Evaluation of Virological Parameters in People Living with HIV on ARVs in Chad ()
1. Introduction
Retroviruses are defined by their structure, but above all by their mode of replication [1].
These RNA viruses, thanks to the enzyme they carry, reverse transcriptase (RT), will have their retro genomics transcribed into viral DNA, which can then integrate the chromosomal DNA of the host cell under the name of provirus [1].
HIV infection remains a major public health problem, caused by a virus of the Retroviridae family that destroys the host organism’s immune system. The result is a syndrome known as acquired immunodeficiency syndrome [2].
In developed countries, the introduction of antiretroviral treatment, coupled with effective virological monitoring, limits the emergence of resistance [3]. In Africa, the situation is worrying. Indeed, acquired resistance tends to be higher there, and is increasing as access to ART expands. Yet access to ART has revolutionized patient care, improving quality of life and preventing many HIV/AIDS-related deaths [3]-[5].
Global AIDS epidemiology statistics based on UNAIDS data show 39.9 million [36.1 - 44.6 million] people living with HIV worldwide in 2023, with sub-Saharan Africa accounting for 62% of new HIV infections. In 2023, in all other regions, more than 73% of new HIV infections were in sub-Saharan Africa. Est accounted for 62% of new HIV infections. By 2023, in all other regions, over 73% of new HIV infections were among men and boys [6].
According to WHO estimates, only 17 million of them are receiving ART. ART coverage is therefore insufficient and disparate, both between developed and developing countries and within the African continent, between East and Southern Africa (54%) and West and Central Africa (28%) [7].
The Chad is experiencing a generalized epidemic, with a prevalence of 1.6% in the 15 - 49 age group, with variations according to sex, province and population sub-groups. The care of people living with HIV in Chad has undergone major changes in recent years. The number of people accessing ARV treatment continues to grow year on year, with 82,082 people on ARV in 2021 out of an expected target of 110,000. Since 2019, the WHO has been recommending Dolutegravir (DTG)-based protocols as first-line treatment for HIV/AIDS patients due to efficacy, tolerability and a good genetic barrier to resistance compared with the protocols used until now. The General objective is to study the evolution of virological parameters in PLHIV on ARVs in Chad.
2. Material and Method
2.1. Material
2.1.1. Study Setting
Center polyvalent Alnadjma in the biomolecular analysis laboratory of APMS and the laboratory of the Hôpital Militaire d’Instruction (HMI) served as the setting for our study.
2.1.2. Type of Study
We carried out a retrospective, prospective, descriptive cohort study with analytical aims on a fixed number of patients living with HIV-1 during a given period and compared it on the same database.
2.1.3. Study Period
Our study took place at the Hôpital Militaire d’Instruction (HMI) and the Centre Polyvalent Alnadjma in Ndjamena-Tchad over a period of 18 months, from November 2022 to May 2024.
2.1.4. Study Population
A total of 372 HIV-1 seropositive patients were registered and followed-up.
2.2. Sample
The sample consisted of all HIV-1-positive patients followed up at the Alnadjma multipurpose center and the Hôpital Militaire d’instruction.
2.2.1. Inclusion Criteria
Any person living with HIV-1 under treatment and who consents.
2.2.2. Non-Inclusion Criteria
- Any non-consenting.
- PVHIV not on ARVs.
2.2.3. Sample Size
The sample size was determined by taking all HIV1-infected patients on antiretroviral treatment.
We were able to follow a total of 372 patients from M0 to M18.
2.3. Variables Studied
- Sociodemographic data: sex, marital status, profession, level of education.
- Biological data: viral load.
- Therapeutic data: line of therapy, treatment regimens, level of compliance.
- Factors linked to compliance: sex, age group, biological and therapeutic data.
2.4. Data Collection
Data were collected from patients’ medical records in an individual survey form was drawn up for each patient on arrival at the laboratory or from the sample sent.
