[Primary isoniazid preventive therapy : A strategy still relevant in the era of test and treat ; literature review]. / Chimioprophylaxie antituberculeuse primaire à l'isoniazide : une stratégie d'actualité à l'ère du tester et traiter ; revue de la littérature.

BACKGROUND: Tuberculosis remains a public health threat responsible as recently as 2018 for more than one million deaths. Chemoprophylaxis with isoniazid is one of the strategies implemented to control the disease. Although it is not yet widely prescribed, its utilization raises additional questions in the "test and treat" era of for anti-retroviral therapy. The objective of this study is to review the different randomized controlled trials of antitubercular Isoniazid Preventive Therapy (IPT). We have distinguished (a) "efficacy trials" (ET) comparing IPT to a placebo or the absence of chemoprophylaxis and (b) "IPT regimen trials" (RT) comparing IPT to one or several other regimens. METHODS: Literature search (keywords from published articles found in the Medline and Scopus data bases: "tuberculosis", "prophylaxis", "HIV", "randomized controlled trial") and standardized reading of selected articles reporting results from randomized trials of IPT in HIV-infected people. RESULTS: Eighteen selected trials (11 ET and 7 RT), including 19,725 participants. The regimens studied were 3H, 6H, 9H, 12H, 12H, 36H/2RZ, 3RH, 3RZ, 3RHZ, and 3HP [H: Isoniazid, R: Rifampicin, Z: Pyrazinamide, P: Rifapentine]. LOCATIONS: Ten in Africa, three in Haiti, one in India, one in the USA, one in the Americas and two multi-continental trials. In ET with or without antiretrovirals (ART), IPT significantly reduces the risk of tuberculosis, by 32 to 71%. In ET prior to ART, IPT does not appear to reduce mortality. In ET in patients receiving ART, on the other hand, IPT reduces mortality. As regards RT, there seems to be no reason to prefer other regimens to IPT. Tolerance is good. Importantly, IPT may reduce (rather than worsen) the risk of multidrug-resistant bacilli selection by decreasing the number of TB episodes and, consequently, the number of curative tuberculosis treatments. CONCLUSION: Far from becoming obsolete due to ARV treatment, IPT has remained a timely and relevant intervention.

Capacity Building in Sub-Saharan Africa as Part of the INTENSE-TBM Project During the COVID-19 Pandemic.

Tuberculous meningitis (TBM) is the most severe and disabling form of tuberculosis (TB), with at least 100,000 cases per year and a mortality rate of up to 50% in individuals co-infected with human immunodeficiency virus type 1 (HIV-1). To evaluate the efficacy and safety of an intensified anti-tubercular regimen and an anti-inflammatory treatment, the INTENSE-TBM project includes a phase III randomised clinical trial (TBM-RCT) in four countries in sub-Saharan Africa (SSA). Within this framework, we designed a comprehensive capacity-building work package ensuring all centres had, or would acquire, the ability to conduct the TBM-RCT and developing a network of skilled researchers, clinical centres and microbiology laboratories. Here, we describe these activities, identify strengths/challenges and share tools adaptable to other projects, particularly in low- and lower-middle income countries with heterogeneous settings and during the coronavirus disease 2019 (COVID-19) pandemic. Despite major challenges, TBM-RCT initiation was achieved in all sites, promoting enhanced local healthcare systems and encouraging further clinical research in SSA. In terms of certified trainings, the achievement levels were 95% (124/131) for good clinical practice, 91% (39/43) for good clinical laboratory practice and 91% (48/53) for infection prevention and control. Platform-based research, developed as part of capacity-building activities for specific projects, may be a valuable tool in fighting future infectious diseases and in developing high-level research in Africa.

The INTENSE-TBM project aimed to design a comprehensive work-package on capacity building, ensuring all centres would acquire the ability to conduct a phase III randomised clinical trial on TBM in sub-Saharan Africa, to reduce tuberculous meningitis mortality and morbidity in patients with/without HIV-1 co-infection. Therefore, the INTENSE-TBM project is an example of how an international clinical research consortium can provide opportunities to enhance local capacity building and promote centres without previous experience in clinical research. This article provides practical approaches for implementing effective capacity-building programmes. We highlight how to overcome limitations imposed by the COVID-19 pandemic to successfully complete clinics, laboratory set-ups and personnel training, so as to optimise resources and empower African institutions on a local level. At the same time, our experience shows how capacity-building programmes can deliver long-lasting impact that extends beyond the original aims of the project (e.g. HIV and TB), and support local health systems in fighting other infectious disease (e.g. COVID-19). Research projects in low- and lower-middle income countries with heterogeneous settings could stand to benefit the most.

