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Li Z, Winer RL, Ba S, Sy MP, Lin J, Feng Q, Gottlieb GS, Salif Sow P, Kiviat NB, Hawes SE. Effect of Human Immunodeficiency Virus Infection on Human Papillomavirus Clearance Among Women in Senegal, West Africa. J Infect Dis 2023; 227:1088-1096. [PMID: 36314598 PMCID: PMC10319963 DOI: 10.1093/infdis/jiac428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Persistent infection with high-risk human papillomavirus (HPV) is associated with development of invasive cervical cancer. METHODS Longitudinal data was collected from 174 Senegalese women. We employed marginal Cox proportional hazards models to examine the effect of human immunodeficiency virus (HIV) status (HIV positive vs HIV negative) and HIV type (HIV-1 vs HIV-2 vs dual HIV-1/HIV-2) on clearance of type-specific HPV infection. Analyses were stratified by incident versus prevalent HPV infection. RESULTS Incident HPV infections in HIV-positive women were less likely to clear than those in HIV-negative women (adjusted hazard ratio [HR] = 0.60; 95% confidence interval [CI], .38-.94). Among HIV-positive women, HIV-2-infected women and HIV-1/2 dually infected women were more likely to clear HPV incident infections than HIV-1-infected women (HR = 1.66; 95% CI, .95-2.92 and HR = 2.17; 95% CI, 1.12-4.22, respectively). Incident HPV infections in HIV-positive women with CD4 cell count ≤500 cells/μL were less likely to clear than those in HIV-positive women with CD4 cell count >500 cells/μL (HR = 0.65; 95% CI, .42-1.01). No significant associations were observed for prevalent HPV infections. CONCLUSIONS HIV infection reduced the likelihood of clearance of incident HPV infection. Furthermore, among HIV-positive women, low CD4 cell count and dual HIV infection were each associated with reduced likelihood of clearance.
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Affiliation(s)
- Zhuochen Li
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Selly Ba
- Service des Maladies Infectieuses Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Sénégal
| | - Marie Pierre Sy
- Service des Maladies Infectieuses Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Sénégal
| | - John Lin
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Pathology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Qinghua Feng
- Department of Pathology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Geoffrey S Gottlieb
- Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Papa Salif Sow
- Service des Maladies Infectieuses Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Sénégal
| | - Nancy B Kiviat
- Department of Pathology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
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Fuge TG, Tsourtos G, Miller ER. Risk factors for late linkage to care and delayed antiretroviral therapy initiation amongst HIV infected adults in sub-Saharan Africa: a systematic review and meta-analyses. Int J Infect Dis 2022; 122:885-904. [PMID: 35843499 DOI: 10.1016/j.ijid.2022.07.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Late treatment initiation threatens the clinical and public health benefits of antiretroviral therapy (ART). Quantitative synthesises of the existing evidence related to this is lacking in sub-Saharan Africa (SSA), which would help ascertain the best evidence-based interventions. This review aimed to systematically synthesise the available literature on factors affecting linkage to care and ART initiation amongst HIV-infected adults in SSA. METHODS Systematic searches were undertaken on four databases to identify observational studies investigating factors affecting both HIV care outcomes amongst adults (age ≥19 years) in SSA, and were published between January 1, 2015 and June 1, 2021. RevMan-5 software was used to conduct meta-analyses and Mantel-Haenszel statistics to pool outcomes with 95% confidence interval and <0.05 level of significance. RESULTS Forty-six studies were included in the systematic review, of which 18 fulfilled requirements for meta-analysis. In both narrative review and meta-analyses, factors related to health care delivery, individual perception and sociodemographic circumstances were associated with late linkage to care and delays in ART initiation. CONCLUSION This review identified a range of risk factors for late linkage to care and delayed ART initiation amongst HIV-infected adults in SSA. We recommend implementation of patient-centred intervention approaches to alleviate these barriers.
