[Tuberculosis and HIV in Bangui, Central African Republic: strong prevalence and management difficulties]. / Tuberculose et VIH à Bangui, République centrafricaine: forte prévalence et difficultés de prise en charge.

The increasing incidence of tuberculosis in relation with the HIV-AIDS epidemic poses a major public health problem in sub-Saharan Africa. The purpose of this retrospective study was to analyze the prevalence of HIV-1 infection, clinical presentation, and bacteriological findings in patients treated for tuberculosis in a hospital department in Bangui, Central African Republic between January 1996 and December 1998. Among the 1142 patients who benefited for HIV serology, HIV-1 prevalence of was 82% (IC95%: 79-85%). Most patients (92%), had not undergone HIV serology before hospitalization. Mean age was 34 years. Sex ratio F/M was 1.21. Diagnosis of tuberculosis was based mainly on clinical and radiological data. Positive sputum smears were available for only 52% of the patients. The most frequent site of tuberculosis was the lungs with no significant difference between the HIV-positive and HIV-negative groups (83% versus 79% respectively). Sputum-smear examination was positive in 42% of the patients with no significant difference between the HIV-positive and HIV-negative groups (43% versus 37%). Upon admission patients usually presented advanced disease, with 11% dying within a week after hospitalization. There was a steep increase in the prevalence of HIV in tuberculosis-infected patients in Banqui, from 32% in 1988 to 62% in 1994. In spite of the existence of a National Tuberculosis Control Program, diagnostic facilities remain limited and diagnosis of tuberculosis and HIV-infection is often delayed. Outpatient care must be improved.

[Tuberculosis and human immunodeficiency virus infection in the Central African Republic]. / Tuberculose et infection par le virus de l'immunodéficience humaine en République Centrafricaine.

In order to determine the proportion of tuberculosis (TB) patients in Bangui (Central African Republic) infected with human immunodeficiency virus (HIV), we collected prospectively serum samples from all new TB patients seen at the University Hospital in Bangui during a three-month period (nov. 87-Jan. 88). 220 serum samples were tested for antibodies to HIV, by an Elisa assay and confirmed by Western-Blot. The general HIV seropositivity rate among TB patients was 27.7% (31.2% in adults (N = 183), and 10.8% in children (N = 37)). Within the adult population, there was non association between HIV infection and sex or previous history of TB. Seropositivity was more common in patients with extrapulmonary TB, especially lymphadenitis, and in patients with mediastinal adenopathy, or extensive pulmonary involvement without cavitation. Seropositivity was also strongly associated with negative tuberculin skin tests, chronic diarrhoea, generalized lymphadenopathy, and thrush. It is concluded that HIV infection is responsible for the increasing incidence of tuberculosis in Central African Republic, and that investigations for TB should be carried out in every symptomatic African patient infected with HIV.