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Tagnouokam-Ngoupo PA, Toby R, Bomba Ebede MO, Kenmoe S, Ngo-Malabo ET, Sadeuh-Mba SA, Biwole-Sida M, Njouom R. Detection of herpesviruses and enteroviruses in patients with suspected infectious meningoencephalitis in three referral hospitals in Yaounde, Cameroon. J Med Virol 2020; 92:3843-3848. [PMID: 32492202 DOI: 10.1002/jmv.26109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/24/2020] [Accepted: 05/31/2020] [Indexed: 11/10/2022]
Abstract
In Cameroon, routine diagnosis of central nervous system (CNS) infections is based on the detection of bacteria, fungi, parasites, and mycobacteria in cerebrospinal fluids. Therefore, there is no data on viral etiologies of meningoencephalitis (ME) in the country. We aim to identify viral etiologies (herpesviruses and enteroviruses) of ME in Cameroon, to provide useful information to physicians that will help improving management of ME. From February to May 2018, adult patients with clinical signs of ME in three referral hospitals in Yaounde were included. Detection of herpesviruses and enteroviruses was performed using reverse transcriptase polymerase chain reaction. P value of 5% was chosen as the threshold for statistical significance in statistical analyses. Eighty-one patients were included and 15 (18.51%) were positive for herpesviruses. No enterovirus was detected. The most prevalent virus was Epstein-Barr virus (8.6%) and most of herpesviruses were detected from human immunodefeciency virus (HIV)-positive patients (86.7%). The overall mortality rate was high, 60.5% (49/81) and analysis of risk factors showed that HIV-positive status and altered state of consciousness were associated with higher risk of death (odds ratio [OR], 5.41; confidence interval [CI]: 1.91-16.88; P = .002 and OR, 3.24; CI: 1.11-0.13; P = .036 respectively). We showed that herpesviruses are present in patients with ME symptoms in Yaounde and can be sometimes in coinfection with others common pathogens of CNS infections. There is therefore a need for increased clinician awareness and education regarding the diagnostic and management of CNS infections in Cameroon to limit unnecessary use of antibiotics.
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Affiliation(s)
| | - Roselyne Toby
- Infectious Disease Ward, Yaounde Central Hospital, Yaounde, Cameroon
| | | | - Sebastien Kenmoe
- Department of Virology, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | | | | | - Magloire Biwole-Sida
- Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaounde, Cameroon
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Boyer S, Nishimwe ML, Sagaon-Teyssier L, March L, Koulla-Shiro S, Bousmah MQ, Toby R, Mpoudi-Etame MP, Ngom Gueye NF, Sawadogo A, Kouanfack C, Ciaffi L, Spire B, Delaporte E. Cost-Effectiveness of Three Alternative Boosted Protease Inhibitor-Based Second-Line Regimens in HIV-Infected Patients in West and Central Africa. Pharmacoecon Open 2020; 4:45-60. [PMID: 31273686 PMCID: PMC7018873 DOI: 10.1007/s41669-019-0157-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND While dolutegravir has been added by WHO as a preferred second-line option for the treatment of HIV infection, boosted protease inhibitor (bPI)-based regimens are still needed as alternative second-line options. Identifying optimal bPI-based second-line combinations is essential, given associated high costs and funding constraints in low- and middle-income countries. We assessed the cost-effectiveness of three alternative bPI-based second-line regimens in Burkina Faso, Cameroon and Senegal. METHODS We used data collected over 2010-2015 in the 2LADY trial/post-trial cohort. Patients with first-line antiretroviral therapy (ART) failure were randomly assigned to tenofovir/emtricitabine + lopinavir/ritonavir (TDF/FTC LPV/r; arm A), abacavir + didanosine + lopinavir/ritonavir (arm B), or tenofovir/emtricitabine + darunavir/ritonavir (arm C). Costs (US dollars, 2016), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios were computed for each country over 24 months of follow-up and extrapolated to 5 years using a simulated patient-level Markov model. We assessed uncertainty using cost-effectiveness acceptability curves, scenarios and prices threshold analysis. RESULTS In each country, over 24 months, arm A was significantly less costly than arms B and C (incremental costs ranging from US$410-$US721 and US$468-US$546 for B and C vs A, respectively) and offered similar health benefits (incremental QALY: - 0.138 to 0.023 and - 0.179 to 0.028, respectively). Over 5 years, arm A remained the least costly, health benefits not being significantly different between arms. Compared with arms B and C, in each study country, Arm A had a ≥ 95% probability of being cost-effective for a large range of cost-effectiveness thresholds, irrespective of the scenario considered. CONCLUSIONS Using TDF/FTC LPV/r as a bPI-based second-line regimen provided the best economic value in the three study countries. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00928187.
