Ambulatory Treatment Center Research Articles

Neutralizing antibody responses assessment after vaccination in people living with HIV using a surrogate neutralization assay

ObjectiveHIV has been reported to interfere with protective vaccination against multiple pathogens, usually through the decreased effectiveness of the antibody responses. We aimed to assess neutralizing antibody responses induced by COVID-19 vaccination in PLWH in Brazzaville, Republique of the Congo.MethodThe study was conducted at the Ambulatory Treatment Center of the National HIV Program, in charge of over 6000 PLWH, and the health center of FCRM in Brazzaville, Republic of the Congo. Participants were divided into two groups: PLWH with well-controlled HIV infection (CD4 counts no older than one week ≥ 800 / mm3, undetectable viral load of a period no older than one week and regularly taking Highly Active Antiretroviral Therapy for at least 6 months) and PLWOH. These groups were subdivided by vaccination status: fully vaccinated with adenovirus-based vaccines (Janssen/Ad26.COV2.S and Sputnik/Gam-COVID-Vac) or inactivated virus vaccine (Sinopharm/BBIP-CorV) and a control group of unvaccinated healthy individuals. All participants were RT-PCR negative at inclusion and/or with no documented history of SARS-CoV-2 infection. ELISA method was used for detecting IgG and neutralizing Antibodies against SARS-CoV-2 antigens using a commercial neutralizing assay.ResultsWe collected oropharyngeal and blood samples from 1016 participants including 684 PLWH and 332 PLWOH. Both PLWH and PLWOH elicited high levels of antibody responses after complete vaccination with inactivated virus vaccine (Sinopharm/BBIP-CorV) and adenovirus-based vaccines (Janssen/Ad26.COV2.S and Sputnik/Gam-COVID-Vac). Overall, no difference was observed in neutralization capacity between PLWOH and PLWH with well-controlled HIV infection.ConclusionThe results from this study underline the importance of implementing integrated health systems that provide PLWH the opportunity to benefit HIV prevention and care, at the same time while monitoring their vaccine-induced antibody kinetics for appropriate booster schedules.

Hepatocellular carcinoma surveillance among people living with hepatitis B in Senegal (SEN-B): insights from a prospective cohort study

Chronic hepatitis B virus (HBV) infection is the predominant cause of hepatocellular carcinoma in west Africa, yet data on the incidence of HBV-related hepatocellular carcinoma remain scarce. We aimed to describe the uptake and early outcomes of systematic ultrasound-based hepatocellular carcinoma screening in SEN-B, which is a prospective HBV cohort in Senegal. In this prospective cohort study, we included treatment-naive, HBsAg-positive individuals who were referred to the two infectious diseases clinics (the Department of Tropical and Infectious Diseases and Ambulatory Treatment Center) at Fann University Hospital of Dakar, Senegal, between Oct 1, 2019, and Oct 31, 2022. All participants resided within the Dakar region. Participants underwent abdominal ultrasound, transient elastography, and clinical and virological assessments at inclusion and every 6 months. Liver lesions at least 1 cm in diameter on ultrasound were assessed using four-phase CT, MRI, or liver biopsy. Adherence to hepatocellular carcinoma surveillance was measured using the proportion of time covered, calculated by dividing the cumulative months covered by abdominal ultrasound examinations by the overall follow-up time, defined as the number of months from the date of cohort entry until the last recorded visit, hepatocellular carcinoma diagnosis, or death. Optimal adherence was defined as a proportion of time covered of 100%. Overall, 755 (99·6%) of 758 participants had at least one abdominal ultrasound performed. The median age of the enrolled participants was 31 years (IQR 25-39), 355 (47·0%) of 755 participants were women, and 82 (10·9%) had a family history of hepatocellular carcinoma. 15 (2·0%) of 755 individuals were HBeAg positive, 206 (27·3%) of 755 individuals had HBV DNA of more than 2000 IU/mL, and 27 (3·6%) of 755 had elastography-defined liver cirrhosis. Of ten (1·3%) participants with a focal lesion at least 1 cm at initial assessment, CT or MRI ruled out hepatocellular carcinoma in nine, whereas imaging and subsequent liver biopsy confirmed one patient with hepatocellular carcinoma. Two further patients with hepatocellular carcinoma were diagnosed at study presentation due to the presence of portal thrombosis on ultrasound. Excluding the three participants with hepatocellular carcinoma identified at baseline, 752 participants were eligible for screening every 6 months. Median follow-up time was 12 months (IQR 6-18) and the median number of ultrasounds per patient was 3 (2-4). During 809·5 person-years of follow-up, one incident hepatocellular carcinoma was reported, resulting in an incidence rate of 1·24 cases per 1000 person-years (95% CI 0·18-8·80). Overall, 702 (93·0%) of 755 participants showed optimal hepatocellular carcinoma surveillance, but this proportion decreased to 77·8% (42 of 54 participants) after 24 months. Hepatocellular carcinoma screening is feasible in HBV research cohorts in west Africa, but its longer-term acceptability needs to be evaluated. Long-term hepatocellular carcinoma incidence data are crucial for shaping tailored screening recommendations. Swiss National Science Foundation, the Swiss Cancer Research Foundation, the National Cancer Institute, and Roche Diagnostics. For the French translation of the abstract see Supplementary Materials section.

