Virological Profile of Patients Infected with HIV Starting Antiretroviral Treatment in Kinshasa

Abstract

Background: Viral Load (VL), CD4 T cells count and clinical signs are significant parameters for the decision of starting ARV Treatment (ART). The aim of this study is to determine the Viral Load profile of eligible patients on treatment in the centers according to the algorithm used in Kinshasa and the DRC. Methodology: Our sample consisted of 153 HIV-positive patients naïve of ART. All patients aged over 18 years were included in the study without gender discrimination. The determination of the VL was made at the laboratory of Molecular Biology of the Faculty of Medicine of the University of Kinshasa using a previously described technique. Results: Of the 153 patients included in the study, 92 (60.1%) were women. The age of the patients was in the range 18-65 years with a mean of 37 years. Most patients (91.5%) were clinical stage 3, while the rest (8.5%) were clinical stage 4 for HIV infection. The rates of CD4+ T lymphocytes were between 8 and 915 cells/mm 3 with a median value of 180 cells/mm 3. Seventy nine patients (86.8%) had CD4 count below 500 cells/mm 3. The median VL of patients is 5.68 log 10 RNA copies/ml. The minimum and maximum values are respectively 0.37 and 7.95 log 10 RNA copies/ml. Conclusion: The majority of patients (63.4%) in Kinshasa begin antiretroviral treatment with a poor prognosis. The Viral loads are usually very high in these patients and CD4 quite collapsed. Indeed, the median value of CD4 for the patients is 180 cells/mm 3 for the population, while the mean value of Viral Load is 5.48 log 10 RNA copies/ml.

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Open Access Library Journal
How to cite this paper: Kamangu, E.N., Bulanda, B.I., Bongenia, B.I., Botomwito, H.T., Mvumbi, G.L., De Mol, P., Vaira, D.,
Hayette, M.-P. and Kalala, R.L. (2015) Virological Profile of Patients Infected with HIV Starting Antiretroviral Treatment in
Kinshasa. Open Access Library Journal, 2: e1564. http://dx.doi.org/10.4236/oalib.1101564
Virological Profile of Patients Infected with
HIV Starting Antiretroviral Treatment in
Kinshasa
Erick Ntambwe Kamangu
1,2*
, Ben Ilunga Bulanda
2
, Berry Ikolango Bongenia
2
,
Huguette Tshweka Botomwito
2
, Georges Lelo Mvumbi
1
, Patrick De Mol
3
, Dolores Vaira
4
,
Marie-Pierre Hayette
3
, Richard Lunganza Kalala
1
1
Molecular Biology Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa (UNIKIN),
Kinshasa, Democratic Republic of Congo (DRC)
2
Research Group “Focus HIV/AIDS”, Kinshasa, Democratic Republic of Congo (DRC)
3
Clinical Microbiology Laboratory, Centre Hospitalier Universitaire-Université de Liège (CHU-Lg), Liège, Belgium
4
AIDS Reference Laboratory (ARL), Centre Hospitalier Universitaire-Université de Liège (CHU-Lg), Liège, Belgium
Email:
*
erick.kamangu@unikin.ac.cd
, erickamangu@gmail.com
Received 17 May 2015; accepted 1 June 2015; published 8 June 2015
Copyright © 2015 by authors and OALib.
This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/
Abstract
Background: Viral Load (VL), CD4 T cells count and clinical signs are significant parameters for the
decision of starting ARV Treatment (ART). The aim of this study is to determine the Viral Load pro-
file of eligible patients on treatment in the centers according to the algorithm used in Kinshasa
and the DRC. Methodology: Our sample consisted of 153 HIV-positive patients naïve of ART. All pa-
tients aged over 18 years were included in the study without gender discrimination. The determi-
nation of the VL was made at the laboratory of Molecular Biology of the Faculty of Medicine of the
University of Kinshasa using a previously described technique. Results: Of the 153 patients in-
cluded in the study, 92 (60.1%) were women. The age of the patients was in the range 18 - 65
years with a mean of 37 years. Most patients (91.5%) were clinical stage 3, while the rest (8.5%)
were clinical stage 4 for HIV infection. The rates of CD4+ T lymphocytes were between 8 and 915
cells/mm
3
with a median value of 180 cells/mm
3
. Seventy nine patients (86.8%) had CD4 count
below 500 cells/mm
3
. The median VL of patients is 5.68 log
10
RNA copies/ml. The minimum and
maximum values are respectively 0.37 and 7.95 log
10
RNA copies/ml. Conclusion: The majority of
patients (63.4%) in Kinshasa begin antiretroviral treatment with a poor prognosis. The Viral
loads are usually very high in these patients and CD4 quite collapsed. Indeed, the median value of
CD4 for the patients is 180 cells/mm
3
for the population, while the mean value of Viral Load is 5.48
log
10
RNA copies/ml.
Keywords
Viral Load, CD4 T Cells, Patients Eligible for Treatment, ART
*
Corresponding author.

