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1. Mortality in relation to hepatitis B virus (HBV) infection status among HIV-HBV coinfected patients in sub-Saharan Africa after immediate initiation of antiretroviral therapy Running head: HBV profiles and mortality in HIV

Author

Kouamé, Gérard Menan, Mohareb, Amir, Gabassi, Audrey, Gabillard, Delphine, Moh, Raoul, Badjé, Anani, Emiene, Arlette, Maylin, Sarah, Menam, Herve, Hyle, Emily, Delaugerre, Constance, Danel, Christine, Anglaret, Xavier, Lacombe, Karine, Eholié, Serge, Boyd, Anders, Infectious diseases in lower-income countries [Bordeaux] (IDLIC), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Harvard Medical School [Boston] (HMS), Laboratoire de Virologie [CHU Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), This work was supported by the Agence Nationale de Rercheches sur le SIDA et les hépatites virales (ANRS), Paris, France.GMK also received doctoral funding from the ANRS. AMM received funding from National Institutes of Health NIAID T32AI007433and NIAID R37AI058736.EPH received funding from National Institutes of Health NHLBIK01HL123349., Gestionnaire, HAL Sorbonne Université 5, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)

Subjects
Hepatitis B virus, Sub‐Saharan Africa, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, virus diseases, HIV, CD4+ cell count, Mortality, digestive system diseases
Abstract

International audience; It is unknown how past and active hepatitis B virus (HBV) infection affect immunorecovery and mortality in people with HIV who initiate tenofovir‐based antiretroviral therapy (ART). Using data collected between 2008 and 2015, we studied people with HIV in sub‐Saharan Africa initiating immediate ART in the Temprano randomized control trial. We classified participants into HBV groups at ART initiation: hepatitis B surface antigen (HBsAg)‐positive with HBV DNA ≥ 2,000 IU/ml; HBsAg‐positive with HBV DNA < 2,000 IU/ml; isolated HBcAb‐positive; resolved infection (HBsAb‐positive/HBcAb‐positive); and HBV non‐immune/vaccinated (HBcAb‐negative). We compared square‐root CD4‐cell count increases using mixed‐effect, non‐linear regression adjusted for age, sex, baseline CD4 cell count, and HIV RNA. We compared all‐cause mortality using Bayesian parametric survival regression. Among 879 participants, 24 (2.7%) had HBsAg with high HBV DNA, 76 (8.6%) HBsAg with low HBV DNA, 325 (37.0%) isolated anti‐HBcAb, 226 (25.7%) resolved HBV infection and 228 (25.9%) HBV non‐immune/vaccinated. We found no significant difference in CD4 cell increases between HBV‐infection groups after adjustment (p = 0.16). Participants with HBsAg and high HBV DNA had the highest incidence of all‐cause mortality (1.9/100 person‐years, 95% Credibile Interval [CrI] = 1.0–3.4). By comparison, incidence rates of mortality were reduced by 57% (95%CrI = −79%, −13%), 60% (95%CrI = −82%, −12%) and 66% (95%CrI = −84%, −23%) in those who had isolated anti‐HBcAb‐positive, resolved HBV infection and HBV non‐immune/vaccinated, respectively. In conclusion, individuals with HIV and past HBV infection or isolated anti‐HBcAb‐positive serology, much like HBV non‐immune/vaccinated, experience lower mortality than those with HBsAg and high HBV DNA. Additional HBV‐related management would not be necessary for these individuals.

Published
2020
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2. Effect of hepatitis B virus (HBV) S-gene variability on markers of replication during treated HIV-HBV infection in Western Africa

Author

Boyd, Anders, Moh, Raoul, Maylin, Sarah, Chekaraou, Mariama, Mahjoub, Nadia, Gabillard, Delphine, Anglaret, Xavier, Paul Eholié, Serge, Danel, Christine, Delaugerre, Constance, Zoulim, Fabien, Lacombe, Karine, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Treichville [Abidjan, Côte d'Ivoire] (CHU de Treichville), Programme PAC-CI, ANRS France Recherche Nord & sud Sida-hiv hépatites, Université Félix Houphouët-Boigny (UFHB), Laboratoire de Virologie [CHU Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2, Génétique et Ecologie des Virus, Génétique des Virus et Pathogénèse des Maladies Virales, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL), Services des Maladies Infectieuses et Tropicales [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Gestionnaire, Hal Sorbonne Université, Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7)

