Abstract
ObjectivesTo evaluate the epidemiological evolution of patients with HIV (PtHIV), between 2002 and 2012, in a day-hospital that became an HIV reference centre for south-west Burkina Faso.Materials and MethodsThis was a retrospective study of PtHIV followed in the Bobo Dioulasso university hospital since 2002. The study was based on clinical data recorded using ESOPE software and analysed using Excel and SAS.ResultsA total of 7320 patients have been treated at the centre since 2002; the active file of patients increased from 147 in 2002 to 3684 patients in 2012. Mean age was stable at 38.4 years and the majority were female (71%). The delay to initiation of antiretroviral (ARV) treatment after HIV diagnosis decreased from 12.9 months in 2002 to 7.2 months in 2012. The percentage of PtHIV lost to follow-up, untreated for HIV and deaths all decreased after 2005. Voluntary anonymous screening and/or an evocative clinical picture were the main reasons for HIV diagnosis, usually at a late stage (41.1% at WHO stage 3). Virological success increased due to a decrease in time to initiation of ARV treatment and an increase in percentage of patients treated (90.5% in 2012, mainly with 1st line drugs). However, there was also a slight increase in the rate of therapeutic failures and the percentage of patients who progressed to 2nd or 3rd line-ARVs.ConclusionOur day-hospital is a good example of the implementation of a specialist centre for the management of PtHIV in a resource-limited country (Burkina Faso).
Highlights
Our day-hospital is a good example of the implementation of a specialist centre for the management of patients with HIV (PtHIV) in a resource-limited country (Burkina Faso)
In 2012, the UNAIDS report estimated that 35.3 million individuals worldwide were living with the human immunodeficiency virus (PtHIV), representing a prevalence of 0.8% [1]
Despite the massive scale-up of combination ART in lowincome and lower middle-income countries, CD4 cell counts at cART initiation have increased slightly [4], after 2010 when the WHO Guidelines for resource-limited settings were revised, increasing the CD4 cell count threshold for cART initiation in asymptomatic HIV-positive patients from 200 to 350 cells/mm3 irrespective of clinical symptoms [5,6]
Summary
In 2012, the UNAIDS report estimated that 35.3 million individuals worldwide were living with the human immunodeficiency virus (PtHIV), representing a prevalence of 0.8% [1]. This figure has increased constantly since 2001, in sub-Saharan Africa. A study of the International Epidemiological Database to Evaluate AIDS in Southern Africa (IeDEA-SA) has demonstrated that a lower CD4 count at cART initiation is associate with increased mortality [7]. An analysis of PEPFAR-supported HIV care clinics in eight sub-Saharan African countries found that CD4 cell counts at cART initiation increased as HIV testing coverage in the region increased [10]. In 2012, there were 95 public health institutions, private or community, offering HIV management in the 13 regions of the country [2]
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