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

High Level of Soluble HLA-G in the Female Genital Tract of Beninese Commercial Sex Workers Is Associated with HIV-1 Infection

Most HIV infections are transmitted across mucosal epithelium. Understanding the role of innate and specific mucosal immunity in susceptibility or protection against HIV infection, as well as the effect of HIV infection on mucosal immunity, are of fundamental importance. HLA-G is a powerful modulator of the immune response. The aim of this study was to investigate whether soluble HLA-G (sHLA-G) expression in the female genital tract is associated with HIV-1 infection.Genital levels of sHLA-G were determined in 52 HIV-1-uninfected and 44 antiretroviral naïve HIV-1-infected female commercial sex workers (CSWs), as well as 71 HIV-1-uninfected non-CSW women at low risk of exposure, recruited in Cotonou, Benin. HIV-1-infected CSWs had higher genital levels of sHLA-G compared with those in both the HIV-1-uninfected CSW (P = 0.009) and non-CSW groups (P = 0.0006). The presence of bacterial vaginosis (P = 0.008), and HLA-G*01:01:02 genotype (P = 0.002) were associated with higher genital levels of sHLA-G in the HIV-1-infected CSWs, whereas the HLA-G*01:04:04 genotype was also associated with higher genital level of sHLA-G in the overall population (P = 0.038). When adjustment was made for all significant variables, the increased expression of sHLA-G in the genital mucosa remained significantly associated with both HIV-1 infection (P = 0.02) and bacterial vaginosis (P = 0.03).This study demonstrates that high level of sHLA-G in the genital mucosa is independently associated with both HIV-1 infection and bacterial vaginosis

Cowpea: a legume crop for a challenging environment

Running title: Cowpea for a challenging environmentCowpea is a grain legume native from Africa and is a primary source of protein for millions of people in sub-Saharan Africa and other parts of the developing world. The main important characteristics of this crop include a good protein quality with a high nutritional value, its nitrogen-fixing ability, and an ability to be more drought- and heat-tolerant than most of its legume relatives. In a research perspective, studies of cowpea are relatively scarce, despite its relevance to agriculture in the developing world and its resilience to stress. The present review provides an overview of different aspects of cowpea, with a special emphasis on the molecular markers for assessing genetic diversity, as well as on biochemical and transcriptomic data with respect to evaluating cowpea drought stress tolerance. The integration of both datasets will be useful for the improvement of cowpea because research on drought stress tolerance is of major interest for this crop in a challenging environment. © 2017 Society of Chemical Industry.This work is supported by European Investment Funds by FEDER/COMPETE/POCI—Operacional Competitiveness and Internacionalization Programme, under Project POCI-01-0145-FEDER-006958 and National Funds by FCT—Portuguese Foundation for Science and Technology, under the project UID/AGR/04033/2013.info:eu-repo/semantics/publishedVersio

Projet de renforcement des capacités de recherche en prévention du VIH en Afrique francophone : rapport technique final du 1er avril 2007 au 31 décembre 2009

Le projet de renforcement des capacités initié par les partenaires du Nord et du Sud et basé au Bénin s’est déroulé de juin 2007 à décembre 2009. Il a permis de créer une Unité de recherche en prévention du VIH de même qu’un Comité d’éthique de la santé au Bénin, dont tous les membres ont été formés en éthique de la recherche. À ce jour, le Comité d’éthique a pu étudier une trentaine de protocoles de recherche, pour approbation éthique. 3 chercheurs africains ont été formés en épidémiologie au Canada, soit 2 au doctorat et 1 à la maîtrise. Des enseignants du Nord et du Sud ont dispensé de la formation lors des 2 sessions de 2 semaines portant sur les aspects « cliniques, éthiques et de laboratoire en lien aux IST/VIH/SIDA » organisées au Bénin à l’intention de 19 médecins et techniciens provenant de différents pays d’Afrique de l’Ouest : Togo, Burkina Faso, Côte d’Ivoire, Bénin et Gabon. 8 stages individuels de 4 à 6 semaines se sont également tenus au Canada. 2 ateliers de rédaction de protocoles ont été mis sur pied au Bénin à l’intention des chercheurs béninois et plusieurs participations à des conférences ont été financées

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

Haemorrhoidal Disease in Cotonou: Epidemiological, Clinical and Anuscopic Aspects

The haemorrhoidal disease is a very common disorder in proctology. It is favoured by many factors. Although benign, its treatment is difficult. Our aim is to study the epidemiological, clini-cal and anuscopic of haemorrhoidal disease. This was a cross sectional, descriptive and pro-spective study covering a three-month period from 06 January 2014 to 10 April 2014. It involved patients seen in gastroenterology consultation in internal medicine of the National Teaching Hos-pital of Cotonou and in the digestive diseases Unit of the Hospital of Menontin. We recorded 182 patients including 57 cases of haemorrhoidal disease, a prevalence of 31.3%. The sex ratio was 1.10. The average age was 43 years with extremes of 18 and 88 years. Anal events were domi-nated by rectal bleeding (54.4%) with a predominance of internal haemorrhoidal disease (87.7%). Stage 2 evolution of the disease was the most represented (65.4%). Haemorrhoidal disease is

Acceptability of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Benin : a qualitative study

In Benin, consistent condom use among men who have sex with men (MSM) is relatively low and providing them with Pre-exposure prophylaxis (PrEP) could be of great relevance. We aimed to describe PrEP knowledge and intention to use it; identify key facilitators and barriers to PrEP; and describe the perceived impact of PrEP on unsafe sexual behavior. MSM, 18 years or older, HIV-negative or of unknown status, were enrolled in five cities of Benin. Intention to use PrEP was assessed through five focus groups (FG). Data were analyzed using manual thematic sorting. Thirty MSM (six per city) participated in the FG. Mean age (standard deviation) was 27.1 (5.0) years. All participants expressed the intention to use PrEP if made available. Facilitators of PrEP use were: availability of medication, safety, absence of constraints as well as freedom to have multiple sex partners and sex with HIV-positive friends. Barriers were: complex procedures for obtaining medication, size and taste of medication, cost of medication, poor PrEP awareness.. Eighteen men admitted that PrEP could lead to decrease in or even abandonment of condom use. In conclusion, MSM showed openness to use PrEP if available, although they recognized that it could lead to risk compensation