Introduction:Laboratory testing is critical for diagnosis and treatment management for people with HIV, but it is costly. When HIV resources are constrained, even before recent disruptions in US funding for the global HIV response, user fees have been used for cost recovery. We describe the availability and charging of user fees for routine HIV laboratory testing globally. Methods:Routine test availability and charging of user fees were examined via an HIV clinic survey conducted September 2020-March 2021; responses reflected clinical practices in 2019. HIV clinics came from 42 low-, middle-, and high-income countries from the International epidemiology Databases to Evaluate AIDS (IeDEA) global research consortium. Results:Across 199 clinics, on-site test availability was generally limited, reflecting constraints in routine test availability across health conditions more broadly. Over 90% of clinics did not report charging user fees. A higher percentage of reporting user fees was from middle-income countries and from countries receiving Global Fund or PEPFAR country support, which may reflect settings with ongoing health funding gaps. Conclusion:Availability and user fees for essential HIV-related laboratory tests were limited in 2019. Monitoring user fees may provide insights about how national health systems are responding to steep reductions in global donor funding.

In Côte d’Ivoire, adolescents living with HIV constitute a vulnerable population whose quality of life remains poorly documented. The aim of this study was to assess the quality of life of HIV- positive adolescents receiving care at the Centre Intégré de Recherches Biocliniques d’Abidjan (CIRBA) and to identify its determinants. A pilot, cross-sectional, descriptive and analytical study was conducted among 32 adolescents aged 10 to 17 years receiving care at CIRBA in Abidjan. Quality of life was measured using the PedsQL™ HIV questionnaire. Spearman’s, Mann-Whitney, Kruskal-Wallis and Fisher’s correlation tests were used to establish links between the various parameters. The results showed a predominance of females (65.6%) with a mean age of 14.1 ± 2.1 years. The school enrolment rate was high (96.9%). These adolescents lived either with their families (53.1%) or in an institution (Centre Espoir) (46.9%). Their overall quality of life was high (80.3 ± 4.1), with good scores in the treatment-related and psychosocial dimensions (≥ 82). In contrast, the understanding/communication dimension was significantly lower (52.6 ± 15.5), whilst the dimension related to HIV symptoms was moderate (65.7 ± 11.9). Analysis of associations showed that treatment adherence was significantly higher at the Centre Espoir than in a family setting (p = 0.018). Age was negatively correlated with understanding/communication (ρ = -0.40; p = 0.023), whilst the duration of antiretroviral treatment was positively associated with perception of treatment (ρ = 0.40; p = 0.025) and overall quality of life (ρ = 0.41; p = 0.020). No significant association was observed with gender, educational level or type of antiretroviral regimen (p > 0.05).

Introduction:While HIV services have scaled up dramatically under universal treatment recommendations, availability of routine laboratory services for HIV diagnosis and management, and the extent to which user fees are charged for these services, are not well documented. We described site-level availability and user fees for adult HIV laboratory testing among 238 sites in 42 countries of the International epidemiology Databases to Evaluate AIDS (IeDEA) global consortium, and contextualized practices by site- and country-level characteristics, including country income level and receipt of Global Fund or PEPFAR support. Methods:Availability of HIV-related laboratory services and charging of user fees, were examined via an IeDEA site assessment survey conducted September 2020-March 2021, with responses reflecting practices in 2019. Laboratory services examined included: HIV-1/HIV-2 antigen/antibody immunoassay test (HIV-1/2 Ag/Ab), HIV-1 p24 antigen test (p24), supplemental HIV-1/HIV-2 antibody differentiation immunoassay (HIV-1/2 Ab suppl), quantitative PCR for HIV viral load (VL), HIV-1 genotypic drug resistance testing (genotyping), and CD4 count testing (CD4). Availability was defined as provided on-site in the HIV clinic or within the same health facility. User fees were fees other than insurance co-pays paid for a given test, conditional on their on-site availability. We reported frequencies and percentages of site-level availability and user fees, overall and by site- and country-level characteristics. Results:Most sites (88%) reported HIV-1/HIV-2 Ag/Ab availability on-site, while fewer than half of sites reported having p24 and HIV-1/2 Ab suppl available. Approximately half of sites reported VL and CD4 testing availability, while less than one-third of sites (28%) reported genotyping availability. The percentage of sites reporting user fees ranged from 6.5% (HIV-1/2 Ag/Ab) to 10.5% (CD4). A higher percentage of sites reporting user fees were from upper-middle income countries, countries receiving any Global Fund or any PEPFAR country support, and the Asia-Pacific region. Conclusions:While most HIV care sites participating in IeDEA did not charge user fees for HIV-related laboratory tests in 2019, on-site availability of such tests was limited. Continued action to identify and address constraints in the routine provision of these laboratory services is critical for appropriate management of HIV.

