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Diallo I, Ouédraogo S, Sawadogo A, Ouédraogo GA, Diendéré EA, Zoungrana J, Sondo AK, Bognounou R, Savadogo M, Poda A, Drabo YJ. Future of HIV2 and HIV2 + 1 Infected Patients Treated with Antiretrovirals Followed at the Day Hospital HIV Care Unit from 2011 to 2015. J Int Assoc Provid AIDS Care 2022; 21:23259582221143675. [PMID: 36474417 PMCID: PMC9732798 DOI: 10.1177/23259582221143675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction: HIV2 is endemic in West Africa. In Burkina Faso, its prevalence was estimated at 2%. The aim of this work was to evaluate the follow-up of patients and also to contribute to the availability of data. Methods: We involved 18 years or older. Infection was screened according to the national algorithm. A cross- sectional study from first June 2017 to 31 December 2017 was performed. For each patient, sociodemographic, clinical, biological, therapeutic and evolution data were collected and analyzed. Results: The proportion of patients infected with HIV2 (n = 48; 1.7%) and HIV2 + 1 (n = 67; 2.4%) was 4.3%. The sex rat mean age was 50.3 ± 8.5 years. The combination of 2INTI + LPV/r was the most prescribed (n = 73; 63.5%). The average gain of LTCD4 has evolved from + 236 cells/mm3 in 2011 to + 364 cells/mm3 in 2015. The retention rate at grade 5 was about 70%. Conclusion: The immunological and clinic response of the patients was satisfactory. More than half of the patients remained in the continuum of care after five years of follow-up.
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Affiliation(s)
- Ismaël Diallo
- Department of Internal Medicine/Day Hospital (HIV Department),
Yalgado Ouedraogo University Hospital, Ouagadougou, Burkina Faso,Training and Research Unit Health Sciences (UFR-SDS), Joseph
KI-Zerbo University, Ouagadougou, Burkina Faso
| | - Smaïla Ouédraogo
- Training and Research Unit Health Sciences (UFR-SDS), Joseph
KI-Zerbo University, Ouagadougou, Burkina Faso,Public Health Department, Yalgado Ouedraogo University Hospital,
Ouagadougou, Burkina Faso
| | - Abdoulaye Sawadogo
- Department of Infectious Diseases, Regional Teaching Hospital of
Ouahigouya, Ouahigouya, Burkina Faso,Abdoulaye Sawadogo, Regional Teaching
Hospital of Ouahigouya, Department of Infectious Diseases, 04 BP : 698
Ouagadougou 04, Ouahigouya, Burkina Faso.
| | | | - Eric Arnaud Diendéré
- Department of Internal Medicine, Teaching Hospital of Bogodogo,
Ouagadougou, Burkina Faso
| | - Jacques Zoungrana
- Superior Institute of Health Sciences, Department of infectious
diseases and tropical medicine, Nazi Boni University, Bobo Dioulasso, Burkina
Faso
| | - Apoline Kongnimissom Sondo
- Training and Research Unit Health Sciences (UFR-SDS), Joseph
KI-Zerbo University, Ouagadougou, Burkina Faso,Department of Infectious Diseases, Yalgado Ouedraogo University
Hospital, Ouagadougou, Burkina Faso
| | - Réné Bognounou
- Department of Internal Medicine/Day Hospital (HIV Department),
Yalgado Ouedraogo University Hospital, Ouagadougou, Burkina Faso
| | - Mamoudou Savadogo
- Training and Research Unit Health Sciences (UFR-SDS), Joseph
KI-Zerbo University, Ouagadougou, Burkina Faso,Department of Infectious Diseases, Yalgado Ouedraogo University
Hospital, Ouagadougou, Burkina Faso
| | - Armel Poda
- Superior Institute of Health Sciences, Department of infectious
diseases and tropical medicine, Nazi Boni University, Bobo Dioulasso, Burkina
Faso
| | - Youssouf Joseph Drabo
- Department of Internal Medicine/Day Hospital (HIV Department),
Yalgado Ouedraogo University Hospital, Ouagadougou, Burkina Faso,Training and Research Unit Health Sciences (UFR-SDS), Joseph
