The validity of the biological eligibility criteria to antiretroviral treatment in comparison to the systematic antiretroviral treatment in a cohort of people living with the HIV in the Southern Kivu Province, Democratic Republic of the Congo

Introduction The late screening of the majority of patients in sub Saharan region would justify a systematic antiretroviral treatment without breaking the country programs vision. he objective of this study was to determine the validity of biological eligibility criteria to antiretroviral treatment compared with systematic antiretroviral treatment in a cohort of the people living with HIV in Bukavu city. Methods One thousand hundred and forty-nine (1149) records of people living with HIV (PLWIV) followed in three HIV health care facilities of Bukavu city were selected systematically. The ROC curve was constructed and analyzed to assess the validity of systematic antiretroviral therapy and a treatment based on WHO biological criteria. Results The CD4 median count was 196 /mm3. On admission, only 17.3% of PLWHIV had a CD4≥500/mm3. Compared to the criteria “systematic antiretroviral treatment”, biological eligibility criteria for antiretroviral therapy, had a sensitivity of 94.9%, a specificity of 100%, an AUC of 0.97 (0.96 to 0.98) (p <0.0001) and correlation coefficient of 0.88. Conclusion This study shows that a systematic antiretroviral treatment of seropositive patients newly detected for the HIV in sub-Saharan Africa area must be requirement outwards WHO current recommendations. Also, in order to optimize expected outcome of a systematic treatment, a systematic screening in the high-risk groups of this area should be recommended.

with a view of their best ART. These criteria have evolved with time according to the aims in view. At the beginning, the objective was to treat the Acquired immunodeficiency syndrome (AIDS) stage in order to reduce mortality and as much as possible to avoid the side effects related to the antiretroviral one [4]. Currently, the treatment goal is to minimize the viral load in order to stop the infection progression and to best restore and as soon as possible the different immune functions destroyed by HIV virus. Accordingly, World Health Organization (WHO) now recommends the treatment of a positive patient newly detected for the HIV systematically regardless CD4 count [5]. Ultimately, there are no more eligibility criteria for starting an ART.
Unfortunately, sub-Saharan Africa, the area most strongly concerned by the HIV by concentrating 67% of the PLWHIV and 75% of deaths due to the AIDS [1], is characterized by a low socioeconomic level of its population and a significant number of hospitals and health centers insufficiently equipped [6]. Thus, almost all of country programs of fight against the HIV in this area are supported by international organizations. These ones usually lay down guidelines in order to optimize the treatment of vulnerable firstly [7]. This vision, if it persists, could be an obstacle for implementation of WHO current recommendations. However, from the late screening viewpoint of most patients in sub-Saharan Africa usually at the advanced stage of the disease, these ones could start ART systematically without breaking the eligibility criteria of treatment theoretically more rational based on the CD4 count [6].
Thus, this work would like to assess the validity of the biological eligibility criteria to the antiretroviral treatment compared with the systematic antiretroviral treatment as recommended by WHO.

Study design
This retrospective study has systematically included the medical records of all adults HIV seropositive patients >15 years followed in

Data collection
For each patient, socio-demographic parameters were recorded (age, sex, marital status).Then, the medical history of HIV infection was studied (the presence of opportunistic infections). Finally, the CD4 count at admission was searched.

Study outcomes
The systematic antiretroviral treatment was to initiate ART for all adults with HIV regardless of WHO clinical stage and at any CD4 cell count [5]. Previously recommended ART for this population was to Initiate ART for all adults with HIV and a CD4 count at or below 500 cells/mm 3 , regardless of WHO clinical stage, giving priority to those with severe or advanced HIV disease (WHO clinical stages 3 or 4) or a CD4 cell count at or below 350 cells/mm 3 [7]. In this study, On the basis of biological criteria, the PLWHIV with CD4 < 500/mm 3 and/or if he is married (bride or divorced or widowed) and/or having an active tuberculosis were eligible to the treatment [7].

Statistical analyses
Data are described, as frequencies or median (interquartile range),   Table 2 shows the results of the construction of the ROC curve.

Discussion
The present study shows that 95.5% of the PLWHIV were at once eligible to the ART according to the biological criteria. In the same way, compared with the systematic treatment, the biological criteria had sensitivity and specificity respectively of 95.0% and 100% as

Competing interests
The authors declare no competing interests.  Table 1: General characteristics of people living with HIV studied   Table 2: Validity of Biological eligibility criteria for treatment