Immunohematological Reference Ranges for Adults from the Central African Republic

A survey was carried out on 150 healthy adults to establish hematological reference ranges for human immunodeficiency virus (HIV)-negative adults from the Central African Republic (CAR). Immunohematological mean values, medians, and 95th-percentile reference ranges were established. Mean values were as follows: leukocyte (WBC) counts, 5.28 × 10(9)/liter (males) and 5.11 × 10(9)/liter (females); erythrocyte counts, 5.20 × 10(12)/liter (males) and 4.50 × 10(12)/liter (females); hemoglobin, 15.1 g/dl (males) and 12.5 g/dl (females); hematocrit, 45% (males) and 37% (females); lymphocytes, 2,587/μl (males) and 2,466/μl (females); CD4 T cells, 927/μl (males) and 940/μl (females); CD8 T cells, 898/μl (males) and 716/μl (females); and CD4/CD8 T-cell ratio, 1.13 (males) and 1.41 (females). We concluded that (i) the WBC and hemoglobin values of healthy HIV-negative adults from the CAR are lower than the reference values currently used in the CAR and (ii) the absolute CD4 T-cell counts of healthy HIV-negative adults from the CAR are similar to values for Europeans but the absolute CD8 T-cell counts are much higher. Thus, the CD4/CD8 T-cell ratios for healthy adults from the CAR are significantly reduced compared to the ratios for healthy Europeans

Screening blood donations for hepatitis C in Central Africa : Analysis of a risk- and cost- based decision tree

International audienceFour screening strategies (no testing, HC Abbott, HC Pasteur, and a combined test) for the detection of hepatitis C virus (HCV) antibody in donated blood were considered ina formal decision tree. Decision criteria included residual risk of infection and overall monetary cost. Tree parameters were determined using data from the Central African Republic. The prevalences observed among blood donors for HIV infection, hepatitis B, syphilis, and hepatitis C varied between 6% and 15%. The current residual risk of transfusion-transmitted infections is very high (8.4%). Screening for HCV would bring that risk down to about 3% with either the HC Pasteur, the HC Abbott, or the combined test. Even though baseline analysis gives preference to the HC Abbott test (the combined test coming out last), Monte Carte sensitivity and uncertainty analyses showed that Abbott's and Pasteur's tests are interchangeable, on the basis or either risk or cost consideration

Pandémie COVID-19 : le défi de la responsabilité sociale des facultés de médecine

Contexte et problématique : Du fait de son ampleur et de sa brutalité, la pandémie COVID-19 interroge les facultés de médecine sur leur préparation et capacité à faire face efficacement à une crise sanitaire. Les leçons à en tirer et les opportunités à saisir pour renforcer la mission de responsabilité sociale des facultés de médecine sont explorées. Exégèse : La pandémie COVID-19 a eu un impact sur la formation médicale en perturbant fortement le fonctionnement académique, elle constitue néanmoins pour la faculté de médecine une opportunité unique dont les leçons doivent être tirées pour mieux se préparer à répondre aux prochains défis de santé, notamment par son anticipation, son engagement, sa solidarité et ses partenariats. Conclusion : La crise sanitaire COVID-19 constitue une expérimentation pour la préparation des équipes décanales, des enseignants, des chercheurs et des étudiants pour adopter une démarche partagée de responsabilité sociale.Context and background: Due to its magnitude and brutality, the COVID-19 pandemic questions medical schools about their preparation and capacity to effectively face a health crisis. The lessons to be learned and the opportunities to be seized to strengthen the social accountability mission of medical schools are explored. Analysis: The COVID-19 pandemic has had an impact on medical training by strongly disrupting academic functioning, it nevertheless constitutes for the faculty of medicine a unique opportunity from which the lessons must be learned to better prepare to respond to the next health challenges, in particular through its anticipation, its commitment, its solidarity and its partnerships. Conclusion: The COVID-19 health crisis is an experiment to prepare decanal teams, teachers, researchers and students to adopt a shared approach of social accountability

Infrequent detection of human papillomavirus infection in head and neck cancers in the Central African Republic: a retrospective study

Abstract We carried out a retrospective study on the prevalence of HPV and genotype distribution by nested PCR and nucleotide sequencing analysis, in formalin-fixed, paraffin-embedded biopsies of 135 head and neck cancers (HNC) and 29 cervical cancers received between 2009 and 2017 for diagnosis at the Laboratoire National de Biologie Clinique et de Santé Publique of Bangui, the capital city of the Central African Republic. One oropharyngeal squamous cell carcinoma sample was positive for HPV type 16. The overall HPV prevalence in HNC biopsies was 0.74% (95% CI: 0.0–2.2). Among the 29 cervical cancer samples, 19 (65.5%; 95% CI: 48.2–82.8) were positive for HPV. These results indicate that HNC are infrequently associated with HPV infection in the Central African Republic

Performance of HerpeSelect and Kalon Assays in Detection of Antibodies to Herpes Simplex Virus Type 2▿