KI-Zerbo University, Ouagadougou, Burkina Faso
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2
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Reeves I, Cromarty B, Deayton J, Dhairyawan R, Kidd M, Taylor C, Thornhill J, Tickell-Painter M, van Halsema C. British HIV Association guidelines for the management of HIV-2 2021. HIV Med 2021; 22 Suppl 4:1-29. [PMID: 34927347 DOI: 10.1111/hiv.13204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Iain Reeves
- Consultant in HIV Medicine, Homerton University Hospital NHS Trust, London, UK
| | | | - Jane Deayton
- Clinical Senior Lecturer in HIV, Barts and the London, Queen Mary University of London, London, UK
| | - Rageshri Dhairyawan
- Consultant in Sexual Health and HIV Medicine, Barts Health NHS Trust, London, UK
| | - Mike Kidd
- Consultant Virologist, National Infection Service, Public Health England, UK
| | - Chris Taylor
- Consultant Physician Sexual Health and HIV, Kings College Hospital, London, UK
| | - John Thornhill
- Consultant in Sexual Health and HIV Medicine, Barts Health NHS Trust, London, UK
| | - Maya Tickell-Painter
- Specialist Registrar in Infectious Diseases and Microbiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Clare van Halsema
- Consultant in Infectious Diseases, North Manchester General Hospital, Manchester, UK
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3
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Pujari S, Patel A, Gaikwad S, Patel K, Dabhade D, Chitalikar A, Joshi K, Bele V. Effectiveness of dolutegravir-based antiretroviral treatment for HIV-2 infection: retrospective observational study from Western India. J Antimicrob Chemother 2021; 75:1950-1954. [PMID: 32277827 DOI: 10.1093/jac/dkaa112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/23/2020] [Accepted: 03/03/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Data on the use of dolutegravir for treatment of HIV-2 infection are limited. OBJECTIVES To assess the effectiveness of dolutegravir in people living with HIV-2 (PLHIV-2). METHODS A retrospective chart review was performed in two clinics in Western India. PLHIV-2 initiated on dolutegravir-based regimens were included. Response to treatment in both treatment-naive (TN) and treatment-experienced (TE; substitution and not in the context of failure) was assessed by CD4 counts and HIV-2 viral load (VL) in a proportion of individuals. The primary objective was to assess immunological effectiveness (absence of a drop in absolute CD4 counts by more than 30% of baseline). Change in absolute CD4 counts was assessed by fitting a mixed-effects model. RESULTS Sixty-two PLHIV-2 treated with dolutegravir were included. The immunological effectiveness rates (95% CI) were 91.9% (82.4%-96.5%), 92% (81.1%-96.8%) and 91.6% (64.6%-98.5%) amongst all, TE and TN individuals, respectively. Median change in absolute CD4 counts at 6, 12 and 18 months were +29 cells/mm3, +101 cells/mm3 and +72 cells/mm3, respectively. The virological effectiveness rates (HIV-2 VL <100 copies/mL) (95% CI) for all, TE and TN individuals were 88.8% (74.6%-95%), 89.6% (73.6%-96.4%) and 85.7% (48.6%-97.4%), respectively. Three clinical events were documented: spinal tuberculosis, relapsed non-Hodgkin's lymphoma and herpes simplex virus retinitis. One individual reported self-limiting somnolence. CONCLUSIONS Dolutegravir was well tolerated and associated with immunological, virological and clinical effectiveness in both TN and TE PLHIV-2 in a large cohort from Western India. Dolutegravir-based ART is an excellent option for treatment of individuals with HIV-2 infection.