Subjects
[SDV.MP.VIR] Life Sciences [q-bio]/Microbiology and Parasitology/Virology, hepatitis B surface antigen, immunosuppression, surface gene, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, genetic variability, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases
Abstract

International audience; BACKGROUND & AIMS: Replication markers exhibit substantial variation during chronic hepatitis B virus (HBV) infection, part of which can be explained by mutations on the surface (S) gene. We aimed to identify S-gene mutations possibly influencing the quantification of HBV replication markers (MUPIQH) in HBV genotype E infection, common to Western Africa.METHODS: Seventy-three antiretroviral treatment (ART)-naïve human immunodeficiency virus (HIV)-HBV co-infected patients from Côte d'Ivoire, initiating anti-HBV-containing ART, had available HBV S-gene sequences. S-gene MUPIQHs were screened at ART initiation based on lower HBV-DNA or HBsAg quantification (qHBsAg) compared to wildtype. Their association with HBV virological response and qHBsAg slope during treatment was evaluated.RESULTS: Genotype E was predominant (95.9%). At ART initiation, median HBV-DNA was 7.27 log10 copies/mL (IQR = 5.26-8.33) and qHBsAg 4.08 log10 IU/mL (IQR = 3.49-4.61). Twelve S-gene MUPIQHs were identified among 21 patients (28.8%): sS140L (n = 4), sD144A (n = 1), sS167L (n = 2), sS174N (n = 6), sP178Q (n = 2), sG185L (n = 2), sW191L (n = 2), sP203Q/R (n = 2), sS204N/I/R/K/T/G (n = 7), sN207T (n = 2), sF212C (n = 1) and sV224A/Y (n = 7). MUPIQHs at positions s185+s191+s224 and s178+s204 were within highly covarying networks of S-gene mutations. Older age (P = 0.02), elevated transaminases (P = 0.03) and anti-hepatitis B "e" antibody-positive serology (P = 0.009) were significantly associated with prevalent MUPIQHs at ART initiation. During treatment, baseline MUPIQHs were not associated with time-to-undetectable HBV-DNA (P = 0.7) and qHBsAg levels decreased at similar rates between those with vs without MUPIQHs (P = 0.5).CONCLUSION: Several novel S-gene mutations were associated with reductions in replication markers among West African co-infected patients. These mutations, however, do not affect response during antiviral treatment. Their diagnostic and clinical consequences need clarification.

Published
2019
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3. Clin Infect Dis

Author

KOUAME, Menan Gerard, BOYD, A., MOH, Raoul, EHOLIE, Serge Paul, DANEL, Christine, LACOMBE, K., ANGLARET, Xavier, Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
IDLIC, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Published
2018
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4. Early ART Initiation in West Africa has no Adverse Social Consequences: A 24-Month Prospective Study

Author

Jean, Kévin, Niangoran, Serge, Danel, Christine, Moh, Raoul, Menan, Gérard Kouamé, Badjé, Anani, Gabillard, Delphine, Eholié, Serge, Dray-Spira, Rosemary, Lert, France, Anglaret, Xavier, Desgrées-Du-Loû, Annabel, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire [Treichville] (CHU), Statistics In System biology and Translational Medicine (SISTM), Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)- Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Centre de recherche en épidémiologie et santé des populations ( CESP ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Programme PACCI, ANRS, Statistiques pour la médecine translationnelle ( SISTM ), Bordeaux population health ( BPH ), Université de Bordeaux ( UB ) -Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Bordeaux ( UB ) -Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Department of Infectious Diseases [Abidjan, Côte d'Ivoire], CHU Treichville [Abidjan, Côte d'Ivoire], Institut Pierre Louis d'Epidémiologie et de Santé Publique ( iPLESP ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ), Centre population et développement ( CEPED - UMR_D 196 ), Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ), Jean, Kévin, and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)

Subjects
[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract

International audience; Based on social indicators collected within the TEMPRANO-ANRS12136 trial, we assessed the social consequences of early antiretroviral therapy (ART) initiation in west Africa. We did not observe any significant differences in the levels or the time trends of various social indicators, including union status, HIV disclosure and HIV-related discrimination, between early and deferred ART initiation. Early ART does not carry detectable adverse social consequences that could impair its clinical and preventive benefits.

