Comparison of Washing and Swabbing Procedures for Collecting Genital Fluids To Assess Shedding of Human Immunodeficiency Virus Type 1 (HIV-1) RNA in Asymptomatic HIV-1-Infected Women

Human immunodeficiency virus type 1 (HIV-1) RNA was detected by means of ultrasensitive reverse transcription-PCR assay of 19 cervicovaginal lavage, 21 cervical mucus, 18 vaginal wall, and 17 vaginal fornix paired samples from 25 asymptomatic HIV-1-infected women (76, 84, 72, and 68%, respectively; P > 0.5). Levels of HIV-1 RNA in cervicovaginal wash samples were highly correlated with those in paired endocervical mucus samples (r = 0.71; P = 0.0006), indicating that cervicovaginal washing and endocervical swabbing are equivalent collection procedures

Risk factors for HIV infection among female sex workers in Bangui, Central African Republic.

The aims of the study were i) to categorize female sex workers (FSW) according to socio-anthropologic criteria in Bangui; ii) to examine the association between a selection of demographic and risk variables with the different categories of female sex work as outcome, and iii) to investigate factors associated with HIV status.A cross-sectional questionnaire survey was conducted to describe the spectrum of commercial sex work in Bangui among 345 sexually active women. After collection of social and behavioral characteristics, each woman received a physical examination and a blood sample was taken for biological analyses, including HIV testing. The relationships between sociodemographic characteristics, behavioral variables involved in high risk for HIV as well as biological results were investigated by bivariate analysis in relationship with FSW categories as main outcomes, and by bivariate analysis followed by multivariate logistic regression analysis in relationship with HIV as the main outcome. The strength of statistical associations was measured by crude and adjusted Odds ratios (OR) and their 95% confidence intervals.The typology of FSW comprised six different categories. Two groups were the "official" professional FSW primarily classified according to their locations of work [i) "kata"(18.55%) representing women working in poor neighborhoods of Bangui; ii) "pupulenge" (13.91%) working in hotels and night clubs to seek white men]. Four groups were "clandestine" nonprofessional FSW classified according to their reported main activity [i) "market and street vendors" (20.86%); ii) "schoolgirls or students" (19.13%) involved in occasional transactional sex (during holidays); iii) "housewives or unemployed women" (15.65%); iv) "civil servants" (11.88%) working as soldiers or in the public sector]. The overall prevalence of HIV-1 was 19.12% (66/345). HIV varied according to FSW categories. Thus, among professional FSW, the HIV prevalence was 6-fold higher in "kata" than "pupulenge" (39.13% versus 6.30%; P = 0.001). Among nonprofessional FSW, the "vendors" showed the highest HIV prevalence (31.91%), which was higher than in "students" (6.10%; P = 0.001), "civil servants" (9.83%; P = 0.005), and "housewives" (13.00%; P = 0.01). In bivariate analysis, the following variables showed statistically significant association with risk for HIV infection: nationality; age of first sexual intercourse; self-assessment of HIV risk; knowledge of HIV status; anal sex practice with last clients; irregular condom use in last week; consumption of alcohol; other psycho-active substances; past history of STIs; HBs Ag; HSV-2 and bacterial vaginosis. However, the variable "sex workers categories" dichotomized into professional versus nonprofessional FSW was no longer associated with HIV. In multivariate logistical regression analysis, HIV infection was strongly associated with nationality (15.65% versus 3.77%) [adjusted OR (aOR) 3.39: 95% CI:1.25-9.16, P<0.05]; age of first sexual intercourse (21.10% versus 14.00%) (aOR 2.13: 95% CI: 1.03-4.39, P<0.05); anal sex practice with last clients (43.40% versus 11.50%) (aOR 4.31: 95% CI:2.28-8.33, P<0.001); irregular condom use in past week (33.50% versus 3.00%) (aOR 5.49: 95% CI:1.89-15.98, P<0.001); alcohol consumption before sex (34.70% versus 7.80%) (aOR 2.69: 95% CI:1.22-4.96, P<0.05); past history of STIs (41.00% versus 10.80%) (aOR 2.46: 95% CI:1.22-4.97, P<0.05) and bacterial vaginosis (29.80% versus 4.29%) (aOR 6.36: 95% CI: 2.30-17.72, P<0.001).Our observations highlight the high level of vulnerability for HIV acquisition of both poor professional "kata" and nonprofessional "street vendor" FSW categories. These categories should be particularly taken into account when designing specific prevention programs for STIs/HIV control purposes

Efficacité de la Combinaison d’Interventions de Prévention chez les Hommes Ayant des Rapports Sexuels avec des Hommes à Bangui (République Centrafricaine)