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Affiliation(s)
| | - Atul Patel
- Infectious Diseases Clinic, Ahmedabad, India
| | | | - Ketan Patel
- Infectious Diseases Clinic, Ahmedabad, India
| | | | | | - Kedar Joshi
- Institute of Infectious Diseases, Pune, India
| | - Vivek Bele
- Institute of Infectious Diseases, Pune, India
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4
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Raugi DN, Ba S, Cisse O, Diallo K, Tamba IT, Ndour C, Badiane NMD, Fortes L, Diallo MB, Faye D, Smith RA, Sall F, Toure M, Sall EI, Diallo Agne H, Faye K, Diatta JP, Sy MP, Chang M, Diaw B, Sambou J, Bakhoum R, Sy MD, Niang A, Malomar JJ, Coombs RW, Hawes SE, Ndoye I, Kiviat NB, Sow PS, Seydi M, Gottlieb GS. Long-term Experience and Outcomes of Programmatic Antiretroviral Therapy for Human Immunodeficiency Virus Type 2 Infection in Senegal, West Africa. Clin Infect Dis 2021; 72:369-378. [PMID: 33527119 PMCID: PMC7850514 DOI: 10.1093/cid/ciaa277] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Programmatic treatment outcome data for people living with human immunodeficiency virus type 2 (HIV-2) in West Africa, where the virus is most prevalent, are scarce. METHODS Adults with HIV-2 initiating or receiving antiretroviral therapy (ART) through the Senegalese national AIDS program were invited to participate in this prospective, longitudinal observational cohort study. We analyzed HIV-2 viral loads, CD4 cell counts, antiretroviral drug resistance, loss to follow-up, and mortality. We also examined changes in treatment guidelines over time and assessed progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets for HIV-2. RESULTS We enrolled 291 participants at 2 sites for 926.0 person-years of follow-up over 13 years. Median follow-up time was 2.2 years per participant. There were 21 deaths reported (7.2%), and 117 individuals (40.2%) were lost to follow-up, including 43 (14.7%) who had an initial visit but never returned for follow-up. CD4 counts and HIV-2 viral suppression (< 50 copies/mL) at enrollment increased over calendar time. Over the study period, 76.7% of plasma viral loads for participants receiving ART were suppressed, and median CD4 gain was 84 cells/μL in participants' first 2 years on study. Since the UNAIDS 90-90-90 strategy was published, 88.1% of viral loads were suppressed. Fifteen percent of patients experienced virologic failure with no known resistance mutations, while 56% had evidence of multiclass drug resistance. CONCLUSIONS Participants in the Senegalese national AIDS program are initiating ART earlier in the course of disease, and more modern therapeutic regimens have improved outcomes among those receiving therapy. Despite these achievements, HIV-2 treatment remains suboptimal, and significant challenges to improving care remain.
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Affiliation(s)
- Dana N Raugi
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Selly Ba
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | | | - Khardiata Diallo
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | | | - Cheikh Ndour
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Ndeye Mery Dia Badiane
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Louise Fortes
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Mouhamadou Baïla Diallo
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | | | - Robert A Smith
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Fatima Sall
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Macoumba Toure
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | | | - Habibatou Diallo Agne
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Khadim Faye
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | | | - Marie Pierre Sy
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Ming Chang
- Laboratory Medicine, Division of Virology, University of Washington, Seattle, Washington, USA
| | - Binetou Diaw
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | | | | | | | | | | | - Robert W Coombs
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Laboratory Medicine, Division of Virology, University of Washington, Seattle, Washington, USA
| | - Stephen E Hawes
- Epidemiology, University of Washington, Seattle, Washington, USA
| | - Ibra Ndoye
- Conseil National de Lutte Contre le SIDA du Senegal, Dakar, Senegal
| | - Nancy B Kiviat
- Pathology, University of Washington, Seattle, Washington, USA
| | - Papa Salif Sow
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales, Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Geoffrey S Gottlieb
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Global Health, University of Washington, Seattle, Washington, USA
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5
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Minchella PA, Adjé-Touré C, Zhang G, Tehe A, Hedje J, Rottinghaus ER, Kohemun N, Aka M, Diallo K, Ouedraogo GL, De Cock KM, Nkengasong JN. Long-term immunological responses to treatment among HIV-2 patients in Côte d'Ivoire. BMC Infect Dis 2020; 20:213. [PMID: 32164565 PMCID: PMC7069012 DOI: 10.1186/s12879-020-4927-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/27/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Studies indicate that responses to HIV-2 treatment regimens are worse than responses to HIV-1 regimens during the first 12 months of treatment, but longer-term treatment responses are poorly described. We utilized data from Côte d'Ivoire's RETRO-CI laboratory to examine long-term responses to HIV-2 treatment. METHODS Adult (≥15 years) patients with baseline CD4 counts < 500 cells/μl that initiated treatment at one of two HIV treatment centers in Abidjan, Côte d'Ivoire between 1998 and 2004 were included in this retrospective cohort study. Patients were stratified by baseline CD4 counts and survival analyses were employed to examine the relationship between HIV type and time to achieving CD4 ≥ 500 cells/μl during follow up. RESULTS Among 3487 patients, median follow-up time was 4 years and 57% had documented ART regimens for > 75% of their recorded visits. Kaplan-Meier estimates for achievement of CD4 ≥ 500 cells/μl after 6 years of follow-up for patients in the lower CD4 strata (< 200 cells/μl) were 40% (HIV-1), 31% (HIV-dual), and 17% (HIV-2) (log-rank p < 0.001). Cox Regression indicated that HIV-1 was significantly associated with achievement of CD4 ≥ 500 cells/μl during follow-up, compared to HIV-2. CONCLUSIONS Sub-optimal responses to long-term HIV-2 treatment underscore the need for more research into improved and/or new treatment options for patients with HIV-2. In many West African countries, effective treatment of both HIV-1 and HIV-2 will be essential in the effort to reach epidemic control.
