Facteurs associés à la dissociation immunovirologique chez les patients infectés par le VIH-1 sous traitement antirétroviral hautement actif au Centre de Traitement Ambulatoire (CTA) de Dakar

Introduction: L'objectif de ce travail était d'évaluer les différents facteurs associés à la dissociation immunovirologique malgré un traitement antirétroviral hautement actif et efficace.Méthodes: Il s'agissait d'une étude de cohorte historique, descriptive et analytique faite à partir de dossiers de patients infectés par le VIH-1; sous traitement antirétroviral depuis au moins 12 mois, suivis dans la cohorte du CTA de 2001 à 2011 et ayant une charge virale indétectable depuis 6 mois.Résultats: Durant cette période d'étude de 10 ans, la prévalence de la DIV était de 19,3%. Le sexe féminin était prédominant avec un sexe ratio de 1,9. La dissociation immunovirologique a été plus fréquemment rencontrée chez les patients de sexe masculin (29,7% vs 14,1%) avec une différence statistiquement significative (p = 0,00006). L'âge médian était de 44 ans ± 10 ans. Un antécédent de tuberculose a été retrouvé dans environ un tiers des cas (31,4%). La dissociation immunovirologique était significativement plus fréquente chez les patients ayant un antécédent de tuberculose (p = 0,00005). La plupart des patients (68%) était au stade SIDA 3 ou 4 de l'OMS. Les patients ayant une dissociation immunovirologique étaient plus souvent aux stades 3 et 4 de l'OMS (p = 0,0001). La dénutrition a été notée dans plus de la moitié des cas (56,2%) et la dissociation immunovirologique prédominait chez les patients dénutris (p=0,005). Le taux moyen de lymphocytes TCD4+ était de 86,7± 83 cellules / mm3. La dissociation immunovirologique était plus fréquente chez les patients ayant un taux de lymphocytes TCD4 bas à l'initiation avec une différence statistiquement significative (p = 0,00000). En analyse multivariée; Seuls l'âge supérieur ou égal à 43 ans, le taux de CD4 initial < 100 c/mm3 et le sexe masculin étaient significativement associés à cette dissociation immunovirologique.Conclusion: Les principaux facteurs associés à la dissociation immunovirologique étant évalués, d'autres études portant sur ce groupe mériteraient d'être envisagées afin de connaitre l'impact de cette réponse immunologique partielle sur la survenue d'infections opportunistes ou bien la mise en place d'une trithérapie spécifique uniquement dans le but d'avoir une restauration immunologique optimale.Mots clés: Dissociation, immunovirologique, VIH, DakarEnglish Title: Factors associated with immunovirologic dissociation in HIV-1-infected patients under highly active antiretroviral therapy in the Ambulatory Treatment Center (ATC) in DakarEnglish AbstractIntroduction: the objective of this work is to evaluate the different factors associated with immunovirologic dissociation despite highly active and effective antiretroviral treatment.Methods: we conducted a retrospective, cohort, descriptive and analytical study of the medical records of HIV-1 infected patients having received at least 12 months of antiretroviral therapy, followed in the ATC cohort from 2001 to 2011 and with undetectable viral load in the last 6 months.Results: during this 10-year study period, the prevalence of IVD was 19.3%. Female sex was predominant, with a sex ratio of 1.9. Immunovirologic dissociation was more frequent in male patients (29.7% vs 14.1%) with a statistically significant difference (p = 0,00006). The average age was 44 years ± 10 years. A history of tuberculosis was found in about a third of the cases (31.4%). Immunovirologic dissociation was significantly more frequent in patients with a history of tuberculosis (p = 0.00005). Most patients (68%) had AIDS at WHO clinical stages 3 or 4. Patients with immunovirologic dissociation were more often in WHO clinical stages 3 and 4 (p = 0.0001). More than half of the cases (56.2%) were found to be malnourished and immunovirologic dissociation was prevalent in malnourished patients (p=0.005). The mean CD4+ T lymphocytes counts was 86.7± 83 cells / mm3. Immunovirologic dissociation was more frequent in patients with initial low CD4+ T lymphocyte counts and with a statistically significant difference (p = 0.00000). By multivariate analysis, only age greater than or equal to 43 years, CD4 initial counts < 100 c/mm3 and male sex were significantly associated with this immunovirologic dissociation.Conclusion: our study assessed the main factors associated with immunovirologic dissociation. Other studies of this nature would also merit consideration in order to highlight the impact of this partial immune response on the emergence of opportunistic infections or the implementation of a specific tritherapy for the sole purpose of producing fully successful immune restoration.Keywords: Dissociation, immunovirologic, HIV, Daka

Réactivation d’une hépatite B occulte chez un patient drépanocytaire homozygote: cas clinique et revue de la littérature

L'hépatite B occulte correspond à la présence de l'ADN du virus de l'hépatite B dans le sérum et/ou dans le foie d'un patient malgré la négativité de l'AgHBs. C'est une forme clinique habituellement asymptomatique. Sa réactivation est rare et survient en général chez le sujet immunodéprimé. Nous rapportons un cas d'un patient sénégalais de 21 ans, drépanocytaire homozygote, qui présentait un ictère de type cholestatique chez qui l'exploration biologique concluait a une réactivation d'une hépatite B occulte. Cette observation souligne la nécessité de rechercher systématiquement une réactivation d'une hépatite B occulte devant toute hépatopathie aigue chez le drépanocytaire

Safety and immunogenicity of human papillomavirus-16/18 AS04-adjuvanted vaccine: a randomized trial in 10-25-year-old HIV-Seronegative African girls and young women.