Prevalence of therapeutic failure and evolution of biological factors amongst people living with HIV enrolled in antiretroviral therapy at the Ambulatory Treatment Center in Nouakchott, Mauritania.

The goal of this study is to determine the prevalence of therapeutic failure and the evolution of the biological factors after 6 and 12 months of anti-retroviral treatment (ART) amongst human immunodefeciency virus (HIV) Patients receiving care through the Ambulatory Treatment Center in Nouakchott. The study presents a descriptive and retrospective analysis of 479 patients enrolled in ART between January 2015 and January 2019, with focus on treatment failures and related biomarkers. The average age of the patients studied was 37 ± 12.94 years. The majority (52.8%) were males, of whom (52.6%) were married. The average body mass index (BMI) of the patients progressively increased after 6 and 12 months on ART. The average BMI increased from 20.3 ± 5.1 kg/m2 , before treatment, to 21.7 ± 5.0 kg/m2 and 22.7 ± 5.4 kg/m2 , after 6 and 12 months of treatment, respectively. Of the 479 patients, 97.3% were on 2 NRTIs + NNRTI. During the first 6 months of treatment, the clinical, immunological, and virological therapeutic failures were 0.6%, 34.10%, and 9%, respectively. After 6 and 12 months of ART, the TCD4, Hemoglobin, platelets, glycemia, creatinemia, and transaminase remained normal during the entire monitoring period. study demonstrated effective HIV treatment amongst the study patients. It showed clearance of virus and immune restoration can be attained after 6 and 12 months of ART. The number of patients who received the tests did decrease during the treatment period, which highlights the importance of adherence to patient management protocols, including clinical and biological monitoring.

Association between depressive symptoms and adherence among adolescents living with HIV in the Republic of Congo: A cross sectional study.

The increasing availability of antiretroviral therapy (ART) worldwide is yet to result in decreasing HIV-related mortality among adolescents (10–19 years old) living with HIV (ALHIV) in part because of poor adherence. the poor adherence might itself be due to high level of depression. We assess the prevalence of depressive symptomatology and it's associated with adherence among ALHIV receiving ART care in Brazzaville and Pointe Noire, Republic of Congo (RoC).Adolescents aged 10 to 19 years, on antiretroviral therapy (ART), followed in the two Ambulatory Treatment Centers (ATC) in Brazzaville and Pointe Noire, RoC were included in this cross-sectional study. From April 19 to July 9, 2018, participants were administered face to face interviews using a standardized questionnaire that included the nine-item Patient Health Questionnaire (PHQ-9). Participants who reported failing to take their ART more than twice in the 7 days preceding the interview were classified as non-adherent. Bivariate and multivariable log-binomial models were used to estimate the prevalence ratio (PR) and 95% confidence interval (95%CI) assessing the strength of association between predictors and presence of depressive symptoms (PHQ-9 score ≥9).Overall, 135 adolescents represented 50% of ALHIV in active care at the 2 clinics were interviewed. Of those, 67 (50%) were male, 81 (60%) were 15 to 19 years old, 124 (95%) had been perinatally infected, and 71 (53%) knew their HIV status. Depressive symptoms were present in 52 (39%) participants and 78 (58%) were adherent. In univariate analyses, the prevalence of depressive symptoms was relative higher among participants who were not adherent compared to those who were (73% vs 33%; PR: 2.20 [95%CI: 1.42–3.41]). In multivariate analysis, after adjustment for report of been sexually active, alcohol drinking, age category (10–14 and 15–19), not in school, loss of both parents, the association between depression and adherence was strengthened (PR: 2.06 [95%CI: 1.23–3.45]).The prevalence of depressive symptoms in adolescents living with HIV is high and was strongly associated with poor adherence even after adjustment of potential confounders. Efforts to scale-up access to screening and management of depression among ALHIV in sub-Saharan is needed for them to realize the full of ART.