Supplemental Digital Content is Available in the Text. Objectives:Efforts to control the COVID-19 pandemic have potentially compromised the availability and/or quality of HIV services. We aimed to assess the pandemic's impact on antiretroviral therapy (ART) initiation and HIV viral load (VL) monitoring in 3 West African countries.Methods:We used routinely collected data from 5 clinics contributing to the International epidemiologic Database to Evaluate AIDS collaboration in Burkina Faso, C & ocirc;te d'Ivoire, and Nigeria. We included ART-na & iuml;ve adults living with HIV initiating ART from January 1, 2018. We conducted regression discontinuity analysis to estimate changes in the number of ART initiations and VL measures per week, before and during the pandemic period in each country.Results:In clinics in Burkina Faso and C & ocirc;te d'Ivoire, ART initiations per week remained constant throughout the studied periods (-0.24 points (p) of ART initiations/week 95% CI: -5.5 to 5.9, -0.9 p, 95% CI: -8.5 to 8.6, respectively), whereas in Nigeria's clinic, they decreased significantly (-6.3 p, 95% CI: -10.8 to -1.7) after the beginning of the pandemic. The volume of VL tests performed decreased significantly in all 3 countries (-17.0 p, 95% CI: -25.3 to -8.6 in Burkina Faso, -118.4 p, 95% CI: -171.1 to -65.8 in C & ocirc;te d'Ivoire and -169.1 p, 95% CI: -282.6 to -55.6 in Nigeria).Conclusions:HIV clinics in two out of three countries in West Africa demonstrated resilience as they successfully maintained access to ART for ALWH despite the challenges imposed by the pandemic. However, VL monitoring was severely disrupted and did not return to prepandemic levels approximately 1 year after the beginning of the pandemic. Continued monitoring of the HIV care continuum in the postpandemic period is essential to mitigate potential enduring effects on ALWH's virological and clinical outcomes.

Transition to dolutegravir among 21 167 individuals experienced in antiretroviral therapy in West Africa showed heterogeneous timelines and patterns. Initially reported sex disparities tended to catch up over time with persisting disparities, according to contributing HIV clinics. Key factors facilitating dolutegravir switch were male sex, age <50 years, viral suppression, and regimens not based on protease inhibitors.

Objective:We studied the transition to dolutegravir-containing antiretroviral therapy (ART) at HIV treatment clinics within the International epidemiology Databases to Evaluate AIDS (IeDEA).Design:Site-level survey conducted in 2020-2021 among HIV clinics in low- and middle-income countries (LMICs).Methods:We assessed the status of dolutegravir rollout and viral load and drug resistance testing practices for persons on ART switching to dolutegravir-based regimens. We used generalized estimating equations to assess associations between clinic rollout of both first- and second-line dolutegravir-based ART regimens (dual rollout) and site-level factors.Results:Of 179 surveyed clinics, 175 (98%) participated; 137 (78%) from Africa, 30 (17%) from the Asia-Pacific, and 8 (5%) from Latin America. Most clinics (80%) were in low- or lower-middle-income countries, and there were a mix of primary-, secondary- and tertiary-level clinics. Ninety percent reported rollout of first-line dolutegravir, 59% of second-line, 94% of first- or second-line and 55% of dual rollout. The adjusted odds of dual rollout were higher among tertiary-level [adjusted odds ratio (aOR) 4.00; 95% confidence interval (CI) 1.39-11.47] and secondary-level clinics (aOR 3.66; 95% CI 2.19-6.11) than in primary-level clinics. Over half (59%) of clinics that introduced first- or second-line dolutegravir-based ART required recent viral load testing before switching to dolutegravir, and 15% performed genotypic resistance testing at switch.Conclusions:Dolutegravir-based ART was rolled out at nearly all IeDEA clinics in LMICs, yet many switched persons to dolutegravir without recent viral load testing and drug resistance testing was rarely performed. Without such testing, drug resistance among persons switching to dolutegravir may go undetected.