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Affiliation(s)
- Terefe Gone Fuge
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - George Tsourtos
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Emma R Miller
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Ramírez Mena A, Tine JM, Fortes L, Ndiaye O, Ka D, Ngom NF, Ramette A, Bittel P, Seydi M, Wandeler G. Hepatitis B screening practices and viral control among persons living with HIV in urban Senegal. J Viral Hepat 2022; 29:60-68. [PMID: 34610183 PMCID: PMC9293347 DOI: 10.1111/jvh.13615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 01/15/2023]
Abstract
Chronic hepatitis B virus (HBV) infection affects >10% of the general population and is the leading cause of liver cirrhosis and cancer in West Africa. Despite current recommendations, HBV is often not tested for in clinical routine in the region. We included all people living with HIV (PLWH) in care between March and July 2019 at Fann University Hospital in Dakar (Senegal) and proposed hepatitis B surface antigen (HBsAg) test to those never tested. All HBsAg-positive underwent HIV and HBV viral load (VL) and liver stiffness measurement. We evaluated, using logistic regression, potential associations between patient characteristics and (a) HBV testing uptake; (b) HIV/HBV co-infection among individual HBsAg tested. We determined the proportion of co-infected who had HBV DNA >20 IU/ml on ART and sequenced HBV polymerase in those with HBV replication.of 1076 PLWH in care, 689 (64.0%) had never had an HBsAg test prior to our HBV testing intervention. Women and individuals >40 years old were less likely to have been previously tested. After HBV testing intervention,107/884 (12.1%) PLWH were HBsAg-positive. Seven of 58 (12.1%) individuals newly diagnosed with HIV/HBV co-infection had a detectable HBV VL, of whom five were HIV-suppressed. Two patients on ART including 3TC and AZT as backbone showed the presence of the triple resistance mutation 180M/204I/80V. In this Senegalese urban HIV clinic, the majority of patients on ART had never been tested for HBV infection. One in ten co-infected individuals had a detectable HBV VL despite HIV suppression, and 8% were not receiving a TDF-containing regimen.
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Affiliation(s)
- Adrià Ramírez Mena
- Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland,Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal,Graduate School for Health SciencesUniversity of BernSwitzerland
| | - Judicaël M. Tine
- Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal
| | - Louise Fortes
- Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal
| | - Ousseynou Ndiaye
- Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal
| | - Daye Ka
- Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal
| | - Ndeye Fatou Ngom
- Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal
| | - Alban Ramette
- Institute of Infectious DiseasesUniversity of BernBernSwitzerland
| | - Pascal Bittel
- Institute of Infectious DiseasesUniversity of BernBernSwitzerland
| | - Moussa Seydi
- Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal
| | - Gilles Wandeler
- Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland,Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal,Institute of Social and Preventive MedicineUniversity of BernSwitzerland
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Ekollo Mbange A, Malick Diouara AA, Diop-Ndiaye H, Diaw Diouf NA, Ngom-Ngueye NF, Ndiaye Touré K, Dieng A, Lô S, Fall M, Fon Mbacham W, Mboup S, Touré-Kane C. High HIV-1 Virological Failure and Drug Resistance among Adult Patients Receiving First-Line ART for At least 12 Months at a Decentralized Urban HIV Clinic Setting in Senegal before the Test-and-Treat. Infect Dis (Lond) 2021; 14:11786337211014503. [PMID: 34025122 PMCID: PMC8120520 DOI: 10.1177/11786337211014503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 04/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The feasibility of antiretroviral therapy (ART) monitoring remains problematic in decentralized HIV clinic settings of sub-Saharan Africa. We assessed the rates and correlates of HIV-1 virological failure (VF) and drug resistance (DR) in 2 pre-test-and-treat urban clinic settings of Senegal. Methods: Consenting HIV-1-infected adults (⩾18 years) receiving first-line ART for ⩾12 months were cross-sectionally enrolled between January and March 2015, at the referral outpatient treatment center of Dakar (n = 151) and decentralized regional hospital of Saint-Louis (n = 127). In the 12 months preceding plasma specimens’ collection patients at Saint-Louis had no viral load (VL) testing. Significant predictors of VF (VL ⩾ 1000 copies/ml) and DR (clinically relevant mutations) were determined using binomial logistic regression in R software. Results: Of the 278 adults on EFV-/NVP-based regimens, 32 (11.5% [95%CI: 8.0-15.9]) experienced VF. Failing and non-failing patients had comparable median time [interquartile] on ART (69.5 [23.0-89.5] vs 64.0 [34.0-99.0] months; P = .46, Mann–Whitney U-test). Of the 27 viraemic isolates successfully genotyped, 20 (74.1%) carried DR mutations; most frequent were M184VI (55.6%), K103N (37.1%), thymidine analog mutations (29.6%), Y181CY (22.2%). The pattern of mutations did not always correspond to the ongoing treatment. The adjusted odds of VF was significantly associated with the decentralized clinic site (P < .001) and CD4 < 350 cells/mm3 (P < .006). Strong correlates of DR also included Saint-Louis (P < .009), CD4 < 350 cells/mm3 (P <. 001), and nevirapine-based therapies (comparator: efavirenz-based therapies; P < .027). In stratification analyses by site, higher rate of VF at Saint-Louis (20.5% [95%CI: 13.8-28.5] vs 4.0% [95%CI: 1.5-8.5] in Dakar) was associated with nevirapine-based therapies (OR = 3.34 [1.07-11.75], P = .038), self-reported missing doses (OR = 3.30 [1.13-10.24], P = .029), and medical appointments (OR = 2.91 [1.05-8.47], P = .039) in the last 1 and 12 months(s), respectively. The higher rate of DR at Saint-Louis (12.9% [95%CI: 7.6-20.1] vs 2.7% [95%CI: 0.7-6.7] in Dakar) was associated with nevirapine-based therapies (OR = 5.13 [1.12-37.35], P = .035). Conclusion: At decentralized urban settings, there is need for enhanced virological monitoring and adherence support. HIV programs in Senegal should intensify early HIV diagnosis for effective test-and-treat. These interventions, in addition to the superiority of efavirenz-based therapies provide a favorable framework for transitioning to the recommended potent drug dolutegravir, thereby ensuring its long-term use.
