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

Place de l'hépatite B parmi les pathologies à l'origine de la perte de statut des donneurs bénévoles de sang de Bangui et Bimbo en Centrafrique : analyse rétrospective de cinq années: Place of hepatitis B among the pathologies at the origin of the loss of status of volunteer blood donors in Bangui and Bimbo in Central Africa: a five-year retrospective analysis

Context and objective. Hemovigilance activities are poorly documented in sub-Saharan African countries. The present study aimed to determine the prevalence of markers of infection in Volunteer Blood Donors (VBD) and to study the place of viral hepatitis B (VHB) in the loss of status of VBD in Bangui and Bimbo. Methods. Data of first-time donors and regular VBD living in the cities of Bangui and Bimbo, who had lost their donor status in the event of positivity of a serological test between 2015 and 2019 were retrospectively examined at the National Blood Transfusion Centre. Results. 51002 VBD were involved. Their average age was 28 years (18 and 64 yrs) and males were preponderant (95%). The majority of VBD were first-time donors (58.9%). The number of donations ranges from 1 to 105. The prevalence rate of VHB had increased from 15.6% in 2015 to 20.1% in 2019, that of HIV from 6.8 to 5.2%, and of VHC from 6.1 to 3.2%. The average prevalence rate of VHB (17.2%) was three times and five times higher than HIV (5.4%), VHC (3.3%), respectively. Young ages (18-34 years) and males were significantly associated with hepatitis B and C (p< 0.05%). By contrast, regular VBD status provides a significant protective effect for all three viral pathologies. Conclusion. VHB is the first pathology to cause the loss of status of VBD in Bangui and Bimbo. Its prevalence is constantly changing. Implementation of the national VHB policy is needed. Contexte et objectif. Les activités de l’hémovigilance dans les pays d’Afrique subsaharienne sont peu documentées. La présente étude avait pour objectifs de déterminer la prévalence des marqueurs de l’infection chez les Donneurs Bénévoles de Sang (DBS) et étudier la place de l’hépatite virale B (HVB) dans la perte de statut des DBS à Bangui et Bimbo. Méthodes. Nous avons rétrospectivement examiné, les données de DBS primo-donneurs et réguliers ; du Centre National de Transfusion Sanguine, des villes de Bangui et Bimbo ayant perdu leur statut de donneur en cas de positivité d’un test sérologique, entre 2015 à 2019. Résultats. Au total, 51002 données de DBS ont été colligées. Leur âge moyen était de 28 ans (extrême 18 et 64 ans) et les hommes étaient prépondérant (95,3 %). La majorité des DBS étaient des primo donneurs (58,9 %). Le nombre de don variait de 1 à 105. Le taux de prévalence de l’HVB était passé de 15,0 % en 2015 à 20,1 % en 2019, celle du VIH de 6,8 à 5,2 % et de l’HVC de 6,1 à 3,2 %. Le taux moyen de prévalence de l’HVB (17,2%) était respectivement, trois fois et cinq fois plus élevé que celui du VIH (5,4 %) et de l’HVC (3,3 %). Le jeune âge (18 à 34 ans) et le sexe masculin étaient significativement associés à la survenue des hépatites B et C (p < 0,05). Le statut DBS régulier était en revanche protecteur pour les trois pathologies virales. Conclusion. L’HVB est la première pathologie à l'origine de la perte de statut des DBS à Bangui et Bimbo. Sa prévalence est en constante évolution. La mise en œuvre de la politique nationale de lutte contre l’HVB s’avère nécessaire

Groupes à Haut Risque du VIH en République Centrafricaine : Classification et interventions précoces

