Evaluation and prioritization of actions on food environments to address the double burden of malnutrition in Senegal: perspectives from a national expert panel.

OBJECTIVE: To evaluate the extent of implementation of public policies aimed at creating healthy eating environments in Senegal compared to international best practice and identity priority actions to address the double burden of malnutrition. DESIGN: The Healthy Food Environment Policy Index (Food-EPI) was used by a local expert panel to assess the level of implementation of 43 good practice policy and infrastructure support indicators against international best practices using a Likert scale and identify priority actions to address the double burden of malnutrition in Senegal. SETTING: Senegal, West Africa. PARTICIPANTS: A national group of independent experts from academia, civil society, non-governmental organizations and United Nations bodies (n =15) and a group of government experts from various ministries (n =16) participated in the study. RESULTS: Implementation of most indicators aimed at creating healthy eating environments were rated as "low" compared to best practice (31 on 43, or 72%). The Gwet AC2 inter-rater reliability was good at 0.75 (CI 0.70 - 0.80). In a prioritization workshop, experts identified forty-five actions, prioritizing ten as relatively most feasible and important and relatively most effective to reduce the double burden of malnutrition in Senegal (example: Develop and implement regional school menus based on local products (expand to 14 regions) and measure the extent of the promotion of unhealthy foods to children). CONCLUSIONS: Significant efforts remain to be made by Senegal to improve food environments. This project allowed to establish an agenda of priority actions for the government to transform food environments in Senegal to tackle the double burden of malnutrition.

Malaria and COVID-19 co-dynamics: A mathematical model and optimal control.

Malaria, one of the longest-known vector-borne diseases, poses a major health problem in tropical and subtropical regions of the world. Its complexity is currently being exacerbated by the emerging COVID-19 pandemic and the threats of its second wave and looming third wave. We formulate and analyze a mathematical model incorporating some epidemiological features of the co-dynamics of both malaria and COVID-19. Sufficient conditions for the stability of the malaria only and COVID-19 only sub-models' equilibria are derived. The COVID-19 only sub-model has globally asymptotically stable equilibria while under certain condition, the malaria-only could undergo the phenomenon of backward bifurcation whenever the sub-model reproduction number is less than unity. The equilibria of the dual malaria-COVID19 model are locally asymptotically stable as global stability is precluded owing to the possible occurrence of backward bifurcation. Optimal control of the full model to mitigate the spread of both diseases and their co-infection are derived. Pontryagin's Maximum Principle is applied to establish the existence of the optimal control problem and to derive the necessary conditions for optimal control of the diseases. Though this is not a case study, simulation results to support theoretical analysis of the optimal control suggests that concurrently applying malaria and COVID-19 protective measures could help mitigate their spread compared to applying each preventive control measure singly as the world continues to deal with this unprecedented and unparalleled COVID-19 pandemic.

Optimal control of a two-group malaria transmission model with vaccination.

Malaria is a vector-borne disease that poses major health challenges globally, with the highest burden in children less than 5 years old. Prevention and treatment have been the main interventions measures until the recent groundbreaking highly recommended malaria vaccine by WHO for children below five. A two-group malaria model structured by age with vaccination of individuals aged below 5 years old is formulated and theoretically analyzed. The disease-free equilibrium is globally asymptotically stable when the disease-induced death rate in both human groups is zero. Descarte's rule of signs is used to discuss the possible existence of multiple endemic equilibria. By construction, mathematical models inherit the loss of information that could make prediction of model outcomes imprecise. Thus, a global sensitivity analysis of the basic reproduction number and the vaccination class as response functions using Latin-Hypercube Sampling in combination with partial rank correlation coefficient are graphically depicted. As expected, the most sensitive parameters are related to children under 5 years old. Through the application of optimal control theory, the best combination of interventions measures to mitigate the spread of malaria is investigated. Simulations results show that concurrently applying the three intervention measures, namely: personal protection, treatment, and vaccination of childreen under-five is the best strategy for fighting against malaria epidemic in a community, relative to using either single or any dual combination of intervention(s) at a time.

Development of Trichosomoides nasalis (Nematoda: Trichinelloidea) in the murid host: evidence for larval growth in striated muscle fibres.