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Affiliation(s)
- Peter A. Minchella
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA USA
| | - Christiane Adjé-Touré
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d’Ivoire
| | - Guoqing Zhang
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA USA
| | - Andre Tehe
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d’Ivoire
| | - Judith Hedje
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d’Ivoire
| | - Erin R. Rottinghaus
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA USA
| | - Natacha Kohemun
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d’Ivoire
| | - Micheline Aka
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d’Ivoire
| | - Karidia Diallo
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - G. Laissa Ouedraogo
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d’Ivoire
| | - Kevin M. De Cock
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - John N Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
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6
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Performance evaluation of a laboratory developed PCR test for quantitation of HIV-2 viral RNA. PLoS One 2020; 15:e0229424. [PMID: 32109949 PMCID: PMC7048284 DOI: 10.1371/journal.pone.0229424] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/05/2020] [Indexed: 11/19/2022] Open
Abstract
Management of Human Immunodeficiency Virus Type 2 (HIV-2) infections present unique challenges due to low viral titers, slow disease progression, and poor response to standard antiviral therapies. The need for a nucleic acid assay to detect and quantify HIV-2 virus has led to the development of a number of molecular-based assays for detection and/or quantification of HIV-2 viral RNA in plasma in order to provide laboratory evidence of HIV-2 infection and viral loads for use in treatment decisions. As HIV-2 is less pathogenic and transmissible than HIV-1 and has resistance to several of the antiretroviral drugs, delay of treatment is common. Cross sero-reactivity between HIV-1 and HIV-2 makes it difficult to distinguish between the two viruses based upon serological tests. As such we developed a quantitative reverse transcription PCR (qRT-PCR) assay targeting the 5' long terminal repeat of HIV-2 for detection and quantification of HIV-2 viral RNA in plasma to identify HIV-2 infection and for use in viral load monitoring. Serial dilutions of cultured HIV-2 virus demonstrated a wide dynamic range (10 to 100,000 copies/ml) with excellent reproducibility (standard deviation from 0.12-0.19), linearity (R2 = 0.9994), and a lower limit of detection at 79 copies/ml (NIH-Z). The assay is highly specific for HIV-2 Groups A and B and exhibits no cross reactivity to HIV-1, HBV or HCV. Precision of the assay was demonstrated for the High (Mean = 6.41; SD = 0.12) and Medium (Mean = 4.46; SD = 0.13) HIV-2 positive controls. Replicate testing of clinical specimens showed good reproducibility above 1,000 copies/ml, with higher variability under 1,000 copies/ml. Analysis of 220 plasma samples from HIV-2 infected West African individuals demonstrated significantly lower viral loads than those observed in HIV-1 infections, consistent with results of previous studies. Slightly more than seven percent of clinical samples (7.3%) demonstrated viral loads above 100,000 copies/ml, while 37.3% of samples were undetectable. The high sensitivity, specificity, precision, and linearity of the WRAIR qRT-PCR assay makes it well suited for detection and monitoring of HIV-2 RNA levels in plasma of infected individuals.
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7
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Matheron S, Descamps D, Gallien S, Besseghir A, Sellier P, Blum L, Mortier E, Charpentier C, Tubiana R, Damond F, Peytavin G, Ponscarme D, Collin F, Brun-Vezinet F, Chene G. First-line Raltegravir/Emtricitabine/Tenofovir Combination in Human Immunodeficiency Virus Type 2 (HIV-2) Infection: A Phase 2, Noncomparative Trial (ANRS 159 HIV-2). Clin Infect Dis 2019; 67:1161-1167. [PMID: 29590335 PMCID: PMC6160602 DOI: 10.1093/cid/ciy245] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/22/2018] [Indexed: 01/28/2023] Open
Abstract
Background New options for first-line treatment of human immunodeficiency virus type 2 (HIV-2) infection are needed. We evaluated an integrase inhibitor (raltegravir)–containing regimen. Methods Antiretroviral therapy (ART)–naive adults with symptomatic infection by HIV-2 only, CD4 count <500 cells/μL or CD4 decrease >50 cells/μL/year over the past 3 years, or a confirmed plasma HIV-2 RNA (pVL) load ≥100 copies/mL were eligible for this noncomparative trial. The composite primary endpoint was survival at 48 weeks without any of the following: CD4 gain from baseline <100 cells/μL, confirmed pVL ≥40 copies/mL from week 24, raltegravir permanent discontinuation, or incident B or C event. HIV-2 ultrasensitive pVL (uspVL) and total DNA were assessed using in-house polymerase chain reaction (PCR) assays. Results Baseline median CD4 count of 30 enrolled individuals (67% women) was 436 cells/µL (interquartile range [IQR], 314–507 cells/µL); pVL was ≥40 copies/mL in 67% of them, uspVL was ≥5 copies/mL in 92%, and total DNA was >6 copies by PCR in 32%. At week 48, the composite endpoint of success was reached in 40% [95% confidence interval, 22.7%–59.4%]. Failure was mainly (50%) due to CD4 gain <100 cells/µL; uspVL was <5 copies/mL in 87% and total DNA >6 copies by PCR in 12% of participants. Median CD4 gain was 87 cells/µL (IQR, 38–213 cells/µL; n = 28). No serious adverse reactions were reported. Conclusions Raltegravir-containing ART is a safe option for first-line treatment of HIV-2 infection, yielding a comparable success rate to protease inhibitors. Clinical Trials Registration NCT 01605890.
