Evaluating the therapeutic care of HIV infection in Tunisia

Our aim is to determine different therapeutic response profiles in Tunisian HIV- 1 infected patients, to identify those with therapeutic failure and to compare the results of the genotypic resistance test used in Tunisia [INNO LiPA Test] with those of automatic sequencing to evaluate its efficacy. The retrospective survey concerns 392 infected patients enrolled from January 2001 to December 2006. Evaluation of HIV INNO LiPA test was performed by comparing these test results with those of automatic sequencing in 36 plasmatic samples for 13 infected patients with therapeutic failure. on the basis of the HIV viral load evolution, 57.55% of patients present a good therapeutic response and 42.44% a bad one. Patients with therapeutic failure require genotypic resistance test. A comparison of HIV INNO LiPA test and direct sequencing showed a strong concordance between the two tests results either for reverse transcriptase gene or protease gene. However, the uninterruptible results obtained by INNO LiPA test [8.79% of analysed codons] and the limited number of analysed codons were the defaults of INNO LiPA technique .the contribution of INNO LiPA technique in the knowledge of the epidemiological HIV resistance profiles of virus strains of HIV infected individuals failing therapy was considerable. However, due to INNO LiPA technique limitations, sequence analysis must be considered a more complete assay for the monitoring of antiretroviral resistance of HIV infected patients

[Virological diagnosis and follow-up of HIV infection]

Human immunodeficiency virus [HIV] is a retrovirus infecting approximatively 40 millions people worldwide. HIV is characterized by a great variability with epidemiological, diagnostic and therapeutic implication. This course of infection goes through three stages [acute infection, clinical latency and AIDS] with the evolution of virological markers [anti-HIV antibodies, p24 antigenemia, plasma RNA and prevail DNA]. Direct virological diagnosis is mainly based on molecular tools allowing viral genome detection and amplification with specific primary and nucleic probes, besides p24 antigenic detection, and more rarely culture. Antigenic properties of viral proteins elicit in infected patients antibody synthesis, which is detected using serology [ELISA and Western blot tests]. The follow-up of infected patients is carried out with plasma HIV-1 RNA quantization and phenotypic or genotypic characterization of variant isolated. Virological testes are prescribed according of clinical presentation [screening, acute infection, newborn from HUIV-infected mother]. Most of these virological tools are available in Tunisia, allowing both diagnosis of HIV infection and monitoring of infected individuals. Regarding diagnostic tests indication and interpretation, multidisciplinary concentration is hopeful in order to optimize patient management