We studied the evolution of drug combinations used, as well as the clinical and immunological profile of patients at initiation of highly active antiretroviral therapy (HAART) between 1996 and 2006 in West Africa. SETTINGS AND METHOD: IeDEA West Africa is a network of HIV care programs established in 2006. We analyzed data from 12 clinical centers treating adults in five countries: Benin, Cote d'Ivoire, Senegal, Gambia, and Mali. Patients 16 years of age or over were included in the study and the following was documented: sex, date of birth and date of initiation of HAART. We included 14,496 adult patients having started HAART, among these 55 % had started HAART between 2005-2006. The proportion of HIV-infected women increased from 46 % in 1996-2000 to 63 % in 2005-2006. The median age at HAART initiation remained constant: 35 years for women and 40 years for men. The proportion of patients having started HAART with a CD4 count<200 cells/microl was 54 % in 1996-2000, and 64 % in 2005-2006. The most frequently prescribed HAART was: AZT/3TC (or d4T/DDI)/IDV (27 %) in 1996-2000; d4T (or AZT)/3TC/EFV (49 %) in 2003-2004, and d4T/3TC/NVP (49 %) in 2005-2006. The first line HAART regimen recommended by WHO was initiated in 83 % of cases in 2005-2006. New approaches to an earlier initiation of ART should be explored to reduce mortality in HIV-infected patients on HAART. (c) 2009 Elsevier Masson SAS. All rights reserved.