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Affiliation(s)
- Sophie Matheron
- Hopital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP).,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche (UMR) 1137.,Université Paris Diderot, Sorbonne Paris Cité
| | - Diane Descamps
- Hopital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP).,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche (UMR) 1137.,Université Paris Diderot, Sorbonne Paris Cité
| | | | - Amel Besseghir
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Université Bordeaux, Institut de santé publique, d'épidémiologie et de développement, Centre Hospitalier Universitaire Bordeaux
| | | | | | | | - Charlotte Charpentier
- Hopital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP).,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche (UMR) 1137.,Université Paris Diderot, Sorbonne Paris Cité
| | - Roland Tubiana
- Hopital Pitié-Salpetriere, AP-HP, Université Paris 6, INSERM, Institut Pierre-Louis Epidémiologie et Santé Publique, UMR en Santé 1136, Paris, France
| | - Florence Damond
- Hopital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP).,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche (UMR) 1137.,Université Paris Diderot, Sorbonne Paris Cité
| | - Gilles Peytavin
- Hopital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP).,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche (UMR) 1137.,Université Paris Diderot, Sorbonne Paris Cité
| | | | - Fideline Collin
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Université Bordeaux, Institut de santé publique, d'épidémiologie et de développement, Centre Hospitalier Universitaire Bordeaux
| | | | - Genevieve Chene
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Université Bordeaux, Institut de santé publique, d'épidémiologie et de développement, Centre Hospitalier Universitaire Bordeaux
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Gunaratne SH, Gandhi RT. HIV-2 Infection: Latest Advances. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2019. [DOI: 10.1007/s40506-019-00201-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Ba S, Dia-Badiane NM, Hawes SE, Deguenonvo LF, Sall F, Ndour CT, Faye K, Traoré F, Touré M, Sy MP, Raugi DN, Kiviat NB, Smith RA, Seydi M, Sow PS, Gottlieb GS. [HIV-2 infection in Senegal: virological failures and resistance to antiretroviral drugs (ARVs)]. Pan Afr Med J 2019; 33:222. [PMID: 31692792 PMCID: PMC6814923 DOI: 10.11604/pamj.2019.33.222.15771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/24/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction Le VIH-2, endémique en Afrique de l'Ouest, est naturellement résistant aux inhibiteurs non nucléosidiques de la rétro transcriptase (INNRTI), ce qui rend difficile la prise en charge dans les pays en développement. L’objectif ici était de déterminer la prévalence de l'échec virologique au 12éme et 24éme mois (M12 et M24) de traitement antirétroviral de première ligne chez les patients infectés par le VIH-2 et d'en décrire les résistances génotypiques associées. Méthodes Il s'agit d'une étude descriptive longitudinale et prospective, durant la période de novembre 2005 à juin 2017. L'échec virologique a été défini comme toute charge virale supérieure à 50 copies/ml après 6 mois de traitement ARV à deux reprises. La recherche de mutations de résistance a été réalisée dans les régions codantes de la protéase et de la transcriptase inverse. Résultats Au total 110 patients ont été colligés, d'âge médian de 46 ans (Extrêmes 18-67) avec un ratio F/H de 2,54. À l'inclusion, la charge virale était détectable dans 44% des cas avec une médiane de 935cp/ml (Extrêmes 17-144038). Le schéma antirétroviral associait 2 INTI à 1IP dans 94% des cas. La durée médiane de suivi était estimée à 1200 jours (Extrêmes 1-3840). 94 puis 76 patients ont respectivement complété leur bilan à M12 et M24. Au suivi M24, 39 patients étaient en échec virologique soit une prévalence de 39% estimée à 33% à M12 et 11% à M24. 45% des patients avaient des résistances aux inhibiteurs nucléosidiques de la transcriptase inverse (INTI), 41% des résistances aux IP et 30% des multi résistances aux INTI et IP. Conclusion Il est impératif de rendre accessible les nouvelles classes thérapeutiques pour le traitement de sauvetage des patients infectés par le VIH-2 dans les pays à ressources limitées.
