Valeur diagnostique de deux tests rapides utilisés dans le diagnostic du VIH-2 au Mali : Diagnosis value of two HIV-2 rapid diagnostic tests used in Mali

Context and objective. In sub-Saharan Africa, the epicenter of HIV infection, rapid tests are proposed in first line, but diagnosis value of these tests is rarely performed. The goal of the present study was to evaluate the performance of 2 rapid tests used for the diagnosis of HIV-2 infection compared to a baseline test in order to propose in algorithm for HIV infection diagnosis in health care system. Methods. A cross-sectional study was carried out in three treatment centers in Mali (Bamako, Segou and Sikasso). The tests evaluated were: Genie® II HIV-1/HIV-2 (Sanofi Diagnostic Pasteur, France) and ImmunoComb® II HIV 1&2 BiSpot (Organics, Strasbourg, France). The study involved 34 sera collected consecutively. The l’INNO-LIA HIV I/II Score confirmatory test was used as a reference test in Belgium. Performance of tests were assessed using sensibility, specificity, positive predictive value, negative predictive value and kappa concordance. Results. Patients’ ages ranged from 12 years to 78 years, 19 patients were women (55.8%) and 28 patients had HIV-2 infection. The sensitivity of the rapid tests was 96.4%. The kappa concordance coefficient was 0.85. We found 28 HIV-2 positive patients out of 34 patients. Conclusions. The two rapid tests used in Mali yielded satisfactory results, but the quality of HIV-1 and 2 discrimination serology could be improved. Contexte et objectif. Dans les pays d’Afrique subsaharienne épicentre de l’infection à VIH, les tests rapides sont proposés en première intention, mais la valeur diagnostique de ces tests est rarement réalisée. L’objectif du présent travail était d’évaluer la performance de 2 tests rapides utilisés pour le diagnostic de l’infection à VIH-2 par rapport un test de référence afin de proposer des algorithmes de tests simples et rapides utilisables dans les structures sanitaires. Méthodes.Une étude transversale a été réalisée, dans trois centres de prise en charge au Mali (Bamako, Ségou et Sikasso). Les tests évalués étaient le Genie® II HIV-1/HIV-2 (Sanofi Diagnostic Pasteur, France) et l’ImmunoComb® II HIV 1&2 BiSpot (Organics, Strasbourg, France). L’étude a porté sur 34 sérums collectés consécutivement. Le test de confirmation l’INNO-LIA HIV I/II Score a été utilisé comme test de référence en Belgique. La performance de deux tests précités a été évaluée en recherchant la sensibilité, la spécificité, la valeur prédictive positive (VPP), la valeur prédictive négative (VPN) et la concordance. Résultats. L’âge des patients variait de 12 ans à 78 ans, 19 patients étaient des femmes (55,8%) et 28 patients avaient le VIH-2. La sensibilité des tests rapides était de 96,4%. Le coefficient de concordance kappa était de 0,85. Conclusions. Les deux tests rapides utilisés au Mali ont donné des résultats satisfaisants, et peuvent être proposés en première intention dans l’algorithme national du diagnostic de l’infection à VIH-2 au Mali

Eliminating Hepatitis C Virus From a Prevalent Kidney Transplant Recipient Population: A Single-Center Study in Belgium in the Direct-Acting Antivirals Era