Trichosomoides nasalis (Trichinelloidea) is a parasite of Arvicanthis niloticus (Muridae) in Senegal. Female worms that harbour dwarf males in their uteri, occur in the epithelium of the nasal mucosa. Young laboratory-bred A. niloticus were either fed females containing larvated eggs or intraperitoneally injected with motile first-stage larvae recovered from female uteri. Both resulted in successful infection. Organs examined during rodent necropsy were blood and lymphatic circulatory systems (heart, large vessels, lymphnodes), lungs, liver, kidneys, thoracic and abdominal cavities, thoracic and abdominal muscular walls, diaphragm, tongue, and nasal mucosa. Development to adult nasal stages took three weeks. Recovery of newly hatched larvae from the peritoneal fluid at four-eight hours after oral infection suggests a direct passage from the stomach or intestinal wall to the musculature. However, dissemination through the blood, as observed with Trichinella spiralis, cannot be excluded even though newly hatched larvae of T. nasalis are twice as thick (15 µm). Developing larvae were found in histological sections of the striated muscle of the abdominal and thoracic walls, and larvae in fourth moult were dissected from these sites. Adult females were found in the deep nasal mucosa where mating occurred prior to worms settling in the nasal epithelium. The present study shows a remarkable similarity between T. nasalis and Trichinella species regarding muscle tropism, but the development of T. nasalis is not arrested at the late first-larval stage and does not induce transformation of infected fibres into nurse cells. T. nasalis seems a potential model to study molecular relations between trichinelloid larvae and infected muscle fibres.

Trichosomoides nasalis (Nematoda: Trichinelloidea) in the murid host Arvicanthis niloticus: migration to the epithelium of the nasal mucosa after intramuscular development.

Knowledge of the biology of the trichinelloid subfamily Trichosomoidinae is poor. Trichosomoides nasalis is a common parasite of Arvicanthis niloticus (Muridae) in Senegal, and a procedure for experimental infections has been established. It has been demonstrated that larvae develop in striated muscle fibres, similar to Trichinella spp., but they are not arrested in the first stage, and they reach the adult stage within three weeks. In the present histological study it is shown that T. nasalis females and dwarf males migrate from the abdomen and thorax to the host's muzzle, moving through connective tissues and between muscles. A few migrating specimens were also found in the blood vessels of the nasal mucosa. While sexes were still separated in the lamina propria of the mucosa, females recovered from the epithelium contained intra-uterine males. Worms were found between the incisors in the mucosa of the anterior and median conchae which are rich in mucous cells. Only the pseudostratified epithelium was parasitized. Under natural conditions, the inflammation of the nasal mucosa that is induced by the parasites might reduce the competitiveness of infected rodents when foraging or looking for potential mates.

HIV and COVID-19 co-infection: A mathematical model and optimal control.

A new mathematical model for COVID-19 and HIV/AIDS is considered to assess the impact of COVID-19 on HIV dynamics and vice-versa. Investigating the epidemiologic synergy between COVID-19 and HIV is important. The dynamics of the full model is driven by that of its sub-models; therefore, basic analysis of the two sub-models; HIV-only and COVID-19 only is carried out. The basic reproduction number is computed and used to prove local and global asymptotic stability of the sub-models' disease-free and endemic equilibria. Using the fmincon function in the Optimization Toolbox of MATLAB, the model is fitted to real COVID-19 data set from South Africa. The impact of intervention measures, namely, COVID-19 and HIV prevention interventions and COVID-19 treatment are incorporated into the model using time-dependent controls. It is observed that HIV prevention measures can significantly reduce the burden of co-infections with COVID-19, while effective treatment of COVID-19 could reduce co-infections with opportunistic infections such as HIV/AIDS. In particular, the COVID-19 only prevention strategy averted about 10,500 new co-infection cases, with similar number also averted by the HIV-only prevention control.

Mathematical modeling and optimal control of SARS-CoV-2 and tuberculosis co-infection: a case study of Indonesia.

A new mathematical model incorporating epidemiological features of the co-dynamics of tuberculosis (TB) and SARS-CoV-2 is analyzed. Local asymptotic stability of the disease-free and endemic equilibria are shown for the sub-models when the respective reproduction numbers are below unity. Bifurcation analysis is carried out for the TB only sub-model, where it was shown that the sub-model undergoes forward bifurcation. The model is fitted to the cumulative confirmed daily SARS-CoV-2 cases for Indonesia from February 11, 2021 to August 26, 2021. The fitting was carried out using the fmincon optimization toolbox in MATLAB. Relevant parameters in the model are estimated from the fitting. The necessary conditions for the existence of optimal control and the optimality system for the co-infection model is established through the application of Pontryagin's Principle. Different control strategies: face-mask usage and SARS-CoV-2 vaccination, TB prevention as well as treatment controls for both diseases are considered. Simulations results show that: (1) the strategy against incident SARS-CoV-2 infection averts about 27,878,840 new TB cases; (2) also, TB prevention and treatment controls could avert 5,397,795 new SARS-CoV-2 cases. (3) In addition, either SARS-CoV-2 or TB only control strategy greatly mitigates a significant number of new co-infection cases.

