Tuberculose vaginale révélée par une fièvre prolongée chez une femme immunodéprimée par le VIH à Cotonou, Bénin

Résumé La tuberculose vaginale est exceptionnelle et sous diagnostiquée sous nos cieux. Nous rapportons le cas d’une patiente de 53 ans, immunodéprimée par le VIH hospitalisée dans le service pour altération de l’état général dans un contexte de fièvre au long cours. L’interrogatoire, et l’examen physique avaient retrouvé les éléments suivants : tousseur chronique dans l’entourage, partenaire sexuel multiple, leucorrhées persistantes. Le Mycobactérium tuberculosis était retrouvé dans les leucorrhées à l’examen direct. La sérologie VIH était positive au VIH1, le taux des lymphocytes TCD4 était à 22 cells/μL. Le diagnostic de tuberculose vaginal sur terrain immunodéprimé sévère au VIH a été retenu. Un traitement antituberculeux fut institué. Le traitement Antirétroviral a démarré deux semaines plus tard. L’évolution a été rapidement favorable et après 6 mois de traitement la patiente était déclarée guérie de la tuberculose. Chez un patient immunodéprimé au VIH, tout écoulement purulent persistant même vaginal doit faire rechercher une tuberculos

Ten-year attrition and antiretroviral therapy response among HIV-positive adults: a sex-based cohort analysis from eight West African countries

INTRODUCTION: Sex differences have already been reported in sub-Saharan Africa for attrition and immunological response after antiretroviral therapy (ART) initiation, but follow-up was usually limited to the first two to three years after ART initiation. We evaluated sex differences on the same outcomes in the 10 years following ART initiation in West African adults. METHODS: We used cohort data of patients included in the IeDEA West Africa collaboration, who initiated ART between 2002 and 2014. We modelled no-follow-up and 10-year attrition risks, and immunological response by sex using logistic regression analysis, survival analysis with random effect and linear mixed models respectively. RESULTS: A total of 71,283 patients (65.8% women) contributed to 310,007 person-years of follow-up in 16 clinics in eight West African countries. The cumulative attrition incidence at 10-year after ART initiation reached 75% and 68% for men and women respectively. Being male was associated with an increased risk of no follow-up after starting ART (5.1% vs. 4.0%, adjusted Odds Ratio: 1.25 [95% CI: 1.15 to 1.35]) and of 10-year attrition throughout the 10-year period following ART initiation: adjusted Hazard Ratios were 1.22 [95% CI: 1.17 to 1.27], 1.08 [95% CI: 1.04 to 1.12] and 1.04 [95% CI: 1.01 to 1.08] during year 1, years 2 to 4 and 5 to 10 respectively. A better immunological response was achieved by women than men: monthly CD4 gain was 30.2 and 28.3 cells/mL in the first four months and 2.6 and 1.9 cells/μL thereafter. Ultimately, women reached the average threshold of 500 CD4 cells/μL in their sixth year of follow-up, whereas men failed to reach it even at the end of the 10-year follow-up period. The proportion of patients reaching the threshold was much higher in women than in men after 10 years since ART initiation (65% vs. 44%). CONCLUSIONS: In West Africa, attrition is unacceptably high in both sexes. Men are more vulnerable than women on both attrition and immunological response to ART in the 10 years following ART initiation. Innovative tracing strategies that are sex-adapted are needed for patients in care to monitor attrition, detect early high-risk groups so that they can stay in care with a durably controlled infection

CD4+ T cell recovery during suppression of HIV replication: an international comparison of the immunological efficacy of antiretroviral therapy in North America, Asia and Africa

