[Failure of first-line antiretroviral therapy in HIV-infected children in Ouagadougou, Burkina Faso]. / Echecs du traitement antirétroviral de première ligne chez les enfants infectés par le VIH à Ouagadougou (Burkina Faso).

Approximately one-fourth of the estimated 10,000 HIV-infected children in Burkina Faso are undergoing antiretroviral (ARV) therapy. At the Charles de Gaulle Pediatric Hospital Center in Ouagadougou, Burkina Faso, Support for ARV therapy began in July 2003 and a total of 250 children were undergoing treatment in late 2007. The purpose of this retrospective case-control study conducted over a period of 54 months from July 2003 to December 2007 was to investigate cases involving failure of first-line ARV therapy in particular with regard to cause. All patients (n = 32) showing poor virological, immunological, and/or clinical response to ARV therapy were considered as failures and thus included in the case group. The control group (n = 160) consisted of patients with good responses to treatment. Cases and controls were compared using the Chi-square test and odds ratio (OR) technique with a confidence interval at 95%. The failure rate was 12.8%. Failure was significantly correlated with low socioeconomic level (OR = 3), orphan status (OR = 4), age over 10 years (OR = 5), male gender (OR = 3), baseline viral load > or = 1,000,000 copies/mL (OR = 9), and poor compliance (OR = 37). Mortality in children who failed to respond to first-line ARV therapy was 25% due to the unavailability of a national second-line ARV therapy program. This study underlines the need for patient education to promote compliance and for creation of reference centers to prescribe ARV therapy to HIV-infected children including second-line ARV and genotyping.

Clinical diagnosis of malaria and the risk of chloroquine self-medication in rural health centres in Burkina Faso.

OBJECTIVE: To assess the quality of healthcare workers' performance with regard to malaria diagnosis and treatment and to assess patients' self-medication with chloroquine (CQ) before and after presentation at a health centre. METHODS: In the rainy season 2004, in five rural dispensaries in Burkina Faso, we observed 1101 general outpatient consultations and re-examined all these patients. CQ whole blood concentrations of confirmed malaria cases were measured before and after treatment. RESULTS: The clinical diagnosis based on fever and/or a history of fever had a sensitivity of 75% and a specificity of 41% when compared to confirmed malaria (defined as an axillary temperature of >/=37.5 degrees C and/or a history of fever and parasites of any density in the blood smear). Few febrile children under 5 years of age were assessed for other diseases than malaria such as pneumonia. No antimalarial was prescribed for 1.3% of patients with the clinical diagnosis malaria and for 24% of confirmed cases, while 2% received an antimalarial drug prescription without the corresponding clinical diagnosis. CQ was overdosed in 22% of the prescriptions. Before and 2 weeks after consultation, 25% and 46% respectively of the patients with confirmed malaria had potentially toxic CQ concentrations. CONCLUSION: As long as artemisinin-based combination therapy remains unavailable or unaffordable for most people in rural areas of Burkina Faso, self-medication with and prescription of CQ are likely to continue despite increasing resistance. Apart from considering more pragmatic first-line regimens for malaria treatment such as the combination of sulfadoxine-pyrimethamine with amodiaquine, more and better training on careful clinical management of febrile children including an appropriate consideration of other illnesses than malaria should be made available in the frame of the IMCI initiative in sub-Saharan Africa.

[Haematological parameters evolution during the antiretroviral therapy of HIV infected patients in Burkina-Faso]. / Evolution des paramètres hématologiques au cours du traitement antirétroviral chez les patients infectés par le VIH au Burkina Faso.

Haematological anomalies are frequent during HIV infection, and can be the fact of virus and or bone marrow toxicity of antiretroviral drugs. In order to analyze the evolution of the haematological parameters during HAART this work was carried out in the internal medicine department of the national teaching hospital Yalgado-Ouédraogo in Ouagadougou. So 107 patients receiving for the first time HAART and followed regularly were retained. The immunological efficacy at the end of the first six months was 60, 75% with an average gain of 119 CD4/mm3. The haematological changes at the end of these first six months showed: --an anaemia in 51.4% of the cases at month 6 versus 80.3% at baseline (p=0.0001). The average rate of haemoglobin was 11.8 versus 11.2 g/dl at baseline in the AZT containing HAART regimen (p=0.014) and 12.2 versus 10.7 g/dl at baseline in the group without AZT (p=0.00006). --a neutropenia in 35.5% of the cases at month 6 versus 31.7% at baseline (p=0.6). The average rate of neutrophil was 1908/mm3 versus 2267.1/mm3 at baseline in the AZT containing HAART regimen and 2150.7/mm3 versus 2001.9/mm3 at baseline in the group without AZT These results show that the therapeutic efficacy measured on the immunological answer is accompanied by a reduction of haematological anomalies. They also suggest the necessity to evaluate the cotrimoxazole impact before deciding the interruption of AZT.

Detection and identification of Trypanosoma of African livestock through a single PCR based on internal transcribed spacer 1 of rDNA.

Primers hybridising with the rDNA cistron have previously been evaluated for PCR diagnosis specific for kinetoplastids, and shown to detect and differentiate the Trypanosoma brucei complex and Trypanosoma cruzi. Kin1 and Kin2 primers, amplifying internal transcribed spacer 1, were subsequently evaluated for the diagnosis of African livestock trypanosomosis. Based on the size of the PCR products obtained, Kin primers allowed detection and identification of three Trypanosoma congolense types (savannah, forest and Kenya Coast), with distinction among themselves and from the subgenus Trypanozoon (T. brucei spp., Trypanosoma evansi and Trypanosoma equiperdum), Trypanosoma vivax, Trypanosoma simiae and Trypanosoma theileri. These primers were shown to be suitable for the sensitive and type-specific diagnosis of African livestock trypanosome isolates through a single PCR even in the case of multi-taxa samples. With field samples (buffy-coat from cattle blood) sensitivity was close to the sensitivity observed in single reactions with the classical specific primers for the Trypanozoon subgenus and T. congolense-type savannah, but was lower for detection of T. vivax. Additional reaction, improvement of DNA preparation, and/or new primers design are necessary to improve the sensitivity for detection of T. vivax in field samples. However, these primers are suitable for isolate typing through a single PCR.

Polymerase chain reaction as a diagnosis tool for detecting trypanosomes in naturally infected cattle in Burkina Faso.

African animal trypanosomoses constitute the most important vector-borne cattle diseases in sub-Saharan Africa. Generally it is considered that there is a great lack of accurate tools for the diagnosis of the disease. During a trypanosomosis survey in the agro-pastoral zone of Sideradougou, Burkina Faso, 1036 cattle were examined for trypanosomes using microscopy. The PCR was applied on a subset of 260 buffy-coat samples using primers specific for Trypanosoma congolense savannah and riverine-forest groups, T. vivax, and T. brucei. Parasitological examination and the molecular technique were compared, showing a better efficiency of the latter. In the near future, the PCR is likely to become an efficient tool to estimate the prevalence of African trypanosomoses in affected areas.