Published
2016

5. Hepatitis B surface antigen quantification as a predictor of seroclearance during treatment in HIV-hepatitis B virus coinfected patients from Sub-Saharan Africa

Author

Boyd, Anders, Maylin, Sarah, Moh, Raoul, Mahjoub, Nadia, Gabillard, Delphine, Eholié, Serge Paul, Danel, Christine, Anglaret, Xavier, Zoulim, Fabien, Girard, Pierre-Marie, Delaugerre, Constance, Lacombe, Karine, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de Virologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Génétique et Ecologie des Virus, Génétique des Virus et Pathogénèse des Maladies Virales, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Programme PAC-CI, ANRS France Recherche Nord & sud Sida-hiv hépatites, Epidemiologie-Biostatistique [Bordeaux], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux Ségalen [Bordeaux 2], Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2, Medical School, University Felix Houphouet Boigny, Department of Infectious and Tropical Diseases, Treichville University Teaching Hospital, Centre de Recherche sur le Cancer de Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Félix Houphouët-Boigny (UFHB), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and HAL-UPMC, Gestionnaire

Subjects
HBeAg quantification, serological endpoints, immunosuppression, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, virus diseases, HBsAg quantification, digestive system diseases, chronic viral hepatitis
Abstract

International audience; AbstractBackground and AimIn Sub-Saharan Africa, seroclearance of hepatitis B surface antigen (HBsAg) and hepatitis B “e” antigen (HBeAg), including their quantifiable markers, have rarely been evaluated during long-term antiviral treatment among patients coinfected with HIV and hepatitis B virus (HBV).MethodsIn this prospective cohort study from two randomized-control trials in Côte d'Ivoire, 161 antiretroviral-naïve HIV-HBV coinfected patients starting lamivudine (n = 76) or tenofovir/emtricitabine (n = 85) containing antiretroviral therapy were included. HBV DNA was quantified using an in-house assay (detection limit = 12 copies/mL) and HBsAg quantification (qHBsAg) using the Elecsys assay.ResultsOverall, 33 (20.5%) patients were HBeAg positive, 121 (75.2%) had detectable HBV DNA, and 92/93 (98.9%) harbored HBV genotype E. Median treatment duration was 35.5 months (interquartile range: 24.3–36.4). Among HBeAg-positive patients, cumulative proportion with HBeAg seroclearance was 46.3% (n = 14). Overall, cumulative proportion of HBsAg seroclearance was 6.6% (n = 10). Lower baseline qHBsAg levels and strong 12-month declines in qHBsAg were significantly associated with HBsAg seroclearance for both HBeAg-negative and HBeAg-positive patients. When taken at certain levels, these determinants provided moderate sensitivity (Se) and specificity (Sp) in predicting HBsAg seroclearance at month 36 (≤ 1000 IU/mL at baseline, Se = 0.80, Sp = 0.80; ≥ 1.0 log10 IU/mL drop at month 12, Se = 0.57, Sp = 1.00). Instead, qHBsAg levels ≤ 100 or ≤ 10 IU/mL at month 12 were optimal (both Se = 0.90 and Sp = 1.00). Detectable HBV-DNA provided fairly high Se and Sp when evaluated at baseline (Se = 1.00, Sp = 0.80), but not at month 12 (Se = 0.80, Sp = 0.40).ConclusionsHBsAg seroclearance rates are not common in patients from Sub-Saharan Africa treated with anti-HBV containing antiretroviral therapy. qHBsAg levels at 12 months of treatment may accurately predict HBsAg seroclearance.