Background: Even among HIV-infected patients who fully suppress plasma HIV RNA replication on antiretroviral therapy, genetic (e.g. CCL3L1 copy number), viral (e.g. tropism) and environmental (e.g. chronic exposure to microbial antigens) factors influence CD4 recovery. These factors differ markedly around the world and therefore the expected CD4 recovery during HIV RNA suppression may differ globally. Methods: We evaluated HIV-infected adults from North America, West Africa, East Africa, Southern Africa and Asia starting non-nucleoside reverse transcriptase inhibitor-based regimens containing efavirenz or nevirapine, who achieved at least one HIV RNA level <500/µl in the first year of therapy and observed CD4 changes during HIV RNA suppression. We used a piecewise linear regression to estimate the influence of region of residence on CD4 recovery, adjusting for socio-demographic and clinical characteristics. We observed 28 217 patients from 105 cohorts over 37 825 person-years. Results: After adjustment, patients from East Africa showed diminished CD4 recovery as compared with other regions. Three years after antiretroviral therapy initiation, the mean CD4 count for a prototypical patient with a pre-therapy CD4 count of 150/µl was 529/µl [95% confidence interval (CI): 517-541] in North America, 494/µl (95% CI: 429-559) in West Africa, 515/µl (95% CI: 508-522) in Southern Africa, 503/µl (95% CI: 478-528) in Asia and 437/µl (95% CI: 425-449) in East Africa. Conclusions: CD4 recovery during HIV RNA suppression is diminished in East Africa as compared with other regions of the world, and observed differences are large enough to potentially influence clinical outcomes. Epidemiological analyses on a global scale can identify macroscopic effects unobservable at the clinical, national or individual regional leve

Manifestations stomatologiques et infection à VIH au Centre national hospitalier et universitaire de Cotonou (Bénin)

Objectif : Les manifestations stomatologiques de l’infection à VIH sont nombreuses et certaines peuvent hypothéquer la survie des personnes infectées. L’objectif de cette étude rétrospective est de contribuer à une meilleure connaissance des manifestations stomatologiques liées à l’infection à VIH chez les sujets suivis au Centre de Traitement ambulatoire du Centre national hospitalier et universitaire de Cotonou (Bénin). Patients et méthode : Cette étude porte sur 300 personnes vivant avec le VIH (PVVIH), reçues entre février et mars 2010. Les dossiers des patients ont été exploités et un examen clinique bucco-dentaire a été réalisé. Résultats : L’âge moyen des PVVIH était de 39 ans et on observait une prédominance féminine (65 % des cas) soit un sex ratio H/F de 0,53. 21 % de l’échantillon n’avaient aucune instruction et seulement 4 % avaient fait des études supérieures. Plus de 97 % des PVVIH étaient infectés par le VIH1 et 45 % étaient au stade clinique III selon la classification de l’OMS. La candidose buccale constituait l’infection la plus fréquente (67 % des PVVIH). L’indice CAOD moyen était de 1,85 et plus de 60 % des PVVIH avaient un indice parodontal (CPI) égal à 2. Les manifestations bucco-faciales survenaient volontiers au stade d’immunodépression sévère. 63 % des patients étaient déjà sous traitement antirétroviral et environ 3 patients sur 4 dans l’échantillon étaient sous traitement prophylactique des infections opportunistes. Conclusion : Les affections bucco-dentaires représentent un réel problème au sein de la population étudiée. Les chirurgiens dentistes doivent être impliqués dans toutes les équipes prenant en charge des PVVIH

Low implementation of Xpert MTB/RIF among HIV/TB co-infected adults in the International epidemiologic Databases to Evaluate AIDS (IeDEA) program.

