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Research paper thumbnail of Evaluation of the Third 90 of the 90-90-90 Cascade for the Period 2019-2020 in the Central African Republic

World Journal of AIDS, 2021

Introduction In Central-African Republic, according to UNAIDS in 2019, out of approximately 100,0... more Introduction In Central-African Republic, according to UNAIDS in 2019, out of approximately 100,000 people living with HIV, 70% (72,000) knew their HIV status and 47,000 (46%) were on ARV therapy; however, there is a paucity of data on viral load suppression in people on ARV therapy. The objective of this study was to assess the third 90 of the UNAIDS strategy for the years 2019 and 2020 in the CAR. Methods We analyzed the available viral load data extracted from the data base of the medical analysis laboratory (SYSLAM) of the Institut Pasteur of Bangui for the years 2019 and 2020. The viral loads were determined based on plasma collected in an EDTA tube with Cepheid's GeneXpert ® 16-module controllers. Viral load data were extracted from SYSLAM, converted to Excel format, and analyzed with STATA version 14 software. The significance threshold for the statistical tests was set at 5%. Results This study included 22,895 patients, of who 72% were female. The average age was 40.82 years, and the majority of the patients (80%) came from the city of Bangui. Regarding the virological parameters associated with this study, 66% of the patients had significant viral load suppression according to the WHO recommendations and 34% were in virological failure. Patients over 50 years of age (71.85%) and age group 40-49 years (69.25%) recorded significant levels of viral load suppression. On the other hand, 63.45% of patients under 18 years of age had virological failure. All of these results were statistically significant (p < 0.005). Conclusion There should be a concerted effort, to make viral load accessible and available to all patients receiving ARV treatment in the CAR and the management of HIV/AIDS infection of children and adolescents should be given special attention.

Research paper thumbnail of Trends of HIV Viral Load in Patients under Combined Antiretroviral Treatment in Bangui, Central African Republic

World Journal of AIDS, 2018

Background: The success of antiretroviral therapy requires better virological monitoring. We desc... more Background: The success of antiretroviral therapy requires better virological monitoring. We described the virological profile of patients on combined antiretroviral therapy (cART) for HIV/AIDS in Bangui, Central African Republic (CAR). Methods: In this prospective cohort study of patients who had been on combined antiretroviral therapy treatment (cART) for at least 12 months in Bangui, only one HIV plasma viral load per patient was realized at the Institut Pasteur of Bangui, between April 4th and November 28th, 2017. Sociodemographic and biological data were collected. Blood samples were taken for viral load. The biocentric generic human immunodeficiency virus (HIV) load test was used to quantify a ribonucleic acid (RNA) HIV-1. Data were analyzed with Stata software version 14. Chi-squared test was used to analyse viral load according to sex and age. The level of significance was set at P ≤ 0.05. Results: A total of 3569 patients were recruited, with a mean age of 40 years (median, 42 years; range, 1-84), patients aged 40-49 predominating (34.2%). The sex ratio was 0.4. No virus was detectable in plasma from 49.2% of patients, while 42.4% had virological failure (viral load, ≥1000 copies/mL) according to WHO criteria. The risk for virological failure decreased with age (P = 0.001) and was higher among females than males (P = 0.001). Conclusions: The rate of virological failure among patients on cART is very high in the CAR, despite the availability of and access to monitoring of HIV plasma viral load in Bangui.

Research paper thumbnail of Evidence of human leptospirosis cases in a cohort of febrile patients in Bangui, Central African Republic: a retrospective study, 2012–2015

BMC Infectious Diseases, 2018

Background: In spite of a local favorable environment, leptospirosis has never been described in ... more Background: In spite of a local favorable environment, leptospirosis has never been described in Central African Republic so far mainly because of the weakness of diagnostic tests and differential diagnostic strategy for febrile jaundice cases negative for yellow fever virus. Here we bring a complementary insight to conclusions of Gadia CLB et al. regarding the presence of leptospirosis in Central African Republic in YFV-negative febrile icteric patients. Methods: Our study included 497 individuals presenting with fever and jaundice but negative for yellow fever infection, retrospectively selected from the national surveillance biobank for yellow fever in Institut Pasteur de Bangui, Central African Republic. A combination of serological (ELISA, agglutination) and molecular biology techniques (quantitative real-time polymerase chain reaction) was used to identify Leptospira or the patient's immune response to the bacteria. Statistical analyses were done using the non parametric Mann-Withney U test with a 5% statistical threshold. Results: ELISA test results showed 46 positive serum samples while 445 were negative and 6 remains equivocal. In addition, the reference microscopic agglutination test for leptospirosis diagnostic confirmed that 7 out of 32 samples tested were positive. Unfortunately, all 497 serum samples tested for leptospirosis were negative using the molecular techniques. Conclusions: Unlike Gadia et al., we confirmed that leptospirosis is circulating in Central African Republic and therefore may be responsible for some of the unexplained cases of febrile jaundice in the country. Thus, leptospirosis needs to be investigated to improve identification of aetiological pathogens. Our study also suggests a need to improve sample transportation and storage conditions.