BACKGROUND: Cervical cancer is a major public health problem for women in sub-Saharan Africa. Availability of a human papillomavirus (HPV) vaccine could have an important public health impact. METHODS: In this phase IIIb, double-blind, randomized, placebo-controlled, multicenter trial (NCT00481767), healthy African girls and young women seronegative for human immunodeficiency virus (HIV) were stratified by age (10-14 or 15-25 years) and randomized (2:1) to receive either HPV-16/18 AS04-adjuvanted vaccine (n = 450) or placebo (n = 226) at 0, 1, and 6 months. The primary objective was to evaluate HPV-16/18 antibody responses at month 7. Seropositivity rates and corresponding geometric mean titers (GMTs) were measured by enzyme-linked immunosorbent assay. RESULTS: In the according-to-protocol analysis at month 7, 100% of initially seronegative participants in the vaccine group were seropositive for both anti-HPV-16 and anti-HPV-18 antibodies (n = 130 and n = 128 for 10-14-year-olds, respectively; n = 190 and n = 212 for 15-25-year-olds). GMTs for HPV-16 and HPV-18 were higher in 10-14-year-olds (18 423 [95% confidence interval, 16 185-20 970] and 6487 [5590-7529] enzyme-linked immunosorbent assay units (EU)/mL, respectively) than in 15-25-year-olds (10 683 [9567-11 930] and 3743 [3400-4120] EU/mL, respectively). Seropositivity was maintained at month 12. No participant withdrew owing to adverse events. No vaccine-related serious adverse events were reported. CONCLUSIONS: The HPV-16/18 AS04-adjuvanted vaccine was highly immunogenic and had a clinically acceptable safety profile when administered to healthy HIV-seronegative African girls and young women

Hydroxychloroquine and Azithromycin Treatment of Hospitalized Patients Infected with SARS-CoV-2 in Senegal from March to October 2020

International audienceAs of today, little data is available on COVID-19 in African countries, where the case management relied mainly on a treatment by association between hydroxychloroquine (HCQ) and azithromycin (AZM). This study aimed to understand the main clinical outcomes of COVID-19 hospitalized patients in Senegal from March to October 20202. We described the clinical characteristics of patients and analysed clinical status (alive and discharged versus hospitalized or died) at 15 days after Isolation and Treatment Centres (ITC) admission among adult patients who received HCQ plus AZM and those who did not receive this combination. A total of 926 patients were included in this analysis. Six hundred seventy-four (674) (72.8%) patients received a combination of HCQ and AZM. Results showed that the proportion of patient discharge at D15 was significantly higher for patients receiving HCQ plus AZM (OR: 1.63, IC 95% (1.09–2.43)). Factors associated with a lower proportion of patients discharged alive were: age ≥ 60 years (OR: 0.55, IC 95% (0.36–0.83)), having of at least one pre-existing disorder (OR: 0.61, IC 95% (0.42–0.90)), and a high clinical risk at admission following NEWS score (OR: 0.49, IC 95% (0.28–0.83)). Few side effects were reported including 2 cases of cardiac rhythmic disorders in the HCQ and AZM group versus 13 in without HCQ + AZM. An improvement of clinical status at 15 days was found for patients exposed to HCQ plus AZM combinatio

Univariate and multivariate risk factors analysis according to "symptomatic/asymptomatic" status for Period 2 (from June 26 to October 31^st, 2020).

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Epidemiological parameters comparison according to different periods.

Epidemiological parameters comparison according to different periods.</p

Heatmap of symptom frequency and histogram of asymptomatic patients by age group.

A. Heatmap of symptom frequency by age group. Symptoms are listed in rows and age groups in columns. Values in cells indicate the frequency of patients from the corresponding age group manifesting the corresponding symptom. The more the red color is accentuated, the more the symptom is frequent. The blue box targets the "cough" symptom, one of the most involved symptoms in transmission due to the dispersed micro-droplets. This symptom is less frequent in young patients (most active sub-population) compared to adult (less active sub-population). B. Histogram of asymptomatic patients by age group. Black vertical bars represent the standard errors.</p

Confirmed COVID-19 cases according to their travel history.

A. Histogram of COVID-19 cases with and without travel history. Dates of onset are represented in the x-axis and number of tested cases on the y-axis. Grey part of the bars represents cases without travel history, black bars cases circulated inside Senegal, green bars cases from the rest of the world, red bars cases from Europe and blue bars cases from other African countries. B. Country’s origin of imported COVID-19 cases.</p

Cumulative incidence of COVID19 in Senegal by region.

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Univariate and multivariable factors analysis according to "symptomatic/asymptomatic" status.

Univariate and multivariable factors analysis according to "symptomatic/asymptomatic" status.</p