Tuberculose vaginale révélée par une fièvre prolongée chez une femme immunodéprimée par le VIH à Cotonou, Bénin

Résumé La tuberculose vaginale est exceptionnelle et sous diagnostiquée sous nos cieux. Nous rapportons le cas d’une patiente de 53 ans, immunodéprimée par le VIH hospitalisée dans le service pour altération de l’état général dans un contexte de fièvre au long cours. L’interrogatoire, et l’examen physique avaient retrouvé les éléments suivants : tousseur chronique dans l’entourage, partenaire sexuel multiple, leucorrhées persistantes. Le Mycobactérium tuberculosis était retrouvé dans les leucorrhées à l’examen direct. La sérologie VIH était positive au VIH1, le taux des lymphocytes TCD4 était à 22 cells/μL. Le diagnostic de tuberculose vaginal sur terrain immunodéprimé sévère au VIH a été retenu. Un traitement antituberculeux fut institué. Le traitement Antirétroviral a démarré deux semaines plus tard. L’évolution a été rapidement favorable et après 6 mois de traitement la patiente était déclarée guérie de la tuberculose. Chez un patient immunodéprimé au VIH, tout écoulement purulent persistant même vaginal doit faire rechercher une tuberculos

Haemorrhoidal Disease in Cotonou: Epidemiological, Clinical and Anuscopic Aspects

The haemorrhoidal disease is a very common disorder in proctology. It is favoured by many factors. Although benign, its treatment is difficult. Our aim is to study the epidemiological, clini-cal and anuscopic of haemorrhoidal disease. This was a cross sectional, descriptive and pro-spective study covering a three-month period from 06 January 2014 to 10 April 2014. It involved patients seen in gastroenterology consultation in internal medicine of the National Teaching Hos-pital of Cotonou and in the digestive diseases Unit of the Hospital of Menontin. We recorded 182 patients including 57 cases of haemorrhoidal disease, a prevalence of 31.3%. The sex ratio was 1.10. The average age was 43 years with extremes of 18 and 88 years. Anal events were domi-nated by rectal bleeding (54.4%) with a predominance of internal haemorrhoidal disease (87.7%). Stage 2 evolution of the disease was the most represented (65.4%). Haemorrhoidal disease is

Factors associated with an undetectable HIV₁ RNA plasma load at the end of pregnancy; univariate logistic regression (N = 217).

<p>OR, odds ratio; CI, confidence interval; ART, antiretroviral therapy, PMTCT, prevention of mother-to-child transmission; ANC, antenatal care. The P values presented were computed with the Wald test.</p>1<p>The Fon ethnic group is the predominant ethnic group in South of Benin where the study took place.</p>2<p>For categories, the proportion of women with undetectable HIV1 RNA load is presented. For continuous variables, the mean in the undetectable group versus detectable group is presented. For continuous variables, means in the undetectable group versus detectable group are presented.</p>3<p>For the 6 patients who presented with two consecutive malaria episodes, the gestational age at the first one was considered.</p

Factors associated with an undetectable HIV₁ RNA plasma load at the end of pregnancy; multivariate logistic regression (N = 208).

<p>AOR, adjusted odds ratio; CI, confidence interval; ART, antiretroviral therapy, PMTCT, prevention of mother-to-child transmission; ANC, antenatal care. The P values presented were computed with the Wald test. Of the 217 women with a third pregnancy HIV viral load determined, 9 were not included in the multivariate analysis because the HIV viral load at enrolment was missing.</p>1<p>Adjustment covariates forced in the multivariate models (for study site, 4 dummy variables).</p>2<p>The Fon ethnic group is the predominant ethnic group in South of Benin where the study took place.</p

Women's characteristics (N = 217).

<p>SD, standard deviation; IQR, interquartile range; ART, antiretroviral therapy; ANC, antenatal care.</p>1<p>The Fon ethnic group is the predominant ethnic group in South of Benin where the study took place.</p>2<p>Defined by four or more of the pre-specified household assets: toilets, electricity, a refrigerator, television, motorbike, car.</p>3<p>Median value and interquartile range are presented for the time since HIV diagnosis; 43% of enrolled women had been diagnosed during the ongoing pregnancy.</p>4<p>Virologic failure defined as the persistence of pVL>5000 copies/ml after 6 months of ART.</p>5<p>If more than one malaria event (n = 6), the gestational age at the first event was considered.</p

Study flow-chart.

<p>Women were eligible for the ancillary study if they had been enrolled during the study period and had their third trimester visit performed.</p

Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study.

HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA).We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d'Ivoire, Mali, and Senegal, in the West Africa region.Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3-51.7) and 42.4 years, IQR (37.0-47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm(3), IQR (83-247) among HIV-2 infected patients and 146 cells/mm(3), IQR (55-249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm(3) after 24 months on ART for HIV-2 patients and 169 cells/mm(3) for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7-4.3).This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population