2.4.1. The Parameters Assessed Included
- Socio-demographic variables: sex, age, marital status, profession, co-infection, residence and other variables were determined for all cases.
- Biological variables: plasma viral load.
2.4.2. Collection Technique
For information on age, sex, duration of treatment and tests ordered, we would refer to the notification forms correctly completed by the prescribing physicians. For blood tests, information was collected on CD4 lymphocyte count and plasma viral load [8]-[11].
2.4.3. Sample Preparation
Blood samples are taken on EDTA tubes. Whole blood is used for plasma viral load and, after centrifugation at 3500 g for 5 minutes, plasma is recovered in anticoagulant-free tubes for plasma viral load determination.
2.5. Ethical Considerations
The present work falls within the scope of scientific research. As such, the study was carried out after obtaining administrative authorizations.
The women included in our studies were mothers who had accepted voluntary testing as part of PMTCT in accordance with the universal informed consent procedure.
2.6. Operational Definitions
Virological efficacy: viral load greater than 1000 copies/ml in patients on ART [12].
Good therapeutic adherence: is the match between a prescription and/or preventive regimen and the patient’s actual behavior [13].
Viral load: is the number of copies of a virus indicating viral replication in a given volume of fluid [14].
2.7. Method
The tests used to carry out HIV1/2 serological examinations consist of three tests in the national algorithm for confirmation of seropositive patients and viral load for virological follow-up.
2.8. Technique [15]-[17]
The two PCR techniques used (closed platform GeneXpert and open platform Bio-Centri) for plasma viral load determinations
2.9. The Molecular PCR Analysis Technique
The GeneXpert Dx system automates the Biocentric system and integrates sample preparation, nucleic acid amplification and target sequence detection in simple or complex samples using real-time polymerase chain reaction (PCR), depending on the device protocol.
2.10. Statistical Analysis
Data entry, word processing and graphics were collected using the information request form, entered using Microsoft Word and processed using Excel 2013.
Descriptive statistical analysis was performed using SPSS.25.0 software.
3. Results and Discussion
From first November 2022 to 31 May, 2024, a total of 372 HIV-1-infected patients constituted our study sample according to the inclusion criteria. The study took place at the Hôpital Militaire d’Instruction (HMI) and at the Centre Polyvalent Alnadjma.
The results obtained after data analysis are presented in the following tables and figures.
Socio-demographic data
Gender distribution of patients on ARVs
Sexe |
Fréquence |
Pourcentage |
Féminin |
270 |
72.6 |
Masculin |
102 |
27.4 |
Total |
372 |
100.0 |
The table above shows that the female sex is the most represented with 72.6%.
Our results are consistent with other studies conducted by DENE Edith in Mali in 2007 at 73.3% [18] and Lawson ATD in Senegal in 2017 reported respectively a sex ratio of 0.37 and 0.56 in favor of women. Mouhari Touré et al. in 2011 found in their study in Togo a female predominance of 68%.
The higher proportion of females may be explained by women’s natural anatomical predisposition to the high risk of HIV transmission, or it may be linked to the predominance of females in the Chadian population. It may also be explained by the fact that more women than men visit health facilities.
Distribution of patients on ARVs by age group
Age |
Frequency |
Percentage |
15 - 25 |
117 |
31.5 |
26 - 35 |
116 |
31.18 |
36 - 45 |
120 |
32.22 |
46 - 55 |
7 |
1.9 |
56 - 65 |
12 |
3.2 |
Total |
372 |
100.0 |
The table below shows that the 36 - 45 age group was the most represented with 32.22%, i.e. an average of 32.05 ± 9.8 years. This result is comparable to that obtained by DAKE in 2022, where the age group [36 - 45] was in the majority with 32.80% [19].
This age bracket corresponds to that of maximum sexual activity exposing to the risks of transmission of sexually transmitted infections.