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Subject Areas: HIV, Immunology
1. Introduction
Thirty years after its appearance, the epidemic in Human Immunodeficiency Virus (HIV) infection remains a
major public health problem. In the Democratic Republic of Congo (DRC), the first case of Acquired Immune
Deficiency Syndrome (AIDS) was documented in 1983 [1]. In recent years, HIV prevalence has remained more
or less stable at less than 5% [1].
Immunological criteria for initiating treatment with antiretroviral drugs (ARVs) have been revised by the Na-
tional Program for the Fight against HIV/AIDS. According to the recommendations of the World Health Organ-
ization (WHO), the cut-off for CD4 T cells increased from ≤200 cells/mm
3
in 2006 to ≤350 cells/mm
3
in 2008,
and then to ≤500 cells/mm
3
in 2013 [2]. The clinical criteria used in the DRC are those recommended by WHO
for countries with limited resources [2] [3]. They depend on the interpretation of clinical parameters and WHO
recommendations by the clinician.
The Viral Load (VL), CD4 T cells count and clinical signs are significant parameters for the decision to start
ARV treatment (ART) [4]. The VL is as important in epidemiological surveillance, diagnosis of children under
18 months, and adherence to treatment at the change of line of treatment [4]-[6]. However, the WHO guidelines
for resource-limited countries only advocate the CD4 count and clinical stages 3 and 4 to set on ART [3], and
VL is not recommended for these countries because of the exorbitant cost [4] [7].
This study aims to determine the profile of Viral Load of eligible patients on treatment in the centers accord-
ing to the algorithm used in Kinshasa and DRC by using the VL.
2. Methodology
This study was conducted in collaboration with different centers of treatment centers and monitoring of people
living with HIV (PLHIV) in Kinshasa. Our sample consisted of 153 HIV-positive treatment-naive patients Anti-
retroviral (ART). All patients aged over 18 years were included in the study without gender discrimination. The
patients were considered eligible for treatment in the different centers.
The determination of Viral Load (VL) was made in the laboratory of Molecular Biology of the Faculty of
Medicine University of Kinshasa (UNIKIN) using a previously described in-house assay from 140 µl of plasma
extracted from 5 ml of whole blood collected in a tube with anticoagulant EDTA [8] [9]. The VL results are
presented as logarithm of 10 copies of RNA per ml. All the PCR were done in triplet and only the mean value
were recorded. The count of CD4+ lymphocytes was done by flow cytometry and the results are presented as
number of cells per mm
3
.
Socio-demographic information as well as clinical and laboratory parameters were recorded from patient
charts from the respective centers. They were confidentially kept in the centers.
3. Results
3.1. Epidemiological Data
Of the 153 patients included in this study, 92 (60.1%) patients were women and 63 (39.9%) men, resulting in a
sex ratio M/F was 0.68. The age of patients is in the range 18 to 65 years with a mean of 37 years. Table 1
presents the epidemiological data with respect to gender and age groups.
3.2. Clinical and Biological Data
According to the WHO classifications, most of the patients (n = 140; 91.5%) were in clinical stage 3 while the
rest (n = 13; 8.5%) is in clinical stage 4 for the HIV.AIDS infection. The rates of CD4 + T lymphocytes were
between 8 and 915 cells/mm
3
with a median value of 180 cells/mm
3
. Seventy nine patients (86.8%) had a CD4
count below 500 cells/mm
3
. The median Viral Loads (VL) of the included patients was 5.48 log
10
RNA cop-
ies/ml. The minimum and maximum values for the VLs were respectively 0.37 log
10
and 7.95 log
10
RNA cop-
ies/ml. Ninety-seven patients (63.4%) had a VL exceeds 100,000 RNA copies/ml or 5.0 log
10
RNA copies/ml;

