[Epidemiological and clinical aspects of prurigo in HIV infected patients in Fousseyni N'Daou hospital of Kayes, Mali]

INTRODUCTION

Prurigo is one of the most common dermatological conditions during HIV infection and AIDS. It appears as an immunosuppression marker associated with HIV infection. The study objective was to determine the prevalence of prurigo in people living with the human immunodeficiency virus (PLHIV) in Fousseyni N'Daou Hospital of Kayes, and to describe the socio-demographic aspects of patients and lesions associated with prurigo among PLHIV.

METHODS

It was a descriptive cross-sectional study included all cases of HIV infected patients with prurigo in the Dermatology-Venomology Department of Fousseyni N'DAOU Hospital from January 1, 2015 to August 31, 2015.

RESULTS

We collected 121 cases of prurigo. The hospital prevalence was 14.5% among PLHIV with 65% Female and the average age was 34.8 years old (SD: 15-81 years). The elementary lesions associated with prurigo were seropapules (40.2%), vesiculo-crusts (13%), excoriated papules (33.3%), lichenified papules (10.8%), and cicatricial lesions (2.7%). The prurigo was generalized in 68.5% of cases and localized in 31.24%. More than half of our patients had weight loss, fever, diarrhea and oral candidiasis in their medical history. Patients were infected with HIV1 in 60.03% and HIV1+ 2 in 24.3%. More than the half of our patients had a CD4 count inferior to 250 cells/mm3 at the time of prurigo diagnosis.

CONCLUSION

In our study, prurigo remains a common condition in PLHIV, particularly in patients with low CD4 counts. Early detection and rapid antietroviral therapy can reduce the frequency of prurigo in PLHIV.

Kaposi's disease in an HIV positive child, with probable contamination from his grandmother

Kaposi's disease in children with HIV is rarely reported in everyday practice. This is a case study of cutaneous Kaposi's disease revealing HIV in a 5-year-old child with polymorphic eruption of papules and nodules on the face, trunk, back, and limbs. Histopathological examination confirmed the diagnosis of Kaposi's disease. The child's HIV serology was positive with a CD4 count of 240/mm³, normochromic and normocytic anemia, and a hemoglobin level at 8.5 g/dl. It was found that the child, after early weaning from his HIV-negative mother, had repeatedly suckled his healthy grandmother, who had no skin lesions but was HIV1 positive. Both grandmother and child were referred for treatment in their locality. The case is noteworthy for the way in which the HIV1 virus infected the child during weaning and then being suckled by his grandmother. The child already had an initial dental flare that could have injured his grandmother. Thus, in our case, there is a contamination by HIV1 virus most likely from the grandmother and contamination by the HHV8 virus, source unidentified as a technical plateau was reached.

[Human papilloma viruses: other risk factor of head and neck carcinoma]

Head and neck carcinoma (HNC) occupy the sixth place as the most frequent type of cancer worldwide. Next to alcohol and tobacco intoxication, other risk factors (RF) are suspected, including the human papilloma viruses (HPVs). The aim of this study was to highlight the prevalence of HPVs and histo-epidemiological characteristics of HNC HPV+ in Senegal. This is a prospective, multicenter preliminary study of 18 months (January 1, 2012-June 30, 2014). The cases of HNC histologically confirmed in Senegal were then sent to the bio-pathology department of the Curie Institute in Paris to search HPVs. In the 90 included cases, the PCR technique was successful in 54 cases (60%). HPVs were found in seven cases, that is, a prevalence of 13%. HPVs were associated with 5 cases of hypopharyngeal carcinoma and 2 cases of carcinoma of the oral cavity. Patients with HNC HPV+ had a median age of 42 years against 49 years for HPV-patients. Three patients (42.8%) with HPV+ carcinomas were smokers. Of the 47 HPV-patients, 40 patients (87.1%) had alcohol intoxication and/or smoking. The concept of oral sex was refuted by all our patients. Squamous cell carcinoma was the only histological type found. HPV+ cell carcinoma showed no specific histological appearance. HPVs are another certain RF of HNC in Senegal. The major therapeutic and prognostic impact of HPVinduced cancers requires the systematic search of the viruses by the PCR technique.