Precore G1896A mutation is associated with reduced rates of HBsAg seroclearance in treated HIV hepatitis B virus co-infected patients from Western Africa.

The nucleotide substitution G1896A on the precore (pc) region has been implicated in virological and serological responses during treatment in hepatitis B virus (HBV)-infected patients. Whether this mutation affects the therapeutic course of HIV-HBV co-infected patients, especially from Western Africa, is unknown. In this prospective cohort study, 86 antiretroviral (ARV)-naïve HIV-HBV co-infected patients from Côte d'Ivoire, initiating ARV-treatment containing lamivudine (n = 53) or tenofovir (n = 33), had available baseline pc sequences. Association of the pcG1896A mutation with time to undetectable HBV-DNA, hepatitis B "e" antigen (HBeAg) seroclearance (in HBeAg-positive patients), and hepatitis B surface antigen (HBsAg) seroclearance was evaluated using Cox proportional hazards regression. At ARV-initiation, median HBV-DNA was 6.04 log10 copies/mL (IQR = 3.70-7.93) with 97.7% harbouring HBV genotype E. Baseline pcG1896A mutation was identified in 51 (59.3%) patients, who were more commonly HBeAg-negative (P < .001) and had basal core promotor A1762T/G1764A mutations (P < .001). Patients were followed for a median 36 months (IQR = 24-36). Cumulative proportion of undetectable HBV-DNA was significantly higher in patients with baseline mutation (pcG1896A = 86.6% vs no pcG1896A = 66.9%, P = .04), but not after adjusting for baseline HBV-DNA levels and anti-HBV agent (P = .2). No difference in cumulative proportion of HBeAg seroclearance was observed between mutation groups (pcG1896A = 57.1% vs no pcG1896A = 54.3%, P = .7). Significantly higher cumulative proportion of HBsAg seroclearance was observed in patients without this mutation (pcG1896A = 0% vs no pcG1896A = 36.9%, P < .001), even after adjusting for baseline HBsAg quantification and anti-HBV agent (P < .001). In conclusion, lacking the pcG1896A mutation before ARV initiation appeared to increase HBsAg seroclearance rates during treatment. The therapeutic implications of this mutation need further exploration in this setting.

[Fluconazole 1200mg or 800mg for cryptococcal meningitis treatment in Ivory Coast]. / Fluconazole 1200mg ou 800mg dans le traitement de la cryptococcose neuroméningée en Côte d'Ivoire.

OBJECTIVE: Assessing the use of high-dose fluconazol monotherapy (1200mg or 800mg) in the treatment and prognosis of HIV-associated cryptococcal meningitis in Ivory Coast. PATIENTS AND METHODS: A retrospective study carried out from August 2008 to August 2011 based on patients charts suffering from CM in the Abidjan Tropicals and Infectious Disease Unit. Mortality rate and associated factors were analyzed. RESULTS: Forty-six cases of cryptococcal meningitis (2.5% of hospitalizations) were included. The sex-ratio was of 1.2. The median age was 40.5 [35-47] years. The symptomatology was subacute (93.5%). The main clinical symptoms were syndrome of pure meningeal irritation (65%), fever (100%); 35% of patients had encephalomeningits. Twenty-one (45.7%) was ART-naïve patients. Fluconazole 1200mg was prescribed to 29 (63%) patients. Therapeutic lumbar punctures were performed in 42 (91.3) patients. The mortality rate was 50%. Significant predictors of mortality were encephalomeningitis and therapeutic lumbar puncture. CONCLUSION: Cryptococcal meningitis associated mortality remains high despite the use of high-dose fluconazole monotherapy. Therapeutic lumbar punctures help to improving the prognosis.

Screening for active tuberculosis before isoniazid preventive therapy among HIV-infected West African adults.

