Incidence of tuberculosis after HAART initiation in a cohort of HIV-positive patients in Burkina Faso.

OBJECTIVE: To determine the incidence rates of tuberculosis (TB) after the initiation of highly active antiretroviral treatment (HAART). METHODS: We conducted a retrospective cohort study on four human immunodeficiency virus (HIV) treatment centres in Ouagadougou, Burkina Faso. TB incidence was measured at different intervals after HAART initiation. Cox regression models were used to identify factors associated with TB incidence. RESULTS: We analysed a cohort of 2383 subjects with a mean follow-up period of 836 days (standard deviation +/- 443.4). TB incidence rate was highest during the first trimester of HAART; after 3 months of treatment, the total TB case incidence dropped by 60% from 5.77/100 person-years (py) to 2.23/100 py. World Health Organization clinical Stage III or IV, CD4+ T-cell count < 50 cells/microl and body mass index (BMI) < 18.5 were associated with increased risk of TB on univariate analysis. In the Cox regression, BMI < 18.5 and CD4+ T-cell count < 50 cells/microl at HAART initiation were independently associated with a two-fold higher risk of TB. CONCLUSIONS: Delaying HAART initiation until the CD4+ T-cell count drops to <50 cells/microl significantly increases TB incidence in the first 3 months after HAART initiation. Active case finding for TB is an essential element of standard clinical care in HIV-positive patients during the initial period of HAART.

Outcome and predictive factors of mortality in hospitalized HIV-patients in Burkina Faso.

BACKGROUND: The aim of this study was to describe the clinical presentation and predictors of death in a HIV population hospitalized in Ouagadougou, Burkina Faso. MATERIALS AND METHODS: Baseline demographics, viro-immunological status, clinical presentations, and outcome have been analyzed by univariate analysis and a multivariate model. RESULTS: A total of 1,071 hospitalizations of HIV-positive patients was recorded between 1 January, 2004 and 31 August, 2006, the majority of whom were female (64.1%). The baseline CD4 cell count/microl was higher in the female patients than in the male ones (166.1 vs 110.9). Gastroenteric symptoms were the first cause of hospitalization (61.7%). The crude mortality rate was higher in males than females (38% vs 25.3%). Baseline World Health Organization clinical stage IV (OR 9.22), neurological syndrome (OR 3.04) or wasting syndrome at admission (OR 2.9), positive malaria film (OR 2.17), and an older age independently predicted death. Weight at admission > 40 kg and a higher platelet count at admission were independently associated with a better outcome. CONCLUSIONS: Females are admitted to hospital earlier than males, probably as an indirect result of the Prevention of Mother-to-Child Transmission (PMTCT) public health initiative. An active search of HIV status in other members of the family (PMTCT-plus) may result in the detection of asymptomatic HIV-infected patients as well. A Plasmodium falciparum-positive smear during admission significantly impacted on outcome as well as low platelet count.

Epidemiological phenotypic characteristics of vaginal yeasts at the Comoros.

The aim of the prospective, descriptive survey conducted in Moroni, Comoros was to establish the distribution of vulvovaginal mycoses in pregnant and symptomatic women and to study the epidemiological characteristics of the yeast isolates. All isolated strains were epidemiologically evaluated by phenotypical methods. Three phenotypic epidemiological studies were performed by morphotyping methods (including the colour reaction according to Quindòs et al. and structural morphotypes as described by Soll), by determination of phospholipase and by chemosensitivity evaluation according to the Clinical and Laboratory Standards Institute approved standard. Out of 253 women, 108 were found positive for yeast culture (42.7%). Fungal identification results showed that 61.6% was Candida albicans and 28.6%C. sake (32/112). Candida sake was a frequent vaginal inhabitant.

Hyper-reactive malarial splenomegaly in a patient with human immunodeficiency virus.

Both hyperreactive malarial splenomegaly (HMS) and HIV infection are highly prevalent in sub-Saharan Africa, but the inter-relationships between the two conditions are not clearly defined. Diagnosis of HMS is particularly difficult in HIV-infected patients, and detection of circulating malaria parasites by polymerase chain reaction (PCR) may represent a useful diagnostic tool.

Conversion rate at two-month follow-up of smear-positive tuberculosis patients in Burkina Faso.