Introduction. Men who have sex with men (MSM) are a high-risk population for STIs/HIV in the Central African Republic (CAR). Our study aimed to test the effectiveness of the combination of behavioral, biomedical and structural interventions in MSM in the context of a security crisis. Materials and methods. The interventions were conducted from June 2014 to October 2016. Participants (n=215) were enrolled in the National Reference Centre for STIs and Antiretroviral Therapy in Bangui, the capital city of CAR. The intervention group (n=40) was randomly selected. The remaining subjects (n= 175) was the control group. Both groups participated in a series of STI/HIV upgrading training sessions at the beginning of the study. Then, intervention group received 1) biomedical interventions (antiretroviral treatment as prevention, STI diagnosis and treatment, and HIV counseling), 2) psychosocio-educational interventions (interactive training, educative talks, social assistance and text messages) and 3) Structural interventions: (condoms available and free of charge). Results. In the intervention group, the median of casual sexual partners in the previous three months was significantly reduced (p < 0.001) ;the percentage of MSM having 100% of protected intercourse increased significantly (p<0.001). Only one MSM out of 40 was infected with HIV versus nine out of 76 in the control group. No negative subjects in the intervention group became positive for hepatitis B. There was no significant increase in the number of new cases of syphilis infection (p<0,001). Conclusion. The combination of interventions has an alleviating impact on risk behaviors and probably reduces the incidence of STI/HIV among MSM, even in times of humanitarian crisis. In view of the small sample size, it would be necessary to carry out a more in-depth study with a larger sample of MSM, in order to confirm these results.info:eu-repo/semantics/publishe

Risk factors for multidrug-resistant tuberculosis in the Central African Republic: A case-control study

Background: The emergence and spread of multidrug-resistant tuberculosis (MDR-TB) presents a challenge to the ''End TB by 2035'' strategy. This study aimed to identify the risk factors associated with MDR-TB in patients admitted to the pneumo-physiology clinic of the National University Hospital of Bangui in Central African Republic. Methods: This was a “retrospective” chart review study. Cases were represented by patients more than 18 years of age treated for MDR-TB and controls were patients with “at least rifampicin-susceptible” TB treated ''with first-line anti-TB regimen'' and who at the end of treatment were declared cured. The status of “cured” was exclusively applicable to non-MDR TB. Risk factors associated with MDR-TB were identified by multivariate analysis. Results: We included 70 cases and 140 controls. The median age was 35 years, IQR (22;46 years). The main factors associated with the occurrence of MDR-TB in multivariate analysis were male gender (0 R = 3.02 [1.89–3.99], p = 0.001), residence in a peri-urban/urban area (0 R = 3.06 [2.21–4.01], p = 0.002), history of previous TB treatment (0 R= 3.99 [2.77–4.25], p < 0.001) and the presence of multidrug-resistant TB in the family (0 R=1.86 [1.27–2.45], p = 0.021). Conclusion: The emergence of MDR-TB can be reduced by implementing appropriate strategies, such as preventive therapy in contacts of MDR-TB patients and detecting and appropriately treating MDR-TB patients to prevent further spread of infection

Cervicovaginal Neutralizing Antibodies to Herpes Simplex Virus (HSV) in Women Seropositive for HSV Types 1 and 2

Antibodies to herpes simplex virus type 1 (HSV-1) and HSV-2 of the immunoglobulin G (IgG) and IgA isotypes were detected in the cervicovaginal secretions (CVS) of 77 HSV-1- and HSV-2-seropositive but clinically asymptomatic African women by type-specific enhanced chemiluminescence Western blotting (ECL-WB). Of the 77 subjects, 34 were HIV negative, shedding HSV-2 DNA in their genital secretions; 20 were HIV positive, shedding HSV-2 DNA; and 23 were HIV negative, not shedding HSV-2 DNA. HSV-specific IgG was detected in CVS of nearly 70% of the women studied. HSV-specific IgA was found in CVS of 50% of the women studied. The distribution of CVS HSV-specific antibodies to each HSV type was highly heterogeneous, with a slight predominance of detectable IgG to HSV-1 (59%) over IgG to HSV-2 (41%), whereas the frequency of detectable IgA to HSV-1 (39%) was similar to that of IgA to HSV-2 (36%). The presence of detectable HSV-specific antibodies was inversely associated with HSV-2 DNA genital asymptomatic shedding but was not affected by HIV seropositivity. In addition, 13 of 77 (17%) CVS samples showed neutralizing activity against HSV-2, as assessed by an HSV-2 in vitro infectivity reduction assay. Neutralizing activity in CVS was associated with the presence of IgG and/or IgA antibodies to HSV-1 and/or to HSV-2 by ECL-WB. Among women whose CVS showed HSV-2-neutralizing activity, the specific activity of HSV-specific neutralizing antibodies was substantially (fivefold) higher in HSV-2 DNA shedders than in nonshedders. In conclusion, HSV-specific antibodies are frequently detected in CVS of asymptomatic African women seropositive for HSV-1 and HSV-2. A subset of these women had functional neutralizing activity against HSV-2 in their CVS. The origin of these antibodies and their role in HSV-2 disease of the female genital tract remain to be determined