SETTING: TEMPRANO was a multicentre, open-label trial in which human immunodeficiency virus (HIV) infected adults with high CD4 counts were randomised into early or deferred antiretroviral therapy (ART) arms with or without 6-month isoniazid preventive therapy (IPT) in a setting where the World Health Organization (WHO) recommends IPT in HIV-infected patients. Despite the WHO recommendation, IPT coverage remains low due to fear of the presence of undiagnosed active TB before prescribing IPT, and the related risk of drug resistance. OBJECTIVE: To report the frequency of undiagnosed TB in patients enrolled for IPT and describe the results of a 1-month buffer period to avoid prescribing IPT for active TB cases. DESIGN: Patients were screened using a clinical algorithm and chest X-ray at Day 0 and started on isoniazid at Month 1 if no sign/symptom suggestive of TB appeared between Day 0 and Month 1. RESULTS: Of 1030 patients randomised into IPT arms. 10% never started IPT at Month 1. Of these, 23 had active TB, including 16 with prevalent TB. Among the 927 patients who started IPT, 6 had active TB, including 1 with prevalent TB. Only 1 patient with active TB received IPT due to the 1-month buffer period between Day 0 and IPT initiation. CONCLUSION: In this study, 1.6% of adults considered free of active TB based on clinical screening at pre-inclusion actually had active TB.

Hepatitis C virus seroprevalence in adults in Africa: a systematic review and meta-analysis.

With the introduction of more efficient treatments for hepatitis C virus (HCV), improved epidemiological information is required at the country level to allow evidence-based policymaking for elaboration of national strategies and HCV resources planning. We present a systematic review with meta-analysis of HCV seroprevalence data in adults in African countries. We conducted a systematic review of all HCV seroprevalence estimates reported in African countries from 2000 to 2014 in MEDLINE, AJOL and grey literature. We assessed studies performed in the general population and among blood donors, pregnant women and HIV-positive patients. A meta-regression analysis was used to provide adjusted estimates of HCV seroprevalence in the general adult population in each country, accounting for the heterogeneity in sample age structure and population types in the included studies. We identified 775 national-level estimations, among which 184 were included. Estimates of HCV seroprevalence were produced for 38 countries, in addition to the results from nationwide representative surveys available in Egypt and Libya. Next to Egypt, which clearly stands out, the highest levels of seroprevalence were found in Middle Africa (e.g. Cameroon, Gabon and Angola) and some West African countries (e.g. Burkina Faso, Benin), and the largest absolute numbers of infected adults were found in Nigeria, Ethiopia and Democratic Republic of Congo. This study exposes the diversity of HCV epidemiology among African countries. Egypt and several countries of West and Middle Africa present a HCV burden that will require strong governmental commitment to promote efficient preventive and curative interventions.

Antiretroviral chemoprophylaxis in children and adolescents victims of rape in Abidjan.

OBJECTIVE: We described the use of antiretroviral drugs to prevent HIV transmission among children and adolescents victims of rape in Abidjan (Ivory Coast). MATERIALS AND METHOD: We conducted a retrospective and descriptive study on children (0-9 years) and adolescents (10-19 years) victims of rape between 2000 and 2013. We analyzed the patients' socio-demographic characteristics and the modality of the chemoprophylaxis. RESULTS: We included 10 children and 89 adolescents in the study. The median age was 16 years old (3-19 years). The median time to consultation was 23.5 hours (5-152 hours). The antiretroviral chemoprophylaxis was administered to 92 patients (93%). No HIV and HBV seroconversion was observed after a 3-month follow-up. CONCLUSION: A better management of rape victims is required in Abidjan.

Seven native cases of dengue in Abidjan, Ivory Coast.

OBJECTIVE: We had for aim to describe the epidemiological, clinical, biological, and outcome features of dengue fever in Abidjan, in 2010. PATIENTS AND METHODS: We retrospectively studied the files of patients hospitalized for dengue fever in 2010, in Abidjan. The diagnosis was made on clinical symptoms and positive dengue PCR and/or IgM. RESULTS: Seven patients were included (5 men, 2 women, median age of 51years [31-65years]). They presented with a febrile pain syndrome (n=7), jaundice (n=3), rash (n=2), and hematemesis complicated by thrombocytopenia (n=6) and leukopenia (n=5). Three patients had a positive IgM serology and 4 had a positive dengue PCR for DENV-3. The outcome was favorable for 6 patients, and 1 patient died of severe hemorrhage. CONCLUSION: The authors advocate the implementation of epidemiological surveillance of dengue and vector control in the Ivory Coast.