The financial burden of morbidity in HIV-infected adults on antiretroviral therapy in Côte d'Ivoire

Background

Large HIV care programs frequently subsidize antiretroviral (ARV) drugs and CD4 tests, but patients must often pay for other health-related drugs and services. We estimated the financial burden of health care for households with HIV-infected adults taking antiretroviral therapy (ART) in Côte d'Ivoire.

Methodology/Principal Findings

We conducted a cross-sectional survey. After obtaining informed consent, we interviewed HIV-infected adults taking ART who had consecutively attended one of 18 HIV care facilities in Abidjan. We collected information on socioeconomic and medical characteristics. The main economic indicators were household capacity-to-pay (overall expenses minus food expenses), and health care expenditures. The primary outcome was the percentage of households confronted with catastrophic health expenditures (health expenditures were defined as catastrophic if they were greater than or equal to 40% of the capacity-to-pay). We recruited 1,190 adults. Median CD4 count was 187/mm³, median time on ART was 14 months, and 72% of subjects were women. Mean household capacity-to-pay was $213.7/month, mean health expenditures were $24.3/month, and 12.3% of households faced catastrophic health expenditures. Of the health expenditures, 75.3% were for the study subject (ARV drugs and CD4 tests, 24.6%; morbidity events diagnosis and treatment, 50.1%; transportation to HIV care centres, 25.3%) and 24.7% were for other household members. When we stratified by most recent CD4 count, morbidity events related expenses were significantly lower when subjects had higher CD4 counts.

Conclusions/Significance

Many households in Côte d'Ivoire face catastrophic health expenditures that are not attributable to ARV drugs or routine follow-up tests. Innovative schemes should be developed to help HIV-infected patients on ART face the cost of morbidity events.

Scaling up antiretroviral therapy for HIV-infected children in Côte d'Ivoire: determinants of survival and loss to programme

OBJECTIVE

To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIV-infected children in Côte d'Ivoire.

METHODS

Between 2004 and 2007, HIV-exposed children at 19 centres were offered free HIV serum tests (polymerase chain reaction tests in those aged < 18 months) and ART. Computerized monitoring was used to determine: (i) the number of confirmed HIV infections, (ii) losses to the programme (i.e. death or loss to follow-up) before ART, (iii) mortality and loss-to-programme rates during 12 months of ART, and (iv) determinants of mortality and losses to the programme.

FINDINGS

The analysis included 3876 ART-naïve children. Of the 1766 with HIV-1 infections (17% aged < 18 months), 124 (7.0%) died, 52 (2.9%) left the programme, 354 (20%) were lost to follow-up before ART, 259 (15%) remained in care without ART, and 977 (55%) started ART (median age: 63 months). The overall mortality rate during ART was significantly higher in the first 3 months than in months 4-12: 32.8 and 6.9 per 100 child-years of follow-up, respectively. Loss-to-programme rates were roughly double mortality rates and followed the same trend with duration of ART. Independent predictors of 12-month mortality on ART were pre-ART weight-for-age z-score < -2, percentage of CD4+ T lymphocytes < 10, World Health Organization HIV/AIDS clinical stage 3 or 4, and blood haemoglobin < 8 g/dl.

CONCLUSION

The large-scale programme to scale up paediatric ART in Côte d'Ivoire was effective. However, ART was often given too late, and early mortality and losses to programme before and just after ART initiation were major problems.

[Determination of the average value of the condylar slope of black Africans]

The objective of this work was to determinate the average value of the condylar slope of Black African subject and to set up its variation according to whether the localization of the hinge axis is real or arbitrary. With this intention, we made an axiographic study at 63 subjects presented complete natural teeth, with a normoclusion in class 1 of Angle. The results of this study reveal that the average value of the slope condylar is 44,28 degrees in arbitrary hinge axis and 45,7 degrees in hinge axis real; and this difference is not statistically significant. The graphic recording of condylar displacement by the "Quick-Axis" is thus possible without risk of error in the layout and the reproduction of the mandible movements which is of a great interest for the general practitioner taking into account the simplicity of handling of the FAG system.