Mutant selection is due to the high rate of viral replication and lack of proofreading activity in the hepatitis B virus (HBV) polymerase thus leading to the generation of mutations in HBV. However naturally occurring HBV strains carrying primary drug resistance mutations are very rare in the absence of prior treatment. Monitoring changes in primary and secondary resistance mutations in patients who haven't been treated is crucial in order to optimize and promote the best treatment, to obtain a sustained virological response (SVR) and therefore, reduce the progression to cirrhosis and later to hepatocellular carcinoma (HCC). The main purpose of this research was to evaluate the resistance of HBV to antivirals and show the genetic variability of HBV in a population of blood donors, carrying HBs antigen, naïve to anti-HBV treatment in Abidjan. A descriptive and analytical cross-sectional method was used to establish the molecular profile and to identify the polymorphism of HBV in treatment-naïve infected study participants. Adults blood donors, of any sex, with a positive result for HBsAg, naïve to any antiviral treatment but with an HBV viral load superior to 1000 IU/ml were included. The ABI 3130 Avant sequencer (Applied Biosystems, Courtaboeuf, France) was used to sequence the polymerase (pol) gene to determine HBV resistance genotypes. Fifty-three (N=53) blood donors infected with HBV (HBs Ag positive) were screened. All patients were naïve to any antiviral treatment. Of all these patients, 30 (56.6%) blood donors, carrying HBsAg with a viral load superior to 1000 IU/mL were included in the study. The median age was 34 years old (21-52). The median viral load was 6561 IU/mL (103 – 1.65 x 109). Two mutations of a single base, notably A181T and A181S were highlighted in this study. The A181T mutation was associated with resistance to adefovir, lamivudine and telbivudine. As for the A181S mutation, it was associated with resistance to adefovir only. Analysis of phylogenetic trees obtained by sequencing confirmed the circulation of 2 genotypes: E (22; 92%) and A (2; 8%). The circulation of genotypes A and E of HBV in Côte d'Ivoire has been confirmed by this study, with an estimated genotypic mutation prevalence of 8%. The resistance of HBV to some antiretroviral drugs in the class of HBV polymerase inhibitors, such as lamivudine (3TC), telbivudine (LdT) adefovir (ADV) may be attributed to these mutations.

Liver disease is a major cause of morbidity and mortality among people living with HIV (PLWH). Diagnosis of these co-infections should be a priority in HIV-infected pregnant women so that they can receive appropriate and effective treatment. However, the prevalence of these infections in this vulnerable population remains poorly documented in Côte d'Ivoire. The objective of this study is to assess the seroprevalence of hepatitis B virus (HBV) or hepatitis C virus (HCV) co-infections in HIV-infected pregnant women undergoing ARV treatment in Abidjan (Côte d’Ivoire). A cross-sectional study among HIV-infected pregnant women was conducted from September 2017 to May 2018 in Abidjan. HBV and HCV serological tests were performed with the electrochemiluminescence method "ECLIA" on Cobas E 411. A total of one hundred (n = 100) HIV-infected pregnant women were included. The results showed that 6% (n=6/100) of the HIV-infected pregnant women had positive HBV serology and no HIV-HCV co-infection was detected. Of the 100 HIV-infected pregnant women included in this study, 23% had undergone surgery. In this population, HBsAg was positive in 9% of patients and HCV antibodies were negative in all patients. The data from this study support the implementation of large-scale sentinel surveillance in Côte d'Ivoire in order to refine data on the prevalence and circulation of viral hepatitis B and C in high-risk populations such as pregnant women.

Treatment scale-up is leading to a progressive increase in HIV resistance to antiretrovirals, especially in children. To assess resistance to reverse transcriptase inhibitors (RTIs) in HIV-1 infected children in Côte d’Ivoire, genotypic resistance tests were performed and interpreted using the ANRS algorithm ( www.hivfrenchresistance.org ). Phylogenetic trees were created using BioEdit v7 and Mega7 software. The frequency of resistance to at least one RTI was 79%. It was 88% for nucleoside reverse transcriptase inhibitors (NRTIs), 71% for non-nucleoside reverse transcriptase inhibitors (NNRTIs), and 63% for both classes (NRTI + NNRTI). The frequency of resistance was 50% for the ZDV + 3TC + EFV combination, 42% for the ABC + 3TC + EFV combination, and 8% for the TDF + 3TC + EFV combination. Frequently encountered resistance mutations were for NRTIs: M184V (88%), TAMs (67%), T215F/I/V/Y (33%), and L74I/V (24%); for NNRTIs: K103N/S (74%), P225H (26%), and G190A/E/Q (24%). The synthesis of phylogenetic analyses showed the predominance of the viral subtype CRF02_AG (85%). These results show a high prevalence of resistance to RTIs in children infected with HIV-1. Hence the interest of a more accessible monitoring of viral load and genotypic resistance tests in HIV-1 infected children undergoing treatment in Côte d’Ivoire.