Faible indice de masse corporelle et impact des antirétroviraux sur la néphrotoxicité, la maladie rénale chronique chez les patients infectés par le VIH à Brazzaville, Congo

ObjectiveTo describe the incidence and risks factors of ART induced nephrotoxicity and chronic kidney disease in HIV-1-infected adults with low body mass index (<18.5kg/m2). MethodsA retrospective cohort study at the Ambulatory Treatment Center in Brazzaville, Congo. Patients with estimated glomerular filtration rate decrease by 25% compared to baseline or a 0.5mg/dL increase in serum creatinine above baseline were classified as having nephrotoxicity, and chronic kidney disease was defined as a value less than 60mL/min/1.73m2. We used Cox proportional hazards regression models to determine factors associated with nephrotoxicity and chronic kidney disease. ResultsOf 325 patients, 73.23% were women. Median values were an age 37.55 years (IQR: 33.51–44.96), weight 45kg (IQR: 41–49), CD4 count 137.5 cells/μL (42–245). In the first 24–months, follow-up on ART incidence rate of nephrotoxicity and chronic kidney disease was 27.95 and 7.44 per 100 persons-year respectively. Multivariate analysis identified as a risk factor of nephrotoxicity, baseline haemoglobin below or equal 8g/dL (aHR=2.25; 95%CI 1.28–3.98; P=0.005) and the use of tenofovir (aHR=1.51; 95%CI 1.01–2.27; P=0.04). DFG between 60-80 mL/min/1.73 m2 (aHR=0.35; 95%CI 0.21–0.59; P<0.001) and 45-59mL/min/1.73 m2 (aHR=0.10; 95%CI 0.01–0.72; P=0.02) was not a contraindication for initiating antiretroviral therapy. Each 10-year older age was associated with an increased risk of developing chronic kidney disease (aHR=1.95; 95%CI 1.2–3.17; P=0.007). ConclusionIncidence of nephrotoxicity and chronic kidney disease were high. African HIV-positive patient with low body mass index at baseline need close monitoring of their renal function when treated with tenofovir.

ONS Staffing Position Statement: Ambulatory Treatment Centers.

Appropriate nurse staffing levels contribute to the delivery of safe quality care and optimal patient outcomes. However, developing nurse staffing models, particularly in the ambulatory setting, is an ongoing challenge. Within this position statement, the term ambulatory setting includes infusion centers that provide treatment to patients with cancer, including non-chemotherapy treatment centers (e.g., blood products) and radiation therapy treatment centers. These settings share commonalities, including rapid turnover of patients and the administration of some type of treatment or intervention. Nurse staffing refers to the clinical nurses in the setting and does not include advanced practice nurses or nurses in other roles.

Evaluation of Early Warning Indicators (EWI) of HIV Drug Resistance According to the World Health Organization (WHO) in Some Treatment Centers in Kinshasa

Background: The Early Warning Indicators (EWI) of Human Immunodefi-ciency Virus (HIV) Drug Resistance measure factors found at the site level and known to be associated with the proper functioning of the program and the prevention of the emergence of R-ARV. The fact strengthening certain aspects of implementation of the program at the sites can help minimize the occurring of HIV Drug Resistance that can be prevented to improve the long-term effectiveness and sustainability of the treatment. Objective: The objective of this study was to assess the quality of the prevention of resistance of HIV Drug compared to EWI set by the World Health Organization (WHO) in the different Ambulatory Treatment Centers (ACT) in the city of Kinshasa. Methods: The present work was a retrospective survey conducted in 2015 in 7 ACTs in the 4 districts of Kinshasa in order to evaluate the EWI. Results: Seven (7) ATCs and 157 patient records were selected based on different inclusion criteria. The maintenance of first-line Antiretroviral Treatment (ART) at 12 months and the consistent delivery of ARVs were the two EWI that were respected, evaluation at 100%, for 6 ACTs. Conclusion: The caregivers and HIV-infected patients should be trained on the EWI and their monitoring to prevent the occurrence of treatment failures and that of HIV drug resistance in Kinshasa.

