A TYPICAL EXTENSIVE GENITAL ULCER IN FULL BLOWN AIDS WITH SLIM DISEASE

Background: Atypical and exceptional clinical presentation of full blown AIDS may be observed in sub-Saharan Africa. We report herein the case of a Central African 37-year-old male patient presented with full blown AIDS, a typical picture of slim disease with marked cachexia and wasting faces. In addition, the patient was suffering from very extensive genital ulcer with complete loss of substance of the genitalia. Methods: Extensive histological and microbiological analysis of the genital lesion was carried out. Results: HIV-1 serology was positive, the HIV-1 RNA plasma viral load was 5.3 log copies/ml and CD4 T cell count was 1 per μL. Search for Mycobacterium tuberculosis in sputum and urine was negative by direct microscopic examination with Ziehl-Neelsen staining. Testing for syphilis serology was negative. Direct immunofluorescence detection on genital ulcer scraping was negative for Chlamydia trachomatis and Treponema pallidum. Furthermore, the infections with Haemophilus ducreyi and Chlamydia trachomatis were excluded by PCR on genital swabs.Genital PCR was positive for herpes simplex virus (HSV) type 2. Marked improvement was observed within 6 weeks after starting empirical therapy including first-line antiretroviral therapy, cotrimoxazole, doxycycline and valacyclovir, with progressive healing of genital ulcer and negativity of HSV PCR. Conclusion: Taken together, the extensive genital ulcer in this patient is likely the result of a multifactorial process, involving both profound cellular immune depression and complex genital infectious process in which herpetic infection may have participated as a chronic worsening co-factor

Episodic Therapy for Genital Herpes in Sub-Saharan Africa: A Pooled Analysis from Three Randomized Controlled Trials

BACKGROUND: A randomized controlled trial in South Africa found a beneficial effect of acyclovir on genital ulcer healing, but no effect was seen in trials in Ghana, Central African Republic and Malawi. The aim of this paper is to assess whether the variation in impact of acyclovir on ulcer healing in these trials can be explained by differences in the characteristics of the study populations. METHODOLOGY/PRINCIPAL FINDINGS: Pooled data were analysed to estimate the impact of acyclovir on the proportion of ulcers healed seven days after randomisation by HIV/CD4 status, ulcer aetiology, size and duration before presentation; and impact on lesional HIV-1. Risk ratios (RR) were estimated using Poisson regression with robust standard errors. Of 1478 patients with genital ulcer, most (63%) had herpetic ulcers (16% first episode HSV-2 ulcers), and a further 3% chancroid, 2% syphilis, 0.7% lymphogranuloma venereum and 31% undetermined aetiology. Over half (58%) of patients were HIV-1 seropositive. The median duration of symptoms before presentation was 6 days. Patients on acyclovir were more likely to have a healed ulcer on day 7 (63% vs 57%, RR = 1.08, 95% CI 0.98-1.18), shorter time to healing (p = 0.04) and less lesional HIV-1 RNA (p = 0.03). Small ulcers (<50 mm(2)), HSV-2 ulcers, first episode HSV-2 ulcers, and ulcers in HIV-1 seropositive individuals responded best but the better effectiveness in South Africa was not explained by differences in these factors. CONCLUSIONS/SIGNIFICANCE: There may be slight benefit in adding acyclovir to syndromic management in settings where most ulcers are genital herpes. The stronger effect among HIV-1 infected individuals suggests that acyclovir may be beneficial for GUD/HIV-1 co-infected patients. The high prevalence in this population highlights that genital ulceration in patients with unknown HIV status provides a potential entry point for provider-initiated HIV testing

TRANSMISSION HETEROSEXUELLE DE L'INFECTION PAR LE VIH EN CONTEXTE D'AFRIQUE CENTRALE (ANALYSE DES PRINCIPAUX COFACTEURS SOCIO-COMPORTEMENTAUX ET BIOLOGIQUES, ET IMPACT SUR LA PREVENTION)

PARIS-BIUSJ-Physique recherche (751052113) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Impact of acyclovir on lesional HIV-1 RNA on Day 7 among 667 HIV-1 seropositive trial participants.

1<p>Adjusted for all other variables in the table.</p>2<p>Insufficient data to estimate risk ratio and 95% CI.</p>3<p>Interaction between non-HSV and HSV ulcers.</p

CONSORT flow diagram of eligibility, enrolment and follow-up in three African randomized controlled trials of episodic therapy for genital herpes.

<p>CONSORT flow diagram of eligibility, enrolment and follow-up in three African randomized controlled trials of episodic therapy for genital herpes.</p

Demographic, behavioural and clinic characteristics of 1478 trial participants with genital ulcer disease (GUD) at enrolment, by trial arm.

a<p>This question was not asked in the South African trial.</p>b<p>For Ghana and CAR, this is current occupation as a sex worker. In Malawi and South Africa, the question refers to ever having exchanged sex for money.</p

Ulcer aetiology in genital ulcer disease patients in Sub-Saharan African trials, by country and sex.

<p>Ulcer aetiology in genital ulcer disease patients in Sub-Saharan African trials, by country and sex.</p

Impact of acyclovir on ulcer healing¹ at Day 7 among 1255 trial participants.

1<p>Defined as a > = 90% reduction in size of largest ulcer from enrolment.</p>2<p>Risk ratio for impact of acyclovir among people in that strata, adjusted for all other variables in the table (ulcer aetiology is categorised as non-HSV ulcer, HSV ulcer).</p>3<p>P-value for interaction.</p>4<p>Interaction between non-HSV and HSV ulcers.</p

Time-to-ulcer-healing among all patients and those HIV-1 infected with HSV ulcers, by site.

<p>Time-to-ulcer-healing among all patients and those HIV-1 infected with HSV ulcers, by site.</p

Demographic, behavioural and clinic characteristics of 1478 trial participants with genital ulcer disease (GUD) at enrolment, by country and sex.

a<p>Interquartile range.</p>b<p>This question was not asked in the South African trial.</p>c<p>For Ghana and CAR, this is current occupation as a sexworker. In Malawi and South Africa, the question refers to ever having exchanged sex for money.</p