Optimal control analysis of a COVID-19 and tuberculosis co-dynamics model.

Tuberculosis and COVID-19 are among the diseases with major global public health concern and great socio-economic impact. Co-infection of these two diseases is inevitable due to their geographical overlap, a potential double blow as their clinical similarities could hamper strategies to mitigate their spread and transmission dynamics. To theoretically investigate the impact of control measures on their long-term dynamics, we formulate and analyze a mathematical model for the co-infection of COVID-19 and tuberculosis. Basic properties of the tuberculosis only and COVID-19 only sub-models are investigated as well as bifurcation analysis (possibility of the co-existence of the disease-free and endemic equilibria). The disease-free and endemic equilibria are globally asymptotically stable. The model is extended into an optimal control system by incorporating five control measures. These are: tuberculosis awareness campaign, prevention against COVID-19 (e.g., face mask, physical distancing), control against co-infection, tuberculosis and COVID-19 treatment. Five strategies which are combinations of the control measures are investigated. Strategy B which focuses on COVID-19 prevention, treatment and control of co-infection yields a better outcome in terms of the number of COVID-19 cases prevented at a lower percentage of the total cost of this strategy.

Integrated array of 2-µm antimonide-based single-photon counting devices.

A 32x32 Sb-based Geiger-mode (GM) avalanche photodiode array, operating at 2 µm with three-dimensional imaging capability, is presented. The array is interfaced with a ROIC (readout integrated circuit) in which each pixel can detect a photon and record the arrival time. The hybridized unit for the 1000-element focal plane array, when operated at 77K with 1 V overbias range, shows an average dark count rate of 1.5 kHz. Three-dimensional range images of objects were acquired.

Transmissivity evolution through interface of composite liners under applied constraint.

In landfill liners, geomembranes have defects that constitute preferential passages of leachate from rainwater percolation. Non-woven geotextiles are widely used in wastelandfills as materials having the functions of protection, separation, filtration and drainage. This study seeks to select geotextiles through an investigation conducted among landfill operators who commonly arise a geotextile in the geomembrane-clay interface to facilitate geomembrane welding and to prevent its puncture by angular materials. It also attempts to find out the influence of geotextile in a decimetric transmissivity cell size under 50 kPa stress and smooth ground surface. The results show that the transmissivity in composite liner interface is almost the same as the one calculated with the European standard EN ISO 12958. Transmissivity depends on the mechanical stress applied to the bottom liner, on the geotextile type in the interface and on the ground surface.

A Mathematical Model of COVID-19 with Vaccination and Treatment.

We formulate and theoretically analyze a mathematical model of COVID-19 transmission mechanism incorporating vital dynamics of the disease and two key therapeutic measures-vaccination of susceptible individuals and recovery/treatment of infected individuals. Both the disease-free and endemic equilibrium are globally asymptotically stable when the effective reproduction number R 0(v) is, respectively, less or greater than unity. The derived critical vaccination threshold is dependent on the vaccine efficacy for disease eradication whenever R 0(v) > 1, even if vaccine coverage is high. Pontryagin's maximum principle is applied to establish the existence of the optimal control problem and to derive the necessary conditions to optimally mitigate the spread of the disease. The model is fitted with cumulative daily Senegal data, with a basic reproduction number R 0 = 1.31 at the onset of the epidemic. Simulation results suggest that despite the effectiveness of COVID-19 vaccination and treatment to mitigate the spread of COVID-19, when R 0(v) > 1, additional efforts such as nonpharmaceutical public health interventions should continue to be implemented. Using partial rank correlation coefficients and Latin hypercube sampling, sensitivity analysis is carried out to determine the relative importance of model parameters to disease transmission. Results shown graphically could help to inform the process of prioritizing public health intervention measures to be implemented and which model parameter to focus on in order to mitigate the spread of the disease. The effective contact rate b, the vaccine efficacy ε, the vaccination rate v, the fraction of exposed individuals who develop symptoms, and, respectively, the exit rates from the exposed and the asymptomatic classes σ and ϕ are the most impactful parameters.

