Impact du traitement antirétroviral sur le profil biologique des enfants VIH positifs suivis au Centre Hospitalier et Universitaire de Yaoundé au Cameroun

Introduction: L'objectif de ce travail était d'évaluer l'impact du traitement antirétroviral sur le profil biologique des enfants VIH positifs suivis auCentre Hospitalier et Universitaire de Yaoundé au Cameroun.Méthodes: Il s'agissait d'une étude rétrospective réalisée de Mai 2003 à Décembre 2012 au CHU de Yaoundé au Cameroun. Pour cette étude, nous avons obtenu une clairance éthique.Résultats: L'âge moyen était de 54.02±46.34 mois. The sexe ratio était de 0.96 en faveur des garçons. Le diagnostic s'était fait tardivement (74.2%) ainsi que la mise sous traitement (83.3%). Seuls 36 des 116 enfants (31%) avait pu avoir un bilan biologique à l'initiation du traitement antirétroviral et six mois après l'initiation du traitement antirétroviral. Après six mois de traitement, nous avons enregistrés une augmentation  significative des paramètres biologiques suivants : taux de glycémie de 0.09g/L (0.75-0.84; p= 0.007), pourcentage de CD4 chez les enfants de moins de 5 ans de 4.62% (20.12-24.75; p=0.022), valeur absolue de CD4 chez les enfants de plus de 5 ans de 294 cellules/mm3 (151.18-445.18; p=0.011), le rapport CD4/CD8 de 0.35 (0.55-0.90; p=0.000). Enfin, après six mois de traitement, on enregistrait une baisse significative de la charge virale du VIH de 3.90 log (5.85-1.95; p=0.006). Conclusion: Il ressort de cette étude que la restauration immunitaire et la suppression virologique peuvent être obtenus après six mois de traitement antirétroviral. Cependant, des efforts doivent encore être faits en ce qui concerne la prise en charge du suivi biologique, gage d'un bon suivi thérapeutique au Cameroun

Evaluation of treatment response, drug resistance and HIV-1 variability among adolescents on first- And second-line antiretroviral therapy: A study protocol for a prospective observational study in the centre region of Cameroon (EDCTP READY-study)

BackgroundSub-Saharan Africa (SSA) alone has nine out of every 10 children living with HIV globally and monitoring in this setting remains suboptimal, even as these children grow older. With scalability of antiretroviral therapy (ART), several HIV-infected children are growing towards adolescence (over 2.1 million), with the potentials to reach adulthood. However, despite an overall reduction in HIV-related mortality, there are increasing deaths among adolescents living with HIV (ADLHIV), with limited evidence for improved policy-making. Of note, strategies for adolescent transition from pediatrics to adult-healthcare are critical to ensure successful treatment response and longer life expectancy. Interestingly, with uptakes in prevention of mother-to-child transmission, challenges in ART programs, and high viremia among children in SSA, the success rate of paediatric ART might be quickly jeopardised, with possible HIV-1 drug-resistance (HIVDR) emergence, especially after years of paediatric ART exposure. Therefore, monitoring ART response in adolescents and evaluating HIVDR patterns might limit disease progression and guide on subsequent ART options for SSA ADLHIV.ObjectivesAmong Cameroonian ADLHIV receiving ART, we shall evaluate the rate of immunovirologic failure, acquired HIVDR-associated mutations, HIV-1 subtype distribution, genetic variability in circulating (plasma) versus archived (cellular) viral strains, and HIVDR early warning indicators (EWIs) at different time-points.MethodsA prospective and observational study will be conducted among 250 ADLHIV (10-19years old) receiving ART in the centre region of Cameroon, and followed-up at 6 and 12months after enrollment. Following consecutive sampling at enrolment, plasma viral load and CD4/CD8 count will be measured, and genotypic resistance testing (GRT) will be performed both in plasma and in buffy coat for participants experiencing virological failure (two consecutive viremia >=1000 copies/ml). Plasma viral load and CD4/CD8 will be monitored for all participants at 6 and 12months after enrolment. HIVDR-EWIs will be monitored and survival analysis performed during the 12months follow-up. Primary outcomes are rates of virological failure, acquired-HIVDR, and mortality.DiscussionOur findings will provide evidence-based recommendations to ensure successful transition from paediatrics to adult ART regimens and highlight further needs of active ART combinations, for reduced morbidity and mortality in populations of ADLHIV within SSA

Human immunodeficiency virus infection in a child revealed by a massive purulent pericarditis mistaken for a liver abscess due to Staphylococcus aureus

Massive purulent andacute pericarditis in children is a life-threatening disease associated with high mortality. It has been described tocomplicate usuallya bronchopulmonary infectionbut is currently uncommon in the era of antibiotics. Acute and massive purulent pericarditis has been rarely reported in children in association with human immunodeficiency virus (HIV) infection. This is a case of a10-year-old boy who presented with signs of sepsis and cardiac tamponade due to a massive staphylococcal purulent pericarditis complicating an unknown HIV infection.The child underwent pericardiectomy, intensive treatment, and survived this life-threatening disease

Feasibility of a simple drainage system in Cameroonian children after thoracotomy and decortication for empyema thoracis

