Jointly conducted by IRD and INSERM, this research highlights the challenges of virological monitoring of HIV in Southern countries.
Emilande Guichet, researcher at TransVIHMI (Institut de Recherche pour le Développement).
Thesis defended in 2016 at the doctoral school École doctorale Sciences Chimiques et Biologiques pour la Santé (Montpellier ; 1992-....).
This research is the result of an international co-supervision between several partner institutions.
Referenced in the ABES/STAR network, this thesis meets the rigorous criteria of French higher education.
The fight against HIV in Southern countries faces major challenges, notably resistance to antiretroviral treatments. Fifteen years after the introduction of these treatments, many patients still fail to achieve viral suppression, a fundamental goal for their health. This situation is all the more concerning as Southern countries, often lacking resources, do not benefit from the same technological and medical advancements as their Northern counterparts. The research conducted by Emilande Guichet at the Institut de Recherche pour le Développement highlights these critical issues.
The data collected shows multi-resistance in almost all patients experiencing virological failure after first-line treatment. This resistance compromises the effectiveness of second-line treatments, making the situation even more alarming. Indeed, while patients are often asymptomatic, high viral loads are associated with multiple resistances, further complicating monitoring and management. The absence of regular virological monitoring, based on accessible viral load tests, could lead to a new epidemic of resistant strains in sub-Saharan Africa.
The research has also enabled the transfer of an effective viral load test to Cameroon, capable of detecting multiple variants of HIV. This test, which has better sensitivity than currently used tests, could revolutionize patient monitoring in decentralized areas where access to care is limited. However, adapting this test for large-scale use remains a challenge. Nucleic acid extraction methods must be optimized to ensure reliable results without incurring additional costs for treatment programs.
It is imperative that decision-makers become aware of these issues and invest in appropriate solutions. Improving virological monitoring is not only a public health issue but also an economic challenge. Indeed, effective monitoring could reduce costs associated with inappropriate treatments and improve the quality of life for patients. Efforts must focus on expanding access to viral load tests, particularly in rural and decentralized areas where infrastructure is often inadequate.
In conclusion, Emilande Guichet's research underscores the urgency of acting to improve the care of patients living with HIV in Southern countries. The challenges are numerous, but opportunities for innovation and improvement in care are also present. Decision-makers must commit to implementing policies that promote access to treatments and virological monitoring to ensure a better future for the millions of people affected by HIV.
Key Facts
- 95% : Agreement of results between the new viral load test and the Abbott test, indicating better sensitivity.
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Sources and Access
Emilande Guichet. Etude des résistances du VIH-1 au traitement antirétroviral et amélioration du suivi virologique des patients vivant avec le VIH dans les pays du Sud. Médecine humaine et pathologie. Université Montpellier, 2016. Français. ⟨NNT : 2016MONTT044⟩. ⟨tel-01647140⟩