World Journal of AIDS, 2013, 3, 364-366
Published Online December 2013 (
Open Access WJA
Viral Characteristic of HIV Infected Patients Naïf o f
Anti-Retroviral Therapy with CD4+ T Lymphocytes Rate
Greater than 350 per Microliter of Blood in Lomé Togo
Ihou Nazoba Majesté Wateba, Akouda Akessiwe Patassi, Abago Balaka, Ousséni Tidjani
Service de Maladies Infectieuses et de Pneumologie, CHU Sylvanus Olympio, Lomé, Togo.
Received September 6th, 2013; revised October 6th, 2013; accepted October 13th, 2013
Copyright © 2013 Ihou Nazoba Majesté Wateba et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Obje ctive: To evaluate the virological status of ineligible HIV patients for anti-retroviral therapy based on the criterion
of CD4+ T lymphocytes rate over than 350/μl of blood. Method: This is a prospective study which was conducted from
November 2011 to July 2012 in the tropical and infectious disease department of CHU Sylvanus Olympio of Lomé. All
HIV-1 infected patients whose CD4+ T lymphocytes rate was 350/μl of blood were retained. The count of CD4+ T
lymphocytes was made by cytometer FACSCalibur® flow of BD biosciences and the determination of viral load was
achieved by NASBA laboratory method of Biomérieux. Results: We have recruited 102 PLWHA aged between 19 and
58 years with a median of 35 years. Biologically, 102 patients had a T-CD4 rate between 355 and 432/μl of blood. The
determination of viral load showed a very high viral replication more than 10,000 copies/ml among all patients and 28
(27.5%) patients had a viral load > 100,000 copies/ml of blood. Conclusion: Our results argue for a reconsideration of
the criteria for starting antiretroviral therapy in Togo by including virological data if necessary in patients with T-CD4
rate below 500/μl of blood.
Keywords: Viral Load; CD4+ T Lymphocytes; Naive Anti-Retroviral Therapy Patients
1. Introduction
Twenty-five years after the start of the pandemic of hu-
man immunodeficiency virus (HIV) and despite the in-
ternational mobilization, HIV/AIDS which is a major
public health problem in developing countries remains.
In Togo, the HIV epidemic has been documented since
1987. Between 1987 and 2005, 20,676 cumulative AIDS
cases were officially registered and 110,000 people are
living with HIV [1]. The prevalence of HIV infection was
successively 5.8% in 2001, 4.1% in 2003, 3.2% in 2005
and 3% in 2008 [1]. In 2012, more than 36,000 people
have had received antiretroviral therapy. Since 2012, the
immunological criteria for starting treatment were recon-
sidered from 200 CD4+ T lymphocytes to 350 CD4+
T lymphocytes per μl of blood. For higher rates, the ini-
tiation of treatment considers the clinical condition of the
patient [2-4]. The aim of our study was to evaluate the
viral status of patients ineligible for anti-retroviral ther-
apy (CD4+ T lymphocytes rate more than 350 per μl of
blood) according to the national algorithm of Togo.
2. Method
This is a prospective study which was done in the tropi-
cal and infectious diseases department of CHU Sylvanus
Olympio of Lomé in Togo. All patients are HIV-1 in-
fected and naive for anti retroviral treatment. The CD4+
T lymphocytes rate is between 350 and 500 per μl of
blood. The T-CD4 count was performed by the technique
of flow cytometry of BD Biosciences FACSCalibur™.
The determination of the viral load was performed by the
NASBA method (Nucleid Acid Sequence Based Ampli-
fication) with EasyQ BioMerieux equipment.
3. Results
Epidemiological data: Two hundred HIV-1 infected pa-
tients were included in the study. Seventy-five patients
(74.5%) were female and 27 were male (25.5%). The sex
ratio M/F was 0.34. The age of patients ranged from 19
to 58 years with a median of 35 years.
Biological data: The rate of CD4+ T lymphocytes was
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 365
between 355 and 432 per μl of blood and the median
value of CD4+ T lymphocyte count was 357 per μl of
blood. The mean viral load of all patients enrolled was
106,136 copies/ml and the maximum viral load was
1,000,000 copies/ml (6 Log/ml) and a minimum value
was less than 10,100 copies/ml. Twenty-eight patients
(27.5%) had a viral load > 100,000 copies/ml (5 Log/ml)
(Table 1).
