Fatal Outcome in a Hepatitis E Virus/Human Immunodeficiency Virus Co-Infected Malnourished Child in the Central African Republic. Infect Dis Rep

International audienceHepatitis E virus (HEV) infection is responsible for major endemic outbreaks in developing countries. Human immunodeficiency virus (HIV) and HEV are widespread in the Central African Republic. We report the first documented case of an HEV infection in a 36-month-old child already suffering from HIV and severe acute malnutrition (SAM). The HIV patient was hospitalized for SAM with persistent diarrhea and prolonged fever. The presence of IgG anti-HEV antibodies was noted. Sequencing of the amplified HEV RNA revealed the presence of genotype 3c. The alanine aminotransferase level was slightly above average. The patient died despite being treated by antiretroviral therapy accompanied by probabilistic antibiotic therapy and nutritional rehabilitation. HEV/HIV co-infection in a malnourished patient can accelerate a fatal outcome. In the presence of biological abnormalities in a severe acutely malnourished HIV-infected patient, HEV RNA detection should be added to the standard medical assessment in sub-Saharan African countries

Prematurity, intrauterine growth retardation and low birth weight : risk factors in a malaria-endemic area in southern Benin

Background: The aim of this study was to describe the contribution of prematurity and small for gestational age (SGA) to low birth weight (LBW) as well as to identify risk factors associated with preterm birth and SGA and to explore their impact on birth weight. Methods: A cross-sectional study was carried out in southern Benin between June 2007 and July 2008. At delivery, women's characteristics and newborn's anthropometric measurements were collected. Gestational age was estimated using the Ballard method; SGA was defined using the William's reference curve. Analyses were performed by multiple logistic and linear regressions. Results: In total, 526 mother-infant pairs were enrolled. LBW (<2500 g), prematurity (<37 weeks) and SGA accounted for 9.1%, 10.3% and 25.3% of the sample, respectively. Infant's male gender was associated with a lower risk of prematurity (p=0.03). Low maternal anthropometric status (p<0.001), primiparity (p=0.017) and infant's male gender (p=0.015) were associated with an increased risk of SGA. Only low maternal anthropometric status and primiparity were associated with an increased risk of LBW, and their effect on LBW was mediated by SGA. Conclusions: SGA was the main mechanism mediating the effect of risk factors on LBW. Maternal undernutrition (either short stature or low anthropometric status) was the most important of them

Factors associated with growth patterns from birth to 18 months in a Beninese cohort of children

The aim of this study was to analyze factors influencing the growth pattern of children from birth to 18 months. A longitudinal prospective study was conducted in three maternity wards in Southern Benin. Inclusion took place between June 2007 and July 2008; children were followed-up until 18 months of age. Height-for-age and weight-for-height Z-scores were computed using the newborn's anthropometric measurements taken at delivery, every month up to 6 months and then quarterly. Infant and young child feeding (IYCF) practices and malarial morbidity were recorded. Gestational age was estimated using the Ballard method; William's sex-specific reference curve of birth weight-for-gestational-age was used to determine intrauterine growth retardation (IUGR). Analyses were performed on 520 children using a linear mixed model. Low birth weight (coef = -0.43; p = 0.002), IUGR (coef = -0.49; p<0.001), maternal short stature (coef = -0.25; p = 0.001) and maternal low weight status (coef = -0.19; p = 0.006) were significantly associated with growth impairment. Only LBW (coef = -0.28; p = 0.05) and maternal low weight status (coef = -0.23; p = 0.004) were associated with wasting. A good IYCF score was positively associated with weight gain (coef = 0.14; p<0.001) whereas we found a paradoxical association with length (coef = -0.18; p < 0.001). Malaria morbidity was not associated with growth. LBW, IUGR and maternal low weight status and height were important determinants of children's growth. These results reinforce and justify continuing public health initiatives to fight IUGR and LBW and break the intergenerational cycle of malnutrition

Anaemia during pregnancy : impact on birth outcome and infant haemoglobin level during the first 18 months of life

To determine the effect of maternal anaemia on pregnancy outcome and describe its impact on infant haemoglobin level in the first 18 months of life, we conducted a prospective study of 617 pregnant women and their children in Benin. Prevalence of maternal anaemia at delivery was 39.5%, and 61.1% of newborns were anaemic at birth. Maternal anaemia was not associated with low birth weight [OR = 1.2 (0.62.2)] or preterm birth [OR = 1.3 (0.72.4)], whereas the newborns anaemia was related to maternal anaemia [OR = 1.8 (1.22.5)]. There was no association between an infants haemoglobin level until 18 months and maternal anaemia. However, malaria attacks during follow-up, male gender and sickle cell trait were all associated with a lower infant haemoglobin level until 18 months, whereas good infant feeding practices and a polygamous family were positively associated with a higher haemoglobin level during the first 18 months of life

Prevalence of human immunodeficiency virus and hepatitis C virus among French prison inmates in 2010: a challenge for public health policy

International audienceWe evaluated prevalence of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among prison inmates in France in 2010, in a cross-sectional single-day study based on a two-stage design. Sampling favoured larger establishments and included all types of prisons. Establishments were stratified by geographical region. Estimates were adjusted by post-stratification of the total population of inmates in France. From 60,975 inmates in all 188 prisons on the sampling day, 2,154 were selected from 27 prisons, and 1,876 questionnaires completed. HIV prevalence was estimated at 2.0% (95% confidence interval (CI): 0.9-4.2), 2.6% (95% CI: 0.7-8.8) in women and 2.0% (95% CI: 0.9-4.3) in men; 75% of inmates were receiving treatment for HIV. HCV prevalence was estimated at 4.8% (95% CI: 3.5-6.5) and was higher for women (11.8%; 95% CI: 8.5-16.1) than men (4.5%; 95% CI: 3.3-6.3). Almost half of HCV-infected inmates had chronic hepatitis C and 44% were receiving or had received treatment. HIV and HCV prevalence was six times higher than in the general population, and 2.5% of inmates had viraemic hepatitis C. The moment of incarceration provides an ideal opportunity for testing and treating, limiting spread of HCV and improving patients' prognosis