Viral Characteristic of HIV Infected Patients Naïf of Anti-Retroviral Therapy with CD4+ T Lymphocytes Rate Greater than 350 per Microliter of Blood in Lomé Togo

doi:10.4236/wja.2013.34047

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World Journal of AIDS, 2013, 3, 364-366

Published Online December 2013 (http://www.scirp.org/journal/wja)

http://dx.doi.org/10.4236/wja.2013.34047

Open Access WJA

Viral Characteristic of HIV Infected Patients Naïf o f

Anti-Retroviral Therapy with CD4+ T Lymphocytes Rate

Greater than 350 per Microliter of Blood in Lomé Togo

Ihou Nazoba Majesté Wateba, Akouda Akessiwe Patassi, Abago Balaka, Ousséni Tidjani

Service de Maladies Infectieuses et de Pneumologie, CHU Sylvanus Olympio, Lomé, Togo.

Email: [email protected]

Received September 6th, 2013; revised October 6th, 2013; accepted October 13th, 2013

License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Obje ctive: To evaluate the virological status of ineligible HIV patients for anti-retroviral therapy based on the criterion

of CD4+ T lymphocytes rate over than 350/μl of blood. Method: This is a prospective study which was conducted from

November 2011 to July 2012 in the tropical and infectious disease department of CHU Sylvanus Olympio of Lomé. All

HIV-1 infected patients whose CD4+ T lymphocytes rate was ≥350/μl of blood were retained. The count of CD4+ T

lymphocytes was made by cytometer FACSCalibur® flow of BD biosciences and the determination of viral load was

achieved by NASBA laboratory method of Biomérieux. Results: We have recruited 102 PLWHA aged between 19 and

58 years with a median of 35 years. Biologically, 102 patients had a T-CD4 rate between 355 and 432/μl of blood. The

determination of viral load showed a very high viral replication more than 10,000 copies/ml among all patients and 28

(27.5%) patients had a viral load > 100,000 copies/ml of blood. Conclusion: Our results argue for a reconsideration of

the criteria for starting antiretroviral therapy in Togo by including virological data if necessary in patients with T-CD4

rate below 500/μl of blood.

Keywords: Viral Load; CD4+ T Lymphocytes; Naive Anti-Retroviral Therapy Patients

1. Introduction

Twenty-five years after the start of the pandemic of hu-

man immunodeficiency virus (HIV) and despite the in-

ternational mobilization, HIV/AIDS which is a major

public health problem in developing countries remains.

In Togo, the HIV epidemic has been documented since

1987. Between 1987 and 2005, 20,676 cumulative AIDS

cases were officially registered and 110,000 people are

living with HIV [1]. The prevalence of HIV infection was

successively 5.8% in 2001, 4.1% in 2003, 3.2% in 2005

and 3% in 2008 [1]. In 2012, more than 36,000 people

have had received antiretroviral therapy. Since 2012, the

immunological criteria for starting treatment were recon-

sidered from ≤200 CD4+ T lymphocytes to ≤350 CD4+

T lymphocytes per μl of blood. For higher rates, the ini-

tiation of treatment considers the clinical condition of the

patient [2-4]. The aim of our study was to evaluate the

viral status of patients ineligible for anti-retroviral ther-

apy (CD4+ T lymphocytes rate more than 350 per μl of

blood) according to the national algorithm of Togo.

2. Method

This is a prospective study which was done in the tropi-

cal and infectious diseases department of CHU Sylvanus

Olympio of Lomé in Togo. All patients are HIV-1 in-

fected and naive for anti retroviral treatment. The CD4+

T lymphocytes rate is between 350 and 500 per μl of

blood. The T-CD4 count was performed by the technique

of flow cytometry of BD Biosciences FACSCalibur™.

The determination of the viral load was performed by the

NASBA method (Nucleid Acid Sequence Based Ampli-

fication) with EasyQ BioMerieux equipment.

3. Results

Epidemiological data: Two hundred HIV-1 infected pa-

tients were included in the study. Seventy-five patients

(74.5%) were female and 27 were male (25.5%). The sex

ratio M/F was 0.34. The age of patients ranged from 19

to 58 years with a median of 35 years.

Biological data: The rate of CD4+ T lymphocytes was

Viral Characteristic of HIV Infected Patients Naïf of Anti-Retroviral Therapy with CD4+ T

Lymphocytes Rate Greater than 350 per Microliter of Blood in Lomé Togo 365

between 355 and 432 per μl of blood and the median

value of CD4+ T lymphocyte count was 357 per μl of

blood. The mean viral load of all patients enrolled was

106,136 copies/ml and the maximum viral load was

1,000,000 copies/ml (6 Log/ml) and a minimum value

was less than 10,100 copies/ml. Twenty-eight patients

(27.5%) had a viral load > 100,000 copies/ml (5 Log/ml)

(Table 1).

