[Efficacy of a short 6 month therapeutic coursefor HIV infected tuberculosis patients in Abidjan, Côte d'Ivoire]. / Efficacité du régime thérapeutique court de six mois chez les tuberculeux infectés par le VIH à Abidjan, Côte d'Ivoire.

From December 1992 to February 1993, 104 newly diagnosed pulmonary tuberculosis patients were enrolled in a prospective cohort study to assess the response to the 6 month-short-course regimen implemented in Cote d'Ivoire. This treatment encompassed the daily intake of Rifampicin and Pyrazinamide for 2 months followed by Rifampicin and Isoniazid for the remaining 4 months. All the patients were enrolled at the Treichville Tuberculosis Treatment Centre in Abidjan, and a follow-up of 6 months was observed for each patient. All in all, 41 patients were HIV-positive whereas 63 where HIV-negative. No statistical difference was noted between HIV-positive and HIV-negative patients with regard to the completion of therapy (85% versus 87%). The cure rate after an effective 6 month-therapy was similar among HIV-positive and HIV-negative patients (83% versus 84%) as well as the treatment failure rate which was 2.4% and 3% respectively. The results clearly indicate that the 6 month-short-course regimen policy implemented in Côte d'Ivoire is as effective for the treatment of HIV-associated tuberculosis as for the treatment of tuberculosis.

[Pulmonary complications of human immunodeficiency virus infection in sub-Saharan Africa]. / Complications pulmonaires de l'infection par le virus de l'immunodéficience humaine en Afrique sub-saharienne.

Based on a selection of articles published in the literature and reports from international AIDS conferences, we present the main pulmonary complications of HIV-infection observed in sub-Saharan Africa. The different clinical studies demonstrate the predominance of infectious complications, mainly tuberculosis (29 to 44%) and bacterial pneumonia (21 to 35%). The frequency of Pneumocystis carinii pneumonia remains low (5 to 19%). Other complications (mycobacterial infection, cytomegalovirus, toxoplasmosis, cryptococcus, aspergillosis, interstitial lymphoid pneumonia, Kaposi sarcoma) are less frequent. The autopsy studies report similar results and mention the predominance of tuberculosis and pneumonia due to common germs as well as the low frequency of pneumocystosis. This analysis of work conducted in sub-Saharan Africa clearly indicate that tuberculosis remains the leading cause of morbidity and mortality in HIV-infected patients.

[The new face of tuberculosis in the context of the tuberculosis-HIV association in Abidjan, Ivory Coast]. / Le nouveau visage de la tuberculose dans le contexte de l'association tuberculose-VIH à Abidjan, Côte d'Ivoire.

This article reviews the main clinical aspects and progression of HIV-related tuberculosis in Abidjan. HIV prevalence in tuberculosis patients is high, estimated at 46.2% in 1992, with a clear predominance of HIV-1 over HIV-2. More than 61% of co-infected tuberculous patients meet the WHO's clinical definition of AIDS (the Bangui definition) at the time of diagnosis of tuberculosis. This rates falls to 46-51% when cough is excluded from the definition. On X-rays, the signs of pulmonary tuberculosis in co-infected tuberculous patients are atypical in the advanced stages of HIV infection, when extra-pulmonary localization, mainly mediastinal adenopathy, is frequent. Short-course chemotherapy consisting of 2 months' unsupervised daily treatment with rifampicin/isoniazid/pyrazinamide, followed by 4 months of a daily combination of rifampicin/isoniazid, applied in the Ivory Coast since 15 July 1985, has proved successful in HIV-associated tuberculosis, with treatment effectiveness rates of more than 90%.

[Etiologic aspects and therapeutic problems of purulent pleurisy in Abidjan (Côte d'Ivoire)]. / Aspects étiologiques et problémes thérapeutiques des pleurésies purulentes à Abidjan (Côte d'Ivoire).