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Affiliation(s)
- S Boyer
- Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France
| | - M L Nishimwe
- Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France.
| | - L Sagaon-Teyssier
- Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - L March
- UMI 233, Institut de Recherche pour le Développement (IRD), INSERM U1175, University of Montpellier, Montpellier, France
| | - S Koulla-Shiro
- Infectious Diseases Department, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - M-Q Bousmah
- Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - R Toby
- Day Care Unit, Central Hospital, Yaoundé, Cameroon
| | - M P Mpoudi-Etame
- Epidemiology and Infectious Diseases Service, Region 1 Military Hospital, Yaoundé, Cameroon
| | | | - A Sawadogo
- Day Care Unit, University Hospital Souro Sanou, Bobo-Dioulasso, Burkina Faso
| | - C Kouanfack
- Yaoundé Central Hospital, Yaoundé, Cameroon
- Faculty of Medicine and Pharmacology Sciences, Dschang University, Dschang, Cameroon
| | - L Ciaffi
- UMI 233, Institut de Recherche pour le Développement (IRD), INSERM U1175, University of Montpellier, Montpellier, France
| | - B Spire
- Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France
| | - E Delaporte
- UMI 233, Institut de Recherche pour le Développement (IRD), INSERM U1175, University of Montpellier, Montpellier, France
- Department of Infectious Diseases, University Hospital, Montpellier, France
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Galy A, Ciaffi L, Mberyo GM, Mbouyap P, Abessolo H, Toby R, Essomba F, Lamarre G, Bikié A, Bell O, Koulla-Shiro S, Delaporte E. Implementation and evaluation of a therapeutic patient education programme during a clinical trial in Yaoundé, Cameroon - Trial ANRS-12286/MOBIDIP. Patient Educ Couns 2018; 101:1262-1269. [PMID: 29433950 DOI: 10.1016/j.pec.2018.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 01/22/2018] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES High adherence is needed to maintain antiretroviral therapy efficacy. Few attempts at therapeutic patient education (TPE) have been made in sub-Saharan Africa. We describe patients' achievements before intervention and identified needs, TPE programme implementation and evaluation, and patients' satisfaction. METHODS The TPE programme was proposed to patients in the ANRS-12286/MOBIDIP trial. Beforehand, a directory of competences to manage HIV infection was designed. Patients' HIV-related knowledge and skills assessment was realised, leading to an educational contract. Evaluation was performed using a standardised collection form and a satisfaction survey. RESULTS Of 154 patients, 146 underwent TPE. During a median of 1.8 years, 47% of patients had ≥3 consultations. Educational assessment revealed limited knowledge about HIV disease. Conversely, patients had frequently managed issues of adherence or disclosure. A median of 12 objectives were considered per patient, and 75% were attained. Objectives from the cognitive domain were less frequently attained. Patients appeared satisfied with the intervention: more emphasis was placed on psycho-affective aspects or experience-sharing than on the acquisition of knowledge. CONCLUSION Active listening, know-how and a space for discussion appear more important for patients than knowledge on disease or treatments. PRACTICE IMPLICATIONS In HIV care, the directory of learning objectives should be revised to include more objectives concerning practical skills for disease management.