Keywords : high risk group- typology - FSW - MSM –HIV -STD- Central AfricanBackground: The population of female sex workers (FSW) and the group of men who have sex with men (MSM) constitutes a priori an important core group of HIV transmission. In the context of the Central African Republic the situation of FSW and MSM is yet unknown. The objectives of this thesis were to establish a documented typology of female sexual transactions in Bangui and to measure the prevalence of HIV and associated comorbidities in these two populations.Materials and Methods: First 1384 sensitized female volunteers were recruited to the site of their activities and oriented at the survey site. Finally, 345 FSW questionnaires were selected for study analysis. MSM were recruited on a voluntary basis by the way of local network of nonprofit organizations working in the field of HIV infection. Included MSM were referred to the National STD center of Bangui for social, behavioral and medical evaluation. After collection of social and behavioral characteristics, each participant received a physical examination and a blood sample was taken for HIV and STD testing.Main results: Female prostitution in the CAR is remarkably heterogeneous. Risk-taking regarding HIV infection is very different between each category of female prostitution. HIV varied according to FSW categories, Thus, HIV prevalence was 6-fold higher among « kata » than « pupulenge » (39.1% versus 6.3%).Among non professionnal FSW, « students », « civil servants » and « housewifes » were the less infected (6.1%, 9.8%, 13.0%, respectively), whereas « sellers » constituted the category of highest HIV prevalence (31.9%).HIV infection in the whole study FSW population was strongly associated with anal sex practice with last clients (adjusted OR, 4.3), condom use in last 3 months (adjusted OR, 24.9), alcohol consumption before sex (adjusted OR, 2.8) and past history of STIs (adjusted OR, 4.2). The population of MSM in Bangui is identified for the first time as a yet unexpected high-risk group for HIV, being 5-fold higher HIV-infected than the general adult heterosexual population. The 131 (100%) MSM accepted blood sampling: 24 % were HIV-1-infected; 20% were infected by hepatitis B virus (HBV) (Ag HBs), including 6 cases of co-infection by HIV and HBV; 3,8 % showed positive syphilis serology. The MSM in Bangui, needing urgently specific interventions for prevention and heath care.Conclusion: The results of this work led to better characterized and documented populations of women and TS MSM in Bangui. Two groups population "original" for the Central African Republic, vulnerable and at high risk of HIV infection.Mots clés : Groupe à Haut risque - Typologie - TS - HSH –VIH -IST- Afrique CentraleProblématique : Les femmes travailleuses du sexe (TS) et les hommes qui ont des rapports sexuels avec des hommes (HSH) constituent les populations les plus à risque d’infection au VIH dans différents pays d’Afrique subsaharienne. A ce jour, très peu d’interventions sont menées pour réduire le risque d’infection en influant sur les facteurs de risque dans ces deux populations en Afrique Centrale et particulièrement en République Centrafricaine. Les objectifs de cette thèse étaient d’établir une typologie documentée des transactions sexuelles féminines à Bangui et de mesurer la prévalence du VIH et des comorbidités associées dans ces deux populations.Méthodologie : D’abord de 1384 femmes volontaires sensibilisées ont été recrutées sur les lieux de leurs activités et orientées au niveau du site de l’enquête. Parmi lesquelles 345 ont été identifiées comme travailleuses du sexe. Et, par effet « boule de neige », 131 Hommes ayant des rapports sexuels avec des Hommes (HSH) ont été recrutés pour constitués la deuxième population de l’étude. Des analyses biologiques ont été effectuées. Un volet d’entretien est réalisé auprès de 20 TS.Résultats : Les résultats en ce qui concerne les TS montrent que cette pratique est très hétérogène et que la prévalence du VIH varie selon les catégories. Ainsi, la prévalence du VIH était de 6 fois plus élevé chez les "katas" que chez les "pupulenge" (39,1% contre 6,3%).Parmi les TS non professionnel, les «élèves/étudiants», «fonctionnaires ou salariées » et «femmes au foyer» étaient moins infectées par le VIH (6,1%, 9,8%, 13,0%, respectivement), tandis que les «vendeuses ambulantes», constituait la catégorie la plus touchées par le VIH (31,9%). Et, l'infection à VIH était fortement associée à la pratique du sexe anal avec les clients (OR ajusté, 4.3), à l'utilisation ou non du préservatif avec les clients (OR ajusté, 24.9), à la consommation d'alcool avant le travail du sexe (OR ajusté, 2.8) et à la notion d’antécédents d'IST (OR ajusté, 4.2).La population de HSH à Bangui est identifiée pour la première fois comme un groupe à haut risque pour l’infection à VIH, étant 5 fois plus infectées par le VIH que la population générale d'adultes hétérosexuels. Parmi eux 20 % étaient infectés par le virus de l'hépatite B (VHB) (Ag HBs), dont 6 cas étaient co- infectés par le VIH et le VHB et dans 3,8 % cas la sérologie positive pour la syphilis. Les HSH à Bangui ont donc besoin d'interventions d'urgence spécifiques de prévention et de soins de santé.Conclusion : Les résultats de ce travail permis de mieux caractérisés et documentés les populations des femmes TS et les HSH à Bangui. Deux groupes de populations « originales » pour la République Centrafricaine, vulnérables et à haut risque d’infection à VIH