We present the results of a retrospective study of 127 cases of empyema admitted to the pneumophtisiology department of the Centre hospitalier universitaire de Treichville (Abidjan), between January 1985 and December 1989. We present the pathogens identified in the pleural fluid and the course of the disease during treatment by repeat thoraco-centesis and systemic antibiotics. During the study period, pleural empyema represented 2.7% of all admissions to the pneumophtisiology department, and 20.5% of those presenting with pleural effusions. Bacteriological examination was recovered in 88 of the 127 patients, and was positive in 57 cases (64.7% of those examined). Of those with positive bacteriology, 50 (56.8%) had non-tuberculous bacterial infections, and 7 (7.9%) had tuberculous infection. Among the non-tuberculous bacterial infections, Gram-negative bacilli were most common (72%), and Pseudomonas was the species most frequently identified (48%). The mean stay in hospital was 47 days (range 10-143) and in 82 patients (64.6%), the outcome was favourable. The presentation was complicated by encystment in 36 cases (28.4%) and 9 patients (7%) died in hospital.

[Autopsy findings in 70 AIDS patients who died in a department of pneumology in Ivory Coast: impact of tuberculosis]. / Données fournies par l'autopsie de 70 sujets décédés de SIDA en milieu pneumologique ivoirien: impact de la tuberculose.

Based on autopsy findings in 70 patients infected by human immunodeficiency virus (HIV) who died in the Pulmonology Department of the Treichville University Hospital Center in Abidjan, Ivory Coast. the authors assess the incidence of tuberculosis as the cause of death and analyze the clinical, bacteriologic, and histologic features of the disease. in this population. Pulmonary tuberculosis was the first cause of death in this series accounting for 31 cases (44.2%). In 12 cases (38.7%), microscopic identification failed during hospitalization and the disease had been misdiagnosed as common bacterial pneumonia. In 29 cases (93.5%) pulmonary tuberculosis was associated with abdominal involvement. In 17 cases (54.8%) involvement of more than two organs was observed. Of the 60 abdominal sites detected during the autopsy of the 31 patients with pulmonary tuberculosis, there were 19 (31.3%) in lymph nodes, 18 (30%) in the liver, 14 (23.3%) in the spleen, and 9 (14.9%) in the kidneys. Histologic features were remarkable by the absence of typical tuberculous granulomas. The findings of this study confirm the high incidence of disseminated tuberculosis in patient infected by HIV as noted in a number of previous studies.

[Hemoptysis: main etiologies observed in a pneumology department in Africa]. / Hémoptysies: principales étiologies observées dans un service de pneumo-phtisiologie en Afrique.

The aim of this work was to ascertain the main aetiologies of haemoptysis observed in the pneumo-phtisiology unit at the University Hospital of Treichville at Abidjan, Ivory Coast. A retrospective survey covering 5 years revealed 142 cases. The annual incidence of haemoptysis was 2.5% of the unit's admissions. The mean age of the patients was 33.2 years and 56.3% were at least 41 years of age. Men were predominate (72.5%). The haemoptysis was a sign of thoracic disease in 66.9% of the cases. The chest X-ray was judged abnormal in all the cases and suggested the aetiology in 87.3%. The main aetiologies were pulmonary tuberculosis (49.3%) and acute pneumopathy (with or without abscess) (13.3%). Other causes included bronchectasis (11.2%) and pulmonary aspergilloma (7.7%), followed by bronchogenic cancer (4.2%). The results of this study indicated that tuberculosis remains one of the main causes of haemoptysis at Abidjan.

[Aspects of thoracic radiography of patients with tuberculosis and HIV infection in Ivory Coast]. / Les aspects de la radiographie thoracique chez les tuberculeux infectés par le VIH en Côte d'Ivoire.

The aim of this prospective study was to investigate the main features of standard chest X-ray in patients with concomitant tuberculosis and HIV infection. From 21 December 1992 to 21 February 1993, we compared 45 chest X-rays of HIV+patients with pulmonary tuberculosis with those of 73 HIV negative patients with pulmonary tuberculosis. Our results revealed that extrapulmonary thoracic localizations were remarkably frequent in HIV+tuberculosis patients (57.8% versus 22% in HIV-patients; P < 0.05). Extrapulmonary localizations were frequently mediastinal lymph nodes (82.7%). Parenchymal involvement was often extensive including frequent miliary images (20% versus 38.3% in HIV-patients). Thus despite the lack of CD4 counts in our study, we were able to observe that about one half the co-infected tuberculosis patients had reached the stage of AIDS as defined by the CDC in 1987. These findings are in agreement with those reported in the literature and would suggest that thoracic manifestations of tuberculosis is a good marker of the state of immunodepression.

