Low prevalence of detectable HIV plasma viremia in patients treated with antiretroviral therapy in Burkina Faso and Mali.
BACKGROUND
Sub-Saharan Africa has seen dramatic increases in the numbers of people treated with antiretroviral therapy (ART). Although standard ART regimens are now universally applied, viral load measurement is not currently part of standard monitoring protocols in sub-Saharan Africa.


METHODS
We describe the prevalence of inadequate virological response (IVR) to ART (viral load >or= 500 copies/mL) and identify factors associated with this outcome in 606 HIV-positive patients treated for at least 6 months. Recruitment took place in 7 hospitals and community-based sites in Bamako and Ouagadougou, and information was collected using medical charts and interviews.


RESULTS
The overall prevalence of IVR in treatment-naive patients was 12.3% and 24.4% for pretreated patients. There were no differences in rates of IVR according to ART delivery sites and time on treatment. Patients living farther away [odds ratio (OR) = 2.48; 95% confidence interval (CI) 1.40 to 4.39], those on protease inhibitor or nucleoside reverse transcriptase inhibitor regimens (OR = 3.23; 95% CI 1.79 to 5.82) and those reporting treatment interruptions (OR = 2.36; 95% CI 1.35 to 4.15), had increased odds of IVR. Immune suppression (OR = 3.32, 95% CI 1.94 to 5.70) and poor self-rated health (OR = 2.00; 95% CI 1.17 to 3.41) were also associated with IVR.


CONCLUSIONS
Sufficient expertise and dedication exist in public hospital and community-based programs to achieve rates of treatment success comparable to better-resourced settings.
Boileau
Catherine
C
Institute for Health and Social Policy-McGill University, Montreal, Quebec, Canada. catherine.boileau@mcgill.ca
Nguyen
Vinh-Kim
VK
Sylla
Mohamed
M
Machouf
Nima
N
Chamberland
Annie
A
Traoré
Hamar A
HA
Niamba
Pascal A
PA
Diallo
Ismaël
I
Maïga
Moussa
M
Cissé
Mamadou
M
Rashed
Sélim
S
Tremblay
Cécile
C
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002050:Burkina Faso / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D003151:Community Health Centers; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006773:Hospitals, Municipal; D006801:Humans; D008297:Male; D008302:Mali / Q000453:epidemiology; D016017:Odds Ratio; D010349:Patient Compliance; D010865:Pilot Projects; D012307:Risk Factors; D016896:Treatment Outcome; D019562:Viral Load