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Affiliation(s)
- Selly Ba
- Service des Maladies Infectieuses CHUN de Fann, Dakar, Sénégal
| | | | | | | | - Fatima Sall
- Service des Maladies Infectieuses CHUN de Fann, Dakar, Sénégal
| | | | - Khadim Faye
- Service des Maladies Infectieuses CHUN de Fann, Dakar, Sénégal
| | - Fatou Traoré
- Service des Maladies Infectieuses CHUN de Fann, Dakar, Sénégal
| | - Macoumba Touré
- Service des Maladies Infectieuses CHUN de Fann, Dakar, Sénégal
| | - Marie Pierre Sy
- Service des Maladies Infectieuses CHUN de Fann, Dakar, Sénégal
| | | | | | | | - Moussa Seydi
- Service des Maladies Infectieuses CHUN de Fann, Dakar, Sénégal
| | - Papa Salif Sow
- Service des Maladies Infectieuses CHUN de Fann, Dakar, Sénégal
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10
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90-90-90 for HIV-2? Ending the HIV-2 epidemic by enhancing care and clinical management of patients infected with HIV-2. Lancet HIV 2019; 5:e390-e399. [PMID: 30052509 DOI: 10.1016/s2352-3018(18)30094-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/23/2022]
Abstract
Distinct from HIV-1 and often neglected in the global campaign to end the AIDS epidemic, HIV-2 presents unique and underappreciated challenges in diagnosis, clinical care, antiretroviral therapy (ART), and HIV programmatic management. Here, we review the epidemiology and natural history of HIV-2, diagnostics and algorithms for accurately diagnosing and differentiating HIV-2 from HIV-1, the unique features of HIV-2 ART and drug resistance, and the clinical care and management of patients infected with HIV-2 in both developed and resource-limited settings. Ultimately, further research is needed to address the gaps in our knowledge of HIV-2 infection, increased resources are needed to specifically target HIV-2 as part of the UNAIDS/WHO 90-90-90 campaign to end AIDS, and increased determination is needed to better advocate for inclusion of people living with HIV-2 in global HIV/AIDS initiatives.
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11
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Wittkop L, Arsandaux J, Trevino A, Schim van der Loeff M, Anderson J, van Sighem A, Böni J, Brun-Vezinet F, Soriano V, Boufassa F, Brockmeyer N, Calmy A, Dabis F, Jarrin I, Dorrucci M, Duque V, Fätkenheuer G, Zangerle R, Ferrer E, Porter K, Judd A, Sipsas NV, Lambotte O, Shepherd L, Leport C, Morrison C, Mussini C, Obel N, Ruelle J, Schwarze-Zander C, Sonnerborg A, Teira R, Torti C, Valadas E, Colin C, Friis-Møller N, Costagliola D, Thiebaut R, Chene G, Matheron S. CD4 cell count response to first-line combination ART in HIV-2+ patients compared with HIV-1+ patients: a multinational, multicohort European study. J Antimicrob Chemother 2018; 72:2869-2878. [PMID: 29091198 DOI: 10.1093/jac/dkx210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/30/2017] [Indexed: 11/14/2022] Open
Abstract
Background CD4 cell recovery following first-line combination ART (cART) is poorer in HIV-2+ than in HIV-1+ patients. Only large comparisons may allow adjustments for demographic and pretreatment plasma viral load (pVL). Methods ART-naive HIV+ adults from two European multicohort collaborations, COHERE (HIV-1 alone) and ACHIeV2e (HIV-2 alone), were included, if they started first-line cART (without NNRTIs or fusion inhibitors) between 1997 and 2011. Patients without at least one CD4 cell count before start of cART, without a pretreatment pVL and with missing a priori-defined covariables were excluded. Evolution of CD4 cell count was studied using adjusted linear mixed models. Results We included 185 HIV-2+ and 30321 HIV-1+ patients with median age of 46 years (IQR 36-52) and 37 years (IQR 31-44), respectively. Median observed pretreatment CD4 cell counts/mm3 were 203 (95% CI 100-290) in HIV-2+ patients and 223 (95% CI 100-353) in HIV-1+ patients. Mean observed CD4 cell count changes from start of cART to 12 months were +105 (95% CI 77-134) in HIV-2+ patients and +202 (95% CI 199-205) in HIV-1+ patients, an observed difference of 97 cells/mm3 in 1 year. In adjusted analysis, the mean CD4 cell increase was overall 25 CD4 cells/mm3/year lower (95% CI 5-44; P = 0.0127) in HIV-2+ patients compared with HIV-1+ patients. Conclusions A poorer CD4 cell increase during first-line cART was observed in HIV-2+ patients, even after adjusting for pretreatment pVL and other potential confounders. Our results underline the need to identify more potent therapeutic regimens or strategies against HIV-2.
