/mm 3 and high viral load at treatment initiation.

Hepatitis B virus (HBV) infection is the first cause of liver cirrhosis and cancer in West Africa. Although the exposure to additional environmental and infectious risk factors may lead to the faster progression of liver disease, few large-scale studies have evaluated the determinants of HBV-related liver fibrosis in the region. We used transient elastography to evaluate the prevalence of liver fibrosis and assessed the association between HBV markers and significant liver fibrosis in a cohort of people living with HBV in Dakar, Senegal. The prevalence of significant liver fibrosis was 12.5% (95% confidence interval [CI] 9.6%–15.9%) among 471 people with HBV mono-infection (pwHBV) and 6.4% (95% CI 2.6%–12.7%) in 110 people with HIV/HBV co-infection (pwHIV/HBV) on tenofovir-containing antiretroviral therapy (p = 0.07). An HBV viral load > 2000 IU/mL was found in 133 (28.3%) pwHBV and 5 (4.7%) pwHIV/HBV, and was associated with significant liver fibrosis (adjusted odds ratio (aOR) 1.95, 95% CI 1.04–3.66). Male participants (aOR 4.32, 95% CI 2.01–8.96) and those with elevated ALT (aOR 4.32, 95% CI 2.01–8.96) were especially at risk of having significant liver fibrosis. Our study shows that people with an HBV viral load above 2000 IU/mL have a two-fold increase in the risk of liver fibrosis and may have to be considered for antiviral therapy, independent of other disease parameters.

The prevalence of active hepatitis B among asymptomatic persons remains unclear in Africa. Of 1,206 newly diagnosed persons in Senegal, 12.3% had significant fibrosis and 31.3% HBV DNA levels &gt;2,000 IU/mL. Overall, 128 (12.9%) were eligible for antiviral therapy. Generalized HBV screening allowed the identification of a large population requiring HBV care.

IntroductionLe tabagisme doublerait la mortalité chez les PvVIH un risque accru de survenue de maladies non classant Sida. La prévalence de la consommation de tabac est plus élevée chez les PvVIH que dans la population générale. Nous nous sommes fixés comme objectifs d'évaluer la prévalence du tabagisme chez les PvVIH, de décrire les caractéristiques cliniques et spirométriques des fumeurs et ex-fumeurs et d'évaluer leurs connaissances et attitudes face au tabagisme.MéthodesNous avons donc mené une étude transversale, descriptive et analytique du 15 Juillet au 15 Décembre 2015, chez les PvVIH suivis au Centre de Traitement Ambulatoire du Centre Hospitalier Universitaire National de Fann.RésultatsLa population d'étude concernait trois cents (300) PvVIH. Le sex-ratio était de 0,8. Nous avons retrouvé 15% de fumeurs et 23,7% d'ex-fumeurs. L'âge moyen des fumeurs était de 44,38 ± 9,55 ans. La quasi-totalité des fumeurs 91,1% avait déjà commencé à fumer avant la connaissance de leur statut sérologique et 35,6% d'entre eux avaient majoré leur consommation de tabac après. Les signes respiratoires étaient dominés par la gêne respiratoire dans 64,4% des cas chez nos fumeurs. Parmi les fumeurs qui ont bénéficié de la spirométrie, 67% d'entre eux avait un trouble ventilatoire obstructif non amélioré par les béta2-mimétiques et 28,1% un syndrome restrictif. Parmi les ex-fumeurs, 40,8% affirmait que le statut sérologique était le motif de sevrage.ConclusionLe tabagisme peut être initié ou majoré après connaissance du statut sérologique. Il peut être à l'origine de nombreuses complications chez le PvVIH.