They have to live with the HIV virus. This plight concerns 35.3 million people throughout the world according to the figures released in 2012 by UNAIDS, the authority set up by the United nations to coordinate the different agencies of the UN that specialize in the fight against HIV/AIDS. There are certainly other more encouraging statistics hidden behind this figure. Indeed, Infections have decreased by 30% since 2001 and there have been around 29% fewer deaths connected with AIDS since 2005. Nevertheless, global statistics still hide large disparities, of a geographical nature in this case. Indeed the challenges are always greater in poor countries with limited resources, both in terms of access to treatment and patient care. Chatté Idékhim Adawaye’s thesis provides clarity that is both pragmatic and useful in relation to this latter point. His research focuses on a very particular situation, that of Chad, and he develops solutions that are both adapted and effective. The aim is to provide people living with HIV in this country with proper care that would make it possible to detect HIV resistance to antiretroviral drugs (ARV) and consequently, to suggest another treatment in time. To succeed in this, it is of the utmost importance that all the actors concerned become aware of the crucial issues surrounding the question of HIV resistance to ARV drugs. This is the condition under which a proper care system for patients could be organized and is an essential condition for successful treatment. There is no resistance test available in this country which requires the development of alternative methods for better epidemiological monitoring of resistance to HIV treatment.

In order to better understand the importance of detecting resistance to antiretroviral treatments (ARV); it will be useful to explain the terminology involved. HIV is not AIDS, yet unfortunately, this confusion still exists. HIV is a virus that weakens the human immune system. We use the term AIDS when HIV has weakened the immune system and a person starts to develop signs of infection. The result is that a person who has AIDS necessarily has HIV because it is HIV that causes AIDS. On the other hand, having HIV does not mean that an individual has or will get AIDS if the advanced stage of infection has not been reached. There are four distinct stages of infection: primary infection, clinically asymptomatic stage, symptomatic HIV infection and AIDS. With the development of treatments, we no longer pass automatically from the first stage to the fourth. On the contrary, a HIV-positive individual can reach stage three and then return to stage 2, or even to return to stage two from stage four. It is not possible to return to stage 1, primary infection.

The preceding digression points to the fact that there are no fatalities during the development of the disease on condition that there is adequate treatment available. This brings us to the tests of HIV to ARV drugs. Without these tests, treatments cannot be entirely effective and cannot therefore halt the fatal progression of the virus. In Chad, “There is no molecular biology laboratory and therefore there is no resistance testing”, says Chatté Adawaye, who is a doctoral student in the AIDS Reference Laboratory of Liege University Hospital.

Resistance of HIV to ARV drugs: the example of Triomune

As an example serving to illustrate the resistance of the virus, a test was carried out during 8 months of observation of 116 patients who served as the standard sample upon which Chatté Adawaye’s thesis is based. This test was conducted by the doctoral student on his own initiative. It involves assessing the resistance to the virus in patients treated by Triomune; these totaled 48 patients out of the 116. The results were staggering: “the rate of failure of Triomune was 43.75% and concerned 21 patients out of 48”. These results must evidently be subjected to more in-depth analysis and take into account the environment of the individuals concerned and the means of treatment. “Resistance to the treatment is often due to the virus which makes a mistake while replicating itself and which leads to mutations. But in Chad we must also factor in the fact that this treatment is not always taken in normal conditions, far from it. We have patients who do not take their medication or who miss doses. They do not benefit from regular assessment. Therefore, in this particular case, failure is directly linked to non-observance of the terms of treatment”.  It is important to point out that “since the end of 2012 in Chad, tritherapy by Triomune or tritherapy for the poor is no longer part of the treatments dispensed. This decision by the government has nothing to do with the failure of the treatment because this can only be proved by a resistance test. It is rather the harmful second effects of this treatment that are behind this measure. At the time we took the samples, this tritherapy was gradually abandoned and we seized the opportunity to carry out an immunovirological assesment of the treatment”. Once we observed the failure of Triomune, it was necessary not only to stop its use but also to resist “cross-resistance”, and in order to do this it was essential not to give a patient a treatment containing a medication from the same family as those contained in Triomune.