Antiretroviral Therapeutic Profile in Patients Living with HIV with Chronic Kidney Disease

Chronic Kidney disease (CKD) is one of the important complications during HIV infection. The advent of Highly Active Antiretroviral Therapy (HAART) has significantly improved the prognosis of these patients. This was a descriptive and analytical cross-sectional study of people living with HIV received at the Ambulatory Treatment Center (ATC) of the Department of Infectious Diseases of Sylvanus Olympio University Hospital (CHU-SO). The study period was 6 months from January 1, 2018 to June 30, 2018. A total of 234 patients were enrolled during the study period. The mean age of patients at initiation of treatment was 42.07 ± 9.49 years with an average duration of follow-up under antiretroviral treatment of 5.61 ± 3.22 years. The female sex was predominant (70.09%) and a sex ratio (M/F) of 0.43. Most people living with HIV were mostly classified at clinical stage 2 (30.77) and 3 (31.62%) of WHO at initiation of HAART. The mean CD4 rate was 223.30 ± 143.764 at initiation of HAART and 462.58 ± 202.723 at the time of study. The frequency of CKD was 11.11%. The majority of patients were placed in a fixed combination of Tenofovir/Lamivudine/Efavirenz in a proportion of 81.20% of cases. In univariate analysis shows that age greater than 45 years (p = 0.017). Pathological proteinuria (p = 0.021) were associated with CKD. In multivariate analysis, only age (p = 0.045) and pathological proteinuria (p = 0.035) were significantly associated with CKD.

Chronic Kidney Disease (CKD) in Patients Living with HIV under Antiretroviral Treatment: Prevalence and Risk Factors

CKD is one of the major complications when infected by HIV. The surveillance of CKD indicators and control of its determinants in the HIV-infected population in our African communities is essential. This was a descriptive and analytical cross-sectional study of people living with HIV received at the Ambulatory Treatment Center (ATC) at Infectious Diseases department of Sylvanus Olympio University Hospital (CHU-SO). The study period was 6 months—from January 1, 2018 to June 30, 2018—CKD was defined by a clearance below 60 ml/min/1.73 m2 for at least 3 months. A total of 117 patients were enrolled during the study period. The average age of patients for trial treatment was between 9.49 and 42.0 7 years. The duration of follow-up for antiretroviral treatment was ±3.22 to ±5.64 years. The female gender was predominant (70.09%) with a sex ratio (M/F) of 0.43. Most of people living with HIV were mostly classified at clinical stage 2 (31.03%) and 3 (31.90%) of WHO at initiation of HAART. The main CD4 rate was 223.30 ± 143.764 at initiation of HAART and 462.58 ± 202.723 at the time of the study. The majority of patients were placed in a fixed combination of Tenofovir/Lamivudine/Efavirenz in a proportion of 81.20% cases. CKD was found in 13 patients—that is 11.11% of patients. Univariate analysis shows that age greater than 45 years plus (p = 0.017) and pathological proteinuria (p = 0.021) were associated with CKD. In multivariate analysis, only ages (p = 0.045) and pathological proteinuria (p = 0.035) were significantly associated with CKD. The prevalence of CKD in HIV-infected patients is significant in Togo. The occurrence of proteinuria is linked to the delay in taking antiretroviral therapy.

Dyslipidemia in People Living with HIV on Anti-Retroviral Treatment: Case of the Ambulatory Treatment Center (ATC) of the Sylvanus Olympio University Hospital of Lome

Introduction: Dyslipidemia is a significant cardiovascular risk factor in patients living with HIV (PLWHIV). Few data are available in Togo. Objective: The purpose of this study is to assess the prevalence of dyslipidemia and associated factors in PLWHIV on Highly Active Antiretroviral Therapy (HAART). Methods: This is a descriptive and analytical cross-sectional study of patients followed at the Sylvanus Olympio University Hospital’s infectious diseases department for six months. The study population consisted of any PLWHIV patient on HAART over 18 years of age who had been regularly monitored and had a serum lipid fraction assay. Results: Two hundred and eighty-four patients were included. 75.4% were women. The median age was 46 years (IQR: 39 - 52) and the median CD4 count was 461 cel/U1 (IQR: 330 - 607). Eighty-three percent of the patients had suppressed viral load. The median duration of follow-up under antiretroviral treatment antiretroviral treatment was 4.18 years (IQR: 2 - 7). The prevalence of dyslipidemia was 72.5%. HDL hypocholesterolemia (HDL-c < 40 mg/dl) was the most represented dyslipidemia in 49.6%. Body mass index, past treated tuberculosis, HAART regimen substitution, abdominal obesity, past smoking and being exposed to Nucleoside reverse transcriptase inhibitors (NRITs) were found to be factors associated to dyslipidemia. Conclusion: Our study revealed a high prevalence of dyslipidemia in patients on HAART as well as associated factors. To this end, it is necessary to insist on screening for dyslipidemia before and after initiation of HAART in order to prevent the occurrence of cardiovascular events in PLWHIV.