Patient distribution by education level
Education level |
Frequency |
Percentage |
Primary |
100 |
26.9 |
Secondary |
27 |
7.3 |
Out of school |
138 |
37 |
Higher |
107 |
28.8 |
Total |
372 |
100.0 |
Non-educated people were the most represented in our study (37%), while 28% had a higher level of education, which highlights their involvement in the spread of the pandemic. This result is lower than that of SAMAKE Bamako 2023, which found 39% and MAIGA 36.20% Bamako 2019 of non-educated people respectively [20].
Distribution of patients by marital status
Marital Status |
Frequency |
Percentage |
Single |
39 |
10.5 |
Divorced |
25 |
6.7 |
Married |
296 |
79.6 |
Widowed |
12 |
3.2 |
Total |
372 |
100.0 |
Of all our cases, married people had the highest rate of seropositivity with a percentage of 79.6%, our results are superior to those of Mohamed in Djibouti in 2011 who found 51.28% of married people [21].
Distribution of patients by function
Function |
Frequency |
Percentage |
Housekeeper |
147 |
39.5 |
Student |
21 |
5.6 |
Student |
30 |
8.1 |
Civil servant |
111 |
29.8 |
Shopkeeper |
63 |
16.9 |
Total |
372 |
100.0 |
Housewives accounted for 39.5% of the total.our results are inferior to those of DENE E. who found in 2011 a dominance of (45%) housewives. According to profession Housewives were the most represented with 27.9%, followed by hairdressers 13.9% and civil servants 12.9%. R. Haidara [22] found 36.3% housewives, 18.9% shopkeepers and 11.5% artisans.
Trends in plasma viral load of PLWHA on ARVs
Viral Load Distribution for Month Zero at Neithen Months
CVMO |
Frequence |
Procentage |
<40 copies/ml |
0 |
0 |
40 - 1000 copies/ml |
25 |
6.7 |
>1000 copies/ml |
347 |
93.3 |
Total |
372 |
100.0 |
CVM6 |
|
|
<40 copies/ml |
28 |
7.5 |
40 - 1000 copies/ml |
243 |
65.3 |
>1000 copies/ml |
101 |
27.2 |
Total |
372 |
100.0 |
CVM12 |
|
|
<40 copies/ml |
292 |
78.5 |
40 - 1000 copies/ml |
39 |
10.5 |
>1000 copies/ml |
41 |
11.0 |
Total |
372 |
100.0 |
CVM18 |
|
|
<40 copies/ml |
352 |
94.6 |
40 - 1000 copies/ml |
5 |
1.3 |
>1000 copies/ml |
15 |
4.0 |
Total |
372 |
100.0 |
Among our patients 93.3% had a CV greater than 1000 copies/ml at M0, after M18 of treatment, we obtained 94.6% of our patients have an undetectable viral load (<40 copies/ml), our results are superior to that of Hama [23]. who found an undetectable cv 90% after 12 months of treatment. A study conducted by DAKE in 2022 in Bamako found an undetectable viral load of 92.31% after six months’ treatment [24].
Good follow-up of DTG treatment enables viral load to be suppressed in a short space of time.
4. Conclusion
Our retrospective study assessed the virological success of dolutegravir after 12 months of treatment in HIV-infected patients treated at the al-nadjma center and military hospital in Ndjamena. In our study, 59.7% of patients were female; the age group most represented was [36 – 45] years, with a frequency of 32%; married people, those not attending school and housewives were the most represented. Patients on 1st-line therapy were in the majority (80.3%). After 12 months of treatment, 352 of our patients had an undetectable viral load, giving a virological success rate of 94.6%. Good treatment follow-up will ensure better viral load suppression.
5. Agreement
1) All authors of the manuscript have read and accepted its contents and are responsible for all aspects of the accuracy and integrity of the manuscript.
2) This submitted article is an original work not considered or reviewed by any other publication and has not been published elsewhere in the same or similar form.