Evaluation of the Upgraded Version 2.0 of the Roche COBAS® AmpliPrep/COBAS® TaqMan HIV-1 Qualitative Assay in Central African Children.

BACKGROUND: Several commercially available molecular techniques were developed based on subtype B of HIV-1, which represents only 10% of HIV strains worldwide. Indeed, in sub-Saharan Africa, non-B subtypes of HIV-1 are predominant. The aim of this study was to evaluate the performances of the COBAS® AmpliPrep/COBAS® (CAP/CTM) HIV-1 Qualitative assays to detect the broad range of HIV-1 variants circulating in Central Africa and compare to the outgoing CAP/CTM HIV-1 Quantitative test v2.0 (Roche Molecular Systems), chosen as reference gold standard molecular assay. METHODS: The CAP/CTM HIV-1 Qualitative tests versions 1.0 and 2.0 (Roche Molecular Systems, Inc., Branchburg, NJ, USA) were evaluated compared to CAP/CTM TaqMan HIV-1 Quantitative test v2.0 (Roche Molecular Systems) on 239 dried plasma spot (DPS) from 133 HIV-1-infected (with detectable plasma HIV RNA load) and 106 uninfected children, followed-up at Complexe Pédiatrique, Bangui, Central African Republic. RESULTS: The version 1.0 showed low sensitivity (93.2%), with 9 (6.8%) false negative results, demonstrating under-detection of non-B HIV-1 subtypes. In contrast, the upgraded version 2.0 showed 100%-sensitivity, 100%-specificity and perfect agreement (κ coefficient, 1.0). CONCLUSION: Our evaluation in the Central African Republic demonstrates the clinical implications of the accuracy and reliability of the CAP/CTM HIV-1 Qualitative assay for early diagnosis of HIV-1 in Central African children.

Variability of human immunodeficiency virus-1 in the female genital reservoir during genital reactivation of herpes simplex virus type 2.

Clinical and subclinical genital herpes simplex virus type 2 (HSV-2) reactivations have been associated with increases in human immunodeficiency virus (HIV)-1 genital shedding. Whether HSV-2 shedding contributes to the selection of specific genital HIV-1 variants remains unknown. We evaluated the genetic diversity of genital and blood HIV-1 RNA and DNA in 14 HIV-1/HSV-2-co-infected women, including seven with HSV-2 genital reactivation, and seven without as controls. HIV-1 DNA and HIV-1 RNA env V1-V3 sequences in paired blood and genital samples were compared. The HSV-2 selection pressure on HIV was estimated according to the number of synonymous substitutions (dS), the number of non-synonymous substitutions (dN) and the dS/dN ratio within HIV quasi-species. HIV-1 RNA levels in cervicovaginal secretions were higher in women with HSV-2 replication than in controls (p0.02). Plasma HIV-1 RNA and genital HIV-1 RNA and DNA were genetically compartmentalized. No differences in dS, dN and the dS/dN ratio were observed between the study groups for either genital HIV-1 RNA or plasma HIV-1 RNA. In contrast, dS and dN in genital HIV-1 DNA were significantly higher in patients with HSV-2 genital reactivation (p <0.01 and p <0.05, respectively). The mean of the dS/dN ratio in genital HIV-1 DNA was slightly higher in patients with HSV-2 genital replication, indicating a trend for purifying selection (p 0.056). HSV-2 increased the genetic diversity of genital HIV-1 DNA. These observations confirm molecular interactions between HSV-2 and HIV-1 at the genital tract level.

[Elimination or control of the onchocerciasis in Africa? Case of Gami village in Central African Republic]. / Élimination ou contrôle de l'onchocercose en Afrique ? Cas du village de Gami en République centrafricaine.

The authors return the results of a transverse prospective survey whose goal was to value the impact of struggle against the onchocerciasis after 20 years of distribution of ivermectin in a village of the Central African Republic. A transverse prospective survey with a descriptive and analytic aim of a sample of 393 topics aged of more than 5 years residing in Gami Village since more of 2 years and having benefitted the ivermectine in the last distribution that took place 10 months before. The epidemiological, clinical and parasitologic data introverted have been compared to the results of the previous investigations in the village. The parameters improved distinctly during the 20 years (1990-2010) notably the microfilarian indication (88% in 1990 against 19% in 2010), the middle microfilarian density (54 against 0,7), the CMFL Indication (39 against 0,67), the Knuttgen indication moved of the trance of age of 5-9 years to the one of more than 45 years since 1998), the cystic indication (36% against 8%), the ocular lesions (31% against 4%) of which onchocercian (28% against 2%), serious ocular lesions (16% against 1,3%), rate of blindness (9% against 0,8%), rate of meadow-blindness (9% against 0,8), important loss of vision (3% against 0,0%), ocular lesions in children of 6-10 years old (6% against 0,3%). These data permit to speak of control but not of elimination of the onchocerciasis in the grouping villager of Gami because of the persistence of the microfilarian indications susceptible to maintain the transmission of where necessity to pursue the struggle.