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Affiliation(s)
- Linda Wittkop
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, F-33000 Bordeaux, France
| | - Julie Arsandaux
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France
| | - Ana Trevino
- Infectious Diseases Department, Hospital Carlos III, Madrid, Spain
| | | | | | | | - Jürg Böni
- Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - Françoise Brun-Vezinet
- Assistance Publique-Hopitaux de Paris, Hopital Bichat-Claude Bernard, Laboratoire de Virologie, Universite Paris 7, Paris, France
| | - Vicente Soriano
- Department of Infectious Diseases, Hospital Carlos III, Sinesio Delgado 10, Madrid 28029, Spain
| | - Faroudy Boufassa
- Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, Epidemiology of HIV and STI Team, Le Kremlin-Bicêtre, France and Univ Paris-Sud, Le Kremlin-Bicêtre, France
| | | | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland
| | - François Dabis
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, F-33000 Bordeaux, France
| | - Inma Jarrin
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Avda. Monforte de Lemos, Madrid 528029, Spain and CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Vitor Duque
- Hospitais da Universidade de Coimbra, Departamento de Doenças Infecciosas, Coimbra, Portugal
| | - Gerd Fätkenheuer
- First Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - Robert Zangerle
- Department of Dermatology and Venerology, Innsbruck Medical University, Innsbruck, Austria
| | - Elena Ferrer
- HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat Barcelona, Spain
| | - Kholoud Porter
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Ali Judd
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Nikolaos V Sipsas
- Pathophysiology Department, Laiko General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Olivier Lambotte
- AP-HP Service de Médecine Interne, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Leah Shepherd
- Department of Infection and Population Health, University College London Medical School, London NW32PF, UK
| | - Catherine Leport
- Universite Paris Diderot, Sorbonne Paris Cite, UMR 1137, Paris, France and INSERM, UMR 1137, Paris, France
| | | | - Cristina Mussini
- Clinic of Infectious Diseases, Department of Internal Medicine and Medical Specialties, University of Modena and Reggio Emilia, Modena, Italy
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jean Ruelle
- Université catholique de Louvain, IREC, AIDS Reference Laboratory, Brussels, Belgium
| | | | - Anders Sonnerborg
- Department of Infectious Diseases, Karolinska Institute, Stockholm, Sweden
| | | | - Carlo Torti
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, University 'Magna Graecia', Catanzaro, Italy
| | - Emilia Valadas
- Clínica Universitária de Doenças Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Celine Colin
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France
| | - Nina Friis-Møller
- CHIP, Department of Infectious Diseases and Rheumatology, 2100 Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ. Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France and INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France
| | - Rodolphe Thiebaut
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, F-33000 Bordeaux, France.,INRIA SISTM, F-33405 Talence, France
| | - Geneviève Chene
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, F-33000 Bordeaux, France
| | - Sophie Matheron
- Assistance Publique-Hôpiteaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France.,IAME, INSERM UMR 1137, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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12
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Requena S, Treviño A, Cabezas T, Garcia-Delgado R, Amengual MJ, Lozano AB, Peñaranda M, Fernández JM, Soriano V, de Mendoza C. Drug resistance mutations in HIV-2 patients failing raltegravir and influence on dolutegravir response. J Antimicrob Chemother 2018; 72:2083-2088. [PMID: 28369593 DOI: 10.1093/jac/dkx090] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/28/2017] [Indexed: 11/14/2022] Open
Abstract