Published
2016
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6. WHO guidelines for antiretroviral therapy in serodiscordant couples in sub-Saharan Africa

Author

Kouamé, Gérard, Danel, Christine, Moh, Raoul, Badjé, Anani, Jean, Kévin, N’takpe, Jean-Baptiste, Gabillard, Delphine, Le Carrou, Jérome, Du Loû, Annabel Desgrées, Deschamps, Nina, Eholie, Serge, Anglaret, Xavier, Ditrame Plus, Programme PAC-CI (ANRS 1201/1202), ANRS France Recherche Nord & sud Sida-hiv hépatites-CHU Treichville, Sexualité et soins (Genre, Sexualité, Santé) (CESP - INSERM U1018 - Equipe 7), Centre de recherche en épidémiologie et santé des populations (CESP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)

Subjects
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2014
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7. Decrease in sexual risk behaviours after early initiation of antiretroviral therapy: a 24-month prospective study in Côte d'Ivoire.: Decrease in sexual risk behaviors after early ART initiation

Author

Jean, Kévin, Gabillard, Delphine, Moh, Raoul, Danel, Christine, Desgrées-Du-Loû, Annabel, N'Takpe, Jean-Baptiste, Le Carrou, Jérôme, Badjé, Anani, Eholié, Serge, Lert, France, Anglaret, Xavier, Dray-Spira, Rosemary, Schmaus, Annie, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Programme PAC-CI, Centre Hospitalier Universitaire [Treichville] (CHU), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Service de Maladies Infectieuses et Tropicales, This trial was supported by a grant from the French Agence Nationale de Recherches sur le SIDA et les hépatites virales (ANRS, Paris, France, and grants ANRS 12136 and ANRS 12239). The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Subjects
AIDS, antiretroviral treatment, sub-Saharan Africa, sexual behaviors, early ART initiation, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, HIV, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, HIV 37 prevention
Abstract

International audience; Introduction: Whether early antiretroviral therapy (ART) initiation could impact sexual risk behaviours remains to be documented. We aimed to investigate changes in sexual behaviours within the 24 months following an early versus standard ART initiation in HIV-positive adults with high CD4 counts. Methods: We used data from a prospective behavioural study nested in a randomized controlled trial of early ART (Temprano-ANRS12136). Time trends in sexual behaviours from enrolment in the trial (M0) to 12-month (M12) and 24-month (M24) visits were measured and compared, using Generalized Estimating Equations models, between participants randomly assigned either to initiate ART immediately (early ART) or to defer ART initiation until on-going WHO starting criteria are met (standard ART). Indicators of sexual behaviours included 1) sexual activity in the past year, 2) multiple partnership in the past year, 3) unprotected sex at last intercourse and 4) risky sex (i.e. unprotected sex with a partner of HIV negative/unknown status) at last intercourse. Results: Analyses included 1952 participants (975 with early ART and 977 with standard ART; overall median baseline CD4 count: 469/mm(3)). Among participants with early ART, significant decreases were found between M0 and M24 in sexual activity (Odds Ratio [OR] 0.72, 95% Confidence Interval [95% CI] 0.57-0.92), multiple partnership (OR 0.57, 95% CI 0.41-0.79), unprotected sex (OR 0.59, 95% CI 0.47-0.75) and risky sex (OR 0.58, 95% CI 0.45-0.76). Among participants with standard ART, sexual behaviours showed similar trends over time. These decreases mostly occurred within the 12 months following enrolment in the trial in both groups and prior to ART initiation in participants with standard ART. For unprotected sex and risky sex, decreases were or tended to be more pronounced among patients reporting that their last sexual partner was non-cohabiting. Conclusions: In these sub-Saharan adults with high CD4 counts, entry into HIV care, rather than ART initiation, resulted in decreased sexual activity and risky sexual behaviours. We did not observe any evidence of a risk compensation phenomenon associated with early ART initiation. These results illustrate the potential behavioural preventive effect of early entry into care, which goes hand in hand with early ART initiation.