COVID-19 and dengue co-infection in Brazil: optimal control and cost-effectiveness analysis.

A mathematical model for the co-interaction of COVID-19 and dengue transmission dynamics is formulated and analyzed. The sub-models are shown to be locally asymptotically stable when the respective reproduction numbers are below unity. Using available data sets, the model is fitted to the cumulative confirmed daily COVID-19 cases and deaths for Brazil (a country with high co-endemicity of both diseases) from February 1, 2021 to September 20, 2021. The fitting was done using the fmincon function in the Optimization Toolbox of MATLAB. Parameters denoting the COVID-19 contact rate, death rate and loss of infection acquired immunity to COVID-19 were estimated using the two data sets. The model is then extended to include optimal control strategies. The appropriate conditions for the existence of optimal control and the optimality system for the co-infection model are established using the Pontryagin's Principle. Different control strategies and their cost-effectiveness analyses were considered and simulated for the model, which include: controls against incident dengue and COVID-19 infections, control against co-infection with a second disease and treatment controls for both dengue and COVID-19. Highlights of the simulation results show that: (1) dengue prevention strategy could avert as much as 870,000 new COVID-19 infections; (2) dengue only control strategy or COVID-19 only control strategy significantly reduces new co-infection cases; (3) the strategy implementing control against incident dengue infection is the most cost-effective in controlling dengue and COVID-19 co-infections.

[Dermatomyositis and polymyositis: 21 cases in Senegal]. / Dermatomyosites et polymyosites: 21 cas au Sénégal.

Dermatopolymyositis (DPM) is a term describing a group of disorders comprising multiple distinct entities depending on interactions between genetic and environmental factor. There is a paucity of studies on DPM in black Africa. The purpose of this report is to describe epidemiological, clinical, laboratory and therapeutic aspects of dermatomyositis (DM) and polymyositis (PM) observed at the Principal Hospital in Dakar, Senegal. A retrospective review as conducted of patients hospitalized for DM and PM in Medical Departments of Principal Hospital. Diagnosis of DRM was based on the criteria of Bohan and Peter's in all cases. A series of 21 black African patients was compiled including 15 with DM and 6 with PM. Mean age was 52 years and the M/F sex ratio was 0.6. The mean delay for diagnosis was 6 weeks (range, 3 to 12 weeks). Initial signs were dermatological in 12 patients, pulmonary in one and muscular in the remaining cases. The most common dermatological sign was erythema characterized by a zebra-like aspect on the extended limbs. Erythema was frequently pruriginous with a flagellate aspect on the back. Muscular signs were observed in 18 patients and included pharyngeal manifestations in 10 patients. Amyopathic DM was not observed. Cardiac abnormalities included tachycardia (4 cases), AVB (1), ischemic lesion (1), relaxation disturbances (4), pericardial effusion (3), myocarditis (2) and pulmonary hypertension (1). The most common pulmonary manifestation was interstitial lung disease observed in 6 patients. Gastrointestinal signs were noted in 9 patients including endoscopic evidence of superficial erosion in 4 cases. Electromyography (EMG) tracings revealed myogenic disease in 14 cases including 2 associated with reduced peripheral nervous conduction speed. Severe lymphopenia was observed in 3 patients but HIV serology was negative in all cases. Paraneoplasic DM was observed in 3 cases. Death occurred in 5 cases due to the cancer-related, pulmonary and infectious complications. Based on the findings of this study, the three main features of DM and PM in Senegal are flagellated and often pruriginous erythema, cardiac and interstitial lung disease, and peripheral neural involvement.

[Acute transverse myelopathy after intramuscular injection of benzathine-benzylpenicillin. Case report in Dakar, Senegal]. / Myélopathie aiguë transverse après injection de benzathine-benzyl pénicilline: une observation à Dakar (Sénégal).

Intramuscular injection of benzathine-benzylpenicillin can cause acute transverse myelopathy. The purpose of this report is to describe a case of acute transverse myelopathy observed after injection of benzathine-benzylpenicillin in a 38-year-old man. The patient who was married and had a history of eczema was admitted to the Department of Neurology of the Fann University Teaching Hospital in 2006. All laboratory findings were normal except high serum immunoglobulin E level. An immunoallergic reaction involving inflammatory transverse myelopathy secondary to vasculitis was proposed as the most likely underlying mechanism. Treatment with corticosteroid and physiotherapy led to a favorable outcome. Health personnel should know the indications for use of benzathine-benzylpenicillin and be aware of the possible medullary complications.