Global Cardiovascular Risk of the HIV Positive Patients Receiving Antiretroviral Therapy in Brazzaville

A cross-sectional, descriptive and analytical study was conducted from January to August 2015 at the Brazzaville Ambulatory Treatment Center and at the National Blood Transfusion Center. The objective was to contribute to improving the care of people living with HIV under antiretroviral therapy by assessing their global cardiovascular risk (CVR). The variables studied focused on the epidemiological, clinical and biological aspects. The global CVR was assessed by the Framingham and WHO/ISH scores. There were 135 HIV-positive subjects, including 64 treated patients and 71 untreated HIV+ subjects. The subjects were divided into 83 men (61.5%) and 52 women (38.5%), with an average age of 42.6 ± 2.9 old years. The subjects were single people (62.2%), of a secondary educational level (63.7%), and civil servants (32.6%). The main risk factors found were dyslipidaemia (60%), obesity (36%), smoking (12.6%), hypertension (5.9%), diabetes (0.7%). The metabolic syndrome was found in seven cases (11.3%). The global CVR according to the score of Framingham, initially moderated at 17.2%, and mean at 1.5% within treated patients, was mean at 9.4% and high at 1.6% of the subjects respectively at the sixth month of treatment (p < 0.03). For the score of the WHO/ISH, the risk was high at 2% and very high at 3% within treated patients initially. This risk was increased to 3.1% for the high and very high risk respectively at sixth month of treatment (p < 0.04). In Congo, the HIV population involves a high global CVR under antiretroviral therapy. Preventive actions are highly recommended.

Gestion Et Dispensation Des Medicaments Antiretroviraux A Brazzaville : Cas Du Centre De Traitement Ambulatoire (Cta) Et De La Pharmacie Du Centre Hospitalier Et Universitaire De Brazzaville (Chub)

In Congo, the distribution of generic drugs including ARVs (Antiretrovirals) is done through dispensing sites. This paper focuses on describing the management, delivery, and supply of ARVs at two sites in Brazzaville, and thus contributes to improving the management of HIVpositive patients. This is a cross-sectional, observational, descriptive, and analytical study of 3,473 patients registered at the Hospital and University Hospital Pharmacy (CHUB) and Ambulatory Treatment Center (CTA) during the period from 1st January to December 31, 2010. The data were collected using medical records, prescriptions, inventory sheets, purchase orders, delivery notes of the Congolaise of Essential Medicines Generic (COMEG), and informal interview with the heads of dispensing units. Of the 3473 patients registered, there were 1412 men (40.65%) and 2061 women (59.34%). A sex ratio of 0.68 at the pharmacy of CHUB 13427 boxes of ARVs was ordered unlike the CTA where this number was 30810 boxes of ARV. The COMEG delivered to the CTA 28,667 boxes of ARVs (93.04%) dispensing 18,994 boxes. Half of the ARVs dispensed were the triple combinations (56,48%). At the CHUB pharmacy, COMEG delivered 15,371 boxes of ARVs, of which 28.16% is also a triple therapy. The analysis of the system revealed a poor estimate of needs because the dispensing and management of these drugs does not conform to the active queue.

Therapeutic status of HIV-infected patients with at least 5 years of follow-up for antiretroviral therapy in a resource-limited setting: the experience of the CNHU ambulatory treatment center in Cotonou, Benin.