Management of BU-HIV co-infection.

BACKGROUND: Buruli Ulcer (BU)-HIV co-infection is an important emerging management challenge for BU disease. Limited by paucity of scientific studies, guidance for management of this co-infection has been lacking. METHODS: Initiated by WHO, a panel of experts in BU and HIV management developed guidance principles for the management of BU-HIV co-infection based on review of available scientific evidence, current treatment experience, and global recommendations established for management of HIV infection and tuberculosis. RESULTS: The expert panel agreed that all BU patients should be offered quality provider-initiated HIV testing and counselling. In areas with high prevalence of malaria and/or bacterial infections, all patients with HIV co-infection should be started on cotrimoxazole preventative therapy. Combination antibiotic treatment for BU should be commenced before starting antiretroviral therapy (ART) and provided for 8 weeks duration. The suggested combination is rifampicin (10 mg/kg daily up to a maximum of 600 mg/day) plus streptomycin (15 mg/kg daily). An alternative regimen is rifampicin plus clarithromycin (7.5 mg/kg twice daily up to a maximum of 1000 mg daily) although due to drug interactions with antiretroviral drugs this regimen should be used with caution. ART should be initiated in all BU-HIV co-infected patients with symptomatic HIV disease (WHO clinical stage 3 or 4) regardless of CD4 cell count and in asymptomatic individuals with CD4 count ≤500 cells/mm(3) . If CD4 count is not available, BU-HIV co-infected individuals with category 2 or 3 BU disease should be offered ART. For eligible individuals, ART should be commenced as soon as possible within 8 weeks after commencing BU treatment, and as a priority in those with advanced HIV disease (CD4 ≤ 350 cells/mm(3) or WHO stage 3 or 4 disease). All co-infected patients should be actively screened for tuberculosis before commencing BU treatment and before starting ART. Programmes should implement a monitoring and reporting system to document the outcomes of BU-HIV interventions. CONCLUSIONS: Knowledge of the clinical and epidemiological interactions between BU and HIV disease is limited. While awaiting more urgently needed evidence, current management practice of both diseases has been useful to build simple 'common sense' preliminary guidance on how to manage BU-HIV co-infection.

[Clinical, biological, therapeutic and evolving profile of patients with HIV infection hospitalized at Infectious and tropical diseases unit in Abidjan (Ivory Coast)]. / Profil clinicobiologique, thérapeutique et évolutif des patients infectés par le VIH hospitalisés au service des maladies infectieuses et tropicales d'Abidjan (Côte d'Ivoire).

The objective of this study is to describe the clinical, biological, therapeutic and evolving current profile of hospitalized patients with HIV infection in the cohort of the Infectious and Tropical Diseases Unit (ITDU) in the aim to improve their care management. This is a retrospective study, conducted on medical data of hospitalized cases of patients with HIV infection in the ITDU at the teaching hospital of Treichville (Abidjan) from 2006 to 2007. During the two years, 447 patients were included in the study. Their average age was 39 years [18 years-86 years] and sex ratio was 0.69. Of the 447 patients, 35% were unemployed and 67% were new patients who had never undergone antiretroviral therapy (ART). The duration of drug exposure was less than 6 months in 59% of treated patients. The average time to initiate ART was seven weeks. Among naive patients 41.9% were lost to follow up, 35.9% were waiting for treatment and 22.1% waiting for baseline biological test to initiate ART. At the initiation of ART, 79.6% of patients had a CD4 count less than 200/mm(3). The reasons of hospitalization defining AIDS were dominated by tuberculosis (34.2%), cerebral toxoplasmosis (17.9%) and neuromeningeal cryptococcosis (8%). The main reasons of hospitalization in classifying non-AIDS were pyelonephritis (6.5%), bacterial pneumonia (5.4%) and undetermined infectious encephalitis (4.9%). Hospital mortality was 24.4%. The leading causes of death were tuberculosis (22.9%), cerebral toxoplasmosis (20.2%), undetermined infectious encephalitis (18.3%) and cryptococcal meningitis (13.7%). The profile of PLHIV in hospital is characterized by profound immunosuppression due to late diagnosis and high mortality associated with severe opportunistic infections and late initiation of ART.