HIV drug resistance surveillance for prioritizing treatment in resource-limited settings

BACKGROUND

Sentinel testing programs for HIV drug resistance in resource-limited settings can inform policy on antiretroviral therapy (ART) and drug sequencing.

OBJECTIVE

: To examine the value of resistance surveillance in influencing recommendations toward effective and cost-effective sequencing of ART regimens.

METHODS

A state-transition model of HIV infection was adapted to simulate clinical care in Côte d'Ivoire and evaluate the incremental cost-effectiveness of (1) no ART; (2) ART beginning with a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen followed by a boosted protease inhibitor (PI)-based regimen; and (3) ART beginning with a boosted PI-based regimen followed by an NNRTI-based regimen.

RESULTS

At a 5% prevalence of NNRTI resistance, a strategy that started with a PI-based regimen had a smaller health benefit and higher cost-effectiveness ratio than a strategy that started with an NNRTI-based regimen (cost-effectiveness ratio $910/year of life saved). Results consistently favored initiation with an NNRTI-based regimen, regardless of the population prevalence of NNRTI resistance (up to 76%) and the efficacy of an NNRTI-based regimen in the setting of resistance. The most influential parameters on the cost-effectiveness of sequencing strategies were boosted PI-based regimen costs and the efficacy of this regimen when used as second-line therapy.

CONCLUSIONS

Drug costs and treatment efficacies, but not NNRTI resistance levels, were most influential in determining optimal HIV drug sequencing in Côte d'Ivoire. Results of surveillance for NNRTI resistance should not be used as a major guide to treatment policy in resource-limited settings.

[Diffuse infiltrative lymphocytosis syndrome (DILS) associated with HIV-1 infection: first Senegalese case report]

INTRODUCTION

The "Diffuse Infiltrative Lymphocytosis Syndrome" [DILS] is a seldom complication and even very particular case of HIV-1 infection, characterized by a merely syndrome and a systemic symptomatology superimposable to the figure met during the Gougerot-Sjögren Syndrome. GSS is nevertheless underlied by a lymphocyte infiltrate composed mainly of TCD8+ lymphocytes, while in the Gougerot-Sjögren syndrome (GSS), the lymphocyte infiltrate is essentially composed of TCD4+ lymphocytes. Despite the antiquity and significance of the HIV/AIDS pandemic, the DILS is not according to our knowledge individualized in the African literature.

OBSERVATION

We are reporting a case revealed by a polyarthritis associated among others with a merely syndrome and a HIV-1 infection in a 32 years old Senegalese patient. Her CD4 rate was 327/mm3 and her viral load 17052. The biopsy of the accessory salivary glands showed a 4 grade lymphocite sialoadenitis according to Chisholm classification. The investigation of rheumatoid factors et anti-nuclear antibodies was negative. Under prednisone, hydroxychloroquine, methotrexate and tritherapy treatment, the evolution was favourable with a current return of 2 years. The rarity of DILS has pushed us to study its epidemiological, clinical, paraclinical, physiopathological and therapeutical aspects.

[The superficial temporal artery: anatomical type and clinical application to the flap of the fascia temporal superficialis]

The goal of our study is to assess the anatomical type of the superficial temporal artery (STA) in the black population using the classification of Ricbourg et al.. Forty-seven fresh cadavers and three extracted and frozen heads were included in this study. The external carotid artery was isolated in the neck and injected by Rhodopas stained with Congo Red. The superficial temporal artery was dissected using a Y-shaped skin incision. The last step of the procedure was to remove the flap of the fascia superficialis temporis. The third segment of the superficial temporal artery and its terminal branches were studied. This segment courses cephalad and wraps the zygomatic arcade. It splits into two terminal branches: the temporo-frontal and the temporo-parietal ones. The most important of its collaterals, the zygomato-maleus artery, plays a crucial role for distinguishing the subtypes of STA according to the classification of Ricbourg et al.. Indeed, this branch can be subdivided into two types: --type I: the zygomato-malar artery arises from the trunk of the STA; it courses perpendicular and with a slightly ascending direction; this type accounts for 93% of the cases. --type II: the zygomato-malar artery originates from the branch of the temporo-frontal artery. Its course is either horizontal or caudad. This type accounts for 3% of the cases. Our results confirm those of Ricbourg et al.. Thus, we could not CONFIRM the notion of a racial predominance of typology of the STA in our context. We did not study the dimensions of STA and also the level of its bifurcation. Indeed, it has been largely reported in the literature. These elements constitute the anatomic basis of the surgical use of temporal flaps. The vessel-containing tissue in which travels the STA forms the so-called fascia temporalis superficialis whose plasticity and polyvalency are critical during the procedures of plastic and reconstructive surgeries.