Published
2014

8. Effect of early antiretroviral therapy on sexual behaviors and HIV-1 transmission risk in adults with diverse heterosexual partnership status in Cote d'Ivoire

Author

Jean, Kévin, Gabillard, Delphine, Moh, Raoul, Danel, Christine, Fassassi, Raïmi, Desgrees-Du-Lou, Annabel, Eholie, Serge, Lert, France, Anglaret, Xavier, Dray-Spira, Rosemary, Schmaus, Annie, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Programme PAC-CI, ANRS France Recherche Nord & sud Sida-hiv hépatites, Department of Population Research and Development, National Institute of Statistics and Applied Economy, Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Service des Maladies Infectieuses et Tropicales (SMIT), CHU de Treichville, This trial was supported by a grant from the French Agence Nationale de Recherches sur le SIDA et les hépatites virales (ANRS, Paris, France, and grants ANRS 12136 and ANRS 12239).

Subjects
[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract

International audience; Background. The effect of early antiretroviral therapy (ART) on sexual behaviors and HIV-1 transmission risk has not been documented beyond the specific population of stable serodiscordant couples.Methods. Based on a behavioral study nested in a randomized controlled trial (Temprano-ANRS12136) of early ART, we compared proportions of risky sex (unprotected sex with a partner of negative/unknown HIV status) reported 12 months after inclusion between participants randomized to initiate ART immediately ('early ART') or according to WHO criteria ('standard ART'). Group-specific HIV-transmission rates were estimated based on sexual behaviors and viral load-specific per-act HIV-1 transmission probabilities. Their ratio was computed to estimate the protective effect of early ART.Results. Among 957 participants (baseline CD4: 478/mm(3)), 46.0% reported sexual activity in the past month, 41.5% of them with non-cohabiting partners. Proportion of risky sex was 10.0% vs. 12.8%, respectively, in participants on early vs. standard ART (p=0.17). Accounting for sexual behaviors and viral load, the estimated protective effect of early ART was 90% (95%CI 81-95%).Conclusion. Twelve months after inclusion, patients on early and standard ART reported similar sexual behaviors. Early ART decreased the estimated risk of HIV transmission by 90%, suggesting a major prevention benefit among both stable and casual partners.

Published
2014
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9. Psychosocial correlates of inconsistent condom use among HIVinfected patients enrolled in a structured ART interruptions trial in Coˆ te d’Ivoire: results from the TRIVACAN trial (ANRS 1269)

Author

Protopopescu, Camelia, Marcellin, Fabienne, Preau, Marie, Gabillard, Delphine, Moh, Raoul, Minga, Albert, Anzian, Amani, Carrieri, Maria Patrizia, Danel, Christine, Spire, Bruno, Greps, Laboratoire, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), ORS PACA, Groupe de Recherche en Psychologie Sociale (GRePS), Université Lumière - Lyon 2 (UL2), Programme PACCI, ANRS France Recherche Nord & sud Sida-hiv hépatites, Department of Infectious Diseases [Abidjan, Côte d'Ivoire], CHU Treichville [Abidjan, Côte d'Ivoire], Programme PAC-CI, Trivacan ANRS 1269 study group, and Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)

Subjects
unsafe sex, [SHS.PSY] Humanities and Social Sciences/Psychology, Africa, steady partner, casual partner, [SHS.PSY]Humanities and Social Sciences/Psychology
Abstract

International audience; objective To investigate the relationship between unsafe sexual behaviours and poor self-perceivedhealth among people living with HIV and AIDS (PLWHA) in western Africa.methods In March 2006, a survey was conducted among patients continuing their participation in theTRIVACAN trial (ANRS 1269) in Coˆ te d’Ivoire, in which patients had been randomized to eithercontinuous or interrupted antiretroviral therapy (ART) (2-months-off ⁄ 4-months-on cycles [2 ⁄ 4-ART])after 6–18 months of continuous ART (C-ART). Socio-demographic and psychosocial information,including data on sexual behaviours during the previous 6 months, was collected using face-to-faceinterviews. Sexually active patients with either a steady partner (serodiscordant or of unknown HIVstatus) or casual partners were considered to have unsafe sexual behaviours if they reported inconsistentcondom use (ICU).results Seventy-seven of the 192 patients reported ICU. In multivariate logistic regression, men weresignificantly less likely to report ICU than women (OR [95% CI] = 0.45 [0.20–0.98]). After adjustment foreducational level and reduced sexual activity since ART initiation, concealment of HIV status (2.08 [1.02–4.25]) and poor self-perceived health (2.32 [0.97–5.52]) were independently associated with ICU.conclusion HIV prevention strategies in resource-limited settings should take into account self-perceivedhealth and difficulties to disclose HIV status. Counselling interventions need to be developed tohelp PLWHA to adopt or negotiate safe behaviours respecting their individual cultures.

