Les hommes qui ont des rapports sexuels avec d’autres hommes (HSH) et l’infection à VIH à Ouagadougou, Burkina Faso : connaissances, attitudes, pratiques et enquête de séroprévalence

Position du problème : A l'instar de plusieurs pays africains, la question des rapports sexuels entre hommes au Burkina Faso reste taboue et est parfois cause d'exclusion sociale. Cette population qui est vulnérable face au VIH sida est méconnue, car n'ayant pas souvent fait l'objet d'exploration scientifique. Objectif : L'objectif de notre étude était de caractériser les connaissances, attitudes, pratiques sexuelles et d'estimer la séroprévalence du VIH parmi les HSH à Ouagadougou. Méthodes : Une étude transversale à visée descriptive et analytique a été conduite auprès de HSH résidant à Ouagadougou recrutés par la technique de « boule de neige », âgés d'au moins 18 ans et acceptant de participer à l'étude. Les données ont été recueillies par un questionnaire administré en face-à-face par deux enquêteurs formés. Le test de dépistage du VIH a été systématiquement proposé aux enquêtés. Résultats : Au total, 142 HSH ont été recrutés durant la période d'étude. L'échantillon était constitué à majorité d'élèves ou d'étudiants (60,8 %), de célibataires (91 %) avec un âge compris entre 18 et 30 ans (96,5 %). Le score médian de connaissance vis-à-vis du VIH était de 8/10. La séroprévalence du VIH était estimée à 8,9 % (4,5–15,4). Conclusion : Notre étude confirme la vulnérabilité des HSH de Ouagadougou vis-à-vis du VIH vu la séroprévalence élevée de l'infection par le VIH. Des interventions ciblées de prévention, de prise en charge et de recherche scientifique s'imposent aux autorités afin de pérenniser les acquis nationaux de la lutte contre le VIH sida

The vulnerability of men to virologic failure during antiretroviral therapy in a public routine clinic in Burkina Faso

Introduction: Gender differences in antiretroviral therapy (ART) outcomes are critical in sub-Saharan Africa. We assessed the association between gender and virologic failure among adult patients treated in a public routine clinic (one of the largest in West Africa) in Burkina Faso. Methods: We performed a case-control study between July and October 2012 among patients who had received ART at the Bobo Dioulasso Day Care Unit. Patients were eligible if they were 15 years or older, positive for HIV-1 or HIV-1 + 2, and on first-line ART for at least six months. Cases were all patients with two consecutive HIV loads >1000 copies/mL (Biocentric Generic or Abbott Real Time assays), or one HIV load >1000 copies/mL associated with immunologic or clinical failure criteria. Controls were all patients who only had HIV loads B300 copies/mL. The association between gender and virologic failure was assessed using a multivariate logistic regression, adjusted on age, level of education, baseline CD4+ T cell count, first and current antiretroviral regimens and time on ART. Results: Of 2303 patients (74.2% women; median age: 40 years; median time on ART: 34 months), 172 had virologic failure and 2131 had virologic success. Among the former, 130 (75.6%) had confirmed virologic failure, 38 (22.1%) had viroimmunologic failure, and four (2.3%) had viro-clinical failure. The proportion of men was significantly higher among the cases than among the controls (37.2% vs. 24.9%; p<0.001). Compared to controls, cases were also younger, more immunodeficient at ART initiation, less likely to receive a protease inhibitor-based antiretroviral regimen and had spent a longer period of time on ART. After adjustment, male gender remained strongly associated with virologic failure (odds ratio 2.52, 95% CI: 1.77 - 3.60; p<0.001). Conclusions: Men on ART appeared more vulnerable to virologic failure than women. Additional studies are needed to confirm the poorer prognosis of men in this setting and to determine the causes for their vulnerability in order to optimize HIV care. From now on, efforts should be made to support the adherence of men to ART in the African setting

Hepatitis B seroprevalence in HIV-infected patients consulting in a public day care unit in Bobo Dioulasso, Burkina Faso

Objective. - The authors had for aim to assess the prevalence of hepatitis B co-infection in a cohort of HIV-infected patients, routinely followed-up at the Day Care Unit of the Bobo Dioulasso Sanou Souro University Hospital, Burkina Faso. Patients and methods. - The Elisa technique was used to dose HBs antigen (AgHBs), antibodies anti-HBs and anti-HBc in all the patients followed by the biological laboratory, from October to December 2008. Results. - The AgHBs prevalence was 12.7% [CI at 95%; 10.7-15.0%] and men were slightly more likely to be positive for AgHBs than women (16.5% [12.0-21.9%] versus 11.6% [9.4-14.1%]; P = 0.047); 83.3% of the patients [80.8-85.6%] were positive for hepatitis B core antibody, and 32.6% [29.7-35.6%] for hepatitis B surface antibody; 29.9% of the patients [27.1-32.8%] had a complete profile of former hepatitis B infection, 41.3% [38.2-44.4%] expressed core antibodies only; 13.8% [11.7-16.0%] had a negative serological test, and 2.3% [1.5-3.4%] presented a vaccinal immunity. Conclusion. - These results stress the usefulness of screening for hepatitis B in all HIV-infected patients, along with the initial biological tests. This would help adapt HIV treatment to co-infected patients and to build an expanded program of vaccination for non-immune patients