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Impact à long terme des traitements antirétroviraux en Afrique, état des connaissances

Long-term impact of antiretroviral therapy in Africa: current knowledge

  • Anthropologie Médicale / Medical Anthropology
  • Published:
Bulletin de la Société de pathologie exotique

Résumé

Fin 2013, 11 millions de PVVIH recevaient des ARVen Afrique ; la mise en application de la recommandation de l’OMS de traiter plus précocement (à partir de 500 CD4/mm3) devrait encore accroitre cet effectif. Actuellement, les deux tiers des patients en Afrique reçoivent leur traitement depuis moins de 5 ans, moins de 10 % sont traités depuis 8 ans au plus. Le recul historique est limité; l’impact à long terme des traitements est encore mal connu. Cet article passe en revue les connaissances acquises sur la période des 10 premières années de mise en oeuvre de la stratégie d’accès universel (2003–2013) en Afrique, en focalisant l’attention sur la prise en charge des adultes et en privilégiant une approche centrée sur les patients. Il s’appuie sur une revue de la littérature documentant les conséquences à long terme des traitements ARV. L’objectif est de rendre compte de l’intrication des aspects biologiques et sociaux, individuels et collectifs, qui influent sur la vie des PVVIH et conditionnent l’impact des traitements ARV dans la longue durée. Les aspects biomédicaux et sociaux sont abordés successivement au travers des résultats les plus significatifs. Les principales connaissances acquises sur le devenir à long terme des PVVIH traitées par ARV apportent des informations essentielles sur les conditions et adaptations des dispositifs de prise en charge nécessaires pour garantir le maintien du bénéfice des traitements dans le temps.

Abstract

By the end of 2013, 11 million PLHIV were taking ARVs in Africa; application of the WHO recommendation to initiate treatment earlier (at CD4 count of 500 cells/mm3 or less) should further increase this number. Currently, twothirds of patients in Africa have been on treatment for less than five years, and less than 10% have received treatment for eight years or more. Given the historical perspective is in its early stages, the long-term impact of ARV therapy is still unclear. This article reviews the knowledge gained over the period marking the first ten years of implementation of the universal access strategy (2003–2013) in Africa, through a review of the literature documenting the long-term consequence of ARV treatment, focusing on medical care for adults with an emphasis on the patient-centered approach. The goal is to understand the interrelationships between biological and social factors and individual and collective aspects that affect the lives of PLHIV and determine the impacts of ARV treatment over the long term. The biomedical and social factors are addressed successively, based on the most significant results. Key knowledge on the long-term outcomes for PLHIVon ARV treatment offers vital information on the necessary conditions and adaptations for care systems needed to ensure the benefits of treatment endure over time.

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Authors and Affiliations

  1. UMI 233 de l’Institut de recherche pour le développement (IRD)/Université Montpellier 1, Montpellier, France

    B. Taverne, A. Desclaux & E. Delaporte

  2. Centre régional de recherche et de formation à la prise en charge clinique, CHU de Fann à Dakar, Sénégal (CRCF) ; UMI 233 de l’IRD TransVIHMI, BP 1386, CP 18524, Dakar, Sénégal

    A. Desclaux & I. Ndoye

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  1. B. Taverne
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Correspondence to B. Taverne.

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Taverne, B., Desclaux, A., Delaporte, E. et al. Impact à long terme des traitements antirétroviraux en Afrique, état des connaissances. Bull. Soc. Pathol. Exot. 107, 222–229 (2014). https://doi.org/10.1007/s13149-014-0392-3

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  • DOI: https://doi.org/10.1007/s13149-014-0392-3

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