OBJECTIVES:A risk score for long-term prediction of chronic kidney disease (CKD) in people living with HIV (PLHIV) has been developed using data from the D:A:D cohort. We assessed the performance of the D:A:D risk score in a cohort of PLHIV in West Africa. METHODS:Data from PLHIV starting antiretroviral treatment in four clinics in Burkina Faso, Côte d'Ivoire and Togo participating in the IeDEA West Africa collaboration were analysed. CKD was defined as two consecutive estimated glomerular filtration rates (eGFRs) of ≤ 60 mL/min/1.73 m2 . The D:A:D score (short version) was calculated using age, gender, nadir CD4 and baseline eGFR and was categorized into low, medium, and high-risk groups. RESULTS:In 14 930 participants (70% female, median age = 38 years; median nadir CD4 count = 183 cells/µL) followed for a median duration of 5.7 years, 660 (4.4%) progressed to CKD, with an incidence [95% confidence interval (CI)] of 7.8 (7.2-8.4) per 1000 person-years (PY). CKD incidence rates were 2.4 (2.0-2.8), 8.1 (6.8-9.6) and, 30.9 (28.0-34.1) per 1000 PY in the low-, medium- and high-risk groups, respectively. In the high-risk group, 14.7% (95% CI: 13.3; 16.3) had progressed to CKD at 5 years. Discrimination was good [C-statistics = 0.81 (0.79-0.83)]. In all, 79.4% of people who progressed to CKD were classified in the medium- to high-risk group at baseline (sensitivity) and 66.5% of people classified in the low risk group at baseline did not progress to CKD (specificity). CONCLUSIONS:These findings confirm the validity of the D:A:D score in identifying individuals at risk of developing CKD who could benefit from enhanced kidney monitoring in West African HIV clinics.

Introduction Extrapulmonary tuberculosis (EPTB) is difficult to confirm bacteriologically and requires specific diagnostic capacities. Diagnosis can be especially challenging in under-resourced settings. We studied diagnostic modalities and clinical outcomes of EPTB compared to pulmonary tuberculosis (PTB) among HIV-positive adults in antiretroviral therapy (ART) programmes in low- and middle-income countries (LMIC). Methods We collected data from HIV-positive TB patients (>= 16 years) in 22 ART programmes participating in the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium in sub-Saharan Africa, Asia-Pacific, and Caribbean, Central and South America regions between 2012 and 2014. We categorized TB as PTB or EPTB (EPTB included mixed PTB/EPTB). We used multivariable logistic regression to assess associations with clinical outcomes. Results and Discussion We analysed 2695 HIV-positive TB patients. Median age was 36 years (interquartile range (IQR) 30 to 43), 1102 were female (41%), and the median CD4 count at TB treatment start was 114 cells/mu L (IQR 40 to 248). Overall, 1930 had PTB (72%), and 765 EPTB (28%). Among EPTB patients, the most frequently involved sites were the lymph nodes (24%), pleura (15%), abdomen (11%) and meninges (6%). The majority of PTB (1123 of 1930, 58%) and EPTB (582 of 765, 76%) patients were diagnosed based on clinical criteria. Bacteriological confirmation (using positive smear microscopy, culture, Xpert MTB/RIF, or other nucleic acid amplification tests result) was obtained in 897 of 1557 PTB (52%) and 183 of 438 EPTB (42%) patients. EPTB was not associated with higher mortality compared to PTB (adjusted odd ratio (aOR) 1.0, 95% CI 0.8 to 1.3), but TB meningitis was (aOR 1.9, 95% CI 1.0 to 3.1). Bacteriological confirmation was associated with reduced mortality among PTB patients (aOR 0.7, 95% CI 0.6 to 0.8) and EPTB patients (aOR 0.3 95% CI 0.1 to 0.8) compared to TB patients with a negative test result. Conclusions Diagnosis of EPTB and PTB at ART programmes in LMIC was mainly based on clinical criteria. Greater availability and usage of TB diagnostic tests would improve the diagnosis and clinical outcomes of both EPTB and PTB.