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Affiliation(s)
- Adrien Galy
- Institut de Recherche pour le Développement (IRD), UMI233 - TransVIHMI, INSERM U1175, University of Montpellier, Montpellier, France; ANRS Research Centre, Yaounde Central Hospital, Yaoundé, Cameroon.
| | - Laura Ciaffi
- Institut de Recherche pour le Développement (IRD), UMI233 - TransVIHMI, INSERM U1175, University of Montpellier, Montpellier, France; ANRS Research Centre, Yaounde Central Hospital, Yaoundé, Cameroon.
| | | | - Pretty Mbouyap
- ANRS Research Centre, Yaounde Central Hospital, Yaoundé, Cameroon
| | - Hermine Abessolo
- ANRS Research Centre, Yaounde Central Hospital, Yaoundé, Cameroon; Department of Infectious Diseases, Yaounde Central Hospital, Yaounde, Cameroon
| | - Roselyne Toby
- ANRS Research Centre, Yaounde Central Hospital, Yaoundé, Cameroon; Department of Infectious Diseases, Yaounde Central Hospital, Yaounde, Cameroon
| | - Frida Essomba
- ANRS Research Centre, Yaounde Central Hospital, Yaoundé, Cameroon
| | | | - Angeline Bikié
- ANRS Research Centre, Yaounde Central Hospital, Yaoundé, Cameroon
| | - Olga Bell
- ANRS Research Centre, Yaounde Central Hospital, Yaoundé, Cameroon
| | - Sinata Koulla-Shiro
- ANRS Research Centre, Yaounde Central Hospital, Yaoundé, Cameroon; Department of Infectious Diseases, Yaounde Central Hospital, Yaounde, Cameroon
| | - Eric Delaporte
- Institut de Recherche pour le Développement (IRD), UMI233 - TransVIHMI, INSERM U1175, University of Montpellier, Montpellier, France; Department of Infectious Diseases, University Hospital, Montpellier, France
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Ciaffi L, Koulla-Shiro S, Sawadogo AB, Ndour CT, Eymard-Duvernay S, Mbouyap PR, Ayangma L, Zoungrana J, Gueye NFN, Diallo M, Izard S, Bado G, Kane CT, Aghokeng AF, Peeters M, Girard PM, Le Moing V, Reynes J, Delaporte E, Reynes J, Delaporte E, Koulla-Shiro S, Ndour CT, Sawadogo AB, Seidy M, Le Moing V, Calmy A, Ciaffi L, Gueye NFN, Girard PM, Eholie S, Guiard-Schmid JB, Chaix ML, Kouanfack C, Tita I, Bazin B, Garcia P, Le Moing V, Izard S, Eymard-Duvernay S, Ciaffi L, Peeters M, Serrano L, Cournil A, Delaporte E, Mbouyap PR, Toby R, Manga N, Ayangma L, Mpoudi M, Zoungrana NJ, Diallo M, Gueye NFN, Aghokeng AF, Guichet E, Bell O, Abessolo HA, Djoubgang MR, Manirakiza G, Lamarre G, Mbarga T, Epanda S, Bikie A, Nke T, Massaha N, Nke E, Bikobo D, Olinga J, Elat O, Diop A, Diouf B, Bara N, Fall MBK, Kane CT, Seck FB, Ba S, Njantou P, Ndyaye A, Fao P, Traore R, Sanou Y, Bado G, Coulibaly M, Some E, Some J, Kambou A, Tapsoba A, Sombie D, Sanou S, Traore B, Flandre P, Michon C, Drabo J, Simon F. Boosted protease inhibitor monotherapy versus boosted protease inhibitor plus lamivudine dual therapy as second-line maintenance treatment for HIV-1-infected patients in sub-Saharan Africa (ANRS12 286/MOBIDIP): a multicentre, randomised, parallel, open-label, superiority trial. The Lancet HIV 2017; 4:e384-e392. [DOI: 10.1016/s2352-3018(17)30069-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 02/22/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
