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Koyalta D, Mboumba Bouassa RS, Maiga AI, Balde A, Bagendabanga JB, Alinity AA, Veyer D, Péré H, Bélec L. High Prevalence of Anal Oncogenic Human Papillomavirus Infection in Young Men Who Have Sex with Men Living in Bamako, Mali. Infect Agent Cancer 2021; 16:51. [PMID: 34210322 PMCID: PMC8252282 DOI: 10.1186/s13027-021-00385-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-risk human papillomavirus (HR-HPV) anal infection is a major problem among men who have sex with men (MSM) living in sub-Saharan Africa. The prevalence of anal HR-HPV infection and associated risk factors were estimated in a cross-sectional study in MSM living in Bamako, Mali. METHODS MSM consulting at sexual health center of the National NGO Soutoura, Bamako, were prospectively included. Sociodemographic and clinical-biological data were collected. HPV detection and genotyping were performed from anal swabs using multiplex real-time PCR. Risk factors associated with anal HPV infection were assessed by logistic regression analysis. RESULTS Fifty MSM (mean age, 24.2 years; range, 18-35) of which 32.0% were infected with HIV-1, were prospectively included. The overall prevalence of anal HPV infection of any genotypes was 70.0% (35/50) with 80.0% (28/35) of swabs positive for HR-HPV. HR-HPV-58 was the most detected genotype [13/35 (37.1%)], followed by HR-HPV-16 and low-risk (LR)-HPV-6 [12/35 (34.2%)], LR-HPV-40 [10/35 (28.6%)], LR-HPV-11 [9/35 (25.7%)], HR-HPV-51 [8/35 (22.8%)], HR-HPV types 18 and 39 [7/35 (20.0%)] and LR-HPV-43 [6/35 (17.1%)]. HR-HPV-52 and LR-HPV-44 were detected in lower proportions [5/35 (14.3%) and 4/35 (11.4%), respectively]. LR-HPV-42, LR-HPV-54, HR-HPV-31 and HR-HPV-35 were detected in very low proportions [3/35 (8.5%)]. Multiple HR-HPV infections were diagnosed in one-third of anal samples [16/50 (32.0%)], including around half of HR-HPV-positive anal swabs [16/35 (45.7%)]. More than half [27/50 (54.0%)] swabs were infected by at least one of HPV genotypes targeted by Gardasil-9® vaccine, including a majority of vaccine HR-HPV [22/50 (44.0%)]. In multivariate analysis, participation to sex in group was associated with anal infection by multiple HPV (aOR: 4.5, 95% CI: 1.1-18.1%; P = 0.032), and HIV-1 infection was associated with anal shedding of multiple HR-HPV (aOR: 5.5, 95% CI: 1.3-24.5%; P = 0.024). CONCLUSIONS These observations indicate that the MSM community living in Bamako is at high-risk for HR-HPV anal infections, with a unique epidemiological HPV genotypes profile and high prevalence of anal HPV covered by the Gardasil-9® vaccine. Scaling up prevention strategies against HPV infection and related cancers adapted to this highly vulnerable MSM community should be urgently prioritized with innovative interventions.
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Affiliation(s)
- Donato Koyalta
- Centre Hospitalo-Universitaire Gabriel Touré, Bamako, Bamako, Mali. .,Faculté des Sciences de la Santé Humaine de N'Djamena, N'Djamena, Chad.