Protease inhibitors (PIs) select more mutations than any other class of antiretroviral drugs (ARV). The objective of our study was to determine minor and major mutations in HIV-1 protease that may decrease the efficacy of PIs in children. The determination of mutations and their interpretations were performed using ANRS techniques and algorithms (www.hivfrenchresistance.org). Sequence analysis identified 13% of children resistant to PIs. Frequent minor mutations were M36I and K20I (100% respectively), H69K (88%), L89M and I54V (75% respectively) and G16E (50%). The major mutations were V82A (75%), M46I (63%), L90M (38%) and L76V (13%). Resistance was noted to Indinavir (IDV) and Fosamprenavir/Ritonavir (FPV/r) (75% respectively), Nelfinavir (NFV) and Saquinavir/Ritonavir (SQV/r) (50% respectively), Atazanavir/Ritonavir (ATV/r) (38%) and Lopinavir/Ritonavir (LPV/r) (25%). This study identified mutations associated with PIs resistance in children. The minor mutations frequently encountered whose association with other mutations cause resistance to LPV/r and ATV/r respectively were I54V and G16E. The major mutation responsible for resistance to LPV/r was L76V. The combination of minor and major mutations frequently associated with PIs ineffectiveness was the combination of 4 mutations, I54V, V82A, L90M and M46I for LPV/r and 3 mutations, G16E, L90M and M46I for ATV/r. No resistance to DRV/r was observed, it could be a surrogate molecule.

The co-infection of the human immunodeficiency virus (HIV) with the viral hepatitis B virus (HBV) is one of the major challenges in the management of HIV. This study aimed to evaluate the prevalence of genotypic mutations of HBV resistance in HBV/HIV co-infected patients and to determine the genetic polymorphism of circulating HBV in a population monitored at CIRBA. The primary objective of this study was to assess the antiviral resistance of HBV and to characterize the genetic variability of HBV in HIV/HBV co-infected patients. This is a cross-sectional descriptive and analytical study conducted from January 2014 to September 2016 at CIRBA. Adult patients co-infected with HBV/HIV on ARV but with detectable HBV viral load were included. HBV resistance genotypes were determined by polymerase (pol) gene sequencing performed on the automatic sequencer (ABI 3130 Avant, Applied Biosystems, Courtaboeuf, France). Of 300 HBV/HIV co-infected patients, thirty-nine (39; 13%) were included. The median viral load was 558 IU/mL. The majority of HBV/HIV co-infected patients (n = 36; 92%) were on triple therapy for HIV-1 infection with two tenofovir + Lamuvidine molecules active on HIV-1 and HBV. Analysis of phylogenetic trees constructed using Mega 7 software confirmed that fifteen (n = 15; 100%) were genotype E strains. Resistance mutations (V173L, L180M, M204V, L180M/L, M204M/V) leading to resistance to Lamuvidine, Telbivudine and Entecavir were observed in five sequenced patients (33.33%). This study confirms the circulation of the HBV genotype E in Cote d'Ivoire with an estimated prevalence of genotypic mutation of 33.3%.

BACKGROUND:In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high. We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy (ART), 6-month isoniazid preventive therapy (IPT), or both among HIV-infected adults with high CD4+ cell counts in Ivory Coast.METHODS:We included participants who had HIV type 1 infection and a CD4+ count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization (WHO) guidelines. Participants were randomly assigned to one of four treatment groups: deferred ART (ART initiation according to WHO criteria), deferred ART plus IPT, early ART (immediate ART initiation), or early ART plus IPT. The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome (AIDS), non-AIDS-defining cancer, non-AIDS-defining invasive bacterial disease, or death from any cause at 30 months. We used Cox proportional models to compare outcomes between the deferred-ART and early-ART strategies and between the IPT and no-IPT strategies.RESULTS:A total of 2056 patients (41% with a baseline CD4+ count of ≥500 cells per cubic millimeter) were followed for 4757 patient-years. A total of 204 primary end-point events were observed (3.8 events per 100 person-years; 95% confidence interval [CI], 3.3 to 4.4), including 68 in patients with a baseline CD4+ count of at least 500 cells per cubic millimeter (3.2 events per 100 person-years; 95% CI, 2.4 to 4.0). Tuberculosis and invasive bacterial diseases accounted for 42% and 27% of primary end-point events, respectively. The risk of death or severe HIV-related illness was lower with early ART than with deferred ART (adjusted hazard ratio, 0.56; 95% CI, 0.41 to 0.76; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.56; 95% CI, 0.33 to 0.94) and lower with IPT than with no IPT (adjusted hazard ratio, 0.65; 95% CI, 0.48 to 0.88; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.61; 95% CI, 0.36 to 1.01). The 30-month probability of grade 3 or 4 adverse events did not differ significantly among the strategies.CONCLUSIONS:In this African country, immediate ART and 6 months of IPT independently led to lower rates of severe illness than did deferred ART and no IPT, both overall and among patients with CD4+ counts of at least 500 cells per cubic millimeter. (Funded by the French National Agency for Research on AIDS and Viral Hepatitis; TEMPRANO ANRS 12136 ClinicalTrials.gov number, NCT00495651.).