Published
2010
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10. Anthropometric and immunological success of antiretroviral therapy and prediction of virological success in west African adults

Author

Messou, Eugène, Gabillard, Delphine, Moh, Raoul, Inwoley, André, Sorho, Souleymane, Eholié, Serge, Rouet, François, Seyler, Catherine, Danel, Christine, Anglaret, Xavier, Mouillet, Evelyne, Epidémiologie, santé publique et développement, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR99-ISPED, Programme PAC-CI, ANRS France Recherche Nord & sud Sida-hiv hépatites, Centre de recherche et de Diagnostic sur le Sida [Abidjan, Côte d'Ivoire] (CeDreS), Centre Hospitalier Universitaire de Treichville [Abidjan, Côte d'Ivoire] (CHU de Treichville), Service des Maladies Infectieuses et Tropicales (SMIT), and CHU de Treichville

Subjects
sub-Saharan Africa, HAART, virological success, predictive value, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, adults, body mass index, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, CD4 count
Abstract

International audience; OBJECTIVE: The 6 month assessment of the response to antiretroviral therapy (ART) is a critical step. In sub-Saharan Africa, few people have access to plasma viral-load measurement. We assessed the gain or loss in body mass index (BMI), alone or in combination with the gain or loss in CD4+ T-cell count (CD4), as a tool for predicting the response to ART. METHODS: In a cohort of 622 adults in Abidjan, C?d'Ivoire, we calculated the sensitivity, specificity and predictive values of BMI and CD4 for treatment success defined as viral-load undetectability (< 300 copies/ml) as gold standard. FINDINGS: After 6 months of ART, the median change in BMI was an increase of 1.0 kg/m(2) (interquartile range, IQR: 0.0-2.1), the median change in CD4 an increase of 148/ml (IQR: 54-230) and 84% of patients reached viral-load undetectability. The distribution of change in BMI was similar among patients who reached undetectability and those who did not (increases of 1.06 kg/m(2) versus 0.99 kg/m(2), P = 0.51). With larger changes in BMI, the specificity for treatment success increased but its sensitivity decreased and its positive predictive value was stable around 85%. All results remained similar when combining changes in BMI with those in CD4 and when stratifying by groups of baseline BMI or CD4. CONCLUSION: In settings where viral-load measurement is not available, a high BMI gain does not reflect virological success, even when combined with a high CD4 gain. In our population, most patients with detectable viral-load had probably adhered to the drug regimen sufficiently to reach significant gains in body mass and CD4 count but had adhered insufficiently to reach viral suppression.

Published
2008

11. Incidence and determinants of mortality and morbidity following early antiretroviral therapy initiation in HIV-infected adults in West Africa.: early ART initiation in West Africa

Author

Moh, Raoul, Danel, Christine, Messou, Eugène, Ouassa, Timothèe, Gabillard, Delphine, Anzian, Amani, Abo, Yao, Salamon, Roger, Bissagnene, Emmanuel, Seyler, Catherine, Eholié, Serge, Anglaret, Xavier, Mouillet, Evelyne, Trivacan ANRS 1269 study group, ANRS France Recherche Nord & sud Sida-hiv hépatites, Centre de recherche et de Diagnostic sur le Sida [Abidjan, Côte d'Ivoire] (CeDreS), Centre Hospitalier Universitaire de Treichville [Abidjan, Côte d'Ivoire] (CHU de Treichville), Service des Maladies Infectieuses et Tropicales (SMIT), CHU de Treichville, Epidémiologie, santé publique et développement, and Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR99-ISPED