[Surgical tetanus in Abidjan, Cote d'Ivoire]. / Tétanos à porte d'entrée chirurgicale à Abidjan, Côte d'Ivoire.

OBJECTIVE: To describe the epidemiological and clinical features and the outcome of tetanus with a surgical wound (open fracture, burn, incision, curettage, etc) as the portal of entry. METHODS: Cross-sectional analysis of records of patients hospitalized in the department of infectious and tropical diseases in Abidjan for surgical tetanus from 2003 to 2008. RESULTS: During the 6-year study period, 29 cases were identified. They accounted for 11% of all tetanus cases admitted to the hospital: 8% from 2003 through 2006 and 14% in 2007 and 2008. The patients' average age was 36 years (range: 11-72). Most cases (86%) involved recent surgery, in both public (51%) and private (49%) health facilities. All patients had generalized tetanus at admission, and 24 (86%) paroxysms. Moderate forms predominated (69%). The lethality of tetanus in these surgical wound cases was 45%. The characteristics statistically associated with death were: age >44 years, time of hospitalization >4 days, the presence of paroxysms, and a Dakar prognosis score ≥4. CONCLUSION: The severity of surgical tetanus remains a concern for practitioners. Its high prevalence in recent years demonstrates the need to increase surgeons' awareness of tetanus prevention.

[Human rabies in Abidjan (Côte d'Ivoire): recent cases]. / Rage humaine à Abidjan (Côte d'Ivoire): nouvelles observations.

OBJECTIVE: To present epidemiological and clinical aspects of human rabies in a hospital center. METHOD: We analyzed medical records of cases of rabies in humans treated at the infectious disease department of the Treichville University Hospital Center from January 2005 through December 2009. RESULTS: Seven cases of human rabies were reported during those five years, four in teenagers and three in adults. Five of the cases involved bites by stray dogs whose vaccine status was unknown. No patient had had a pre-exposure prophylactic vaccination, and only four post-exposure prophylaxis, all incomplete. All of the patients developed furious rabies and fever 21 to 96 days (mean: 47.7) after the dog bite, when the wounds had healed and scars formed. Death occurred 4 to 10 days after the onset of symptoms (mean: 4.7). Relatives refused autopsies in all cases. CONCLUSION: It is indispensable to increase population awareness of prevention by vaccination against human rabies, reduce the population of stray dogs, and promote mass vaccination of dogs in the Ivory Coast.

Cryptoccocal meningitis and HIV in the era of HAART in Côte d'Ivoire.

OBJECTIVE: The authors had for aim to describe the management of cryptococcal meningitis in HIV infected adults, in Ivory Coast. PATIENTS AND METHODS: A retrospective study was made from January 1, 2005 to December 31, 2008 on the files of consecutive hospitalized patients presenting with cryptococcal meningitis, at the Treichville University Hospital, Infectious and tropical diseases department (Abidjan). The socio-demographic, clinical, and biological aspects as well as the outcome were analyzed. RESULTS: Eighty patients presenting with cryptococcal meningitis, (2.6% of hospitalized patients) were included: 41 men (51.25%) and 39 women (48.75%); mean age: 40 years (range 26 to 58 years). The delay before consultation was 5.4 days, range 2-12 days). The mains symptoms were headache (83.7%), fever (63.7%), and consciousness disorders (60%). Meningo-encephalitis accounted for 75% of the clinical presentations; 54 patients (67.5%) were naive of antiretroviral treatment (mean CD4: 45/mm(3) (range 5-103/mm(3)), while 26 (32.5%) had received antiretrovirals before presenting with cryptococcal meningitis (Nadir CD4=81/mm(3)). Amphotericin B relayed by fluconazole was prescribed to 86.2% of the patients, associated with a therapeutic lumbar puncture for 30 patients. The death rate was 41.2%. CONCLUSION: In spite of antiretroviral treatment availability in Ivory Coast, cryptococcal meningitis remains frequent with a high death rate. This study stresses the importance of early management to improve the prognosis.