Background A broader extent of amino acid substitutions in the integrase of HIV-2 compared with HIV-1 might enable greater cross-resistance between raltegravir and dolutegravir in HIV-2 infection. Few studies have examined the virological response to dolutegravir in HIV-2 patients that failed raltegravir. Methods All patients recorded in the HIV-2 Spanish cohort were examined. The integrase coding region was sequenced in viraemic patients. Changes associated with resistance to raltegravir and dolutegravir in HIV-1 were recorded. Results From 319 HIV-2-infected patients recorded in the HIV-2 Spanish cohort, 53 integrase sequences from 30 individuals were obtained (20 raltegravir naive and 10 raltegravir experienced). Only one secondary mutation (E138A) was found in one of the 20 raltegravir-naive HIV-2 patients. For raltegravir-experienced individuals, the resistance mutation profile in 9 of 10 viraemic patients was as follows: N155H + A153G/S (four); Y143G + A153S (two); Q148R + G140A/S (two); and Y143C + Q91R (one). Of note, all patients with Y143G and N155H developed a rare non-polymorphic mutation at codon 153. Rescue therapy with dolutegravir was given to 5 of these 10 patients. After >6 months on dolutegravir therapy, three patients with baseline N155H experienced viral rebound. In two of them N155H was replaced by Q148K/R and in another by G118R. Conclusions A wide repertoire of resistance mutations in the integrase gene occur in HIV-2-infected patients failing on raltegravir. Although dolutegravir may allow successful rescue in most HIV-2 raltegravir failures, we report and characterize three cases of dolutegravir resistance in HIV-2 patients, emerging variants Q148K and Q148R and a novel change G118R.
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Affiliation(s)
- Silvia Requena
- Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Ana Treviño
- Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | | | | | | | | | | | | | - Vicente Soriano
- La Paz University Hospital & Autonomous University, Madrid, Spain
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13
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Menon S, Rossi R, Zdraveska N, Kariisa M, Acharya SD, Vanden Broeck D, Callens S. Associations between highly active antiretroviral therapy and the presence of HPV, premalignant and malignant cervical lesions in sub-Saharan Africa, a systematic review: current evidence and directions for future research. BMJ Open 2017; 7:e015123. [PMID: 28780541 PMCID: PMC5724112 DOI: 10.1136/bmjopen-2016-015123] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES In sub-Saharan Africa, substantial international funding along with evidence-based clinical practice have resulted in an unparalleled scale-up of access to antiretroviral treatment at a higher CD4 count. The role and timing of highly active antiretroviral therapy (HAART) in mediating cervical disease remains unclear. The aim of this article is to systematically review all evidence pertaining to Africa and identify research gaps regarding the epidemiological association between HAART use and the presence of premalignant/malignant cervical lesions. METHOD Five databases were searched until January 2017 to retrieve relevant literature from sub-Saharan Africa. Publications were included if they addressed prevalence, incidence or clearance of human papillomavirus (HPV) infection in women undergoing HAART as well as cytological or histological neoplastic abnormalities. RESULTS 22 studies were included, of which seven were prospective studies. Women receiving HAART are less likely to develop squamous intraepithelial lesions (SILs). There is evidence that duration of HAART along with the CD4 count may reduce the prevalence of high-risk HPV (HR-HPV), suggesting that without HAART, severe immunosuppression increases the risk of becoming or remaining infected with HR-HPV. Furthermore, according to existent literature, the CD4 count, rather than HAART coverage or its duration, plays a central role in the prevalence of cervical intraepithelial neoplasia (CIN) 2 and CIN 3. CONCLUSION Our findings suggest a positive impact of HAART duration, in conjunction and interaction with CD4 count, on reducing the prevalence of HR-HPV. The greatest treatment effect might be seen among women starting at the lowest CD4 count, which may have a more instrumental role in cervical oncogenesis than either HAART use or the treatment duration on the prevalence of CIN 2 and CIN 3. There is still insufficient evidence to show a clear association between HAART coverage and the incidence of invasive cervical cancer. Enhanced surveillance on the impact of HAART treatment is crucial.
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Affiliation(s)
- Sonia Menon
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
- CDC Foundation, Atlanta, Georgia, USA
| | - Rodolfo Rossi
- Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium
| | - Natasha Zdraveska
- Department of Clinical Pharmacy, Saints Cyril and Methodius, Republic of Macedonia
| | | | | | - Davy Vanden Broeck
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
- AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, National Reference Centre for HPV, Laboratory of Molecular Pathology, Antwerp, Belgium
| | - Steven Callens
- Department of Internal Medicine & Infectious diseases, University Hospital, Ghent, Belgium
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