[Scabies: epidemiological, clinical and therapeutic features in Bangui]. / Gale sarcoptique : aspects épidémiologiques, cliniques et thérapeutiques à Bangui.

The scabies infects about 300 million people worldwide. Its spread is linked to living conditions especially in economically poor countries. In Central African Republic (CAR) we do not have data on this disease often causes morbidity and expenses, and the disease is often confused and poorly treated. The authors' goal was to describe the epidemiological, clinical and therapeutic characteristics of scabies in Bangui. This was a cross-sectional study by counting records of cases of scabies observed in the dermatology and venereology department of Bangui from 1 January 2006 to 31 December 2010. The diagnosis was based mainly on the combination of a concept of pruritus predominantly night with the notion of contagion and preferential localization of lesions. Three hundred and seventy six cases of scabies were identified from a total of 6391 patients (a hospital prevalence of 5.88%) with high frequency among the population aged 0 to 9 years (33%), an important achievement of the disadvantaged classes (preschool age and pupils / students respectively 25.5% and 26.3%), a prevalence of scabies nodules as type of clinical lesion, localization predominantly on buttocks and the most common complication of eczema-type (19.9 %). Benzyl benzoate solution at 25% applied for 2 consecutive days yielded very satisfactory results (96.7% on day 28) in all forms. The scabies is present in CAR with classical clinical and epidemiological aspects. We recommend first-line benzyl benzoate in two days of application.

[Cervical dysplasia in women with human immunodeficiency virus (HIV) in areas of high prevalence of infection]. / Dysplasies cervicales chez les femmes séropositives pour le VIH en zone de forte prévalence de l'infection.

OBJECTIVES: To determine the prevalence of cervical squamous intraepithelial lesions among HIV-positive women, compared to that of HIV-negative women and identify the different types of lesions in both groups. PATIENTS AND METHODS: Cross-sectional study conducted in 16 months in two facilities and the service of pathological anatomy of Bangui. The sample consisted of 250 HIV-positive women matched to 250 HIV-negative women. The parameters studied were the HIV status, the result of cervical smear screening, the rates of CD4 and the data of the interview. RESULTS: The smears were inflammatory in 54.4% of HIV-negative and 46.4% of HIV-positive. Epidermoid intraepithelial lesions of the cervix were more frequent among HIV-positive women than among HIV-negative women with respectively 34.8% and 16.4% (P<0.0001). The low-grade lesions were more common regardless of HIV status of patients. The median age of onset of the LEI was lower among HIV-positive whatever the grade of the lesion. Koïlocytosis was found in 27.2% of HIV-positive women against 9.2% among HIV-negative (P<0.001). DISCUSSION AND CONCLUSION: The prevention of infection by HIV and HPV and the monitoring of precancerous lesions would allow to prevent their evolution towards invasive cancer.

L'endemie filarienne dans la ville de Bangui; Republique Centrafricaine

Dans les pays intertropicaux; les filarioses posent de sante publique; touchant environ150 millions de sujets dans le monde. La Republique Centrafricaine; a l'instar des autres pays tropicaux; n'est pas epargnee par ce fleau. Deux types de filarioses font l'objet de preoccupation a cause de leurs consequences socio-economiques et medicales; la dracunculose et l'onchocercose .Deux programmes de lutte sont en cours d'execution mais toutes les regions ne sont pas entierement couvertes.les objectifs specifiques de ce travail prospectif qui a dure 5 mois etaient de determiner la prevalence des filarioses dans la capitale et etudier les profils epidemiologiques et les aspects cliniques des personnes atteintes dans les Arrondissements et quartiers de Bangui choisis au hasard. Les sujets jeunes de 15 a 44 ans etaient 266 sur les 323 sujets de l'etude; soit 82 ; 4. Le sexe masculin representaient 44.Le prurit etait present dans 87;6des cas ; la gale 31;4;les nodules 8; 7et les depigmentations des jambes ; 15 ;5des cas .La gale etaient surtout observee dans le septiemea arrondissement .Les microfilaires dermiques etaient retrouvees dans 36; 84des cas avec une predominance masculine (57 ;5) et le septieme Arrondissement etaient plus touche que les autres .Les microfilaires sanguine etaient retrouvees dans 15 ; 79des cas .Pour ces filarioses ; Bangui est une ville mesoendemique avec cependant une forte prevalence dans les quartiers proches du Fleuve