[Antiretroviral prophylaxis after non-occupational exposure to HIV in Abidjan (Cote d'Ivoire)]. / Prophylaxie antirétrovirale après expositions non professionnelles au VIH à Abidjan (Cote d'Ivoire).

OBJECTIVE: The aim of this study was to assess the tolerability and adherence to all non-occupational post-exposure prophylaxis (PEP) for cases of HIV exposure in Abidjan. METHOD: We retrospectively studied all post-exposure prophylaxis for non-occupational exposures to HIV prescribed from January 1st, 2000 to December 31st, 2007 in the Abidjan infectious diseases department. We analyzed the types of exposure, socio-demographic characteristics of patients, antiretroviral therapy regimens, adherence and tolerability, duration of the treatment, and post-exposure follow-up. RESULTS: Over these eight years, we managed 128 consultations for non-professional exposures to HIV (50 male [39%], 78 female patients [61%]), average age 24.8 years (four-54 years). The most frequent exposures were due to rape (n=74), condom rupture (n=29), and occasional unprotected sex (n=21). The average delay before consultation was 20.8 hours. The antiretroviral chemoprophylaxis included a protease inhibitor in 93% of the cases; 80.5% of patients completed 28 days of chemoprophylaxis, while 8.6% interrupted the treatment, and 10.9% were lost to follow-up. The most frequent adverse effects were gastrointestinal, reported by 79 patients (61.7%). Only 34 patients (26.6%) returned for clinical and biological post-exposure follow-up with HIV control at third month, without documented seroconversion. CONCLUSION: Cases of sexual exposure to HIV are the main indication for post-exposure prophylaxis in Abidjan, except for occupational exposure to blood. However, post-exposure prophylaxis should be available in the units of primary care, such as emergencies departments.

[Time trends in demographic and clinical characteristics of adult patients on HAART initiation in West Africa]. / Evolution des conditions d'initiation du traitement antirétroviral des patients infectés par le VIH en Afrique de l'Ouest.

OBJECTIVE: We studied the evolution of drug combinations used, as well as the clinical and immunological profile of patients at initiation of highly active antiretroviral therapy (HAART) between 1996 and 2006 in West Africa. SETTINGS AND METHOD: IeDEA West Africa is a network of HIV care programs established in 2006. We analyzed data from 12 clinical centers treating adults in five countries: Benin, Cote d'Ivoire, Senegal, Gambia, and Mali. Patients 16 years of age or over were included in the study and the following was documented: sex, date of birth and date of initiation of HAART. RESULTS: We included 14,496 adult patients having started HAART, among these 55 % had started HAART between 2005-2006. The proportion of HIV-infected women increased from 46 % in 1996-2000 to 63 % in 2005-2006. The median age at HAART initiation remained constant: 35 years for women and 40 years for men. The proportion of patients having started HAART with a CD4 count<200 cells/microl was 54 % in 1996-2000, and 64 % in 2005-2006. The most frequently prescribed HAART was: AZT/3TC (or d4T/DDI)/IDV (27 %) in 1996-2000; d4T (or AZT)/3TC/EFV (49 %) in 2003-2004, and d4T/3TC/NVP (49 %) in 2005-2006. CONCLUSION: The first line HAART regimen recommended by WHO was initiated in 83 % of cases in 2005-2006. New approaches to an earlier initiation of ART should be explored to reduce mortality in HIV-infected patients on HAART.

[Efficiency and safety of antiretroviral treatment among the elderly in Abidjan]. / Efficacite et tolerance du traitement antiretroviral chez les sujets ages a Abidjan.