[Anatomy of the marginal mandibular branch of the facial nerve]

INTRODUCTION

the position of the marginal branch of the mandicular nerve is crucial for the surgical approach to the sub-mandibular region.

MATERIAL AND METHOD

we performed 54 dissections of 30 fresh cadavers to study the anatomy of this branch.

RESULTS

we found a unique marginal branch in 43% of the cases, two branches in 44% and three branches in 13%. In the sub-mandibular region the branch ran lateral to the vessel bundle in 51 cases, was medial to the artery but lateral to the vein in two. In one case, the nerve was lateral to the artery and medial to the vein. The lowest marginal branch was situated 17.5 mm from the inferior border of the mandible and crossed the facial vessels at a point situated 24 mm posteroinferiorly from the mandibular angle.

DISCUSSION

our study demonstrated the wide variability of the marginal branch of the mandibular nerve. We found a variable number of branches, different from earlier reports which have generally described two branches in about 50% of the cases. These differences can be explained by the difficulty in recognizing the marginal branch arising from the inferior buccal branch during dissection. The technique of ligaturing the marginal branch of the facial nerve is not reliable in all cases, since the branch sometimes passes lateral to the artery and vein.

[Compliance in HIV infected adults. Study of opportunistic infection prophylaxis with cotrimoxazole in Ivory Coast]

BACKGROUND

The compliance to a daily treatment for illimited duration and the factors that influence it have been rarely studied in sub-Saharian Africa.

OBJECTIVE

Describe the compliance to prophylaxis with cotrimoxazole fort (one tablet per day) and its associated factors in patients infected by HIV participating in a clinical trial in Abidjan.

METHOD

The tablets packed in individual blisters were provided every month, and the blisters were recuperated the following month. A global compliance ratio (GCR) was established for each patient (empty blisters at the end of the study/follow-up period during the study) and monthly compliance ratio [MCR] (empty blisters during a visit/time lapse since last visit). For each monthly visit foreseen in the protocol, a respect of the appointment ratio (RAR) was described (visits foreseen in the protocol respected that month/visits foreseen in the protocol). The association of GCR with the characteristics on inclusion was studied using logistic regression methods.

RESULTS

530 adults were followed-up for a mean of 10 months. The MCR and the RAR progressed in parallel, decreasing the first 5 months and stabilizing at around 0.80 for the RAR and 0.70 for the MCR. The mean GCR was of 0.77. Three hundred and nine patients (58%) were considered as compliant (0.80<GCR<1). In multivariate analysis, those belonging to the group of compliers were associated with a paid occupation and with a past of tuberculosis, and was not associated with age, gender, level of education, nationality, civil status, number of persons in the home, proximity of a care center, clinical grade or CD4.

DISCUSSION

The estimated compliance was correct and stable. The association with a history of tuberculosis suggests that a person having already followed prolonged daily treatment would be more readily compliant to other long term treatments.

CONCLUSION

In Africa, cotrimoxazole is initiated long before the stage of antiretroviral treatment. The concern regarding the efficacy of such prophylaxis raises the question of compliance early on in the disease. This prepares the teams that organise the management of such patients to being faced with the problems of compliance to antiretrovirals.

[A new case of rhinoscleroma with skin extension]

Scleroma is a chronic and specific granulomatous disease of bacterial origin. Klebsialla rhinoscleromatis, a gram-negative bacillus. The majority of cases affect the upper airways, particularly the nose, thus justifying the term of rhinoscleroma. Extension to the palate, the upper lip and the skin is possible. A new case of rhinoscleroma with skin extension is reported. To us, this is the second case in Senegal (Casamance). Epidemiological, clinical, bacteriological and histological aspects of the disease are reviewed. Under suitable antibiotic, evolution is currently favorable.