The aim of this study was to describe the therapeutic situation of patients who had been followed up for antiretroviral therapy for at least 5 years. A retrospective and descriptive study reviewed records of the historical cohort of adults infected with HIV in the national and teaching hospital at Cotonou from January 2, 2002, to March 31, 2013. It included all patients with follow-up for ART for at least five years. Immunological success was defined as a CD4 count above 350 cells/μl at the last test during the study period, and therapeutic success by viral load determined to be undetectable at its last measurement. Data were extracted from the updated ESOPE. STATA 11 software was used for data analysis. In March 2013, 979 patients, accounting for 27.1% of the overall cohort at the site, had been followed up for at least 5 years for ART. Their mean age was 38.1 ± 9.6years and the sex-ratio (M/F) was 0.7. Analysis showed that 12.3% had been lost to follow-up, 2.3% had died, and 83.6% remained in treatment. The mean CD4 count at treatment initiation was 113.4±90.7 cells/μl, at 5 years 566.6±355.2 cells/μl, and at 10 years, 557.5±311.2 cells/μl. More than half (56.1%) of patients were treated with a first-line ART combination. Immunological success was reported for 63.2% of the patients. Of the 144 patients with a last viral load available, the therapeutic success rate was 76.4%. The probability of survival was 0.95 at 5 years and 0.91 at 10 years. Improving the quality and continuity of care can help to ensure short-term survival for PLHIV under a first-line ART treatment in resource-limited countries.

A population based perspective of twenty years of specialized ambulatory treatment for alcohol use disorders in publicly financed clinics. Barcelona 1996–2015

ObjectiveTo provide information on persons treated for alcohol use disorders (AUD) over 20 years in a large city in a Southern European country and its trends, adding knowledge on the frequency of treatment from a population perspective. MethodsThis is a study of the number of annual admissions to ambulatory addiction treatment centers funded by the public sector in Barcelona (Catalonia, Spain) for the years 1996–2015. Descriptive analyses of AUD admissions were conducted, comparing changes in the number of patients entering treatment by different independent variables across periods. For city residents, sex and age-specific population annual treatment initiation rates were estimated. ResultsThe number of ambulatory admissions to AUD treatment increased over the study period. There were about 2100 treatment admissions per year in 2011–2015, of which one fourth were women. About half of these patients had never been treated before for any substance use disorder. Annual rates of treatment initiation among city residents were 208 and 68 per 100,000 people aged 15 and older for men and women respectively, almost the double among 45–54 years old citizens. Rates of total AUD treatment admission increased moderately, but declined among younger adult men. ConclusionsThese figures provide a basic population-based estimation for formal AUD treatment use in a Southern European urban setting with services available free of charge. The development of ambulatory publicly funded addiction centers may have improved access to treatment for people with AUD. age-related changes in treatment admissions may either be related to trends in the population pattern of drinking or to changes in the city demographics.

Factors associated to loss of follow-up in patients underwent antiretroviral therapy in an ambulatory HIV treatment center at Conakry

Late or inadequate therapeutic management increases the risk of mortality associated with HIV/AIDS. The aim of this study was to analyze the proportion and factors associated with loss of follow-up in HIV patients who receiving antiretroviral therapy at Conakry. A retrospective cohort study was conducted in HIV patients aged over 15 years and who receiving antiretroviral therapy. Between August 1, 2008 and July 31, 2015, all patients managed by the ambulatory treatment center of the Guinean Women Association against AIDS and sexually and transmissible infection were included. Loss of follow-up was defined as no follow-up visit within 3 months. Kaplan-Meier curves and multivariate Cox regression models were used to analyze factors associated with loss of follow-up. Analyses were performed by using Stata 13 software. 614 patients aged 36.3±11.2 years, mainly females (68.4%) and living in Conakry (80.5%) were included. Among them, 104 were loss to follow-up, corresponding to a proportion rate of 16.9% (95% CI: 14.2-19.7%) or 5.79/100 person-years. The results of multivariate analyses showed that factors independently associated with loss of follow-up were malnutrition (AHR=7.05; 95% CI: 2.05-24.27; P=0.002) and CD4 cells account at the initiation of AHR (2.35; 95% CI: 1.61-6.39; P=0.016) in patients with 201-350 CD4/μL and 5.83 (95% CI: 2.85-11.90; P<0.001) in patients with less than 150CD4/μL. Despite efforts of health care workers and free antiretroviral therapy, many patients were loss to follow-up. Multivariate analysis showed that malnutrition and low CD4 account were independently associated with loss to follow-up.

