Tritherapies using antiretroviral drugs have proved their worth in industrialized countries in the fight against Aids. However, in Sub-Saharan Africa, where 70 % of people infected with HIV live, access to such treatments is extremely limited. High cost, complicated procedures, combined with inadequate infrastructures for following up patients or capable of delivering medicines regularly partly explain this situation. Moreover, efficacy of antiretroviral agents might not be the same for some HIV strains present in Africa. And not enough is yet known about the response to therapy (viral resistance, adverse effects and so on), notably in patients in advanced stages of immune deficiency. These factors are considered as obstacles to mounting concerted therapy programmes in Africa. For some government authorities they provide the arguments for concentrating control campaigns solely on prevention with no involvement of antiretroviral drugs.
Since 1998 the Senegalese government has been developing a programme facilitating access to Aids treatments (1). Within this, an assessment programme, coordinated by the IRD and the Senegal National Committee for Aids Control, and financed by the Agence nationale de recherches sur le sida (ANRS), has been deployed aiming to determine the effectiveness, the tolerance, the acceptability and feasibility of the standard form of antiretroviral therapy. This study was conducted in a cohort of 58 patients aged between 16 and 56 years, having high viral load and low CD4 cell count. Most of them (86.2%) had developed the disease before the start of the antiretroviral therapy. All received a combination treatment of two nucleoside reverse transcriptase inhibitors plus one protease inhibitor (2) The drugs were taken in three doses per day, just as in the industrialized countries. A sociological survey was done in parallel which assessed patients’ ability to contribute to part of the cost of the treatment depending on their financial resources. The rest would be subsidized by the programme.
At the end of the 18 month study, the results were comparable with those obtained in the countries of the North. Most patients (87.9 %) regularly followed the course of treatment over the whole period monitored. Also, contrary to prior assumptions, financial difficulties did not hinder adherence to the therapy. Furthermore, the same therapeutic efficacy was observed here as in the industrialized countries. After a year and a half of treatment the viral load was almost undetectable (below 500 copies/ml) in 59.3 % of cases and the CD4 cell count had risen markedly (about 180/mm3). Tolerance to antiretroviral medicines was generally good, adverse effects observed being only mild. Only two cases of viral resistance to the drugs were found.
Marie-Lise Sabrie | alfa
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