Medium-term survival, morbidity and immunovirological evolution in HIV-infected adults receiving antiretroviral therapy, Abidjan, Côte d'Ivoire

OBJECTIVES

To evaluate survival, morbidity, and CD4 and viral load (VL) evolution in HIV-infected adults receiving antiretroviral therapy (ART) in Côte d'Ivoire.

METHODS

Since 1996, 723 HIV-infected adults have been followed up in the ANRS 1203 cohort study in Abidjan. For those patients who received ART, we describe data between ART initiation and August 2002.

RESULTS

One-hundred-and-one adults (61% women) were followed up under ART for a median of 17 months. At ART initiation, median age, CD4 count and VL were 36 years, 135/mm3 and 5.3 log10 copies/ml, respectively. Initial ART regimens were two nucleoside reverse transcriptase inhibitors (NRTIs) plus one protease inhibitor in 74 patients, two NRTIs plus one non-nucleoside reverse transcriptase inhibitor in 16, and two NRTIs in 11. No patient was lost to follow-up. The most frequent causes of severe morbidity were bacterial infections [11.6/100 person-years (PY), 95% CI: 7.2-18.7], drug-related events (6.5/100 PY, 3.5-12.0), tuberculosis (3.1/100 PY, 1.3-7.4) and malaria (3.1/100 PY, 1.3-7.4). The incidence of death was 3.0/100 PY (1.1-8.0) in patients with baseline CD4 > or = 50/mm3 and 16.1/100 PY (7.2-35.9) in patients with CD4 < 50/mm3. Fifty percent of causes of death were active infections pre-existing ART initiation, mainly atypical mycobacteriosis. After 1 year, 51% of patients had undetectable VL, 28% had detectable VL reduced by more than 0.5 log10 copies/ml since ART initiation, and the median gain in CD4 was +115/mm3.

CONCLUSION

Medium-term survival under ART may be as good in Africa as in industrialized countries, provided that patients benefit from access to care for opportunistic infections, including bacterial diseases, tuberculosis and malaria.

Medium-Term Survival, Morbidity and Immunovirological Evolution in HIV-Infected Adults Receiving Antiretroviral Therapy, Abidjan, Côte D'Ivoire

Objectives

To evaluate survival, morbidity, and CD4 and viral load (VL) evolution in HIV-infected adults receiving antiretroviral therapy (ART) in Côte d'Ivoire.

Methods

Since 1996, 723 HIV-infected adults have been followed up in the ANRS 1203 cohort study in Abidjan. For those patients who received ART, we describe data between ART initiation and August 2002.

Results

One-hundred-and-one adults (61% women) were followed up under ART for a median of 17 months. At ART initiation, median age, CD4 count and VL were 36 years, 135/mm3 and 5.3 log10 copies/ml, respectively. Initial ART regimens were two nucleoside reverse transcriptase inhibitors (NRTIs) plus one protease inhibitor in 74 patients, two NRTIs plus one non-nucleoside reverse transcriptase inhibitor in 16, and two NRTIs in 11. No patient was lost to follow-up. The most frequent causes of severe morbidity were bacterial infections [11.6/100 person-years (PY), 95% CI: 7.2–18.7], drug-related events (6.5/100 PY, 3.5–12.0), tuberculosis (3.1/100 PY, 1.3–7.4) and malaria (3.1/100 PY, 1.3–7.4). The incidence of death was 3.0/100 PY (1.1–8.0) in patients with baseline CD4 ≥50/mm3 and 16.1/100 PY (7.2–35.9) in patients with CD4 <50/mm3. Fifty percent of causes of death were active infections pre-existing ART initiation, mainly atypical mycobacteriosis. After 1 year, 51% of patients had undetectable VL, 28% had detectable VL reduced by more than 0.5 log10 copies/ml since ART initiation, and the median gain in CD4 was +115/mm3.