Factors Associated with Non-Adherence to Antiretroviral Therapy among HIV-Infected Adolescents at Pediatric Department of Yopougon University Hospital, C&amp;#244;te d’Ivoire

Context: The consequences of non-adherence to antiretroviral therapy (ART) are harmful in terms of morbidity and mortality among HIV-infected adolescents. There is a little data in this population in West Africa, about non-adherence to ART. Objective: To identify factors associated with non-adherence to ART in adolescents at the Pediatric Ambulatory Treatment Center (PATC) of the pediatric department of Yopougon University Hospital. Materials and Methods: A cross-sectional study was conducted from May to July 2017 among adolescents aged 10 to 19 years old at PATC of pediatrics department of Yopougon University Hospital. We have considered that adolescent was not adherent to ART when he affirm that he have not taking ART at least once in the week before the survey. A logistic regression model was used to identify factors associated with non-adherence to ART. Results: Overall 166 adolescents were included. The median age was 15 years old [IQI = 13 - 17 years]. They had a detectable viral load greater than 1000 copies/ml in 41.8% of cases. The rate of non-adherence to ART was 40.4%. The factors associated with non-adherence to ART were male [OR = 2.5 (CI = 1.1 - 10.0)], having parent widowed [OR = 7.8 (CI = 1.6 - 39.3)] or divorced [RC= 3.7 (IC=1.1 - 13.5)], CD4 inclusion rate ≥ 500 cells/ml [OR = 8.5 (CI = 1.6 - 45.5)] and duration on ART ≥ 10 years [OR = 8.9 (CI = 1.6 - 50)]. Conclusion: A rigorous therapeutic education taking into account associated factors in this study is necessary to reduce the rate of non-adherence among adolescents at PATC.

Prevalence of TB/HIV coinfection in antiretroviral-naïve patients at the Fann Ambulatory Treatment Center in Dakar.

To determine the prevalence of tuberculosis and describe its epidemiological, clinical, paraclinical, and therapeutic characteristics and its outcome in patients with HIV. This retrospective, descriptive, and analytical study examined the records of patients with HIV at our outpatient treatment center and selected those who were antiretroviral-naive and presented tuberculosis between January 2008 and December 2012. Among a total of 757 HIV-positive patients, 76had tuberculosis, for a prevalence of 10%. The sex ratio of 1.23favored men. The average age was 42.5years (range: 25 to 69years. Nearly all these patients (71cases) had HIV-1. A history of tuberculosis was reported by 39.5%. Seventeen patients were malnourished. Management included chemoprophylaxis with cotrimoxazole for 64patients. The pulmonary form predominated (72.4%). Among these forms, there were 34cases of negative microscopy tuberculosis and 21cases of positive microscopy tuberculosis. The extrapulmonary forms (21cases) were dominated by tuberculosis in the lymph nodes (11cases), the pleura (7), pericardium (2), and peritoneum (1). Anemia was found in 44patients. Severe immunosuppression was noted in 90%, with CD4+ cell counts <350/mm3. Lethality was 7.9%. TB/HIV coinfection is a major public health problem in Africa. Better coordination of activities in support of programs for tuberculosis and HIV/AIDS are needed.

Mucocutaneous manifestations in human immunodeficiency virus (HIV)-infected patients in Nouakchott, Mauritania.

Mucocutaneous manifestations are one of the first clinical signs in patients infected with human immunodeficiency virus (HIV). To the best of our knowledge, there has been no previous study describing dermatologic manifestations in Mauritanians infected with HIV. The aim of the present study was to determine the profiles of mucocutaneous manifestations in relation to CD4 T cell count in HIV-positive Mauritanian patients. A total of 86 adult patients aged > 18 years old attending the Ambulatory Treatment Center of the National Hospital of Nouakchott, Mauritania, with newly diagnosed HIV and who were not under antiretroviral treatment were included in the study in 2015. Dermatologic manifestations were documented before initiating antiretroviral treatment. Most of the included patients were in clinical stage 3 of the World Health Organization classification at initial diagnosis, with the mean CD4 T cell count (± SD) of 514 ± 319 cells/mm3 (range, 2-1328 cells/mm3 ), and 19 of 86 (22.1%) patients had CD4 T cell counts below 200 cells/mm3 . More than half (64%) of newly diagnosed HIV-infected patients had dermatoses, including the following: pruritic papular eruption (44.2%), seborrheic dermatitis (4.7%), Kaposi's sarcoma (3.5%), extensive xerosis cutis (2.3%), drug-induced skin reactions (1.2%), and various infectious dermatoses (dermatophyte infections [16.3%], oral candidiasis [11.6%], herpes zoster [8.1%], and scabies [2.3%]). A low CD4 T cell count (< 200 cells/mm3 ) was significantly correlated (P < 0.05) with the presence of following dermatoses: dermatophytosis, oral candidiasis, Kaposi's sarcoma, seborrheic dermatitis, and extensive xerosis cutis. Mucocutaneous lesions occur throughout the course of HIV infection, and dermatologic findings in Mauritanian HIV-positive patients are similar to those of patients in other countries. Early detection of skin disorders in some patients may help establish the diagnosis of HIV and management of HIV-associated diseases, limiting the cost of care in low-resource countries.

