Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Sciences and Health Technologies, Epidemiology and biomedical unit, 26000 Settat. University Complex, Casablanca Road km 3.5 B. P 555 Settat, Morocco.
Laboratory of Medical Analysis, Ibn Zohr Regional Hospital Center, Marrakech, Morocco.
Afr Health Sci. 2023 Jun;23(2):109-120. doi: 10.4314/ahs.v23i2.12.
BACKGROUND & OBJECTIVE: Human Immunodeficiency Virus (HIV) remains one of the world's most serious health challenges. The development of therapeutic regimens has significantly increased survival and reduced HIV-associated morbidities in HIV-infected individuals. However, some people living with HIV may not respond as expected, resulting in treatment failure. The objective of this study is to identify and characterize, by immunological (T-cell CD4) and virological (viral load) parameters, HIV infected patients with therapeutic failure in Morocco.
Prospective cross-sectional studies were conducted over a 5-years period (between January 2015 and December 2019) at the referral center of Ibn Zohr Hospital, Marrakech, Morocco. A total, of 1088 HIV-infected patients diagnosed by the rapid test (Immunochromatography) in addition to Western Blot analysis, was recruited. All patients were under the antiretroviral therapy (ART) for at least six months and followed every six months. Sociodemographic, clinical, and biological data as well as information on patient adherence were collected.
Out of 1088 patients, 92.46% were under treatment based on non-nucleoside reverse transcriptase inhibitors (NNRTIs) including 26.20% first line first intention and 66.26% first line second intention, and 7.54% of patients on a protease inhibitor (PI) therapy. Regarding the immunological and virological status, 76% of HIV-infected patients had a CD4 count > 200 cells/µl and 24% had a CD4 count < 200 cells / µl, while 69.5% had an undetectable viral load and 30.05% had a detectable viral load (including 11.86% with viral load < 1000 copies / ml and 18.20% viral load > 1000 copies / ml) (P-values < 0.05).
In our study, we showed a therapeutic failure rate of 18.2% in HIV-infected patients under treatment in Marrakech region. These failures were mainly related to poor adherence and low CD4+ rates at the initiation of treatment. We concluded that immunological monitoring alone is insufficient to predict virological suppression and therapeutic success. Consequently, we recommend the HIV plasma viral load test be accessible as a routine exam.
人类免疫缺陷病毒（HIV）仍然是世界上最严重的健康挑战之一。治疗方案的发展显著提高了 HIV 感染者的生存率并降低了与 HIV 相关的发病率。然而，一些 HIV 感染者可能无法达到预期的效果，导致治疗失败。本研究的目的是通过免疫（T 细胞 CD4）和病毒学（病毒载量）参数，确定并描述摩洛哥治疗失败的 HIV 感染患者。
本前瞻性横断面研究于 2015 年 1 月至 2019 年 12 月在摩洛哥马拉喀什 Ibn Zohr 医院的转诊中心进行。共招募了 1088 名通过快速检测（免疫层析法）和 Western Blot 分析诊断为 HIV 感染的患者。所有患者均接受抗逆转录病毒治疗（ART）至少 6 个月，并每 6 个月随访一次。收集社会人口学、临床和生物学数据以及患者依从性信息。
在 1088 名患者中，92.46%接受基于非核苷类逆转录酶抑制剂（NNRTIs）的治疗，其中 26.20%为一线初治，66.26%为一线二线治疗，7.54%的患者接受蛋白酶抑制剂（PI）治疗。关于免疫和病毒学状态，76%的 HIV 感染者 CD4 计数> 200 个细胞/µl，24%的患者 CD4 计数< 200 个细胞/µl，69.5%的患者病毒载量不可检测，30.05%的患者病毒载量可检测（包括 11.86%病毒载量< 1000 拷贝/ml和 18.20%病毒载量> 1000 拷贝/ml）（P 值<0.05）。
在我们的研究中，我们显示在马拉喀什地区接受治疗的 HIV 感染者的治疗失败率为 18.2%。这些失败主要与治疗开始时的依从性差和 CD4+率低有关。我们得出结论，单独进行免疫监测不足以预测病毒学抑制和治疗成功。因此，我们建议将 HIV 血浆病毒载量检测作为常规检查。