4. Discussion

Epidemiological data: We observed a female predomi-

nance and the sex ratio M/F was 0.34. Our result is simi-

lar to the data reported by the national program against

HIV in Togo which has related a sex ratio of 0.32 in

2007 [1]. This observation is consistent with the UN-

AIDS report in 2007 which indicates that 61% of people

infected with HIV in sub-Saharan Africa are women [5]

The predominance of women within HIV-1 infected pa-

tients in Togo and in the sub-Sahara Africa Region could

be explained by early sexual relation among girls, the

lack of training and information on the prevention of

HIV-AIDS and high-risk behaviours of their partner(s)

who provide them incomes and very often, they can not

make them use preservative [5]. The age of patients is

between 19 and 52 years with a median age of 35 years.

This age group is the most active mass of the Togolese

population in terms of production of income-generating

activities. They also correspond to the sexual active po-

pulation. Our results are similar to the national HIV pro-

gram data of Togo in 2007 where more than 74% of HIV

infected patients were aged from 25 to 49 years old.

Biologically, all patients included in this study were

not eligible for anti retroviral therapy because of the

CD4+ T lymphocyte rate > 350/μl of blood according to

the national HIV algorithm in Togo [2]. Indeed, for a

long time, Togo as the majority of developing countries

had recommended to start the anti retroviral therapy

when the CD4+ T lymphocyte rate is ≤200/μl of blood. If

a better result was demonstrated in many clinical trials

with patients who had started the anti retroviral therapy

at AIDS stage (CD4+ T lymphocytes rate < 200/μl of

blood) and in many cohort studies of patients with CD4 <

350 per μl of blood, several new arguments, also from

cohort studies, argue for an earlier introduction of the

first antiretroviral therapy in asymptomatic patients with

CD4 rate > 350/μl. The benefit is the better viral and im-

Table 1. Distribution of patients according to the viral load.

Viral load Viral load

<100.000 copies/ml >100.000 copies/ml

Total strength 74 (72.5%) 28 (27.5%)

mune response [6] and the reduction of the morbidity [7]

or the improvement of the mortality [8,9]. In addition,

HIV infection, regardless of immune deficiency, includ-

ing levels of CD4+ T lymphocytes > 350/μl, increase a

risk of morbidity and mortality of cancer, cardiovascular

disease and neuro-cognitive disorders which could also

justify earlier introduction of antiretroviral therapy [8,10,

11].

Virologically, 27.5% of patients had a viral load >

100.000/ml blood. Indeed, the prognostic value of

plasma viral load to initiate anti retroviral treatment is

less important than the CD4+ T lymphocytes rate when

the viral load < 100,000 copies/ml (5 Log/ml). However,

several cohort studies have shown that high plasma viral

load (especially >100,000 copies/ml) is a bad prognostic

factor regardless of the CD4 T lymphocytes rate [12-14].

In addition, the quality of the immunological response to

antiretroviral therapy decreases with age and is signifi-

cantly worse after 60 years [15]. The clinical response is

also lower in patients over 50 years [16]. A first HAART

should help to make undetectable viral load (<50 copies

ARN-VIH/ml) within 6 months from the beginning of

the treatment. However, with some patients, this goal is

not reached at that date, and the viral load becomes un-

detectable after 6 months of treatment. This can be seen

especially when the initial viral load > 5 Log copies/ml

or in case of low CD4 T lymphocytes rate.

5. Conclusion

Our study has provided sufficient evidence that the rela-

tively high rates of CD4 T lymphocytes (>350/μl) may

be accompanied by a very high viral replication. It is for

that reason that today all recommendations argue at early

beginning of the anti-retroviral therapy with those HIV

infected. However, it is difficult to implement the viral

load measurement in developing countries, which ap-

pealed to the international generosity to take care of their

patients. This study deserves to demonstrate that many

remains have to be done to attend universal access care

and to achieve the objective 06 of Millennium Develop-

ment Goals on HIV/AIDS.

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Open Access WJA

Viral Characteristic of HIV Infected Patients Naïf of Anti-Retroviral Therapy with CD4+ T

Lymphocytes Rate Greater than 350 per Microliter of Blood in Lomé Togo

Open Access WJA

366

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