The severity of rheumatoid arthritis at the first rheumatology consultation and factors associated with initial structural damage in sub Saharan patients

Background: The severity of Rheumatoid Arthritis (RA) at diagnosis has not been fully described in sub-Saharan Africa in recent years, nor have been the factors associated with it.Objective: The aim of this study was to determine the frequency of severe RA at the first rheumatology consultation and assess the factors associated with this early severity.Design: This was a retrospective study.Methods: The study was carried out in the rheumatology service of the Yaoundé Central Hospital, Cameroon. Files (one patient = one file) of patients diagnosed with RA during January 2004-May 2018 were included. RA severity was defined by the presence of at least one of these markers: Disease Activity Score-28 with Erythrocyte Sedimentation Rate (DAS28-ESR) > 5.1, initial structural damage on hand X-rays which was defined by a Larsen score ≥ 2 per joint and the presence of Rheumatoid Factor (RF) and/or Anticitrullinated Protein Antibodies (ACPA). Files with no information to assess disease severity at the time of diagnosis were excluded. Data were analyzed with Epi-info version 7.0. Statistical significance was set at p-values less than 0.05.Results: Forty-nine patients were included. Their mean age was 48 ± 14 years. Eighty percent of them were females. Sixty-seven percent had established RA, 33% had early-stage RA and two patients had ever smoked. None of them had received biological diseasemodifying antirheumatic drugs. RA was severe in 82% of patients, with DAS28- ESR > 5.1 in 71%, positivity of at least one autoantibody found in 63% to 82%, and initial structural damage found in 55% of them. Initial structural damage was only associated with the presence of ≥ 10 swollen joint counts.Conclusions: RA was severe from the onset in most patients and structural damage was associated with the presence of ≥ 10 swollen joint counts. Key words: Rheumatoid arthritis, Severity, Initial presentation, Structural damage, Sub-Saharan Africa

Pre-treatment drug resistance and HIV-1 genetic diversity in the rural and urban settings of Northwest-Cameroon

Background With the scale-up of antiretroviral therapy (ART), pre-treatment drug resistance (PDR) appears >= 10% amongst ART-initiators in many developing countries, including Cameroon. Northwest region-Cameroon having the second epidemiological burden of HIV infection, generating data on PDR in these geographical settings, will enhance evidence-based decision-making. Objectives We sought to ascertain levels of PDR and HIV-1 clade dispersal in rural and urban settings, and their potential association with subtype distribution and CD4-staging. Methods A cross-sectional study was conducted from February to May 2017 among patients recently diagnosed with HIV-infection and initiating ART at the Bamenda regional Hospital (urban setting) and the Mbingo Baptist hospital (rural setting). Protease and reverse transcriptase sequencing was performed using an in-house protocol and pre-treatment drug resistance mutations were interpreted using StanfordHIVdb.v8.3. Phylogeny was performed for subtype assignation. Results A total of 61 patient sequences were generated from ART initiators (median age: 37 years old; 57.4% female; median CD4 cell count: 184 [IQR: 35-387] in urban vs. 161 [IQR: 96-322] cells/mm(3)in rural). Overall, the level of PDR was 9.8% (6/61). Of note, burden of PDR was almost doubled in urban (12.9% [4/31]) compared to rural setting 6.7% (2/30),p= 0.352). Fifteen (15) PDR mutations were found among four patients the urban settings [6 resistance mutations to NRTIs:[M41L (2), E44D (1), K65R (1), K70E (1), M184V/I (2), K219R (1)] and 6 resistance mutations to NNRTIs: K103N (1), E138A/G (2), V179E (1), M230L (1), K238T (1), P225H (1)] against two (02) mutations found in two patients in the rural setting[2 resistant mutations to NNRTIs: E138A (1) and Y188H (1)]. The rural setting showed more genetic diversity (8 subtypes) than the urban setting (5 subtypes), with CRF02_AG being the most prevalent clade (72.1% [44/61]). Of note, level of PDR was similar between patients infected with CRF02_AG and non-CRF02_AG infected (9.1% [4/44]) vs. 11.8% [2/17]),p= 1.000). Moreover, PDR appeared higher in patients with CD4 cell count <200 cells/mm(3)compared to those with CD4 cell count >= 200 cells/mm(3)(14.7% [5/34]) vs. 3.7% [1/27]),p= 0.214). Conclusions PDR is at a moderate rate in the Northwest region of Cameroon, with higher burden within urban populations. CRF02_AG is the most predominant clade in both urban and rural settings. No effect of HIV molecular epidemiology and CD4-staging on the presence of PDR in patients living in these settings was found. Our findings suggest close monitoring, NNRTI-sparing regimens or sequencing for patients initiating ART, especially in urban settings

Mapping and size estimates of female sex workers in Cameroon: Toward informed policy for design and implementation in the national HIV program.

BackgroundDue to high HIV prevalence among Female Sex Workers (FSWs) in Cameroon (36.5%), this population is especially vulnerable to HIV acquisition and transmission nationwide. Though being prioritized in the national HIV response, it would be relevant to generate statistics on the number of FSWs in order to guide HIV interventions among FSWs. Our objective was to estimate the size of FSWs within hotspots of Cameroon.MethodsA cross-sectional study was conducted from September-November 2015 in selected cities in Cameroon: Bafoussam, Bamenda, Bertoua, Buea, Douala, Kribi, Limbé, and Yaoundé. A programmatic mapping was used, consisting of interviews with secondary key informants (KI) to identify hotspots of FSWs and their respective estimated numbers. Validation of size estimates was done by interviews with FSW at each hotspot. Size estimations in the councils mapped were extended to others not mapped using a Poisson regression model.ResultsA total of 2,194 hotspots were identified: Douala (760), Yaoundé (622), Bamenda (263), Bafoussam (194), Kribi (154), Bertoua (140), Limbé (35), and Buea (26). The estimated total number (range) of FSWs was 21,124 (16,079-26,170), distributed per city as follows: Douala 7,557 (5,550-9,364), Yaoundé 6,596 (4,712-8,480), Bafoussam 2,458 (1,994-2,923), Bamenda 1,975 (1,605-2,345), Kribi 1,121 (832-1,408), Bertoua 1,044 (891-1,198), Buea 225 (185-266), and Limbé 148 (110-148). The variability of estimates among cities was also observed within the councils of each city. The national predicted estimate of FSW population was 112,580 (103,436-121,723), covering all councils of Cameroon. An estimate of 1.91% (112,580/5,881,526; 0.47%-3.36%) adult female population in Cameroon could be sex workers.ConclusionThere are considerable numbers of FSW in major cities in Cameroon. There is a need to prioritize interventions for HIV prevention toward this population in order to limit the burden of HIV sexual transmission nationwide