Incidence of Tuberculosis During the First Year of Antiretroviral Treatment in West African HIV-Infected Adults.

We estimated tuberculosis incidence during the first year on antriretroviral therapy without isoniazid-preventive treatment in 6938 West African HIV-infected adults at 3.33 cases per 100 person-years (95% CI, 2.85-3.80). In multivariate Poisson models, sites in Cote d'Ivoire, male gender, low body mass index, low hemoglobin, low CD4 count, and young age were significantly associated with higher incidence.

[Factors associated with immunovirologic dissociation in HIV-1-infected patients under highly active antiretroviral therapy in the Ambulatory Treatment Center (ATC) in Dakar]. / Facteurs associés à la dissociation immunovirologique chez les patients infectés par le VIH-1 sous traitement antirétroviral hautement actif au Centre de Traitement Ambulatoire (CTA) de Dakar.

INTRODUCTION: The objective of this work is to evaluate the different factors associated with immunovirologic dissociation despite highly active and effective antiretroviral treatment. METHODS: We conducted a retrospective, cohort, descriptive and analytical study of the medical records of HIV-1 infected patients having received at least 12 months of antiretroviral therapy, followed in the ATC cohort from 2001 to 2011 and with undetectable viral load in the last 6 months. RESULTS: During this 10-year study period, the prevalence of IVD was 19.3%. Female sex was predominant, with a sex ratio of 1.9. Immunovirologic dissociation was more frequent in male patients (29.7% vs 14.1%) with a statistically significant difference (p = 0,00006). The average age was 44 years ± 10 years. A history of tuberculosis was found in about a third of the cases (31.4%). Immunovirologic dissociation was significantly more frequent in patients with a history of tuberculosis (p = 0.00005). Most patients (68%) had AIDS at WHO clinical stages 3 or 4. Patients with immunovirologic dissociation were more often in WHO clinical stages 3 and 4 (p = 0.0001). More than half of the cases (56.2%) were found to be malnourished and immunovirologic dissociation was prevalent in malnourished patients (p=0.005). The mean CD4+ T lymphocytes counts was 86.7± 83 cells / mm3. Immunovirologic dissociation was more frequent in patients with initial low CD4+ T lymphocyte counts and with a statistically significant difference (p = 0.00000). By multivariate analysis, only age greater than or equal to 43 years, CD4 initial counts < 100 c/mm3 and male sex were significantly associated with this immunovirologic dissociation. CONCLUSION: Our study assessed the main factors associated with immunovirologic dissociation. Other studies of this nature would also merit consideration in order to highlight the impact of this partial immune response on the emergence of opportunistic infections or the implementation of a specific tritherapy for the sole purpose of producing fully successful immune restoration.

[Prevalence of hepatitis B surface antigen and its associated factors in Senegalese military personnel sent on mission to Darfur]. / Prévalence de l'antigène de surface du virus de l'hépatite B et facteurs associés chez des militaires sénégalais envoyés en mission au Darfour.

INTRODUCTION: In Senegal, 85% of the adult population have been exposed to the hepatitis B virus and about 11% of them are chronic surface antigen (HBsAg) carriers. This infection is poorly documented among Senegalese Armed Forces. The aim of this study was to assess the prevalence of HBsAg in Senegalese military personnel on mission to Darfur (Sudan) and to identify its associated factors. METHODS: We conducted a cross-sectional study among Senegalese military personnel stationed in Darfur from 1 July 2014 to 31 July 2014. HBsAg test was performed on serum of participants using immunochromatographic method. The search for associated factors was carried out using multivariate logistic regression. RESULTS: Our study included 169 male military personnel. The average age was 36.6 ± 9.5 years. A history of familial chronic liver disease, blood exposure and sexual exposure were found in 12.4%, 24.9% and 45.6% of the study population respectively. HBsAg was found in 24 participants [14.2% (CI 95% = 8.9-19.5)]. After adjusting for potential confounding factors, age (OR = 0.9 CI 95% = 0.9-1.0), university level (OR = 9.5 CI 95% = 1.3 - 67 , 1>) and sexual exposure (OR = 3.3 <; CI 95% = 1.0 - 10.3) were independently associated with hepatitis B. CONCLUSION: Our study shows high prevalence of HBsAg and underlines the need for further evaluation of hepatitis B in this population.

[Occult hepatitis B reactivation in a patient with homozygous sickle cell disease: clinical case and literature review]. / Réactivation d'une hépatite B occulte chez un patient drépanocytaire homozygote: cas clinique et revue de la litérature.

Occult Hepatitis B corresponds to the presence of hepatitis B virus-deoxyribonucleic acid (HBV-DNA) in serum and/or in liver of a patient despite HBsAg negativity. Clinically, it is usually asymptomatic. Its reactivation is rare and commonly occurs in immunosuppressed individuals. We report the case of a 21-year old patient from Senegal, with homozygous sickle cell disease, presenting with cholestatic jaundice. Laboratory tests showed reactivation of occult Hepatitis B. This study emphasizes the need to systematically investigate the presence of occult Hepatitis B in patients with sickle cell disease suffering from acute liver disease.

Therapeutic itinerary of severe malaria in adults admitted to a teaching hospital in Dakar, Senegal.

INTRODUCTION: Despite prevention efforts, malaria remains a public health problem. METHODOLOGY: This was a prospective study conducted between October and December 2010 that aimed to describe the therapeutic route of adults presenting with severe malaria prior to being admitted to Fann Teaching Hospital in Dakar, Senegal. RESULTS: A total of 90 patients were included. The majority of them had consulted a public or private health care facility (92%) prior to admission. First consultation occurred on average two days after the onset of the disease. Self-medication (67.4%) and traditional medicine (26.1%) were the main causes of delaying care. CONCLUSIONS: Early care and adequate management are needed to reduce malaria mortality.

[Assessment of the medical care of HIV-infected patients in a voluntary and anonymous screening center in Senegal]. / Bilan de la prise en charge médicale des patients infectés par le VIH dans un centre de dépistage volontaire et anonyme au Sénégal.

The purpose of this study was to conduct a cohort analysis six years after the introduction of medical care for HIV-infected patients in the first voluntary and anonymous screening center in Senegal. This paper provides a retrospective descriptive study of the medical records of HIV-infected patients followed between 2004 and 2009. The center provided care to 389 patients over the course of the six-year period. The median age of patients was 36 years [17- 69 years], with a sex-ratio (F/M) of 2.5. Access to care was mainly by voluntary screening (313 cases). Two thirds (65%) of patients were either asymptomatic or pauci-symptomatic (WHO Stage I/II). Prurigo (20%) and sexually transmitted infections (19%) were the main diseases diagnosed among patients. 66.6% of patients had a CD4+ cell count ? 200/mm3. By the end of 2009, two hundred and thirty-five patients were still being followed. The rate of patients lost to follow-up was 29%, while the lethality rate was 6%. The assessment of the activities of the voluntary, anonymous and free screening center shows the importance of screening centers in the fight to promote knowledge about HIV infection.