Epidemiological and Evolutionary Profile of HIV-HBV Co-Infected Patients Followed at Ambulatory Treatment Center in Fann Hospital Dakar-Senegal

CONTEXT: Human immunodeficiency virus (HIV) and Hepatitis B virus (HBV) infections are major global public health problems because of their frequency, complications and probable socio-demographic consequences.Viral hepatitis B is identified as more frequent cause of morbidity and mortality in people living with HIV.The objective of this study was to describe the epidemiological and evolutionary profile of HIV-HBV co-infected patients, treated at CTA/CHNU Fann, in Dakar, Senegal.METHODOLOGY: This is a retrospective, descriptive and analytical study of patients aged at least 18 years, co-infected with HIV-HBV and followed-up at CTA under ART for at least one year from January 2010 to December 2014.RESULTS: The study included 457 patients. 58 of these patients were diagnosed positive, (12.7%) of HIV-HBV prevalence. The average age of patients was 39.62 ± 10.12 years with extremes ranging from 21 to 61 years. The sex ratio was 1.23. (96%) of patients were infected with HIV-1 and those at WHO stages III and IV were (67%). The average CD4 count at baseline was 235 cells/mm3 [3-936]. Plasma HIV viral load average at baseline was 4.1 log copies/ml [3.89-5.12] copies/ml. The average body mass index (BMI) was 21.42 ± 3.82 Kg/m². Fever and degraded general status were respectively (65%) and (60%) followed by hepatomegaly and jaundice. The lethality was 3.45%. Of the 58 patients co-infected with HIV-HBV, 51/58 (87.93%) were under a therapeutic regimen containing Tenofovir/lamivudine or Tenofovir/Emtricitabine and 7 patients under a regimen containing lamivudine. At 48 weeks of treatment a good evolution of the biological parameters was noted: (90%) had a controlled viral load, (91%) a normal transaminase, (79%) a normal serum creatinine. Only 29% had a CD4 cell count &lt;350 cells/mm3.CONCLUSION: The Seroprevalence of viral hepatitis B remains relatively high (12.70%) among PLHIV in Dakar. While active search for hepatitis B has been effective in all PLHIV since 2010, overall management remains a challenge as hepatitis B markers and viral DNA assay are not at the reach of patients.

Prevalence of Hypertension and Associated Factors in Patients Living with HIV Followed at the Ambulatory Treatment Center (CTA) of Fann National University Hospital in Dakar

Introduction: The efficacy of antiretroviral therapy in people living with HIV (PLHIV) has been associated with an important increase in metabolic disorders, such as hypertension (HTA). This work allowed us to estimate the prevalence of hypertension in PLHIV and to describe associated factors. Methods: A retrospective, descriptive and analytical study was carried out based on the records of people living with HIV followed at the Ambulatory Treatment Center (CTA), from January 1st 1998 to 31st, December 2014. The WHO criteria were used to diagnose hypertension. Data entry was performed using ESOPE software and data analysis was done using Epi Info software version 3.5.3. A multiple logistic regression was used to identify the risk factors associated with hypertension. Results: During the study period, 3624 patients followed at CTA were included of which 1184 patients (32.7%) had hypertension. The average age was 47. 3 years ±10.5 years, with a sex ratio of 0.7. The most common opportunistic infections at diagnosis were tuberculosis (14.9%) and oral candidiasis (15.3%). The HIV infection was advanced (stage 3 or 4 of WHO classification) for 39% of cases. Overweight and obesity was found in 19.1%. Only 17.6% were treated by protease inhibitors. Higher average age (OR:1,05; IC [1.04 - 1.05], p = 0.000001), higher average BMI (OR:5,3; IC [3.3 - 8.5], p = 0.00001), WHO clinical stage I-II (OR:1,4; IC [1.2 - 1.6], p = 0.00003), and ARV treatment (OR:2,5; IC [1.7 - 3.7], p = 0.000001) are associated with the occurrence of hypertension. Conclusion: The prevalence of hypertension was high among PLHIV and associated factors were: advanced age, high BMI, WHO clinical stages I and II and antiretroviral therapy. Hence, the interest of a systematic screening of hypertension and others cardiovascular risk factors particularly in patients under ARV antiretroviral therapy.