HIV infection in Africa: clinical and therapeutic research

A major health problem: Human Immunodeficiency Virus (HIV) infection is a m ajor public health problem in sub-Saharan Africa and the care of HIV-infect ed patients is limited by the lack of resources. Clinical research can play a major role to assess the benefit of preventive and/or curative measures adapted to the context of these countries. To illustrate advances and gaps in HIV/AIDS clinical research in Africa, we explored three issues relevant to this research :opportunistic infections in adults, mother-to-child trans mission of HIV and the ethical questions. Epidemiology: Epidemiological African studies have shown: the omnipresence of tuberculosis, first cause of death among HIV+ patients; the frequency of bacterial infections, first cause of serious morbidity and second cause of death; the high frequency of of toxoplasmosis, cryptococcal meningitis iso sporiasis, cryptosporidiasis, and other infectious syndromes of unknown eti ology. More research efforts need to be done for Improving tuberculosis dia gnosis, compliance to treatment (evaluation of Directed Observed Therapy), resistance to treatment and primary chemoprophylaxis which has shown clear short term benefit but median term interest remains to be demonstrated. Che moprophylaxis of opportunistic infections other than tuberculosis needs als o to be evaluated : cotrimoxazole reduces the short term mortality of HIVpatients with tuberculosis and the early serious morbidity of HIV+ patients without tuberculosis. Transmission: Mother-to-child transmission of HIV can occur during pregnanc y during delivery and the postnatal period by breastfeeding, a common pract ice in Africa. The overall risk of vertical transmission is estimated to be 30% but the attributable part of breastfeeding needs to be further explore d. Beyond the prevention of sexual transmission of HIV among childbearing w omen and family planning for HIV+ women, interventions aimed to reduce moth er-to-child transmission depend an the availability or not of a proposing a nd realising an HIV counselling and testing: antiretroviral treatments and/ or breastfeeding alternatives which reduce efficaciously transmission requi re HN testing while vaginal disinfection and vitamin supplementation whom e fficacy needs to be demonstrated do not Prevention: Prevention of mother-to-child transmission and care of HIV+ adu lts in the area of opportunistic infections are feasible in Africa with an acceptable cost This requires first to train and inform health care provide rs and the populations. Lots of uncertainties in these areas are likely to be alleviated by reinforcing clinical and therapeutic research of good qual ity including the questions of antiretroviral treatment Ethical issues rais ed by the design and conduct of clinical research in Africa need a positive thinking to race the HIV African pandemic.