Le traitement antirétroviral en Côte d'Ivoire : observance, surveillance immunologique et impact sur les comportements vis-à-vis du VIH/SIDA

Authors: Diabate, Souleymane
Advisor: Alary, Michel
Abstract: Objectives: The aims of this study conducted in Côte d’Ivoire were to: 1) propose an algorithm for highly active antiretroviral therapy (HAART) initiation and assess the determinants of immune response; 2) measure adherence level and determine factors associated with poor-adherence to HAART; and 3) assess the determinants of unsafe sex and see whether HAART initiation is related to changes towards unsafe sex. Methods: 311 patients under HAART for at least one year (group I), 303 patients initiating HAART (group II) and 312 non treated patients (group III) were enrolled and followed-up for six months. Eligibility to HAART (baseline CD4 count < 200/µl in groups II/III) was analysed according to a score system and a ROC curve. A gain > 50 CD4/µl was used to evaluate immune response (group II). Poor-adherence was defined as an adherence level < 95% (group I/II). The proportions of unsafe sex before and after HAART initiation (group II) were compared to those of the non treated patients (group III) during the same periods. Results: No accurate and clinically meaningful algorithm that could be substituted to CD4 count to determine eligibility to HAART was found. In group II, 79.5% patients gained more than 50 CD4/µl during follow-up (median increase 128/µl). Increase in absolute total lymphocyte count (p< 0.0001) and adherence ≥95% (p=0.022) were associated with a positive immune response. 74.3% of the 614 treated patients (groups I/II) reported adherence levels ≥95%. Absence of social support was related to poor-adherence. Drug supply interruptions in the pharmacies were reported by 10% of the non adherent patients as the reason for missing pills. A significant increase in unsafe sex among treated patients (group II, RR 1.40; 95% CI 1.21 – 1.61) and a stability among untreated ones (group I; RR 1.07; 95% CI 0.94 – 1.20) were observed. Conclusion: Although adherence was found to be good, scaling-up HAART in sub-Saharan Africa should be preceded by reliable drug supply and distribution systems. The positive impact of generic combinations of HAART on immune response seemed to induce risk-taking among treated patients. Treatment programs should carry preventive interventions aiming to encourage treated patients to adopt and maintain safer sexual behaviour. In order to enhance the management of HIV-infected patients in sub-Saharan Africa, efforts should target the development of low cost CD4 count laboratory tests.
Document Type: Thèse de doctorat
Issue Date: 2008
Open Access Date: 20 April 2018
Permalink: http://hdl.handle.net/20.500.11794/25649
Grantor: Université Laval
Collection:Thèses et mémoires

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