Research paper thumbnail of Evaluation of the Third 90 of the 90-90-90 Cascade for the Period 2019-2020 in the Central African Republic

World Journal of AIDS, 2021

Introduction In Central-African Republic, according to UNAIDS in 2019, out of approximately 100,0... more Introduction In Central-African Republic, according to UNAIDS in 2019, out of approximately 100,000 people living with HIV, 70% (72,000) knew their HIV status and 47,000 (46%) were on ARV therapy; however, there is a paucity of data on viral load suppression in people on ARV therapy. The objective of this study was to assess the third 90 of the UNAIDS strategy for the years 2019 and 2020 in the CAR. Methods We analyzed the available viral load data extracted from the data base of the medical analysis laboratory (SYSLAM) of the Institut Pasteur of Bangui for the years 2019 and 2020. The viral loads were determined based on plasma collected in an EDTA tube with Cepheid's GeneXpert ® 16-module controllers. Viral load data were extracted from SYSLAM, converted to Excel format, and analyzed with STATA version 14 software. The significance threshold for the statistical tests was set at 5%. Results This study included 22,895 patients, of who 72% were female. The average age was 40.82 years, and the majority of the patients (80%) came from the city of Bangui. Regarding the virological parameters associated with this study, 66% of the patients had significant viral load suppression according to the WHO recommendations and 34% were in virological failure. Patients over 50 years of age (71.85%) and age group 40-49 years (69.25%) recorded significant levels of viral load suppression. On the other hand, 63.45% of patients under 18 years of age had virological failure. All of these results were statistically significant (p < 0.005). Conclusion There should be a concerted effort, to make viral load accessible and available to all patients receiving ARV treatment in the CAR and the management of HIV/AIDS infection of children and adolescents should be given special attention.

Research paper thumbnail of Trends of HIV Viral Load in Patients under Combined Antiretroviral Treatment in Bangui, Central African Republic

World Journal of AIDS, 2018

Background: The success of antiretroviral therapy requires better virological monitoring. We desc... more Background: The success of antiretroviral therapy requires better virological monitoring. We described the virological profile of patients on combined antiretroviral therapy (cART) for HIV/AIDS in Bangui, Central African Republic (CAR). Methods: In this prospective cohort study of patients who had been on combined antiretroviral therapy treatment (cART) for at least 12 months in Bangui, only one HIV plasma viral load per patient was realized at the Institut Pasteur of Bangui, between April 4th and November 28th, 2017. Sociodemographic and biological data were collected. Blood samples were taken for viral load. The biocentric generic human immunodeficiency virus (HIV) load test was used to quantify a ribonucleic acid (RNA) HIV-1. Data were analyzed with Stata software version 14. Chi-squared test was used to analyse viral load according to sex and age. The level of significance was set at P ≤ 0.05. Results: A total of 3569 patients were recruited, with a mean age of 40 years (median, 42 years; range, 1-84), patients aged 40-49 predominating (34.2%). The sex ratio was 0.4. No virus was detectable in plasma from 49.2% of patients, while 42.4% had virological failure (viral load, ≥1000 copies/mL) according to WHO criteria. The risk for virological failure decreased with age (P = 0.001) and was higher among females than males (P = 0.001). Conclusions: The rate of virological failure among patients on cART is very high in the CAR, despite the availability of and access to monitoring of HIV plasma viral load in Bangui.

Research paper thumbnail of Evidence of human leptospirosis cases in a cohort of febrile patients in Bangui, Central African Republic: a retrospective study, 2012–2015

BMC Infectious Diseases, 2018

Background: In spite of a local favorable environment, leptospirosis has never been described in ... more Background: In spite of a local favorable environment, leptospirosis has never been described in Central African Republic so far mainly because of the weakness of diagnostic tests and differential diagnostic strategy for febrile jaundice cases negative for yellow fever virus. Here we bring a complementary insight to conclusions of Gadia CLB et al. regarding the presence of leptospirosis in Central African Republic in YFV-negative febrile icteric patients. Methods: Our study included 497 individuals presenting with fever and jaundice but negative for yellow fever infection, retrospectively selected from the national surveillance biobank for yellow fever in Institut Pasteur de Bangui, Central African Republic. A combination of serological (ELISA, agglutination) and molecular biology techniques (quantitative real-time polymerase chain reaction) was used to identify Leptospira or the patient's immune response to the bacteria. Statistical analyses were done using the non parametric Mann-Withney U test with a 5% statistical threshold. Results: ELISA test results showed 46 positive serum samples while 445 were negative and 6 remains equivocal. In addition, the reference microscopic agglutination test for leptospirosis diagnostic confirmed that 7 out of 32 samples tested were positive. Unfortunately, all 497 serum samples tested for leptospirosis were negative using the molecular techniques. Conclusions: Unlike Gadia et al., we confirmed that leptospirosis is circulating in Central African Republic and therefore may be responsible for some of the unexplained cases of febrile jaundice in the country. Thus, leptospirosis needs to be investigated to improve identification of aetiological pathogens. Our study also suggests a need to improve sample transportation and storage conditions.