[Use of spirulina supplement for nutritional management of HIV-infected patients: study in Bangui, Central African Republic]. / Intérêt de la Spiruline chez les personnes vivant avec le VIH a Bangui (RCA).

Treatment of HIV-infected persons including nutritional management is a major concern in Africa and in particular in the Central African Republic (CAR). This six-month randomized prospective longitudinal study was carried out at the Friends of Africa Center that was a facility for comprehensive management of persons infected and affected by HIV in Banqui, CAR. The purpose of the study was to assess the impact of spirulina supplement on clinical and laboratory findings in HIV-infected patients who were not indications for ARV treatment. A total of 160 patients were randomly assigned to two groups. Patients in group 1 (n=79) received 10 grams of spirulina per day on a regular basis while patients in group 2 (n = 81) received a placebo. In addition patients in both groups received dietary products supplied by the World Food Program (WFP). Follow-up of the 160 patients at three and six months showed that 16 patients had been lost from follow-up and 16 had died, with no difference in distribution between the two groups. A significant improvement in the main follow-up criteria, i.e., weight, arm girth, number of infectious episodes, CD4 count, and protidemia, was observed in both groups. No difference was found between the two groups except with regard to protidemia and creatinemia that were higher in the group receiving spirulina supplement. From a clinical standpoint results were less clear-cut since the Karnofsky score was better in the group receiving spirulina than in the group receiving the placebo at 3 months but not at 6 months and fewer patients presented pneumonia at six months. Further study over a longer period will be needed to determine if spirulina is useful and to evaluate if higher doses can have beneficial nutritional and immunitary effects without adverse effects, in particular renal problems.

Evolution de la trypanosomiase humaine africaine en Republique Centrafricaine

La trypanosomiase humaine africaine (THA) ou maladie du sommeil est une affection redoutable qui fit jadis beaucoup de ravages au sein de la population de differentes regions d'Afrique dont celle de la Republique Centrafricaine (RCA). Elle pose un probleme de sante publique en Afrique sub-saharienne. Cette etude retrospective nous a permis de decrire l'evolution de la maladie dans les differents foyers de la Centrafrique de 1998 a 2008. Durant cette periode; 8086 nouveaux patients ont ete recenses sur les 175243 personnes examinees; soit un taux de prevalence de 4;61. Les femmes etaient plus atteintes (66;65) que les hommes avec un sex-ratio de 1;5. La tranche d'age la plus touchee est celle de 20 a 29 ans (45;3). La majorite des malades depistes etaient en deuxieme phase (58). On a observe une resurgence d'un ancien foyer au nord du pays. La deterioration des systemes de sante; l'abandon ou l'affaiblissement des programmes de lutte; l'instabilite sociopolitique avec les mouvement incessant des populations sont les principaux facteurs expliquant cette flambee. Le depistage et le traitement couples a la lutte antivectorielle permettront a moyen de reduire significativement la prevalence de la THA en Centrafrique

Detection of Y chromosome DNA as evidence of semen in cervicovaginal secretions of sexually active women.

The detection of traces of semen in cervicovaginal secretions (CVS) from sexually active women practicing unprotected sex is a prerequisite for the accurate study of cervicovaginal immunity. Two semen markers, the prostatic-specific antigen (PSA) and the Y chromosome, were detected in parallel in CVS obtained by a standardized vaginal washing of consecutive women attending the principal medical center for sexually transmitted diseases of Bangui, Central African Republic. PSA was detected by immunoenzymatic capture assay in the cell-free fraction of CVS, and the Y chromosome was detected by a single PCR assay of DNA extracted by silica from the cell fraction (Y PCR). Fifty (19%) cell-free fractions of the 264 beta-globin-positive CVS samples were positive for PSA, and 100 (38%) cell fractions of the CVS samples were positive for the Y chromosome. All the 50 (19%) PSA-containing CVS samples were also positive for the Y chromosome. Fifty (19%) CVS samples were positive only for the Y chromosome, with no detectable PSA. The remaining 164 (62%) CVS samples were both PSA and Y chromosome negative. These findings demonstrate that CVS from sexually active women may contain cell-associated semen residues unrecognized by conventional immunoenzymatic assays used to detect semen components. The detection of cell-associated male DNA with a highly sensitive and specific procedure such as Y PCR constitutes a method of choice to detect semen traces in female genital secretions.