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Serris A, Zoungrana J, Diallo M, Toby R, Mpoudi Ngolle M, Le Gac S, Coutherut J, Cournil A, De Beaudrap P, Koulla-Shiro S, Delaporte E, Ciaffi L. Getting pregnant in HIV clinical trials: women's choice and safety needs. The experience from the ANRS12169-2LADY and ANRS12286-MOBIDIP trials. HIV Clin Trials 2016; 17:233-241. [PMID: 27801628 DOI: 10.1080/15284336.2016.1248624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Pregnancy is an exclusion criteria in most clinical trials involving antiretroviral therapy (ART) and modern contraception methods are systematically proposed to women of childbearing age. Nevertheless pregnancies are often observed. Reproductive choices during clinical trials should be understood to adapt interventions to the level of risk for mother and baby safety. Our goal was to describe the reproductive behavior and pregnancy outcomes among HIV-infected women on second-line antiretroviral treatment enrolled in two clinical trials and to compare them with those of HIV-positive women in non-research settings. METHODS The number and outcomes of pregnancies were recorded among 281 non menopausal women enrolled in the ANRS 12169-2LADY and ANRS 12286-MOBIDIP clinical trials in Cameroon, Senegal and Burkina Faso. All participants had agreed to use a least one contraceptive method (barrier or non-barrier) which was provided for free during the study. Data were collected through revision of pregnancy notification forms and by data extraction from the study database, regularly updated and checked during the study. RESULTS Sixty-six women had 84 pregnancies between January 2010 and July 2015 resulting in a pregnancy rate of 8.0 per 100 women-years (WY) (95% CI 6.5-9.9) which is similar to the ones observed in cohort studies in Sub-Saharan Africa (varying from 2.5 to 9.4 pregnancies per 100 WY). Among 60 live births, 10 (16.6%) were born prematurely and 9 (15%) had a low birth weight. Sixteen miscarriages/stillbirths occurred (19.5%). This percentage is comparable to the one expected in the seronegative population which is reassuring for HIV-positive women considering pregnancy on ART. Only one minor birth defect was diagnosed. In univariate and multivariate analysis, miscarriages/stillbirths were not associated either with age, nadir of CD4 count, duration of ART, CD4 count, or viral load at the beginning of pregnancy. CONCLUSION HIV-positive women participating in clinical trials conducted in Sub-Saharan Africa tend to get pregnant as often as seropositive women who received medical care in non-research settings. It is therefore essential to adopt a pragmatic approach by re-evaluating the relevance of the criteria for exclusion of pregnant women according to the risk associated with exposure and to seek more effective and innovating contraceptive strategies when using potentially teratogenic molecules.
