HIV-1: Improving care in the Central African Republic

Dr Vincent Lacoste of the Institut Pasteur (Paris), currently on mission in the Central African Republic, is setting up a new competence at the Medical Analysis Laboratory of the Institut Pasteur de Bangui. In addition to determining the viral load of the human immunodeficiency virus type 1 (HIV-1), this new analysis aims to identify HIV resistance to antiretroviral drugs (ARVs) in people infected with the virus. This mission is funded by the 5% - Channel 1 Initiative of the Global Fund managed by Expertise France.

A current need in the care of people living with HIV-1 in Central Africa

UNAIDS target 90-90-90 aims to have by 2020: (1) 90% of people living with HIV-1 (PLWHA) are diagnosed; (2) 90% of people diagnosed are given antiretroviral (ARV) treatment; (3) 90% of people on treatment have controlled viremia.

Since 2017, viral load quantification has been carried out in CAR at the Institut Pasteur de Bangui and the National Laboratory with the support of the Global Fund. After nearly 2 years, it can be seen that a significant proportion of PLWHA followed remain in virological failure, despite ARV treatments.

Achieving the 3rd objective now requires genotypic tests to be carried out to detect mutations associated with the virus' resistance to ARVs in patients who have failed and to validate second-line treatments.

The implementation of HIV-1 ARV resistance genotyping

Led by Dr Vincent Lacoste of the Institut Pasteur (Paris), a 2-month mission to the Central African Republic aims to set up a new complementary analysis to identify HIV-1 resistance to antiretroviral drugs. This analysis will be available at the Medical Analysis Laboratory of the Institut Pasteur de Bangui from April 2019. Its implementation includes the training of 2 service staff, a medical biologist and a technician. This action is taking place in the context of the financial support provided to CAR by the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The technique currently being deployed is based on the ANRS (National French Agency of esearch on AIDS and viral hepatitis) protocol. It is based on the study of the virus genes encoding the 3 main enzyme targets of ARVs: retrotranscriptase, protease and integrase.

In addition, the analysis of viral gene sequences will allow the identification of the HIV-1 subtype, information that contributes to improving local epidemiological knowledge.

This article was first published by the Institut Pasteur de Bangui and translated in english by Afriscitech.


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