OBJECTIVE: To evaluate the efficacy of antiretroviral treatment in elderly people followed at the Unit for Infectious and Tropical Diseases at the University Hospital in Abidjan. MATERIAL AND METHODS: We performed a retrospective descriptive study of the files of people aged at least 60 years, infected by HIV who were treated and followed-up in the Unit between 1 January 1999 and 31 December 2006. We analysed sociodemographic (age, sex), clinical (weight, Karnofsky scale, CDC, opportunistic infections), biological (HIV, CD4, haemogram, glycaemia, creatininaemia, transaminasaemia) and therapeutic (antiretroviral regimens, evolution, side-effects) parameters. The efficacy of treatment was evaluated as the percentage of patients with < 200 CD4/ml, and its safety was based on deleterious effects. RESULTS: We studied 62 patients (44 men, 18 women), of whom 13 had been treated (21%), 46 had not been treated (74.2%) and 48 (77.4%) were undergoing chemoprophy-laxis with cotrimoxazole. Most were infected with HIV1 (93.6%), 3.2% with HIV2 and 3.2% with both HIV1 and HIV2. The majority (93.3%) was symptomatic, and 67.8% had AIDS. During 34 months of follow-up, 48 patients (77.4%) received first-line treatment, 13 (21%) received second-line and only one patient (1.6%) had third-line treatment. The percentage of patients with more than 200 CD4/ml increased from 20% at baseline to 36% at 6 months and 39% at 12 months. The main clinical side-effect was peripheral neuropathy (30.5%), and the main biological effect was hypertransaminasaemia > 2N (32.3%). The median rate of loss to follow-up was 17.7%, and two patients (3.2%) died. CONCLUSION: Antiretroviral treatment is effective in the elderly, with few biological disorders. A prospective study of a larger sample would elucidate the differences from younger people in the efficacy of such treatment.

[Impact of access to antiretroviral therapy in Côte d'Ivoire]. / Bilan de l'accès aux antirétroviraux en Côte d'Ivoire.

In 1998 UNAIDS implemented the national drug access initiative (DAI) in Côte d'Ivoire. The Ivorian government took the DAI over in 2000 with the support of the Global Fund and Presidential Emergency Program For AIDS Relief (PEPFAR). The ensuing affordability of antiretroviral therapy (ART), medical staff training, and healthcare equipment allowed Ministry of Health to improve HIV care throughout the country. Since 2008 ART and follow-up monitoring have been free of charge for people living with HIV/AIDS (PLWHA). In January 2009 a total of 57,833 PLWHA received ART and follow-up at 274 HIV care centers. Use of ART has improved the life expectancy of PLWHA. However morbidity and mortality remained high during the first year of ART implementation with respective frequencies of 5-10% person-year (PY) and 2-3% PY. Morbidity was mainly related to infectious disease (tuberculosis and bacteriaemia) and earlier onset of adverse events (AE). In most cases ART has been well tolerated. The main adverse effects have been anemia, neuropathy, skin toxicity and liver enzyme elevation. The incidence of stage 3/4 AE has been low (< 2 %PY). Although overall compliance has been good (<80%), data among children and adults suggest the need for further work to reinforce support mechanisms. Convincing results have been obtained in the management of PLWHA. Nevertheless greater funding and commitment must be given to management of opportunistic infections and side effects and to development of nutrition support services.

Tobacco use and its determinants in HIV-infected patients on antiretroviral therapy in West African countries.

BACKGROUND: Tobacco smoking is common in human immunodeficiency virus (HIV) infected patients from industrialised countries. In West Africa, few data concerning tobacco consumption exist. METHODS: A cross-sectional survey of the International Epidemiological Database to Evaluate AIDS (IeDEA) network in West Africa was conducted. Health workers administered a questionnaire assessing tobacco and cannabis consumption among patients receiving antiretroviral treatment. Regular smokers were defined as current smokers who smoked >1 cigarette per day for >or=1 year. RESULTS: Overall, 2920 patients were enrolled in three countries. The prevalence of ever smokers and regular smokers were respectively 46.2% (95%CI 42.8-49.5) and 15.6% (95%CI 13.2-18.0) in men and 3.7% (95%CI 2.9-4.5) and 0.6% (95%CI 0.3-0.9) in women. Regular smoking was associated with being from Côte d'Ivoire or Mali compared to Benin (OR 4.6, 95%CI 2.9-7.3 and 7.7, 95%CI 4.4-13.6), severely impaired immunological status at highly active antiretroviral treatment initiation (OR 1.5, 95%CI 1.1-2.2) and history of tuberculosis (TB; OR 1.8, 95%CI 1.1-3.0). CONCLUSION: There are marked differences in smoking prevalence among these West African countries. This survey approach also provides proof of the association between cigarette smoking and TB in HIV-infected patients, a major public health issue in this part of the world.