4. Discussion
Epidemiological data: We observed a female predomi-
nance and the sex ratio M/F was 0.34. Our result is simi-
lar to the data reported by the national program against
HIV in Togo which has related a sex ratio of 0.32 in
2007 [1]. This observation is consistent with the UN-
AIDS report in 2007 which indicates that 61% of people
infected with HIV in sub-Saharan Africa are women [5]
The predominance of women within HIV-1 infected pa-
tients in Togo and in the sub-Sahara Africa Region could
be explained by early sexual relation among girls, the
lack of training and information on the prevention of
HIV-AIDS and high-risk behaviours of their partner(s)
who provide them incomes and very often, they can not
make them use preservative [5]. The age of patients is
between 19 and 52 years with a median age of 35 years.
This age group is the most active mass of the Togolese
population in terms of production of income-generating
activities. They also correspond to the sexual active po-
pulation. Our results are similar to the national HIV pro-
gram data of Togo in 2007 where more than 74% of HIV
infected patients were aged from 25 to 49 years old.
Biologically, all patients included in this study were
not eligible for anti retroviral therapy because of the
CD4+ T lymphocyte rate > 350/μl of blood according to
the national HIV algorithm in Togo [2]. Indeed, for a
long time, Togo as the majority of developing countries
had recommended to start the anti retroviral therapy
when the CD4+ T lymphocyte rate is 200/μl of blood. If
a better result was demonstrated in many clinical trials
with patients who had started the anti retroviral therapy
at AIDS stage (CD4+ T lymphocytes rate < 200/μl of
blood) and in many cohort studies of patients with CD4 <
350 per μl of blood, several new arguments, also from
cohort studies, argue for an earlier introduction of the
first antiretroviral therapy in asymptomatic patients with
CD4 rate > 350/μl. The benefit is the better viral and im-
Table 1. Distribution of patients according to the viral load.
Viral load Viral load
<100.000 copies/ml >100.000 copies/ml
Total strength 74 (72.5%) 28 (27.5%)
mune response [6] and the reduction of the morbidity [7]
or the improvement of the mortality [8,9]. In addition,
HIV infection, regardless of immune deficiency, includ-
ing levels of CD4+ T lymphocytes > 350/μl, increase a
risk of morbidity and mortality of cancer, cardiovascular
disease and neuro-cognitive disorders which could also
justify earlier introduction of antiretroviral therapy [8,10,
Virologically, 27.5% of patients had a viral load >
100.000/ml blood. Indeed, the prognostic value of
plasma viral load to initiate anti retroviral treatment is
less important than the CD4+ T lymphocytes rate when
the viral load < 100,000 copies/ml (5 Log/ml). However,
several cohort studies have shown that high plasma viral
load (especially >100,000 copies/ml) is a bad prognostic
factor regardless of the CD4 T lymphocytes rate [12-14].
In addition, the quality of the immunological response to
antiretroviral therapy decreases with age and is signifi-
cantly worse after 60 years [15]. The clinical response is
also lower in patients over 50 years [16]. A first HAART
should help to make undetectable viral load (<50 copies
ARN-VIH/ml) within 6 months from the beginning of
the treatment. However, with some patients, this goal is
not reached at that date, and the viral load becomes un-
detectable after 6 months of treatment. This can be seen
especially when the initial viral load > 5 Log copies/ml
or in case of low CD4 T lymphocytes rate.
5. Conclusion
Our study has provided sufficient evidence that the rela-
tively high rates of CD4 T lymphocytes (>350/μl) may
be accompanied by a very high viral replication. It is for
that reason that today all recommendations argue at early
beginning of the anti-retroviral therapy with those HIV
infected. However, it is difficult to implement the viral
load measurement in developing countries, which ap-
pealed to the international generosity to take care of their
patients. This study deserves to demonstrate that many
remains have to be done to attend universal access care
and to achieve the objective 06 of Millennium Develop-
ment Goals on HIV/AIDS.
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Open Access WJA
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
Open Access WJA
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