Aetiology of urethral discharge in Bangui, Central African Republic.

OBJECTIVES: To determine the aetiology of urethritis in Bangui, Central African Republic. METHODS: 410 men presenting with urethral discharge and 100 asymptomatic controls were enrolled. Urethral swabs were obtained and processed by gonococcal culture and polymerase chain reaction for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, and Ureaplasma urealyticum. RESULTS: In multivariate analyses, M genitalium and C trachomatis were significantly associated with urethral discharge when comparing cases of non-gonococcal urethritis (NGU) with controls. T vaginalis was also more common in cases than in controls, but this reached statistical significance only among cases in whom N gonorrhoeae was also detected. U urealyticum was not associated with urethritis. The gonococcus was found in 69% of cases of urethral discharge. M genitalium was the predominant pathogen in patients with NGU, being found in 42% (53/127) of such patients while C trachomatis was found in only 17% (22/127). T vaginalis was found in 18% (23/127) of patients with NGU, but also in 15% (43/283) of patients with gonococcal urethritis, and two thirds of patients with T vaginalis also had the gonococcus. Multiple infections were common. M genitalium caused a syndrome similar to chlamydial urethritis, with a less severe inflammation than in gonococcal infection. No behavioural or clinical characteristic could discriminate between the various aetiological agents. CONCLUSIONS: M genitalium is more prevalent than C trachomatis and is the most common cause of NGU in BANGUI: It causes a syndrome similar to chlamydial urethritis. T vaginalis is weakly associated with urethritis, and is often found along with other pathogens.

Quality of sexually transmitted disease treatments in the formal and informal sectors of Bangui, Central African Republic.

BACKGROUND: Interventions for upgrading sexually transmitted disease (STD) management in sub-Saharan Africa have focused on the public sector, and to a much lower extent on private medical practitioners and pharmacies. However, in most African cities there is a large informal sector that provides care to many patients with STD symptoms. GOAL: To compare the quality of treatments offered to patients with major STD syndromes in the public sector, pharmacies, and the informal sector of the same city. STUDY DESIGN: Healthcare providers in health centers, pharmacies, private laboratories, and market drug peddlers in Bangui, Central African Republic, were asked to complete a short form for every patient consulting them with genital complaints. The treatments they ordered were evaluated for their potential efficacy against the major etiologic agents of the syndrome for which the patient consulted. RESULTS: The majority of male patients with STDs preferred to seek care in pharmacies and in the informal sector. The STD treatments offered to patients with urethral discharge or genital ulcers in pharmacies and in the informal sector tended to focus on a single etiologic agent. The quality of STD treatments offered by drug peddlers and private laboratories was poor, apart from adequate coverage of syphilis in patients with genital ulcers and of candidiasis in women with vaginal discharge. For instance, 41% and 34% of patients with urethral discharge managed by drug peddlers and private laboratories did not receive a drug active against either Neisseria gonorrhoeae or Chlamydia trachomatis, whereas this proportion was 22% in pharmacies and 14% in health centers. For patients with genital ulcers, the proportion offered a drug active against Haemophilus ducreyi was 2% if seen by drug peddlers, 0% in laboratories, 10% in pharmacies, and 25% in health centers. For each syndrome and each category of provider, between one fourth and two thirds of patients had already received another ineffective treatment elsewhere. CONCLUSION: National STD and HIV control programs will have to improve STD management in pharmacies and in the informal sector if they are to have any impact on the dynamics of HIV infection in urban centers.

Interactions between herpes simplex virus type 2 and human immunodeficiency virus type 1 infection in African women: opportunities for intervention.