Group High Risk of HIV in Central African Republic : Classification and arly Intervention

Mots clés : Groupe à Haut risque - Typologie - TS - HSH –VIH -IST- Afrique CentraleProblématique : Les femmes travailleuses du sexe (TS) et les hommes qui ont des rapports sexuels avec des hommes (HSH) constituent les populations les plus à risque d’infection au VIH dans différents pays d’Afrique subsaharienne. A ce jour, très peu d’interventions sont menées pour réduire le risque d’infection en influant sur les facteurs de risque dans ces deux populations en Afrique Centrale et particulièrement en République Centrafricaine. Les objectifs de cette thèse étaient d’établir une typologie documentée des transactions sexuelles féminines à Bangui et de mesurer la prévalence du VIH et des comorbidités associées dans ces deux populations.Méthodologie : D’abord de 1384 femmes volontaires sensibilisées ont été recrutées sur les lieux de leurs activités et orientées au niveau du site de l’enquête. Parmi lesquelles 345 ont été identifiées comme travailleuses du sexe. Et, par effet « boule de neige », 131 Hommes ayant des rapports sexuels avec des Hommes (HSH) ont été recrutés pour constitués la deuxième population de l’étude. Des analyses biologiques ont été effectuées. Un volet d’entretien est réalisé auprès de 20 TS.Résultats : Les résultats en ce qui concerne les TS montrent que cette pratique est très hétérogène et que la prévalence du VIH varie selon les catégories. Ainsi, la prévalence du VIH était de 6 fois plus élevé chez les "katas" que chez les "pupulenge" (39,1% contre 6,3%). Parmi les TS non professionnel, les «élèves/étudiants», «fonctionnaires ou salariées » et «femmes au foyer» étaient moins infectées par le VIH (6,1%, 9,8%, 13,0%, respectivement), tandis que les «vendeuses ambulantes», constituait la catégorie la plus touchées par le VIH (31,9%). Et, l'infection à VIH était fortement associée à la pratique du sexe anal avec les clients (OR ajusté, 4.3), à l'utilisation ou non du préservatif avec les clients (OR ajusté, 24.9), à la consommation d'alcool avant le travail du sexe (OR ajusté, 2.8) et à la notion d’antécédents d'IST (OR ajusté, 4.2).La population de HSH à Bangui est identifiée pour la première fois comme un groupe à haut risque pour l’infection à VIH, étant 5 fois plus infectées par le VIH que la population générale d'adultes hétérosexuels. Parmi eux 20 % étaient infectés par le virus de l'hépatite B (VHB) (Ag HBs), dont 6 cas étaient co- infectés par le VIH et le VHB et dans 3,8 % cas la sérologie positive pour la syphilis. Les HSH à Bangui ont donc besoin d'interventions d'urgence spécifiques de prévention et de soins de santé.Conclusion : Les résultats de ce travail permis de mieux caractérisés et documentés les populations des femmes TS et les HSH à