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Affiliation(s)
- Alexandra Serris
- a UMI233 Institut de Recherche pour le Développement (IRD), INSERM U1175 , University of Montpellier , Montpellier , France
| | - Jacques Zoungrana
- b Day care unit , Sanou Sauro hospital , Bobo Dioulasso , Burkina Faso
| | - Mamadou Diallo
- c CRCF, Regional Research and Training Centre for HIV , Fann University Hospital , Dakar , Senegal
| | - Roselyne Toby
- d Department of Infectious Diseases , Central Hospital , Yaounde , Cameroon
| | | | - Sylvie Le Gac
- f ANRS Research Centre, Central Hospital , Yaounde , Cameroon
| | | | - Amandine Cournil
- a UMI233 Institut de Recherche pour le Développement (IRD), INSERM U1175 , University of Montpellier , Montpellier , France
| | | | - Sinata Koulla-Shiro
- d Department of Infectious Diseases , Central Hospital , Yaounde , Cameroon.,i Faculté de Médecine et des Sciences Biomédicales , University of Yaoundé 1 , Yaounde , Cameroon
| | - Eric Delaporte
- a UMI233 Institut de Recherche pour le Développement (IRD), INSERM U1175 , University of Montpellier , Montpellier , France.,j Department of Infectious Diseases , University Hospital , Montpellier , France
| | - Laura Ciaffi
- a UMI233 Institut de Recherche pour le Développement (IRD), INSERM U1175 , University of Montpellier , Montpellier , France
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Galy A, Ciaffi L, Le Moing V, Eymard-Duvernay S, Abessolo H, Toby R, Ayangma L, Le Gac S, Mpoudi-Etame M, Koulla-Shiro S, Delaporte E, Cournil A. Incidence of infectious morbidity events after second-line antiretroviral therapy initiation in HIV-infected adults in Yaoundé, Cameroon. Antivir Ther 2016; 21:547-552. [PMID: 26882335 DOI: 10.3851/imp3030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Since antiretroviral therapy (ART), HIV-infected individuals experience mainly non-AIDS-related conditions, among which infectious events are prominent. We aimed to estimate incidence and describe overall spectrum of infectious events, including all grade events, among HIV-1-infected adults failing first-line ART in Yaoundé, Cameroon. METHODS All patients from Cameroon enrolled in the second-line ART 2LADY trial (ANRS12169) were included in this secondary analysis. Medical files were reviewed with predefined criteria for diagnosis assessment. Incidence rates (IR) were estimated per 100 person-years (% PY). RESULTS A total of 302 adult patients contributing 840 PY experienced 596 infectious events (IR 71% PY). Only 29 (5%) events were graded as severe. Most frequent infections were upper respiratory tract infections (15% PY), diarrhoea (9% PY) and malaria (9% PY). A total of 369 (62%) infections occurred during the first year (IR 130% PY) followed by a persistent lower incidence during the following 3 years. Higher IR were observed in patients with CD4+ T-cell count <200 cells/mm3 for all infectious events except for mycobacterial and parasitic infections. IR of viral, bacterial and parasitic infectious events were lower in case of co-trimoxazole use in patients with CD4+ T-cell count <200 cells/mm3. CONCLUSIONS Infectious events are common and mainly occur during the first year after treatment initiation. Second-line ART initiation had a positive impact on the entire spectrum of infectious morbidity.
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Affiliation(s)
- Adrien Galy
- Institut de Recherche pour le Développement (IRD) UMI233, INSERM U1175, University of Montpellier, Montpellier, France
| | - Laura Ciaffi
- Institut de Recherche pour le Développement (IRD) UMI233, INSERM U1175, University of Montpellier, Montpellier, France.,ANRS Research Center, Hôpital Central de Yaoundé, Yaoundé, Cameroon
| | - Vincent Le Moing
- Institut de Recherche pour le Développement (IRD) UMI233, INSERM U1175, University of Montpellier, Montpellier, France.,Department of Infectious Diseases, University Hospital, Montpellier, France