The aim of this study is to evaluate and to characterize the iron metabolism in women of reproductive age infected by VIH in Abidjan. In order to review the iron stores in women of reproductive age, 180 women were recruited in a specialized center for treatment of HIV (ICBRA) based on the criteria for inclusion and exclusion. The mean age of women was 34.7 ± 0.5 years with extremes of 18 and 45 years. These women were classified into two groups of subjects namely 120 HIV positive women and 60 HIV negative as control women. Blood samples were taken from each of the selected women. Assays of various biological indicators (haematological and biochemical parameters) assessment of iron status were performed by different kits adequate for the automatic COBAS INTEGRA 400 Plus. The results of our investigations have demonstrated that all the searched biological has been degraded in enrolled women. Indeed our study found that for all subjects 79.4 % of women reported an abnormal iron status namely 71.7 % and 83.3 % respectively in control women and women with HIV. Abnormal iron status consisted of iron deficiency, iron deficiency anaemia, inflammatory anaemia and inflammatory anaemia associated with iron deficiency. Among the observed various components of iron status, inflammatory anaemia revealed the high prevalence rates in both groups of subjects (46.7 % vs 67.5 %). Our findings have then indicated that HIV infection has dramatically altered iron stores in women of reproductive especially those living with HIV/AIDS.

We have initiated the investigations in women of reproductive age with HIV to evaluate and to characterize their iron metabolism. Moreover, to demonstrate the importance of ART, a study was conducted to compare the iron stores and the components of iron status between women of reproductive age with ART and those naive of ART. To do this, 60 women with ART and 60 women naive of ART were recruited in a specialized centre for treatment of HIV (ICBRA) based on the criteria for inclusion and exclusion. The mean age of women was 35.9 ± 0.4 years with extremes of 18 and 45 years. Blood samples were obtained from each subject to search the different biological indicators of iron status assessment. The results of our investigations showed that all the biological parameters searched of iron status evaluation, are degraded in enrolled women. Otherwise, our study revealed that women naive of ART indicated a more altered iron status than those with ART (88.3 % vs 78.3 %). Abnormal iron status consisted of iron deficiency, iron deficiency anaemia, inflammatory anaemia and inflammatory anemia associated with iron deficiency. Among the different components of iron status, inflammatory anaemia indicated high prevalence rates both in women naive of ART and women with ART (70 % vs 65 %). It appears from this study that antiretroviral treatment greatly disturbs iron metabolism in women of reproductive age with HIV infection. In addition, the inflammatory anaemia is significantly associated with ART in women with HIV infection.

