**3.2 HIV carriage in SCD patients**

As it has been said above, the literature on HIV carriage in SCD patients is very scars, due to the paucity of patients themselves. In fact, the clinical experience in Central Africa where HIV carriage is higher than 10% in general population, shows that this rate is not significantly higher in homozygous HbSS patients. Further more, as the large majority of HbSS homozygous patients are also sexually active, it make sense to believe that the HIV infection in these specific set, is got through the same pathways with the general population. One of the rare related paper we could found regarding this matter is the one of Bagasra O et al; it suggests that, in patients with both SS and HIV-1 infection, the retroviral disease may be ameliorated by host factors of which absence of splenic function prior to HIV-1 contamination may be one. In another term, this author assume that HbSS carriage makes the body more resistant to HIV process as into his experimental case-control study of ten years follow-up, both the CD4 count and the Viral load were better in HbSS patients with HIV infection compare to HbAA counter part with the same viral infection. This may be explained by the fact that, as the spleen and lymph nodes are major sites of human immunodeficiency virus type 1 replication, mutation, and genetic variation in vivo; and as a major portion of this lymphatic tissue, such as the spleen, is removed or otherwise is unavailable for invasion by the HIV-1 virus, the course of this infection is altered. The clinical consequence is a prolonged symptom-free interval or even increased survival that we experience in daily clinical follow up of homozygous HbSS patients. Into the contrary, as it was reported by Sellier P et al, no significant difference in HIV infection progression is observed between heterozygous SCD carriers with HIV and their normal Hemoglobin counter part with the same virus.

Therefore, as far as HIV carriage is concerned in SCD patients, we should always distinguish homozygous patients in which, the expected course of retroviral process is slow than usual in one side, and in the other side, heterozygous patient in which it does not differ from that of the non SCD-non HIV patients. The same differentiation may be necessary regarding the management of antiretroviral therapy (ARVT) in this field.