Subjects
sub-Saharan Africa, bacterial diseases, HAART, MESH: Humans, MESH: CD4 Lymphocyte Count, MESH: AIDS-Related Opportunistic Infections, MESH: Time Factors, morbidity, MESH: Adult, MESH: HIV Infections, MESH: Epidemiologic Methods, MESH: Male, MESH: Antiretroviral Therapy, Highly Active, MESH: Body Mass Index, tuberculosis, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, risk factors, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Anti-HIV Agents, MESH: Viral Load, antiretrovirals, MESH: Female, MESH: Treatment Outcome
Abstract

International audience; OBJECTIVE: To estimate the incidence and risk factors of mortality and severe morbidity during the first months following antiretroviral therapy (ART) initiation in West African adults. METHODS: A cohort study in Abidjan in which 792 adults started ART with a median CD4 cell count of 252 cells/mul and were followed for a median of 8 months. Severe morbidity was defined as all World Health Organization stage 3 or 4-defining morbidity events other than oral candidiasis. RESULTS: In patients with pre-ART CD4 cell count < 200, at 200-350 and > 350 cells/mul, incidence of mortality was 5.0 [95% confidence interval (CI), 2.6-8.7], 1.7 (95% CI, 0.6-3.8) and 0.0 (95% CI, 0.0-3.4]/100 person-years, and incidence of severe morbidity was 13.3 (95% CI, 9.0-19.1), 9.5 (95% CI, 6.2-12.9) and 7.9 (95% CI, 3.4-15.5)/100 person-years, respectively. The most frequent diseases were invasive bacterial diseases (32/65 episodes, 49%) and tuberculosis (25/65 episodes, 38%). Both diseases followed the same curve of decreasing incidence over time. Patients who experienced severe morbidity had higher risks of mortality, virological failure and immunological failure. Other independent risk factors for mortality and/or severe morbidity were: at baseline, high viral load, advanced clinical stage, past history of tuberculosis, low BMI, low haemoglobin and low CD4 cell count; during follow-up: low CD4 cell count and persistently detectable viral load. CONCLUSION: These data give new arguments to reinforce the hypothesis that, in this region, ART should be started before the CD4 cell count drops below 350 cells/mul. Further studies should assess whether patients with low BMI, low haemoglobin, high viral load or past history of tuberculosis should start ART earlier.

Published
2007
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12. Describing, analysing and understanding the effects of the introduction of HIV self-testing in West Africa through the ATLAS programme in Côte d’Ivoire, Mali and Senegal