SETTING: Burkina Faso, West Africa. OBJECTIVE: 1) To determine the trend of sputum smear conversion rates at the 2-month follow-up of new smear-positive tuberculosis (TB) patients; and 2) to compare conversion rates in cured TB patients and treatment failures. DESIGN: Retrospective cohort study based on TB registers from all 80 diagnostic and treatment centres from 1995 to 2003. The conversion rate was defined as the number of negative results divided by the number of smear-positive patients for whom the 2-month follow-up examination was completed. RESULTS: The 2-month follow-up completion rate was 92.1%; it increased from 86.3% in 1996 to 94.3% in 2003. The conversion rate was 82.9%, increasing from 76.3% in 1995 to 87.9% in 1997 and falling to 80.3% in 2003. The cure rate was higher among patients who were smear-negative at the 2-month follow-up (77.3%) CONCLUSION: The conversion rate was satisfying, but had declined since 1997, which may be a matter of concern. This could be due to patient characteristics such as associated conditions (human immunodeficiency virus, malnutrition) or to drug management (ineffective administration of drugs even under directly observed treatment, insufficient dosages, resistance). Thorough research is needed to elucidate this negative trend.

Effective program against mother-to-child transmission of HIV at Saint Camille Medical Centre in Burkina Faso.

The present research was aimed to prevent mother-to-child transmission of HIV; to use RT-PCR in order to detect, 6 months after birth, infected children; and to test the antiretroviral resistance of both children and mothers in order to offer them a suitable therapy. At the Saint Camille Medical Centre, 3,127 pregnant women (aged 15-44 years) accepted to be enrolled in the mother-to-child transmission prevention protocol that envisages: (i) Voluntary Counselling and Testing for all the pregnant women; (ii) Antiretroviral therapy for HIV positive pregnant women and for their newborns; (iii) either powdered milk feeding or short breast-feeding and RT-PCR test for their children; (iv) finally, pol gene sequencing and antiretroviral resistance identifications among HIV positive mothers and children. Among the patients, 227/3,127 HIV seropositive women were found: 221/227 HIV-1, 4/227 HIV-2, and 2/227 mixed HIV infections. The RT-PCR test allowed the detection of 3/213 (1.4%) HIV infected children: 0/109 (0%) from mothers under ARV therapy and 3/104 (2.8%) from mothers treated with Nevirapine. All children had recombinant HIV-1 strain (CRF06_CPX) with: minor PR mutations (M36I, K20I) and RT mutations (R211K). Among them, two twins had Non-Nucleoside Reverse Transcriptase Inhibitor mutation (Y18CY). Both mothers acquired a major PR mutation (V8IV), investigated 6 months after a single-dose of Nevirapine. Prevention by single-dose of Nevirapine reduced significantly mother-to-child transmission of HIV, but caused many mutations and resistance to antiretroviral drugs. Based on present study the antiretroviral therapy protocol, together with the artificial-feeding, might represent the ideal strategy to avoid transmission of HIV from mother-to-child.

Completion of screening for latent tuberculosis infection among immigrants.

The objective of our study was to evaluate the sociodemographic factors associated with completion of screening for latent tuberculosis infection (LTBI) among undocumented immigrants in Brescia, Italy. Screening for LTBI was offered to 649 immigrants; 213 (33%) immigrants completed the first step of screening; only 44% (55/124) of individuals with a positive tuberculin skin test result started treatment for LTBI. The univariate analysis showed that being unmarried, of Senegalese nationality and being interviewed by a health-care worker with the same native language as the immigrant were significantly associated with completion of screening for LTBI. In the multiple logistic regression, being interviewed in the native language of the health-care worker (OR 2.5, 95% CI 1.3-4.8, P = 0.004) and being of Senegalese origin (OR 2.3, 95% CI 1.4-3.6, P = 0.0005) were independently associated with adherence to LTBI screening. Our results suggest that knowledge of the sociodemographic characteristics of immigrants, and the participation of health-care workers of the same cultural origin as the immigrant during the visits, can be an important tool to improve completion of screening for LTBI.

Editorial introduction to the paper by A. Castellani "Researches on the Etiology of Sleeping Sickness" reprinted from the Journal of Tropical Medicine, June 1, 1903.

The paper by Professor Aldo Castellani represents the first report suggesting the causative role of Trypanosoma spp. in the pathogenesis of sleeping sickness and confirms his pivotal role in solving the etiologic dilemma of the disease. Professor Castellani also contributed to a large extent to many other important microbiological discoveries, mainly in the field of mycology, protozoology and bacteriology.