AIMTo determine the prevalence of hepatitis B virus (HBV) in adult human immunodeficiency virus (HIV) patients with CD4+ T-cell count less than 500/mm(3) and without antiretroviral therapy; to describe different HBV-HIV coinfection virological profiles; and to search for factors associated with HBs antigen (HBsAg) presence in these HIV positive patients.METHODSDuring four months (June through September 2006), 491 patients were received in four HIV positive monitoring clinical centers in Abidjan.INCLUSION CRITERIAHIV-1 or HIV-1 and 2 positive patients, age ≥ 18 years, CD4+ T-cell count < 500/mL and formal and signed consent of the patient. Realized blood tests included HIV serology, CD4+ T-cell count, quantitative HIV RNA load and HBV serological markers, such as HBsAg and HBc antibody (anti-HBcAb). We performed HBeAg, anti-HBe antibody (anti-HBeAb), anti-HBc IgM and quantitative HBV DNA load in HBsAg positive patients. Anti-HBsAb had been tested in HIV patients with HBsAg negative and anti-HBcAb-positive. HBV DNA was also tested in 188 anti-HBcAb positive patients with HBsAg negative status and without anti-HBsAb. Univariate analysis (Pearson χ(2) test or Fischer exact test) and multivariate analysis (backward step-wise selection logistic regression) were performed as statistical analysis.RESULTSMean age of 491 patients was 36 ± 8.68 years and 73.3% were female. Type-1 HIV was found in 97% and dual-type HIV (type 1 plus type 2) in 3%. World Health Organization (WHO) clinical stage was 1, 2, 3 and 4 respectively in 61 (12.4%), 233 (47.5%), 172 (35%) and 25 patients (5.1%). Median CD4+ T-cell count was 341/mm(3) (interquartile range: 221-470). One hundred and twelve patients had less than 200 CD4+ T-cell/mm(3). Plasma HIV-1 RNA load was elevated (≥ 5 log(10) copies/mL) in 221 patients (45%). HBsAg and anti-HBcAb prevalence was respectively 13.4% and 72.9%. Of the 66 HBsAg positive patients, 22 were inactive HBV carriers (33.3%), 21 had HBeAg positive hepatitis (31.8%) and 20 had HBeAg negative hepatitis (30.3%). HBeAg and anti-HBeAb were indeterminate in 3 of them. Occult B infection prevalence (HBsAg negative, anti-HBcAb positive, anti-HBsAb negative and detectable HBV DNA) was 21.3%. Three parameters were significantly associated with the presence of HBsAg: male [odds ratio (OR): 2.2; P = 0.005; 95% confidence interval (CI): 1.3-3.8]; WHO stage 4 (OR: 3.2; P = 0.01; 95% CI: 1.3-7.9); and aspartate aminotransferase (AST) level higher than the standard (OR: 1.9; P = 0.04; 95% CI: 1.02-3.8).CONCLUSIONHBV infection prevalence is high in HIV-positive patients. HBeAg positive chronic hepatitis and occult HBV infection are more frequent in HIV-positive patients than in HIV negative ones. Parameters associated with HBsAg positivity were male gender, AIDS status and increased AST level.

Background In countries with high rates of chronic HBV, the World Health Organization recommends screening all HIV-infected adults for hepatitis B surface antigen (HBsAg) before initiating antiretroviral therapy (ART), and starting HIV–HBV-coinfected patients on regimens containing lamivudine (3TC) or emtricitabine (FTC) plus tenofovir disoproxil fumarate (TDF). Here, we estimated the prevalence of untreated HIV-infected adults with negative serum HBsAg and detectable plasma HBV DNA in Côte d'Ivoire. Methods This was a cross-sectional survey. We tested all untreated HIV type-1 (HIV-1)-infected adults with CD4+ T-cell counts <500 cells/mm3 for HBsAg, hepatitis B core antibodies (anti-HBc) and HBsAg antibodies (anti-HBs). We measured plasma HBV DNA in patients who tested positive for HBsAg and/or anti-HBc. Results We included 495 adults, of whom 73% were women. Median CD4+ T-cell count was 329 cells/mm3 and median HIV RNA was 4.9 log10 copies/ml. Overall, 63 (13%) patients had chronic hepatitis B (HBsAg-positive), 115 (23%) had never been exposed to HBV (HBsAg-negative, anti-HBc-negative and anti-HBs-negative), 108 (22%) had signs of cured infection (anti-HBc-positive and anti-HBs-positive) and 209 (42%) had isolated anti-HBc (HBsAg-negative, anti-HBc-positive and anti-HBs-negative). Of these, 51 (10%) had detectable HBV DNA. Median HBV DNA level was 5.2 log10 copies/ ml (interquartile range [IQR] 3.2–8.8) for patients with chronic hepatitis and 2.2 log10 copies/ml (IQR 1.8–2.7) for those with occult HBV infection. Conclusions Among ART-naive HIV-1-infected African adults, 13% were HBsAg-positive and 42% had isolated anti-HBc, including 10% who had occult HBV. The clinical implications of high occult HBV prevalence are unknown. Future studies should assess the benefits of routine use of 3TC or FTC plus TDF as first-line ART in African settings, where HBV DNA tests are unavailable.