Background: To analyse the outcome of children with empyema thoracis treated by decortication followed by a simple drainage system. Patients and Methods: Retrospective chart review from July 2001 to June 2010 of all cases of children who had a thoracotomy for empyema. We used an endotracheal tube as chest drain and a urinary bag as a collector. Statistical analyses were done using EXCEL and SPSS 9.0. Results: Forty one children underwent thoracotomy and decortication for empyema, there were 23 boys and 18 girls with a sex ratio of 1, 21. The mean age was 2½ years with a minimum of 1 month and a maximum of 15 years of age; 27 children were below two years of age. All the patients have received antibiotic for a long period before surgery. The culture was negative, except in two cases where we found Klebsiella pneumonia and Staphylococcus aureus. In five cases, the empyema was due to Mycobacterium tuberculosis. Three children presented a complication: One child had a persistent purulent drainage for 2 weeks; another one was re-operated upon because of necrotic lung abscess and one child died of sepsis. In most cases, the chest tube was removed between day 4 and day 6 post-operatively. The average length of hospital stay after the surgery was 10 days. Conclusion: Thoracotomy and decortication in children with empyema can be safely done in Cameroon using a simple drainage system with good results compared to those in the literature

Altered Toll-Like Receptor-4 Response to Lipopolysaccharides in Infants Exposed to HIV-1 and Its Preventive Therapy

Pathogen sensing and recognition through pattern recognition receptors, and subsequent production of pro-inflammatory cytokines, is the cornerstone of the innate immune system. Despite the fact that HIV-exposed uninfected (HEU) infants are prone to serious bacterial infections, no study has focused on the functionality of their bacteria recognition system. This is the first study to investigate baseline levels of three critically important immune response molecules in this population: complement component (C)-3, toll-like receptor (TLR)-4, and C-reactive protein (CRP). We enrolled 16 HEU and 6 HIV-unexposed (HU) infants. TLR4 function was investigated by stimulating whole blood with increasing concentrations of TLR4-agonist ultrapure lipopolysaccharides. TLR4/TLR4-agonist dose response were assessed by measuring IL-6 secretion. Complement C3 and CRP were measured by photo spectrometry. Data showed no significant differences in baseline concentration of CRP between HEU and HU infants. Complement C3 was significantly higher in HEU infants than HU infants. TLR4 anergy was observed in 7 of 12 HEU infants, whereas the rest of HEU infants (n = 4) and the control HU infants tested (n = 3) showed responsive TLR4. None of the HEU infants investigated in this study had severe infections in the year after their birth. In conclusion, TLR4 anergy can occur in HEU infants without necessarily translating to increased vulnerability to infectious diseases

Reviewing the Insights of Confinement and Social Distancing as Measures Involved in the Prevention of the COVID-19 Pandemic

Confinement and social distancing have been widely used in the prevention of the COVID-19 pandemic, as interventions consisting in reducing physical contact between individuals to prevent the spread of the disease. In order to demonstrate the pattern of these measures, we did a review of pertinent articles on the subject available online. We found that though confinement and social distancing significantly contributed to the mitigation of the COVID-19 infection in a number of countries worldwide, there however exist a dilemma in choosing between the expected benefits and adverse effects, especially when applied on a large scale. Thus considerations with regards to socio-anthropological and politico-economic impacts should be considered in order to protect citizens, especially the vulnerable. Besides, population information, education and communication helps to increase adherence and observation of recommendations. However, further improvements need to be implemented in other to render these measures more bearable and less restrictive while ameliorating their efficacy

First case of Dolutegravir and Darunavir/r multi drug-resistant HIV-1 in Cameroon following exposure to Raltegravir: lessons and implications in the era of transition to Dolutegravir-based regimens

Background Sub-Saharan African countries are transitioning to dolutegravir-based regimens, even for patients with extensive previous drug exposure, including first-generation integrase strand-transfer inhibitors (INSTI) such as raltegravir. Such exposure might have implications on cross-resistance to dolutegravir-based antiretroviral therapies (ART). Case presentation We report a 65 years old Cameroonian, previously exposed to raltegravir, and failing on third-line treatment with multi-drug resistance to darunavir/r and dolutegravir. Genotypic resistance testing (GRT) and viral tropism were performed during monitoring time points. The patient initiated ART in August 2007. At the time point of the first (29.04.2010), second (01.12.2017) and third (08.08.2019) GRT, prior ART exposure included 3TC, d4T, NVP and EFV; additionally TDF, DRV/r and RAL; and additionally ABC and DTG respectively. First GRT revealed mutations associated with resistance only to first-generation Non-nucleoside reverse transcriptase inhibitors (NNRTI). Second GRT revealed mutations associated with high-level resistance to all NRTIs, first generation NNRTIs, all ritonavir boosted protease inhibitors (PI/r), and all INSTI, while viral tropism (using geno2pheno) revealed a CCR5-tropic virus with a false positive rate (FPR) of 60.9% suggesting effectiveness of maraviroc (MRV). The third GRT showed high-level resistance to NRTI, NNRTI, all PI and all INSTI, with additional mutations (H221HY for NNRTI and S147G for INSTI), and a CCR5-tropic virus with a slightly reduced FPR (57.0%). Without any locally available active therapeutic option, the patient has been on a maintenance therapy with "DRV/r (600mg x 2/day)+TDF+3TC" and patient/family-centered adherence has been reinforced. Since the first viral load (VL) measurement in 2010, the patient has had 12 VL tests with the VL ranging from 4.97 Log to 6.44 Log copies/mL and the CD4 count never exceeded 200 cells/mu L. Conclusions As African countries transition to dolutegravir-based regimens, prior raltegravir-exposure may prompt selection (and potential transmission) of dolutegravir-resistance, supporting case surveillance