[Relationship between oral health status of parents and that of their children]. / Relation entre l'état de santé bucco-dentaire des parents et celui de leurs enfants.

The aim of this study was to evaluate the oral health status of the parents and their children and the relationships between the parents' oral health status and their children one. Subjects comprised 200 parents (mothers and fathers) and 200 of their children selected at the pediatric dental clinic of the children's hospital Albert Royer and the pediatric dental clinic of the Department of Odontology. In both groups, we have evaluated the dental caries prevalence and dental examination was performed using DMFT or DMF teeth for children. To evaluate the oral hygiene habits we used the Silness and Löe index and a questionnaire. We have finally assessed the relationships between the parents' oral health status and their children' oral health. The dental caries prevalence was 63% for the parents with mean DMF teeth of 5.8 and 5.2 SD and for the children it was 94% and the DMF teeth was 5.85 and 4.00 SD. The parents' DMF teeth, their gingival health and their oral hygiene habits were significantly associated to their professional status (ANOVA: p = 0.00 < 0.05). The DMF teeth of the children was associated with those of their parents and to their parents' professional status. The children's oral hygiene habits and their parents' habits were also associated.

[Epilepsy in a cohort of Senegalese children]. / Epilepsie dans le contexte neuropédiatrique sénégalais.

Epilepsy is a significant health public problem in Senegal with an estimated prevalence of 8 to 14%. The aim of this study was to determine the clinical and electroencephalographic features of epilepsy in a cohort of Senegalese infants, search for etiological factors and determine the impact of disease on school life. This retrospective study concerned 459 children who attended the neurological outpatients clinic at the Fann hospital, Dakar, Senegal, between July 2003 and December 2006. All were aged under 19 years. Among the 135 children with idiopathic epilepsy, 23.7% had parental consanguinity and 37.77 % familial epilepsy. Rolandic epilepsy and epilepsy with absences were more frequent but several infants with idiopathic epilepsy were not classified. Non-idiopathic epilepsy was noted in 312 children. In this group, estimates of parental consanguinity and familial epilepsy were of 21.79 and 17.94%, respectively. Etiological factors were predominantly pregnancy and birth abnormalities (28.84%) and central nervous system infection (20.19%). Twelve children had febrile seizures. Of patients with idiopathic epilepsy, 65.18% were attending school versus only 9.29 with non-idiopathic epilepsy.

[Study of oro-dental injuries during seizures in Senegalese children with epilepsy]. / Etude des traumatismes bucco-dentaires au cours de l'epilepsie chez l'enfant au Sénégal.

The objectives of this study were to study the prevalence of oral traumatisms and their relationship to epileptic seizures in Senegalese children. This study was undertaken in the Children's National Hospital of Dakar and deal with children with epilepsy. Sotf tissues and the teeth traumatisms that have occurred during epileptic seizures were recorded. We have also studied the relationship between the frequency of the seizures and the oral soft and hard tissues traumatisms. One hundred and eight children aged from 5 to 15 years with 67 boys and 41 girls with an average age of 8.16+/-2.86 years were enrolled. Several types of epileptic seizures were observed during which 44.5% of the children presented oral traumatisms of soft tissues (27.8%) and the teeth (16.7%). There is no significant relationship between the number of seizures and the frequency of the dental traumatisms (p = 0.352). The tooth fractures are the lesions most frequently noticed and are observed in 24.4% of the children. The traumatisms of the maxillary central incisors account for 38% of the traumatisms, followed by the canines (2.7%) and the molars (1.9%). The lower central incisors are the least affected. The traumatisms of soft tissues were observed in 27.8% of the children: the lips are more often affected (44%), followed by the tongue (30%), the association between lip and tongue (18%) and the cheeks (8%). There is no significant relationship between the number of seizures and the frequency of the traumatisms of soft tissues (p = 0.35).

[Evaluation of the cost of stroke management in Dakar, Senegal]. / Evaluation du coût de prise en charge des accidents vasculaires cérébraux à Dakar--Senegal.

