Epidemiological and virological characteristics of people living with HIV on antiretroviral treatment for more than 6 months in virological failure in Brazzaville, Republic of Congo
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Introduction. Virological failure is one of the main causes of failing to treat, and better management of HIV infection requires understanding and controlling the factors that contribute to this phenomenon. The main objective was to characterize the patients of the active file of the Brazzaville Outpatient Treatment Center in virological failure to identify predictive factors leading to virological failure.
Methods. Conducted between June and December 2020, this was a cross-sectional study. Patients enrolled were HIV-1-infected patients from the Brazzaville Outpatient Treatment Center receiving a potent combination therapy for at least 6 months but experiencing virological failure. Viral load was measured using the automated Abbott Real-time HIV-1 m2000rt System. Sociodemographic and clinical data were collected from a computerized patient record software called Santia. For the identification of the independent predictors of virological failure, statistical analysis was performed.
Results. A total of 109 patients with virological failure were recruited. The median age of the patients was 45 years (interquartile range: 37–52 years) and women were more represented (74%). More than half of the patients had World Health Organization stage IV HIV and the median duration of antiretroviral treatment was 96 months. The most followed treatment regimen was AZT+3TC+EFV (or nevirapine) with 48%, while the median viral load was 12985 copies ml −1 .
Conclusion. In our study, we did not identify any sociodemographic or clinical variables predictive of virological failure. However, we felt that it would be desirable to carry out a study with temporal follow-up and the possibility of sequencing in order to identify the different circulating genotypes and resistance mutations.
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The work presented is clear and the arguments well formed. This study would be a valuable contribution to the existing literature.
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Comments to Author
Need more samples to enroll in this study. HIV genotyping is important results that should be very much considered in this study. Not sure if we can get the benefit from the data illustrated in table2, regarding the viral load?!
Please rate the manuscript for methodological rigour
Satisfactory
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or …
Comments to Author
Need more samples to enroll in this study. HIV genotyping is important results that should be very much considered in this study. Not sure if we can get the benefit from the data illustrated in table2, regarding the viral load?!
Please rate the manuscript for methodological rigour
Satisfactory
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-
The work presented is clear and the arguments well formed. This study would be a valuable contribution to the existing literature.
-
Comments to Author
The study investigates possible correlates for virological failure among HIV-1 positive individuals in the Republic of Congo. The study outlines the challenges in understanding virological failure in resource limited settings, where access to CD4 measures an drug resistance testing may be limited. The methods are sound, and the results are well presented but the study can be improved by addressing the following: Discussion The discussion could benefit from more detail overall and more references to other scientific studies. -On line 187-190, the authors try to link education as a demographic factor contributing to adherence, even though they did not measure adherence levels in their study and they agree on that. "Although we have no data on patient's adherence, we can nevertheless note some facts …
Comments to Author
The study investigates possible correlates for virological failure among HIV-1 positive individuals in the Republic of Congo. The study outlines the challenges in understanding virological failure in resource limited settings, where access to CD4 measures an drug resistance testing may be limited. The methods are sound, and the results are well presented but the study can be improved by addressing the following: Discussion The discussion could benefit from more detail overall and more references to other scientific studies. -On line 187-190, the authors try to link education as a demographic factor contributing to adherence, even though they did not measure adherence levels in their study and they agree on that. "Although we have no data on patient's adherence, we can nevertheless note some facts influencing patient's adherence such as: nearly 40% of patients were unemployed and so might neglect treatment because of difficulties in eating, which would demotivate them to stick to taking their medication." What is critical here is that they try to link education to eating and therefore adherence which is difficult to understand. Though, the authors do not provide any literature support to this argument. I would like to see some scientific examples of such a link. -on lines 192-195, they make the statement "One of the other important factors linked to poor adherence that we can also point to is the untimely rupture of molecules, which could lead to viral replication because of low plasma drug concentration and then favors the virological failure." This is also difficult to understand and do not know the exact argument they make. It will be good to rewrite and provide and references. -Another important argument they make is on CD4 count which is well known. The authors agree they did not measure this and need to state it as part of the limitations they state just before this argument on line 199. - The authors state that "We would also have liked to take this study to the molecular characterization of HIV strains given to have led to the identification of resistance, given to the great genetic diversity of HIV-1 that had been reported in the country". I think the discussion on this could be extended. Minor comments Introduction - On line 55, consider changing the word "Highly" to highly in Highly active antiretroviral therapy (HAART) or capitalize each word. - On lines 55-57, rewrite the sentence for clarity. How does HAART lag behind in reaching the goal of reaching undetectable viral load? Do authors mean to say "even though HAART greatly improves life expectancy, we still have a challenge in reaching the UNAIDS 95/95/95 third target". - On line 56, people living with HIV must first be defined as "people living with HIV (PLWHIV)" before used on line 58 and subsequently. - On line 61, capitalize west and central Africa. Importantly, they need to provide references to the statements made on lines 61 and 63. - On line 66, authors need to first define anti-CCR5 before used subsequently, do same for ART on line 62 and WHO on line 75 and just abbreviate subsequently. - On lines 67-72, the authors need to rewrite the sentences for clarity. - Generally, authors need to work on the sentence structures for clarity. For example, they could rewrite the concluding sentences under the introduction on lines 82-84. Results -On line 123, no need to define IQR as it is already defined on line 115. - On line 127, the authors state that 42 (39%) were unemployed and noted a majority. This is not entirely correct as the cumulative proportion of employed (Daily labour + self-employed + employed) is 61% and rather is the majority. Need to rewrite for accuracy. - The authors state the rounded percentages in the results descriptions but rather have the decimal versions the tables. This can be confusing and need to adopt one way, either the rounded or decimals for both the tables and table descriptions. Eg. On line 123,"According to marital status. 30 (27.5%) were single" as reported in the table. - On line 132, define ARV as antiretroviral (ARV) before abbreviated or simply change ARV treatment to ART as that is already defined. - The numbers and percentages in tables must be consistent throughout. Eg 37.0, 56.7 etc and not round off some and leave others. - On table 3, the authors need to specify the limits of the VL and make it consistent with table 2. Eg 10e3≤VL≤ 10e4
Please rate the manuscript for methodological rigour
Good
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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