| | - Sabrina Eymard-Duvernay
- Institut de Recherche pour le Développement (IRD) UMI233, INSERM U1175, University of Montpellier, Montpellier, France
| | - Hermine Abessolo
- ANRS Research Center, Hôpital Central de Yaoundé, Yaoundé, Cameroon
| | - Roselyne Toby
- ANRS Research Center, Hôpital Central de Yaoundé, Yaoundé, Cameroon
| | | | - Sylvie Le Gac
- ANRS Research Center, Hôpital Central de Yaoundé, Yaoundé, Cameroon
| | | | - Sinata Koulla-Shiro
- ANRS Research Center, Hôpital Central de Yaoundé, Yaoundé, Cameroon.,Faculté de Médecine et des Sciences Biomédicales (FMSB), University of Yaoundé 1, Yaoundé, Cameroon
| | - Eric Delaporte
- Institut de Recherche pour le Développement (IRD) UMI233, INSERM U1175, University of Montpellier, Montpellier, France.,Department of Infectious Diseases, University Hospital, Montpellier, France
| | - Amandine Cournil
- Institut de Recherche pour le Développement (IRD) UMI233, INSERM U1175, University of Montpellier, Montpellier, France
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Agbor AA, Bigna JJR, Plottel CS, Billong SC, Tejiokem MC, Ekali GL, Noubiap JJN, Toby R, Abessolo H, Koulla-Shiro S. Characteristics of patients co-infected with HIV at the time of inpatient tuberculosis treatment initiation in Yaoundé, Cameroon: a tertiary care hospital-based cross-sectional study. ACTA ACUST UNITED AC 2015; 73:24. [PMID: 25941570 PMCID: PMC4418067 DOI: 10.1186/s13690-015-0075-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/07/2015] [Indexed: 12/26/2022]
Abstract
Background Knowledge of the characteristics of patients co-infected with tuberculosis (TB) and human immunodeficiency virus (HIV) when TB treatment is initiated would allow clinicians to improve care and help policy-makers develop relevant and realistic guidelines. The aim of this study was to describe socio-demographic, clinical, and laboratory characteristics of TB/HIV co-infected patients starting inpatient TB treatment in Yaoundé, Cameroon. Methods We conducted a retrospective cross-sectional study, collecting data from medical records of HIV-infected patients with TB, aged 15 years old or more, hospitalized in the Infectious Diseases Unit of the Yaoundé Central Hospital, Cameroon from January 1, 2006 to June 30, 2013. Results The mean age of 337 patients meeting study inclusion criteria was 39.3 years. More than half were female (53.4%). Most (89.3%) resided in urban areas, 44.2% had a secondary education, and 46.0% were married. The majority was receiving co-trimoxazole prophylaxis (79.5%), and two thirds were taking antiretroviral therapy (67.4%). The mean duration of known HIV infection before TB treatment was 8.4 months. Most (88.1%) had newly diagnosed TB, rather than relapsed disease. Smear-positive pulmonary TB was documented in a third, (35.3%). Laboratory data revealed a median white blood cell count of 5,100 cells/mm3 (IQR 3,300-7,990 cells/mm3), a median hemoglobin level of 8 g/dl (IQR 7–10 g/dl), and a median CD4 cell count of 102 cells/mm3 (IQR 33–178 cells/mm3). Sex differences in our study included older age in the men (p < 0.001), more of whom were married (p < 0.001) and had achieved a higher level of education (p = 0.042). Men had fewer diagnoses of smear-positive pulmonary TB (p = 0.020). They weighed more than the women (p = 0.001) and had higher hemoglobin levels (p = 0.003). Conclusions Suboptimal adherence to WHO treatment recommendations in our Cameroonian study reinforces the importance of prescribing co-trimoxazole in HIV infection and ART for all TB/HIV co-infected persons. We urge that Ministries of Health continue implementing and disseminating guidelines for management of TB/HIV co-infected patients, and we call for measures ensuring that healthcare facilities’ stocks of ART and co-trimoxazole are sufficient to meet the need for both.