Conclusion

Medium-term survival under ART may be as good in Africa as in industrialized countries, provided that patients benefit from access to care for opportunistic infections, including bacterial diseases, tuberculosis and malaria.

Causes and empirical treatment of fever in HIV-infected adult outpatients, Abidjan, Côte d'Ivoire

OBJECTIVES

In Abidjan, HIV prevalence has been estimated at 20% in outpatients attending community clinics. Documenting causes of fever in HIV-infected adult outpatients may help to improve care in these centres with limited facilities.

DESIGN

Prospective study.

METHODS

We describe all diagnoses and treatments made during febrile episodes in HIV-infected adults participating in the ANRS 059 trial and followed up in a dedicated outpatient centre.

RESULTS

Causes of fever could be identified in half of the 269 febrile episodes. Bacterial diseases were the leading identified cause of fever in all CD4 cell count strata (53, 56 and 43% of identified causes in episodes with CD4 count < 200 x 106/l, 200-499 x 106/l, and >or= 500 x 106/l, respectively), followed by malaria (5, 22, and 38%, respectively). Among febrile bacterial diseases, respiratory tract infections and enteritis accounted for 62% of organ involvement, and Streptococcus pneumoniae and non-typhi Salmonella represented 69% of isolated bacterial strains. In these bacterial episodes, an early empirical antibacterial treatment was associated with shorter duration of hospitalization and fever. In the 19 episodes leading to death (7%), the two leading diagnoses were atypical mycobacteriosis (26%) and acute unexplained fever (21%). Death was associated with the absence of antimalarial treatment in the group of acute unexplained fevers.

CONCLUSIONS

African HIV treatment guidelines should take into account the predominant role of bacterial infections and malaria in HIV-infected adult outpatients. Reports from other African settings would be useful to compare experiences in algorithms of empirical early antibacterial and antimalarial treatments.

Prognostic value of cross-sectional anthropometric indices on short-term risk of mortality in human immunodeficiency virus-infected adults in Abidjan, Côte d'Ivoire

In sub-Saharan Africa where weight loss is very difficult to estimate, cross-sectional anthropometric indicators could be useful to predict human immunodeficiency virus (HIV)-associated mortality. The study objective was to look for threshold values of baseline body mass index, arm muscle circumference, and fat mass to predict the risk of death in HIV-infected adults included in a 1996-1998 trial of early cotrimoxazole chemoprophylaxis in Abidjan, Côte d'Ivoire (COTRIMO-CI-ANRS 059 trial). The authors graphically determined if consecutive anthropometric categories with the closest hazards ratios of the risk of death could be clustered to obtain a unique threshold that distinctly separated two categories. When the threshold values were determined, the authors estimated the hazards ratio of mortality of this two-category model. A significant increase of mortality was observed for a body mass index of < or =20.3 in men (hazards ratio = 2.6; 95% confidence interval (CI): 1.4, 5.0) and of < or =18.5 in women (hazards ratio = 2.2; 95% CI: 1.05, 4.5) and for a fat mass of < or =6% in men (hazards ratio = 4.6; 95% CI: 2.3, 9.4) and of < or =18% in women (hazards ratio = 2.4; 95% CI: 1.2, 4.9). No simple threshold could be identified for arm muscle circumference. In Côte d'Ivoire where chemoprophylaxis of opportunistic infections has recently been recommended to be widely initiated on clinical criteria, such thresholds may help to screen patients with higher risks of mortality.

[Etiologic and nosologic considerations apropos of 574 cases of cardiac decompensation in Conakry]

The authors analyze 574 cases of heart failure observed in the Cardiology Department of the University Hospital Ignace-Deen in Conakry, in a period of 5 years (1981-1985), from the etiological and nosological standpoints. The result is that cardiac insufficiency is very frequent in the department and the patients, in most cases, are found in stage IV of the NYHA (64.98%). There are more men (59.75%) than women (40.25%). Age varies from 15 to 80 years (mean: 49.2 years). Hypertension (37.47%), senile cardiopathies (20.20%), various myocardiopathies (17.24%), rheumatoid valvulopathies (13.95%) are the most frequently encountered etiologies. Pericarditis is rare (0.34%).