Author

Rouveau, Nicolas, Ky-Zerbo, Odette, Boye, Sokhna, Fotso, Arlette Simo, d’Elbée, Marc, Maheu-Giroux, Mathieu, Silhol, Romain, Kouassi, Arsène Kra, Vautier, Anthony, Doumenc-Aïdara, Clémence, Breton, Guillaume, Keita, Abdelaye, Ehui, Eboi, Ndour, Cheikh Tidiane, Boilly, Marie-Claude, Terris-Prestholt, Fern, Pourette, Dolorès, Desclaux, Alice, Larmarange, Joseph, Malbec, Odile, Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Santé, vulnérabilités et relations de genre au sud (SAGESUD - ERL Inserm U1244), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité)-Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), London School of Hygiene and Tropical Medicine (LSHTM), McGill University = Université McGill [Montréal, Canada], Imperial College London, Solidarité thérapeutique & initiatives contre le sida (SOLTHIS), Institut National de Recherche en Santé Publique [Bamako] (INRSP), Programme National de Lutte contre le Sida [Abidjan, Côte d'Ivoire] (PNLS), Ministry of Health - Ministère de la Santé et de l'Action Sociale [Dakar] (MSAS), ATLAS Team: Marie-Claude Boily, Alice Desclaux, J Oseph Larmarange, Dolorès Pourette, Fern Terris-Prestholt, Abdelaye Keita, Arlette Simo Fotso, Arsène Kouassi Kra, Anne Bekelynck, Guillaume Breton, Marc d'Elbée, Desgree du Lou Annabel, Elvis Georges Amani, Jean Kévin, Ky-Zerbo Odette, Kéba Badiane, Maheu-Giroux Mathieu, Moh Raoul, Mosso Rosine, Métogara Mohamed Traore, Paltiel David, Eboi Ehui, Silhol Romain, Rouveau Nicolas, Sokhna Boye, Clémence Doumenc-Aïdara, Sanata Diallo, Odé Kanku Kabemba, Olivier Geoffroy, Vautier Anthony, Alain-Michel Kpolo, Annie Diokouri, Armand Abokon, Blaise Kouame, Camille Anoma, Venance Kouakou, Odette Koffi, Josiane Tety, Yacouba Traore, Abdoulaye S Anogo, Daouda Diakite, Djelika Berthé, Camara Adam Yattassaye, Dembele Bintou Keita, Dramane Koné, Jules Bagendabanga, Aminata Saran Keita, Septime Hessou, Telly Nouhoum, Fadiala Sidibé, Kanoute Abdul Karim, Madani Tall, Mahamadou Diakite, Maiga Almoustapha, Mariam Koné, Minta Daouda, Saidou Kanambaye, Youssouf Diallo, Alassane Moussa Niang, Fatou Fall, Idrissa Bâ, N Dèye Fatou N Gom Guèye, Oumar Samba, Papa Amadou Niang, Safiatou Thiam, Nguissali M E Turpin, Sidy Mokhtar NDiaye, Brou Alexis Kouadio, Cheick Sidi Camara, Sarrassat Sophie, Seydou Bouaré, Souleymane Sow, Ndour Cheikh Tidiane, Institut de Recherche pour le Développement (IRD)-Université de Paris (UP), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Ministère de la santé de Dakar, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Ministère de la Santé et de l'Action sociale (Sénégal) (MSAS), and 2018-23-ATLAS, Unitaid

Subjects
Male, Sex Workers, Côte d’Ivoire, [SDV]Life Sciences [q-bio], HIV self-testing, HIV Infections, Mali, Senegal, [SDV] Life Sciences [q-bio], Study Protocol, Sexual and Gender Minorities, Cote d'Ivoire, Self-Testing, West Africa, HIV/AIDS, Humans, Female, Homosexuality, Male
Abstract

Background The ATLAS programme aims to promote and implement HIV self-testing (HIVST) in three West African countries: Côte d’Ivoire, Mali, and Senegal. During 2019–2021, in close collaboration with the national AIDS implementing partners and communities, ATLAS plans to distribute 500,000 HIVST kits through eight delivery channels, combining facility-based, community-based strategies, primary and secondary distribution of HIVST. Considering the characteristics of West African HIV epidemics, the targets of the ATLAS programme are hard-to-reach populations: key populations (female sex workers, men who have sex with men, and drug users), their clients or sexual partners, partners of people living with HIV and patients diagnosed with sexually transmitted infections and their partners. The ATLAS programme includes research support implementation to generate evidence for HIVST scale-up in West Africa. The main objective is to describe, analyse and understand the social, health, epidemiological effects and cost-effectiveness of HIVST introduction in Côte d’Ivoire, Mali and Senegal to improve the overall HIV testing strategy (accessibility, efficacy, ethics). Methods ATLAS research is organised into five multidisciplinary workpackages (WPs): Key Populations WP: qualitative surveys (individual in-depth interviews, focus group discussions) conducted with key actors, key populations, and HIVST users.Index testing WP: ethnographic observation of three HIV care services introducing HIVST for partner testing.Coupons survey WP: an anonymous telephone survey of HIVST users.Cost study WP: incremental economic cost analysis of each delivery model using a top-down costing with programmatic data, complemented by a bottom-up costing of a representative sample of HIVST distribution sites, and a time-motion study for health professionals providing HIVST.Modelling WP: Adaptation, parameterisation and calibration of a dynamic compartmental model that considers the varied populations targeted by the ATLAS programme and the different testing modalities and strategies. Discussion ATLAS is the first comprehensive study on HIV self-testing in West Africa. The ATLAS programme focuses particularly on the secondary distribution of HIVST. This protocol was approved by three national ethic committees and the WHO’s Ethical Research Committee. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10212-1.

Published
2021
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