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Table 1. Characteristics of patients.
Characteristics Patients
Sex (n = 153)
Male 61 (39.87%)
Female 92 (60.13%)
Age (years) (n = 153)
Male Female Total
18 - 25 12 (19.67%) 20 (21.74%) 32 (20.92%)
26 - 35 10 (16.39%) 32 (34.78%) 42 (27.45%)
36 - 45 18 (29.51%) 22 (23.91%) 40 (26.14%)
46 - 55 16 (26.23%) 10 (10.87%) 26 (16.99%)
56 - 65 5 (8.20%) 8 (8.69%) 13 (8.50%)
Interval 18 - 65
Mean 37
CD4 T cell count (cells/mm
3
) (n = 92)
Interval 8 - 915
Median 180
Viral Loads (log
10
RNA copies/ml) (n = 153)
Interval 0.37 - 7.95
Median 5.48
Male 5.47
p = 0.270
Female 5.48
18 - 25 5.50
p = 0.157
26 - 35 5.36
36 - 45 5.69
46 - 55 5.22
56 - 65 5.49
49 (32.0%) had a VL from 3.0 to 5.00 log
10
; and 7 (4.6%) had a VL less than 3.0 log
10
. Differences VLs com-
pared to different age groups and types are not significant (Table 1).
4. Discussion
The aim of this study was to determine the virological profiles of patients infected with HIV eligible for Antire-
troviral Therapy (ART) in Kinshasa. Our sample consisted of 92 women (60.1%) and 63 men (39.9%), a sex ra-
tio M/F of 0.68. These observations in relation to the gender difference are similar to that published by the na-
tional program that gives a sex ratio M/F below 1.00 [1]. Various other studies have also published M/F sex ra-
tios that tend to feminize HIV infection in our environment [10]-[12]. The predominance of female patients in-
fected with HIV in Kinshasa, Democratic Republic of Congo and in Sub-Saharan Africa can be explained by
early sexual intercourse, the lack of information and education on sexuality, life and HIV, and sexual risky be-
havior [13].
The age interval most presented is that of 26 to 35 years with 42 patients (27.5%), followed by those 36 to 45

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years (26.2%) and 18 to 25 years (20.9%). This predominant age group is the active mass of the population. This
population is most active in terms of resource production (labor), but also in terms of sexual activities. These
results are similar to those reported in various local literatures [10]-[12].
All patients in this study were eligible for ART in their respective centers. In agreement with the clinical and
immunological criteria, clinicians decide the initiation of ART in monitoring patient. Clinically, starting treat-
ment is justifiable for all patients because they are all in advanced stage of HIV infection (91.5% clinical stage 3
and 8.5% clinical stage 4). The CD4 T cells counts were performed for 91 patients (59.5%). Although recom-
mended by the national program, the CD4 count is not done routinely in all centers [7]. For these patients with
the results of CD4, 79 (86.8%) have values less than 500 cells/mm
3
. For patients who had values greater than
500 cells/mm
3
, the clinical criterion had predominance for initiation to treatment.
The median Viral Loads (VL) of patients included in the study is of 5.48 log
10
RNA copies/ml. The minimum
and maximum values of the VLs are respectively 0.37 log
10
and 7.95 log
10
RNA copies/ml. Ninety-seven pa-
tients (63.4%) have a VL higher than 100,000 RNA copies/ml or 5.0 log
10
RNA copies/ml; 49 (32.0%) have a
VL between 3.0 log
10
and 5.00 log
10
RNA copies/ml; and 7 (4.6%) have a VL under 3.0 log
10
RNA copies/ml.
Differences VLs in age groups and with respect to gender were not significant; the age group 36 to 45 years has
the highest median VL (5.69 log
10
RNA copies/ml), while the group of 46 to 55 years has the lowest median
(5.22 log
10
RNA copies/ml). Several studies have shown that VL higher than 100,000 RNA copies/ml (5.0 log
10
RNA copies/ml) is a poor prognosis for treatment regardless of CD4 baseline [14]-[16]. In this case, 63.4% of
patients started ART with a poor prognosis, a program that could lead very quickly to treatment failure or to ev-
er higher VL after 6 months of ART. The rest of the patients (36.6%) started ART within standards for a correct
prognosis. It is therefore important for the clinician to have the results of the VL at initiation of ART to better
guide treatment for a correct prognosis [4]. Hence, the importance of implementing VL assays accessible to all.
5. Conclusion
The majority of patients (63.4%) in Kinshasa begin antiretroviral treatment with a poor prognosis. The Viral
Loads are usually very high in these patients and CD4 quite collapsed. Indeed, the median value of CD4 for the
patients is 180 cells/mm
3
for the population, while the mean value of Viral Load is 5.48 log
10
RNA copies/ml.
The Viral Load should also be used as a criterion for starting treatment for countries with limited resources in
order to achieve the goals of universal access to treatment for HIV.
References
[1] Programme National de Lutte contre le VIH/SIDA et les Infections Sexuellement Transmissible (PNLS), Ministère de
la Santé Publique, République Démocratique du Congo (RDC). Rapport Annuel. 2009 à 2012.
[2] Programme National de Lutte contre le VIH/SIDA et les Infections Sexuellement Transmissible (PNLS), Ministère de
la Santé Publique, République Démocratique du Congo (RDC). Guide National de Prise en Charge de l’Infection à
VIH en RDC. Version révisé 2013.
[3] World Health Organization. Antiretroviral Therapy for HIV Infection in Adults and Adolescents, Recommendations
for a Public Health Approach. Revision 2010. http://whqlibdoc.who.int/publications/2010/9789241599764_eng.pdf
[4] Ingole, N.A., Kukreja, S.M. and Mehta, P.R. (2011) Role of HIV-1 Viral Load in Initiating Antiretroviral Therapy. World
Journal of AIDS, 1, 149-154. http://dx.doi.org/10.4236/wja.2011.14022
[5] Kamangu, N.E., Kawila, M.E., Mukumbi, H. and Mvumbi, L.G. (2012) Estimated Rates of Treatment Failure in First-
Line Antiretroviral Treatment in Kinshasa: Case of the ACS AMO-Congo. International Journal of Collaborative Re-
search on Internal Medicine and Public Health (IJCRIMPH), 4, 885-891.
[6] Calmy, A., Ford, N., Hirschel, B., Reynolds, S.J., Lynen, L., Goemaere, E., De la Vega, F.G., Perrin, L. and Rodriguez,
W. (2007) HIV Viral Load Monitoring in Resource-Limited Regions: Optional or Necessary? Clinical Infectious Dis-
eases, 44, 128-134. http://dx.doi.org/10.1086/510073
[7] Kamangu, N.E., Kalala, N.H. and Mesia, K.G. (2012) Profile of Antiretroviral Treatment Centers in Kinshasa, Demo-
cratic Republic of Congo [Poster 388]. Proceedings of the 1st International African Society of Laboratory Medicine
(ASLM) Conference, Cape Town, 1-7 December 2012, 377.
[8] Kamangu, N.E., Adawaye, C., Boreux, R., Kalala, L.R., Mvumbi, L.G., Vaira, D. and Hayette, M.P. (2014) Mise en
place d’une PCR Quantitative Temps Réel pour la détermination de la Charge Virale VIH à Kinshasa. Journal de Re-
chercheBioMédicale, 1, 7-12.

