Progression to WHO criteria for starting antiretroviral therapy in a 7-year cohort of adult HIV-1 seroconverters in Abidjan, Cote d'Ivoire

Abstract

Objective To estimate the probability of reaching the criteria for starting highly active antiretroviral therapy (HAART) in a prospective cohort of adult HIV-1 seroconverters in Abidjan, Côte d'Ivoire. Methods We recruited participants from HIV-positive donors at the blood bank of Abidjan for whom the delay since the estimated date of seroconversion (midpoint between last negative and first positive HIV-1 test) was < 36 months. Participants were offered early trimethoprim-sulfamethoxazole (cotrimoxazole) prophylaxis, twice-yearly measurement of CD4 count and we made standardized records of morbidity. We used the Kaplan-Meier method to estimate the probability of reaching the criteria for starting HAART according to WHO 2006 guidelines. Findings 217 adults (77 women (35%)) were followed up during 668 person-years (PY). The most frequent diseases recorded were mild bacterial diseases (6.0 per 100 PY), malaria (3.6/100 PY), herpes zoster (3.4/100 PY), severe bacterial diseases (3.1/100 PY) and tuberculosis (2.1/100 PY). The probability of reaching the WHO 2006 criteria for HAART initiation was estimated at 0.09, 0.16, 0.24, 0.36 and 0.44 at 1, 2, 3, 4 and 5 years, respectively. Conclusion Our data underline the incidence of the early HIV morbidity in an Ivorian adult population and provide support for HIV testing to be made more readily available and for early follow-up of HIV-infected adults in West Africa.Bulletin of the World Health Organization 2007;85: 116-123. Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. IntroductionExperts from the World Health Organization (WHO) and the United Nations Joint Programme on AIDS (UNAIDS) have estimated that at the end of 2005, 65% of the 39 million people with HIV worldwide were living in sub-Saharan Africa. 1 In Africa, only a small proportion of people who need highly active antiretroviral therapy (HAART) are currently being treated. However, the number who receive HAART has been increasing rapidly since 2004, and will continue to increase within the next few years thanks to national and international funds and initiatives.In 2003 and 2006, WHO experts defined criteria for initiating HAART in low-resource areas based on clinical criteria and, depending on the availability of laboratory facilities, either CD4 count or total lymphocyte count. Since cohort studies of patients from the time of HIV seroconversion are rare, little is known Methods PatientsRecruitment for the The Primo-CI ANRS 1220 prospective cohort started in 1997 in the HIV care clinic (FonSIDA clinic) of the Centre National de Transfusion Sanguine (CNTS), at the national blood bank of Abidjan.2 The study protocol was approved by the ethics committees of the national Ivorian program on AIDS and the institutional review board of the French Agency for Research on AIDS (ANRS).In the Côte d'Ivoire, blood donors are adult volunteers who are not paid. Blood donations are limited to five per year in men and four per year in women. ...

The natural history of HIV-1 subtype E infection in young men in Thailand with up to 14 years of follow-up

“…Another study of HIV-1 among female commercial sex workers in northern Thailand found a survival rate similar to our military cohort after 5-7 years of follow-up [19]. Several studies from sub-Saharan Africa [22][23][24], however, reported that the disease progression after HIV-1 infection was very similar to that reported from high income countries before the widespread use of HAART. The differences in disease progression among various populations may be the result of differences in the host, the viruses, or the environment.…”

Comparison of Early CD4 T-Cell Count in HIV-1 Seroconverters in Côte d'Ivoire and France: The ANRS PRIMO-CI and SEROCO Cohorts

“…There is good evidence of such a difference when it comes to the spectrum of HIV-related morbidity between regions, with active tuberculosis and invasive bacterial diseases being more frequent in sub-Saharan Africa than in industrialized countries. 3,10 Though curable, these diseases may lead to death in settings with limited access to diagnostic and treatment facilities and might explain a significant death rate in HIV-infected adults with CD4 + above 200 cells per cubic millimeter in sub-Saharan Africa. 11 Nevertheless, little is known about the potential link between this spectrum of morbidity or other region-specific factors and the CD4 + decrease in untreated sub-Saharan African adults.…”

Treatment acceleration program and the experience of the DREAM program in prevention of mother-to-child transmission of HIV

“…The program has demonstrated that there are many special circumstances that should be taken into consideration in managing patients from lowincome settings. The additional burden of diseaseincluding malnutrition, tuberculosis, anemia, malaria, and parasitosis -aggravates HIV disease itself [3,4] and in many cases appears to accelerate mortality, both in children and in adults [5][6][7]. It appears that western guidelines for initiation of antiretroviral treatment in HIV-positive patients do not take into account the background morbidity common in African countries, and initiation of treatment at higher strata of CD4 counts and in patients with lower body mass index may be warranted [8].…”