The purpose of this one-year cross-sectional study conducted in 1997 was to estimate the direct cost of stroke management in the Neurology Department of Fann University Hospital in Dakar, Senegal. Data were collected about the type of care services required and related spending. Cost analysis was made in CFA Francs (CFAF), the Senegalese currency (1 USD = 500 CFAF in 1997). A total of 1260 patients were hospitalized in the department including 383 for stroke (30.4%). Mean age was 60.8 +/- 14.2 years and men accounted for 49.2% of the population. The mortality rate was 46.2% among hospitalized patients. A total of 33,573 medical acts were carried out including 12,052 (35.9%) for stroke management. The direct cost of stroke management was 32,614,442 CFAF with a mean cost of 78,426 CFAF per patient. The cost was 18,839 CFAF in the patient care unit (57.8%) and 4,954,635 CFAF in the neuroradiology unit (15.2%). The cost of health care personnel was 19,373,172 CFAF (59.4%) and the cost for drugs and other medical products was 8,253,246 CFAF. Health education programs aimed at increasing awareness of risk factors are needed to reduce the cost of stroke management in this difficult economic period.

[Diabetic neuropathies in Neurological Clinic of Dakar]. / Neuropathies diabetiques a La Clinique Neurologique de Dakar.

INTRODUCTION: Common diabetic mellitus complication, neuropathies present various clinical forms. OBJECTIVE to evaluate the hospital frequency and clinical features of diabetic neuropathies. PATIENTS AND METHOD: It is a retrospective study concerning peripheral neuropathies observed in "clinique neurologique" of Dakar between January 1991 and December 2001 in diabetic patients treated for a long time. Inclusion criterion are distal and/or proximal sensitive and/or motor neuropathies with abolition or reduction of patellar reflex. Are excluded neuropathies of others aetiologies. Electrophysiological examination with motor conduction velocity measure is performed in about half of them . One neuro-muscular biopsy was performed using current neuropathological examination including teased fiber technic. RESULTS: 17 cases of peripheral neuropathy are observed on 10,000 documents (0.17%). They were 11 males and 6 females, aged from 27 to 77 years (means 56.41). Among them, 10 cases of distal motor sensitive neuropathy are identified; 2 cases of sensitive neuropathy, 3 cases of pure motor neuropathy and 2 cases of multiple mononeuritis neuropathy with dysautonomic disorders of sphincter and genital type in one of them. Glucose serum level was between 1.25 to 4.25 g/l . Diabetes was 18 months to 20 years of duration at the moment of admission . Normal serum level glucose was rapidly obtained with insulin treatment. The evolution was favourable in 82.9% of cases under anti-diabetic treatment, vitamin B and kinesitherapy. CONCLUSION: diabetes mellitus neuropathies are rare in "Clinique n eurologique" of Dakar where diverse clinical forms are observed. Favourable outcome in most of cases occurred when serum glucose equilibration is rapidly obtained.

[Peripheral neuropathies and antiretroviral drugs. Preliminary results]. / Neuropathies peripheriques et traitements antiretroviraux. Etude clinique, électrophysiologique et neuropathologique des biopsies neuro-musculaires chez 18 patients vih séropositifs. Résultats préliminaires.

INTRODUCTION: In order to appreciate the antiretroviral drugs impact in the HIV positive patients with peripheral neuropathy, a clinical, electrophysiological and neurpathological study of nerve biopsies was performed. PATIENTS AND METHODS: A group of 8 HIV seropositive patients with peripheral neuropathy was compared with an other group of 10 HIV seropositive patients treated with multiple antiretroviral drugs. Electrophysiological examination with motor nerve conduction velocity (MNCV) mesure of the median and the sciatic popliteal nerve was followed by nerve biopsy. Nerve fragments carried out the neuropathological technics for morphological examination. RESULTS: Eighteen seropositive HIV patients (16 HIV-1 and 2 HIV-2) were included in this study. Six patients among them had motor and sensitive neuropathy of the four limbs and 2 patients had sensitive neuropathy associated with pyramidal signs. In fine, 1 patient had sensitive neuropathy with distal amyotrophy of the four limbs. Slow MNCV was observed in all the patients and more severe in the lower limbs. Nerve were unexciting in the lower limbs in 2 patients. Nerve biopsy showed severe axonal loss in all the patients treated but one. They associated axonal lesion in 5 cases and myelinated lesions in 2 cases. Two patients non treated had normal nerve biopsy. Axonal loss was mild in 2 cases and very severe in one case associated with non inflammatory demyelinated lesions. CONCLUSION: we observed more severe and more frequent nerve lesions in treated patients than in no treated patients, as at the clinical, electrophysiological and neuropathological examination. Antiretroviral drugs cause more frequently pain motor and sensitive neuropathies at usual posologies. The occurence of recrudescence of pain peripheral neuropathy under antiretroviral treatment allows to reconsider drugs posologies.