Bangui. Deux groupes de populations « originales » pour la République Centrafricaine, vulnérables et à haut risque d’infection à VIH.Keywords : high risk group- typology - FSW - MSM –HIV -STD- Central AfricanBackground: The population of female sex workers (FSW) and the group of men who have sex with men (MSM) constitutes a priori an important core group of HIV transmission. In the context of the Central African Republic the situation of FSW and MSM is yet unknown. The objectives of this thesis were to establish a documented typology of female sexual transactions in Bangui and to measure the prevalence of HIV and associated comorbidities in these two populations.Materials and Methods: First 1384 sensitized female volunteers were recruited to the site of their activities and oriented at the survey site. Finally, 345 FSW questionnaires were selected for study analysis. MSM were recruited on a voluntary basis by the way of local network of nonprofit organizations working in the field of HIV infection. Included MSM were referred to the National STD center of Bangui for social, behavioral and medical evaluation. After collection of social and behavioral characteristics, each participant received a physical examination and a blood sample was taken for HIV and STD testing.Main results: Female prostitution in the CAR is remarkably heterogeneous. Risk-taking regarding HIV infection is very different between each category of female prostitution. HIV varied according to FSW categories, Thus, HIV prevalence was 6-fold higher among « kata » than « pupulenge » (39.1% versus 6.3%).Among non professionnal FSW, « students », « civil servants » and « housewifes » were the less infected (6.1%, 9.8%, 13.0%, respectively), whereas « sellers » constituted the category of highest HIV prevalence (31.9%).HIV infection in the whole study FSW population was strongly associated with anal sex practice with last clients (adjusted OR, 4.3), condom use in last 3 months (adjusted OR, 24.9), alcohol consumption before sex (adjusted OR, 2.8) and past history of STIs (adjusted OR, 4.2). The population of MSM in Bangui is identified for the first time as a yet unexpected high-risk group for HIV, being 5-fold higher HIV-infected than the general adult heterosexual population. The 131 (100%) MSM accepted blood sampling: 24 % were HIV-1-infected; 20% were infected by hepatitis B virus (HBV) (Ag HBs), including 6 cases of co-infection by HIV and HBV; 3,8 % showed positive syphilis serology. The MSM in Bangui, needing urgently specific interventions for prevention and heath care.Conclusion: The results of this work led to better characterized and documented populations of women and TS MSM in Bangui. Two groups population "original" for the Central African Republic, vulnerable and at high risk of HIV infection