OBJECTIVE:Xpert MTB/RIF is recommended by the World Health Organization (WHO) as the initial tuberculosis (TB) diagnostic test in individuals suspected of HIV-associated TB. We sought to evaluate field implementation of Xpert among a cohort of HIV/TB co-infected individuals, including availability, utilization and outcomes. DESIGN:Observational cohort study (patient-level data) and cross-sectional study (site-level Xpert availability data). METHODS:Data were collected at 30 participating International epidemiologic Databases to Evaluate AIDS (IeDEA) sites in 18 countries from January 2012-January 2016. All patients were HIV-infected and diagnosed with TB, either bacteriologically or clinically, and followed until a determination of TB treatment outcome. We used multivariable modified Poisson regression to estimate adjusted relative risk (RR) and 95% confidence intervals for unfavorable TB treatment outcomes. RESULTS:Most sites (63%) had access to Xpert, either in the clinic (13%), in the same facility (20%) or offsite (30%). Among 2722 HIV/TB patients included, median age was 35.4 years and 41% were female; BMI and CD4 count were low. Overall, most patients (76%) received at least one TB test; 45% were positive. Only 4% of all patients were tested using Xpert: 64% were Xpert-positive, 13% showed rifampicin (RIF) resistance and 30% were extrapulmonary (EPTB) or both pulmonary-EPTB. Treatment outcomes were mostly favorable (77%) and we found little association between Xpert use and an unfavorable TB treatment outcome (RR 1.25, 95%CI: 0.83, 1.90). CONCLUSIONS:In this cohort, Xpert utilization was low even though the majority of sites had access to the test. Our findings show the need for expanded implementation and further research exploring barriers to use in low-resource settings

Pre‐exposure prophylaxis in real life: experience from a prospective, observational and demonstration project among men who have sex with men in Benin, West Africa

Abstract Introduction Since many countries in sub‐Saharan Africa are willing to implement HIV oral pre‐exposure prophylaxis (PrEP) for men who have sex with men (MSM), data are needed to assess its feasibility and relevance in real life. The study objectives were to assess drug uptake, adherence, condom use and number of sexual partners, HIV incidence and trends in the prevalence of gonorrhoea and chlamydia. Methods In this oral PrEP demonstration study conducted prospectively in Benin, a combination of tenofovir disoproxil fumarate‐TDF 300 mg and emtricitabine‐FTC 200 mg (TDF‐FTC) was offered daily or on‐demand to MSM. Participants were recruited from 24 August to 24 November 2020 and followed over 12 months. At enrolment, month‐6 and month‐12, participants answered to a face‐to‐face questionnaire, underwent a physical examination and provided blood samples for HIV, gonorrhoea and chlamydia. Results Overall, 204 HIV‐negative men initiated PrEP. The majority of them (80%) started with daily PrEP. Retention rates at month‐3, 6, 9 and 12 were 96%, 88%, 86% and 85%, respectively. At month‐6 and month‐12, respectively, 49% and 51% of the men on daily PrEP achieved perfect adherence (self‐reported), that is seven pills taken during the last week. For event‐driven PrEP, the corresponding proportions for perfect adherence (last seven at‐risk sexual episodes covered) were 81% and 80%, respectively. The mean number (standard deviation) of male sexual partners over the last 6 months was 2.1 (1.70) at baseline and 1.5 (1.27) at month‐12 (p‐value for trend <0.001). Consistent condom use during the last 6 months was 34% (enrolment), 37% (month‐6) and 36% (month‐12). Three HIV seroconversions (2‐daily and 1‐event‐driven) were recorded. Crude HIV incidence (95% confidence interval) was 1.53 (0.31−4.50)/100 person‐years. Neisseria gonorrhoeae and/or Chlamydia trachomatis prevalence at the anal and/or pharyngeal and/or urethral sites was 28% at baseline and 18% at month‐12 (p‐value = 0.017). Conclusions In West Africa, oral PrEP introduction in routine practice as a component of a holistic HIV prevention package is feasible and may not result in a significant increase in condomless sex among MSM. Since HIV incidence was still higher, additional interventions, such as culturally tailored adherence counselling, may be needed to optimize the benefits of PrEP

RESEARCH Open Access

Incidence of malaria-related fever and morbidity due to Plasmodium falciparum among HIV1-infected pregnant women: a prospective cohort study in South Beni

Patient characteristics at time of TB diagnosis (n = 2722).

<p>Patient characteristics at time of TB diagnosis (n = 2722).</p

Multivariable modified Poisson regression analysis of factors associated with an unfavorable TB treatment outcome.

<p>Multivariable modified Poisson regression analysis of factors associated with an unfavorable TB treatment outcome.</p