Sexually transmitted diseases (STDs) are cofactors for human immunodeficiency virus (HIV) transmission, but the specific role of herpes simplex virus type 2 (HSV-2) is unclear. This study aimed to examine the in vivo relationships between HSV-2 and HIV-1 in 300 women in Bangui, Central African Republic. Sera were tested for syphilis, HIV-1, HSV-2 antibody, and levels of vitamins A and E. Genital specimens were tested for other STDs. HSV-2 DNA and HIV-1 RNA were quantified in cervicovaginal lavage. The prevalences of HSV-2 antibody (91% vs. 78%, P=.02), HSV-2 shedding (43% vs. 22%, P=. 003), and levels of HSV-2 DNA (P=.01) were all significantly higher among HIV-1-seropositive than among HIV-1-seronegative women. There was a significant correlation between genital HIV-1 RNA and HSV-2 DNA levels (P=.02) among the 23 women who were shedding HSV-2 DNA. If confirmed, such associations highlight the urgent need for HSV-2 control measures in populations at high risk of both infections.

Sexually transmitted infections in young pregnant women in Bangui, Central African Republic.

In early 1996, 481 women visiting the antenatal services of the 3 major governmental health centres in the capital city of the Central African Republic (CAR) were included in the study. All study participants underwent the health centre's routine gynaecological examination, including laboratory diagnosis of trichomoniasis, candidiasis, gonorrhoea, syphilis and bacterial vaginosis. Cervical secretions and blood samples from study participants were sent to the National STD Reference Centre for diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, Candida albicans, Treponema pallidum, and HIV. Overall, 34% of the study women were diagnosed with at least one sexually transmitted infection (STI) (3.1% N. gonorrhoeae, 6.2% C. trachomatis, 9.9% T. vaginalis, 6.7% T. pallidum, 12.2% HIV-1). In addition, 29.1% of women were diagnosed with bacterial vaginosis and 46.6% with candidiasis. Only a small proportion of these women had sought treatment during the weeks before, despite the recognition of genital symptoms. Self-reported and health worker-recognized symptoms, signs and laboratory results exhibited only low sensitivities, specificities, and positive predictive values in the diagnosis of STIs. These findings confirm the high vulnerability of young African women to STIs and emphasize the need for specific control interventions which should include affordable and user-friendly services. Moreover, these results call for more effective quality control in case of laboratory-based STI control strategies and question the validity of syndromic STI management strategies in women attending antenatal care services in Africa.

PIP: This study reports on the prevalence of sexually transmitted infections (STIs) among pregnant women in Bangui, Central African Republic. A total of 481 pregnant women visiting the antenatal services of the 3 major governmental health centers were included in the study. All these women were interviewed and underwent gynecological examination, including laboratory diagnosis of trichomoniasis, candidiasis, gonorrhea, syphilis and bacterial vaginosis. The results revealed that 34% of the women were diagnosed with at least one STI. Gonorrhea accounted for 3.1%, chlamydiasis for 6.2%, trichomoniasis for 9.9%, syphilis for 6.7%, and HIV-1 for 12.2%. In addition, 29.1% of women were diagnosed with bacterial vaginosis and 46.6% with candidiasis. The majority of the women diagnosed with an STI reported specific clinical symptoms during the week before they entered into the study, but only a minority of them actively sought treatment, and only half of those consulted the formal health sector. Self-reported and health worker-recognized symptoms, signs and laboratory results manifested only low sensitivities, specificities, and positive predictive values in STI diagnosis. These results confirmed the high susceptibility of young African women to STIs. Therefore, specific control interventions should be carried out which incorporate affordable and user-friendly services.

Screening blood donations for hepatitis C in Central Africa: analysis of a risk- and cost-based decision tree.

Four screening strategies (no testing, HC Abbott, HC Pasteur, and a combined test) for the detection of hepatitis C virus (HCV) antibody in donated blood were considered in a formal decision tree. Decision criteria included residual risk of infection and overall monetary cost. Tree parameters were determined using data from the Central African Republic. The prevalences observed among blood donors for HIV infection, hepatitis B, syphilis, and hepatitis C varied between 6% and 15%. The current residual risk of transfusion-transmitted infections is very high (8.4%). Screening for HCV would bring that risk down to about 3% with either the HC Pasteur, the HC Abbott, or the combined test. Even though baseline analysis gives preference to the HC Abbott test (the combined test coming out last), Monte Carlo sensitivity and uncertainty analyses showed that Abbott's and Pasteur's tests are interchangeable, on the basis or either risk or cost considerations.