E. N. Kamangu et al.
OALibJ |
DOI:10.4236/oalib.1101564 5 June 2015 | Volume 2 |
e1564
[9] Kamangu, N.E., Chatte, A., Boreux, R., Kalala, L.R., Mvumbi, L.G., De Mol, P., Vaira, D. and Hayette, M.P. (2014)
Implementation of an In-House Quantitative Real-Time PCR for Determination of HIV Viral Load in Kinshasa. Open
Access Library Journal, 1, e855. http://dx.doi.org/10.4236/oalib.1100855
[10] Desclaux, A. and Desgrées du Lou, A. (2006) Les Femmes Africaines face à l’épidémie du SIDA. Population etSo-
ciétés, 428, 1-4.
[11] Karier, R. and Marissa, Y. (2009) Renforcement de l’intégration des services de planification familiale et de traitement
du VIH. PRB USAID.
[12] Kamangu, N.E., Situakibanza, N.H., Mvumbi, L.G., Kakudji, I.L., Tshienda, T.D. and Mesia, K.G. (2012) Infections
Opportunistes chez les Personnes Vivant avec le VIH suivi à l’Hôpital Militaire de Référence de Kinshasa (Camp
Kokolo). Revue Congolaise des Sciences, 1, 66-76.
[13] ONUSIDA (2006) Rapport sur l’épidémiologie Mondiale du SIDA. ONUSIDA, Genève, 3-4.
[14] Wateba, I.N., Patassi, A.A., Balaka, A. and Tidjani, O. (2013) 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.
World Journal of AIDS, 3, 364-366. http://dx.doi.org/10.4236/wja.2013.34047
[15] Egger, M., May, M. and Chêne, G. (2002) Prognosis of HIV-1-Infected Patients Starting Highly Active Therapy: A
Collaborative Analysis of Prospective Studies. The Lancet, 360, 119-129.
http://dx.doi.org/10.1016/S0140-6736(02)09411-4
[16] Phair, J.P., Mellors, J.W., Detels, R., Margolick, J.B. and Munoz, A. (2002) Virologic and Immunologic Values Al-
lowing Safe Deferral of Antiretroviral Therapy. AIDS, 16, 2455-2459.
http://dx.doi.org/10.1097/00002030-200212060-00011