The performances of commercial enzyme-linked immunosorbent assays (ELISAs) in detecting herpes simplex virus type 2 (HSV-2) antibodies have been inconsistent for African and human immunodeficiency virus (HIV)-positive populations. We compared the performances of the HerpeSelect and Kalon glycoprotein G2 ELISAs for patients with genital ulcer disease in Ghana and the Central African Republic. Sera from 434 women were tested with the HerpeSelect assay, and a subsample (n = 199) was tested by the Kalon assay. Ulcer swabs and cervicovaginal lavage samples were tested for HSV-2 DNA by PCR. HSV-2-seronegative women with detectable genital HSV-2 DNA were retested for HSV-2 antibodies 14 and 28 days later by the two ELISAs. A total of 346 (80%) women were positive by HerpeSelect at baseline, and 225 (54%) had detectable genital (lesional or cervicovaginal) HSV-2 DNA. Sixty-six (19%) HerpeSelect-positive samples had low-positive index values (1.1 to 3.5), and 58% of these samples had detectable genital HSV-2 DNA. Global agreement between the two serological assays was 86%. Concordance was high (99%) for sera that were negative by HerpeSelect or had high index values (>3.5). Defining infection detected by HSV-2 DNA PCR and/or Kalon assay as true infection, 71% of sera with low-positive index values were associated with true HSV-2 infection. Twenty-five women were identified as having nonprimary first-episode genital HSV-2 infection. Rates of HSV-2 seroconversion at day 14 were 77% (10/13 patients) by HerpeSelect assay and 23% (3/13 patients) by Kalon assay, with four additional seroconversions detected by Kalon assay at day 28. HIV serostatus did not influence assay performance. Low index values obtained with the HerpeSelect assay may correspond to true HSV-2 infection, in particular to nonprimary first episodes of genital HSV-2 infection, and need to be interpreted in the context of clinical history

Accréditation pour l’excellence et excellence dans l’accréditation. Faculté de médecine et santé du public

Contexte : Le concept de responsabilité sociale fait l’objet d’un intérêt croissant à l’échelle universelle. Appliqué aux facultés de médecine, il tend à examiner dans quelle mesure leurs missions de formation, de recherche et de prestation de services ont un impact sur la santé de la société. Cet article est motivé par une réflexion sur la pertinence des systèmes d’accréditation en rapport avec la responsabilité sociale telle que définie dans la littérature récente. Méthodes : Trois importants systèmes d’accréditation de facultés de médecine sont examinés : la LCME ( Liaison committee on medical education), la WFME (World federation for medical education ) et la CIDMEF (Conférence internationale des doyens et facultés de médecine d’expression française). Leurs normes ont été étudiées quant à leur congruence avec les principes de responsabilité sociale. Résultats : Bien que chacun des systèmes évoque la nécessité de normes s’adaptant aux besoins du système de santé et de la population, les recommandations restent assez théoriques et s’exposent à des interprétations diverses, ne permettant pas de faire des propositions d’amélioration suffisamment pertinentes. Conclusion : La conjoncture mondiale étant relativement favorable à une plus forte adhésion des institutions académiques aux principes de responsabilité sociale, il conviendrait d’harmoniser les systèmes d’accréditation des facultés de médecine, non seulement pour une amélioration des normes, mais aussi pour une intégration de partenaires de santé dans le processus d’accréditation

Cervicovaginal HIV-1 and herpes simplex virus type 2 shedding during genital ulcer disease episodes.

OBJECTIVE: To investigate correlates of herpes simplex virus type 2 (HSV-2) DNA and HIV-1 RNA among women with genital ulcer disease (GUD). DESIGN: Baseline data from a randomized placebo-controlled trial of episodic herpes treatment in Ghana and the Central African Republic. METHODS: GUD aetiology was determined by polymerase chain reaction (PCR) from a lesional swab. Real-time PCR was used to quantify HIV-1 RNA, and HSV-2 DNA in cervicovaginal lavages (CVL) and HIV-1 RNA in plasma. Genital infection was defined as the presence of virus in the lesion or CVL. RESULTS: Of 441 women enrolled, 79.0% were HSV-2 seropositive, 46.6% were HIV-1 seropositive, and 50.0% had an HSV-2 ulcer. Among 180 HSV-2/HIV-1 co-infected women, cervicovaginal HIV-1 RNA was detected more frequently in women with HSV-2 ulcers (67.9%) or cervicovaginal HSV-2 DNA only (72.3%) compared with women without genital HSV-2 infection (42.4%) (P = 0.004). Women with genital HSV-2 infection had higher median cervicovaginal HIV-1-RNA loads (3.14 log10 copies/mL versus 2.10 log10 copies/mL; P = 0.003), higher plasma HIV-1-RNA loads (median 5.10 versus 4.65 log10 copies/mL; P = 0.07), and lower median CD4 cell counts) (198 versus 409 cells/mm, P = 0.03). Cervicovaginal HIV-1 RNA and HSV-2 DNA were significantly correlated after adjusting for plasma HIV-1 RNA and CD4 cell counts (P < 0.001) and a 10-fold increase in cervicovaginal HSV-2 DNA was associated with a 1.7-fold increase in plasma HIV-1 RNA (P = 0.003). CONCLUSION: Genital HSV-2 infection is associated with increased cervicovaginal and plasma HIV-1 RNA among co-infected women with genital ulcers, independently of the level of immunodeficiency, highlighting the close interaction between these two viruses and the role of HSV-2 as a co-factor for the sexual transmission of HIV-1