Persistent high-risk behavior and escalating HIV, syphilis and hepatitis B incidences among men who have sex with men living in Bangui, Central African Republic

Introduction: HIV in sub-Saharan Africa remains a great concern in men who have sex with men (MSM). Intervention on MSM is a key strategy to control the burden of HIV among this population. Herein we assessed the effect of 2 years of HIV testing and counseling on risk-tacking and HIV and STI incidences among MSM living in Bangui in the Central African Republic. Methods: The incidences of HIV, syphilis and hepatitis B and the sexual behavior characteristics were assessed at inclusion and after 2 years of follow up in the prospective MSM cohort. Results: 99 MSM were included and followed up during 2 years. The mean age of study MSM was 24 years (range, 14-39); among those, the majority was single (84.8%) and unemployed (33.3%) or students (23.9%). The majority (up to 80%) were living in only 4 (out of 10) neighboring district of Bangui. Insertive anal intercourse showed significant decrease from 54% at inclusion to 46% after 2 years of follow up (P &lt; 0.001). In contrast, we observed slight increase in receptive anal intercourse (60% versus 66%) and oral sex (70% versus 74%), but the difference did not reach statistical significance. Finally, the prevalences of HIV, syphilis and hepatitis B increased significantly from 29% to 41%, 12% to 21% and 14% to 23%, respectively. Conclusion: These observations indicate that medical care and counseling on MSM does not provide significant changes in risk-taking, whereas the incidences of HIV, syphilis and hepatitis B remained high. Innovative interventions should be conceived for the MSM population living in Bangui

Virological response and resistance profiles after 24 months of first-line antiretroviral treatment in adults living in Bangui, Central African Republic.

International audienceThe rate of virological failure was assessed in 386 adult patients attending the Centre National Hospitalier Universitaire of Bangui, the capital city of the Central African Republic (CAR), receiving their first-line antiretroviral (ARV) drug regimen for 24 months, according to the World Health Organization (WHO) recommendations. In addition, genotypic resistance testing was carried out in 45 of 145 randomly selected patients whose plasma HIV-1 RNA load was detectable. Overall, 28.5% of ARV-treated patients were in virological failure (e.g., HIV-1 RNA >3.7 log(10) copies/ml). Twenty-four percent of patients in virological failure showed wild-type viruses, likely indicating poor adherence. Even after excluding the M184V mutation, all 76% of patients in virological failure displayed viruses harboring at least one major drug resistance mutation to nucleoside reverse transcriptase inhibitors (NRTI), non-NRTI, or protease inhibitors. Whereas the second-line regimen proposed by the 2010 WHO recommendations, including zidovudine, tenofovir, lopinavir, and atazanavir, could be effective in more than 90% of patients in virological failure with resistant viruses, the remaining patients showed genotypic profiles highly predictive of resistance to the usual WHO second-line regimen, including complex genotypic profiles diagnosed only by genotypic resistance tests in some patients. In conclusion, our observations highlight the high frequency of therapeutic failure in ARV-treated adults in this study, as well as the urgent and absolute need for improving viral load assessment in the CAR to prevent and/or, from now on, to monitor therapeutic failure

Persistent high-risk behavior and escalating HIV, syphilis and hepatitis B incidences among men who have sex with men living in Bangui, Central African Republic

Introduction: HIV in sub-Saharan Africa remains a great concern in men who have sex with men (MSM). Intervention on MSM is a key strategy to control the burden of HIV among this population. Herein we assessed the effect of 2 years of HIV testing and counseling on risk-tacking and HIV and STI incidences among MSM living in Bangui in the Central African Republic. Methods: The incidences of HIV, syphilis and hepatitis B and the sexual behavior characteristics were assessed at inclusion and after 2 years of follow up in the prospective MSM cohort. Results: 99 MSM were included and followed up during 2 years. The mean age of study MSM was 24 years (range, 14-39); among those, the majority was single (84.8%) and unemployed (33.3%) or students (23.9%). The majority (up to 80%) were living in only 4 (out of 10) neighboring district of Bangui. Insertive anal intercourse showed significant decrease from 54% at inclusion to 46% after 2 years of follow up (P < 0.001). In contrast, we observed slight increase in receptive anal intercourse (60% versus 66%) and oral sex (70% versus 74%), but the difference did not reach statistical significance. Finally, the prevalences of HIV, syphilis and hepatitis B increased significantly from 29% to 41%, 12% to 21% and 14% to 23%, respectively. Conclusion: These observations indicate that medical care and counseling on MSM does not provide significant changes in risk-taking, whereas the incidences of HIV, syphilis and hepatitis B remained high. Innovative interventions should be conceived for the MSM population living in Bangui.SCOPUS: ar.jinfo:eu-repo/semantics/publishe