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Affiliation(s)
- Ako A Agbor
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | - Claudia S Plottel
- Department of Medicine, New York University Langone Medical Center, New York, USA ; Department of Medicine, New York University School of Medicine, New York, USA
| | - Serges Clotaire Billong
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon ; National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - Mathurin Cyrille Tejiokem
- Department of Epidemiology and Public Health, Centre Pasteur du Cameroun, Member of International Network of the Pasteur Institutes, Garoua, Cameroon
| | - Gabriel L Ekali
- National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - Jean Jacques N Noubiap
- Internal Medicine Unit, Edéa Regional Hospital, Edéa, Cameroon ; Medical Diagnostic Center, Yaounde, Cameroon
| | - Roselyne Toby
- Infectious Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Hermine Abessolo
- Infectious Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Sinata Koulla-Shiro
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon ; Infectious Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
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Agbor AA, Bigna JJR, Billong SC, Tejiokem MC, Ekali GL, Plottel CS, Noubiap JJN, Abessolo H, Toby R, Koulla-Shiro S. Factors associated with death during tuberculosis treatment of patients co-infected with HIV at the Yaoundé Central Hospital, Cameroon: an 8-year hospital-based retrospective cohort study (2006-2013). PLoS One 2014; 9:e115211. [PMID: 25506830 PMCID: PMC4266669 DOI: 10.1371/journal.pone.0115211] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/19/2014] [Indexed: 11/21/2022] Open
Abstract
Background Contributors to fatal outcomes in TB/HIV co-infected patients actively undergoing TB treatment are poorly characterized. The aim was to assess factors associated with death in TB/HIV co-infected patients during the initial 6 months of TB treatment. Methods We conducted a hospital-based retrospective cohort study from January 2006 to December 2013 at the Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify hospitalized co-infected TB/HIV patients aged 15 years and older. Death was defined as any death occurring during TB treatment, as per the World Health Organization's recommendations. We conducted logistic regression analysis to identify factors associated with a fatal outcome. Magnitudes of associations were expressed by adjusted odds ratio (aOR) with 95% confidence interval. Results The 337 patients enrolled had a mean age of 39.3 (standard deviation 10.3) years and 54.3% were female. TB treatment outcomes were distributed as follows: 205 (60.8%) treatment success, 99 (29.4%) deaths, 18 (5.3%) not evaluated, 14 (4.2%) lost to follow-up, and 1 (0.3%) failed. After exclusion of patients lost to follow-up and not evaluated, death in TB/HIV co-infected patients during TB treatment was associated with a TB diagnosis made before 2010 (aOR = 2.50 [1.31–4.78]; p = 0.006), the presence of other AIDS-defining diseases (aOR = 2.73 [1.27–5.86]; p = 0.010), non-AIDS comorbidities (aOR = 3.35 [1.37–8.21]; p = 0.008), not receiving cotrimoxazole prophylaxis (aOR = 3.61 [1.71–7.63]; p = 0.001), not receiving antiretroviral therapy (aOR = 2.45 [1.18–5.08]; p = 0.016), and CD4 cells count <50 cells/mm3 (aOR = 16.43 [1.05–258.04]; p = 0.047). Conclusions The TB treatment success rate among TB/HIV co-infected patients in our setting is low. Mortality was high among TB/HIV co-infected patients during TB treatment and is strongly associated with clinical and biological factors, highlighting the urgent need for specific interventions focused on enhancing patient outcomes.
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Affiliation(s)
- Ako A. Agbor
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
| | - Jean Joel R. Bigna
- Goulfey Health District Unit, Ministry of Public Health, P.O. Box 62 Kousséri, Goulfey, Cameroon
- * E-mail:
| | - Serges Clotaire Billong
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
- National AIDS control committee, Ministry of Public Health, P.O. Box 1459, Yaoundé, Cameroon
| | - Mathurin Cyrille Tejiokem
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroun, P.O. Box 1264 Yaoundé, Cameroon, Member International Network of the Pasteur Institute
| | - Gabriel L. Ekali
- National AIDS control committee, Ministry of Public Health, P.O. Box 1459, Yaoundé, Cameroon
| | - Claudia S. Plottel
- Department of Medicine, New York University Langone Medical Center, New York, New York, United States of America
- Department of Medicine, New York University School of Medicine, New York, New York, United States of America
| | | | - Hortence Abessolo
- Infectious Diseases Unit, Yaoundé Central Hospital, P.O. Box 5555 Yaoundé, Cameroon
| | - Roselyne Toby
- Infectious Diseases Unit, Yaoundé Central Hospital, P.O. Box 5555 Yaoundé, Cameroon
| | - Sinata Koulla-Shiro
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
- Infectious Diseases Unit, Yaoundé Central Hospital, P.O. Box 5555 Yaoundé, Cameroon
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