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Affiliation(s)
- Aristid Ekollo Mbange
- The Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Diamniadio, Senegal.,The Biotechnology Center and Department of Biochemistry, University of Yaoundé I, Yaoundé, Cameroon.,Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire, Aristide Le Dantec/Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Abou Abdallah Malick Diouara
- The Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Diamniadio, Senegal.,Département de Génie Chimique et de Biologie Appliquée, Ecole Supérieure Polytechnique/Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Halimatou Diop-Ndiaye
- The Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Diamniadio, Senegal.,Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire, Aristide Le Dantec/Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Ndèye Aminata Diaw Diouf
- The Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Diamniadio, Senegal.,Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire, Aristide Le Dantec/Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | | | | | - Ahmed Dieng
- Centre de Traitement Ambulatoire, Centre Hospitalier Universitaire de Fann, Dakar, Sénégal
| | - Seynabou Lô
- Hôpital Régional de Saint-Louis, Saint-Louis, Sénégal
| | - Mamadou Fall
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire, Aristide Le Dantec/Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Wilfred Fon Mbacham
- The Biotechnology Center and Department of Biochemistry, University of Yaoundé I, Yaoundé, Cameroon
| | - Souleymane Mboup
- The Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Diamniadio, Senegal
| | - Coumba Touré-Kane
- The Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF), Diamniadio, Senegal.,Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire, Aristide Le Dantec/Université Cheikh Anta Diop de Dakar, Dakar, Sénégal.,Laboratoire de Bactériologie-Virologie CHNU Dalal Jam, Dakar, Sénégal
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Tagny CT, Bissim M, Djeumen R, Ngo Sack F, Angandji P, Ndoumba A, Kouanfack C, Eno L, Mbanya D, Murphy EL, Laperche S. The use of the Geenius TM HIV-1/2 Rapid confirmatory test for the enrolment of patients and blood donors in the WHO Universal Test and Treat Strategy in Cameroon, Africa. Vox Sang 2020; 115:686-694. [PMID: 32468573 DOI: 10.1111/vox.12942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE In the WHO Universal test and treat strategy, false-positive HIV blood donors and patients may be unnecessarily put under antiretroviral treatment and false-negative subjects may be lost to follow-up. This study assessed the false positivity rate of the Cameroonian national HIV screening testing algorithm and the benefit of a confirmation test in the enrolment of patients and donors in the HIV care programme. METHODS We included initial HIV reactive blood donors and patients in a cross-sectional study conducted in two Cameroonian hospitals. Samples were retested according to the Cameroon national algorithm for HIV diagnosis. A positive or discordant sample was retested with the Geenius Bio-Rad HIV 1&2 (Bio-Rad, Marnes-la-Coquette, France) for confirmation. The Geenius HIV-1-positive results with 'poor' profiles were retested for RNA as well as the Geenius indeterminate results. RESULTS Of the 356 participants, 190/225 (84·4%) patients and 76/131 (58%) blood donors were declared positive with the national algorithm; 257 participants (96·6%) were confirmed HIV-1-positive. The study revealed that about 34/1000 blood donors and patients are false-positive and unnecessarily put on treatment; 89/1000 blood donors and patients declared discordant could have been included immediately in the HIV care programme if confirmatory testing was performed. The second test of the algorithm had a false-negative rate of 3%. Eleven samples (3·1%) were Geenius poor positive and NAT negative. CONCLUSION The universal test and treat strategy may identify and refer more individuals to HIV care if a third rapid confirmatory test is performed for discordant cases.
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Affiliation(s)
- Claude T Tagny
- Hematology and Blood Transfusion Service, Yaoundé University Hospital, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, UY1, Yaoundé, Cameroon
| | - Marie Bissim
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Rolande Djeumen
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | | | | | - Annick Ndoumba
- Faculty of Medicine and Biomedical Sciences, UY1, Yaoundé, Cameroon.,School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | | | - Laura Eno
- The US Center for Diseases' Control, Yaoundé, Cameroon
| | - Dora Mbanya
- Hematology and Blood Transfusion Service, Yaoundé University Hospital, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, UY1, Yaoundé, Cameroon
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