| | - Ralph-Sydney Mboumba Bouassa
- Ecole Doctorale Régionale en Infectiologie Tropicale, Franceville, Gabon.,Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université de Paris, Paris, France
| | | | - Aliou Balde
- Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Sorbonne University, INSERM, Paris, France
| | | | | | - David Veyer
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université de Paris, Paris, France
| | - Hélène Péré
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université de Paris, Paris, France
| | - Laurent Bélec
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université de Paris, Paris, France
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Maiga Y, Sangho O, Konipo F, Diallo S, Coulibaly SDP, Sangare M, Péréon Y, Giumelli B, Sanou M, Coulibaly A, Diallo S, Daou M, Traoré Z, Albakaye M, Traoré HA, Guinto CO, Ouologem M, Kuate-Tegueu C, Bouhassira D, Cowan R, Nizard J. Neuropathic pain in Mali: The current situation, comprehensive hypothesis, which therapeutic strategy for Africa? eNeurologicalSci 2021; 22:100312. [PMID: 33537467 PMCID: PMC7841313 DOI: 10.1016/j.ensci.2021.100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION According to the taxonomy of the International Association for the Study of Pain (IASP 2011), neuropathic pain (NeuP) is defined as "pain caused by a lesion or disease of the somatosensory nervous system". NeuP is currently well-defined clinically, despite a high degree of etiological variation, and it has become a significant public health problem. This work aimed to study the situation regarding NeuP in current practice in Mali, as well as to analyze the therapeutic environment of the patients. METHODOLOGY This was a retrospective and cross-sectional study, carried out in two phases: (1) compilation of the files of patients according to the ICD-11, over a period of 24 months (2) a second prospective phase regarding the Knowledge, Attitudes, and Practices (KAP) of general practitioners and neurologists in regard to NeuP. The focus of the first phase of the study was the files of the patients who had undergone a consultation at the Gabriel Touré UHC. The second phase of the study focused on the general practitioners (Community Health Centers (comHC) of Bamako) and neurologists (Malian or not). RESULTS Over the period of the study, 7840 patients were seen in consultation in the Department of Neurology, of whom 903 for NeuP, thus amounting to a NeuP frequency of 11.5%. Women accounted for 58.9% (532/903), with a sex ratio of 1.4. Using a comparative normal law, the difference in frequency was statistically significant between males and females (p < 10-7) and between two age groups (p 〈10-3). The 49-58 years of age group was represented the most. Diabetic NeuP (21%), lumbar radiculopathies (14%), HIV/AIDS NeuP (13%), and post-stroke NeuP (11%) were the most represented. The survey among the carers revealed: a need for training, a low level of compliance with the therapeutic guidelines, and the use of traditional medicine by the patients. DISCUSSION/CONCLUSION This work confirms that NeuP is encountered frequently in current practice, and its optimal management will involve specific training of carers and improvement of access to the medications recommended in this indication. In light of this issue, we revisit the debate regarding the concept of essential medications and the relevance of taking into account effective medications for the treatment of NeuP.
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Affiliation(s)
- Youssoufa Maiga
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
- Laboratoire de Thérapeutique (EA3826), Faculté de Médecine de Nantes, Nantes, France
| | - Oumar Sangho
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Fatoumata Konipo
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Seybou Diallo
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | | | - Modibo Sangare
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Yann Péréon
- Laboratoire d'Explorations Fonctionnelles, Centre de Référence Maladies Neuromusculaires Atlantique-Occitanie-Caraïbes, Hôtel-Dieu, CHU de Nantes, France
| | | | - Martin Sanou
- Faculté de Chirurgie Dentaire, Université de Nantes, France
| | - Awa Coulibaly
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
| | - Salimata Diallo
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
| | - Mariam Daou
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
| | | | - Mohamed Albakaye
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
| | - Hamar A. Traoré
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Cheick Oumar Guinto
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | | | - Callixte Kuate-Tegueu
- Département de Médecine Interne et Spécialités, FMSB, Université de Yaoundé 1, Cameroon
| | - Didier Bouhassira
- INSERM E-332, Centre d'Evaluation et de Traitement de la Douleur, Ambroise Paré Hospital, 9, avenue Charles de Gaulle, 92 100 Boulogne-Billancourt, France
| | - Robert Cowan
- Department of Neurology, Stanford University, California, USA
| | - Julien Nizard
- Laboratoire de Thérapeutique (EA3826), Faculté de Médecine de Nantes, Nantes, France
- Centre Fédératif Douleur Soins Palliatifs et Support, Laboratoire de Thérapeutique, CHU Nantes, Nantes, France
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