Attitude des hommes ayant des rapports sexuels avec les hommes (HSH) face au préservatif, bangui, république centrafricaine (RCA)

Objective: to understand the attitude of men who have sex with men (MSM) towards the use of condoms, to identify potential barriers to their use, environmental factors that facilitate or on the contrary, prevent this use, beliefs about contracting HIV, and priority needs of MSM for general prevention of sexually transmitted infections (STI). Method: Individual interviews conducted in private with 20 MSM. Results: In general, MSM recognize that condoms protect against STI as well as preventing unwanted pregnancies (although this is not our purpose here). The disadvantages of condom use that they reported included the potential for them to break and their reduction of pleasure. Barriers to their use include the belief that the partner is not HIV-positive, the shame of buying condoms, inability to wear them, and lack of financial resources, as well as social norms and false beliefs. Conclusion: MSM are aware of the positive role of condoms against STIs, including HIV. They perceive the dangerousness of the HIV, but do not feel vulnerable to this disease. They have identified obstacles to condom use, and their lists of perceived needs suggest solutions to them. Implementing these solutions in interventions should improve the frequency of condom use.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Spectrum of female commercial sex work in Bangui, Central African Republic

Classification of professional and non-professional female sex workers (FSWs) into different categories, never previously reported in the Central African Republic (CAR), may be useful to assess the dynamics of the human immunodeficiency virus (HIV) epidemic, design operational intervention programmes to combat HIV and other sexually transmitted infections (STIs) and to adapt these programmes to the broad spectrum of sexual transactions in the CAR. Our study proposes a socio-behavioural classification of FSWs living in the CAR and engaged in transactional and commercial sex. Thus, the aims of the study were these: (i) to categorize FSWs according to socio-anthropologic criteria in Bangui and (ii) to examine the association between a selection of demographic and risk variables with the different categories of female sex work as an outcome. A cross-sectional questionnaire survey was conducted in 2013 to describe the spectrum of commercial sex work (CSW) in Bangui among 345 sexually active women having more than 2 sexual partners, other than their regular partner, during the prior 3 months and reporting to have received money or gifts in return for their sexual relationships. According to socio-behavioural characteristics, FSWs were classified into six different categories. Professional FSWs, constituting 32.5% of the interviewed women, were divided in two categories: pupulenge (13.9%), i.e., dragonflies (sometimes called gba moundjou, meaning literally look at the White) consisting of roamers, who travel around the city to hotels and nightclubs seeking wealthy clients, with a preference for French men; and the category of kata (18.6%), i.e., FSWs working in poor neighbourhoods. Non-professional FSWs, constituting 67.5% of the interviewed women, were divided into four categories: street and market vendors (20.8%), students (19.1%), housewives (15.7%) and unskilled civil servants (11.9%). In general, CSW in the CAR presents a remarkably heterogeneous phenomenon. Risk-taking behaviour regarding STI/HIV infection appears to be different according to the different categories of female CSW. The groups of katas and street vendors were poorer and less educated, consumed more alcohol or other psycho-active substances (cannabis, tramadol and glue) and, consequently, were more exposed to STI. Our results emphasise the high level of vulnerability of both poor professional FSWs (kata) and non-professional sex workers, especially street vendors, who should be taken into account when designing prevention programmes targeting this population for STI/HIV control purposes

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

Performance evaluation of the touchscreen-based Muse™ Auto CD4/CD4% single-platform system for CD4 T cell numeration in absolute number and in percentage using blood samples from children and adult patients living in the Central African Republic

Abstract Background The new microcapillary and fluorescence-based EC IVD-qualified Muse™ Auto CD4/CD4% single-platform assay (EMD Millipore Corporation, Merck Life Sciences, KGaA, Darmstadt, Germany) for CD4 T cell numeration in absolute number and in percentage was evaluated using Central African patients’ samples compared against the reference EC IVD-qualified BD FACSCount (Becton–Dickinson, USA) flow cytometer. Methods EDTA-blood samples from 124 adults, 10 adolescents, 13 children and 3 infants were tested in parallel at 2 reference laboratories in Bangui. Results The Muse™ technique was highly reproducible, with low intra- and inter-run variabilities less than 15%. CD4 T cell counts of Muse™ and BD FACSCount in absolute number and percentage were highly correlated (r2 = 0.99 and 0.98, respectively). The mean absolute bias between Muse™ and BD FACSCount cells in absolute number and percentage were −5.91 cells/µl (95% CI −20.90 to 9.08) with limits of agreement from −77.50 to 202.40 cells/µl, and +1.69 %CD4 (95% CI ±1.29 to +2.09), respectively. The percentages of outliers outside the limits of agreement were nearly similar in absolute number (8%) and percentage (10%). CD4 T cell counting by Muse™ allowed identifying the majority of individuals with CD4 T cell <200, <350 or <750 cells/µl corresponding to the relevant thresholds of therapeutic care, with sensitivities of 95.5–100% and specificities of 83.9–100%. Conclusions The Muse™ Auto CD4/CD4% Assay analyzer is a reliable alternative flow cytometer for CD4 T lymphocyte enumeration to be used in routine immunological monitoring according to World Health Organization recommendations in HIV-infected adults as well as children living in resource-constrained settings