Background: Direct-acting antivirals (DAAs) have revolutionized the treatment of hepatitis C virus (HCV) infection. Although previous studies have reported positive results with DAAs after kidney transplantation (KT), their impact on the prevalence of HCV viremia (HCVv) in prevalent kidney transplant recipients (KTRs) remains ill defined. Methods: We retrospectively reviewed the HCV status of all patients followed at Cliniques Universitaires Saint-Luc, Brussels, Belgium, outpatient KT clinic between January 2014 and December 2018. We collected the clinical features of KTRs treated with DAAs during this period and calculated the annual prevalence of HCVv over this period. Results: Out of 1451 KTRs, 22 (1.52%) had HCVv in 2014 to 2018. From 2014 to 2018, the annual prevalence of HCVv dropped from 1.97% to 0.43%, (P < .001). Fourteen KTRs were treated with DAAs a median of 197 months (range: 5-374) after KT, mostly (79%) in 2017 after reimbursement restrictions of DAAs for KTRs in Belgium were removed. DAA treatment was safe with a sustained virological response rate at 12 weeks after treatment (SVR12) of 93%. Two patients died 14 months (lymphoma, despite SVR12) and 7 months (hepatocarcinoma, no SVR12) after DAAs initiation, respectively. Among HCVv KTRs not treated with DAAs (n = 8), 2 lost their graft, 5 died, and 1 is initiating therapy. The current prevalence of HCVv in the cohort is 0.08%, with a single patient currently on treatment. Conclusion: Treatment with DAAs led to a dramatic decrease of HCVv prevalence in this KTR cohort. DAA use was safe and effective. Elimination of HCV is possible at KT clinics

Metal mining and birth defects : a case-control study in Lubumbashi, Democratic Republic of the Congo

Background Widespread environmental contamination caused by mining of copper and cobalt has led to concerns about the possible association between birth defects and exposure to several toxic metals in southern Katanga, Democratic Republic of the Congo (DRC). We therefore aimed to assess the possible contribution of parental and antenatal exposure to trace metals to the occurrence of visible birth defects among neonates. Methods We did a case-control study between March 1, 2013, and Feb 28, 2015, in Lubumbashi, DRC. We included newborns with visible birth defects (cases) and healthy neonates born in the same maternity ward (controls). Mothers were interviewed about potentially relevant exposures, including their partners' jobs. Various trace metals were measured by inductively coupled plasma mass spectrometry in maternal urine, maternal blood, umbilical cord blood, placental tissue, and surface dust at home. Multivariable logistic regression analyses were done to calculate adjusted odds ratios and their 95% CIs (CI). Findings Our study included 138 neonates with visible birth defects (about 0.1% of the 133 662 births in Lubumbashi during the study period) and 108 control neonates. Potential confounders were similarly distributed between cases and controls. Vitamin consumption during pregnancy was associated with a lower risk of birth defects (adjusted odds ratio 0.2, 95% CI 0.1-0.5). Mothers having paid jobs outside the home (2.8, 1.2-6.9) and fathers having mining-related jobs (5.5, 1.2-25.0) were associated with a higher risk of birth defects. We found no associations for trace metal concentrations in biological samples, except for a doubling of manganese (Mn; 1.7, 1.1-2.7) and zinc (Zn; 1.6, 0.9-2.8) in cord blood. In a separate model including placentas, a doubling of Mn at the fetal side of the placenta was associated with an increased risk of birth defects (3.3, 1.2-8.0), as was a doubling of cord blood Zn (5.3, 1.6-16.6). Interpretation To our knowledge, this is the first study of the effects of mining-related pollution on newborns in sub-Saharan Africa. Paternal occupational mining exposure was the factor most strongly associated with birth defects. Because neither Mn nor Zn are mined in Lubumbashi, the mechanism of the association between their increased prenatal concentrations and birth defects is unclear

Poliomyelitis-like syndrome with matching magnetic resonance features in a case of Lyme neuroborreliosis

Lyme disease is a multisystemic disorder caused by an epizootic organism of the spirochete group, called Borrelia burgdorferi, which is transmitted to humans by ticks of the genus Ixodes. Lyme neuroborreliosis may occur during the early dissemination phase, most often as a painful meningo-radiculitis and very rarely as a radiculo-myelitis, whereas encephalomyelitis is observed in the late phase. We report the case of a patient with an early subacute poliomyelitis-like syndrome closely matching the selective involvement of the anterior horns and roots of the cervical spinal cord seen on magnetic resonance imaging. This condition improved with appropriate antibiotics