PIP: In the Ivory Coast, pneumologists examined 188 chest X-rays of patients with pulmonary tuberculosis (TB) treated at the Treichville Antituberculosis Center to compare the principal X-ray characteristics of patients with only TB with those of patients infected with TB and HIV. They did not conduct CD4 counts. 45 TB patients were also infected with HIV for an HIV prevalence rate of 38%. 73.3% of HIV infected TB patients were infected with HIV-1. 4.4% were infected with HIV-2. 22.3% were infected with both HIV-1 and HIV-2. Men predominated in both the TB only group and the TB-HIV group (67.1% and 77.7%, respectively). HIV infected patients were more likely to have thoracic extrapulmonary TB lesions than HIV seronegative patients (57.8% vs. 22%; P 0.05). Thus, 57.8% of co-infected patients had AIDS as defined by the CDC in 1987. Among co-infected patients, lesions on the mediastinal lymph nodes predominated (80.7%). Involvement of the parenchyma, demonstrated by miliary X-rays, was rather common (22.3% vs. 38.3% for HIV negative patients). The X-ray of 84.6% of patients with caseous pneumonia were infected with HIV and TB. These findings parallel those in the literature. They suggest that thoracic manifestations of TB indicate the state of immunodepression.

[Prevalence of pneumocystosis in HIV infected patients in a pneumology unit. Autopsy study performed in Abidjan (Côte d'Ivoire)]. / Prévalence de la pneumocystose chez les sujets infectés par le VIH dans un service de pneumophtisiologie. Etude autopsique réalisée à Abidjan (Côte d'Ivoire).

Autopsies were performed in the Pathology Department of the Treichville University Hospital, Abidjan, Ivory Coast in 70 HIV infected subjects who had died in the Department of Pneumophtisiology. The prevalence of Pneumocystis carinii pneumonia was determined. None of the patients had received prophylaxis against P. carinii and none had bee treated for pneumocystosis. Autopsies were performed within 6 to 48 hours after death and the diagnosis of pneumocystosis was confirmed with the Gomori-Grocott staining technique on lung specimens. Among the 70 autopsies Pneumocystis carinii pneumonia was observed in 6. Thus the prevalence of P. carinii pneumonia in these patients infected with HIV was 8.57%.

[Acute bacterial pneumonia in retroviral infections. Epidemiologic, clinical, radiologic, bacterial and developmental aspects]. / Pneumopathies aiguës bacteriennes au cours de l'infection rétrovirale. Aspects épidémiologiques, cliniques, radiologiques, bactériologiques et évolutifs (Centre Hospitalier Universitaire de Treichville-Abidjan).

From a prospective study starting January 8 to 1990 October 20, the authors discuss 70 cases of acute pneumopathy, supposed to be bacteriologic in patients infected by HIV. The observed pneumopathies are more frequent in young adults, with a pic between 20 to 40 (67.15 p.c). The positivity rate of hemocultures was estimated at 17.14 p.c. with a clear predominance of non typhic Salmonellae. The evolution observed, generally favourable at 72.85 p.c was fatal in 17.15 p.c.

[Pulmonary diseases and retrovirus infections. A pathological study in 70 cases]. / Pathologie pulmonaire et infection rétrovirale. Etude nécropsique de 70 cas.

A necroscopic study, conducted in the Pathology Department of the Centre Hospitalier Universitaire (CHU) de Treichville in Abidjan, included 70 seropositive subjects who died in the Pneumophtisiology Department. We attempted to determine the different pulmonary affections occurring during infection with the human immunodeficiency virus (HIV). This study demonstrated the predominant role of tuberculosis (44%) and bacterial pneumonia (30%) which remain the predominant aetiologies. Other opportunistic affections were rare including: Pneumocystises, Mycobacteriaceae, and Cytomegalovirus infection and the Kaposi sarcoma. The absence of pulmonary cryptococcosis and non-Hodgkin lymphoma were also noted. Necroscopic examinations do not necessarily provide evidence of the in vivo pathologies, the autopsy being able to identify only the causal diseases or those present at death.

Pneumocystis carinii pneumonia. An uncommon cause of death in African patients with acquired immunodeficiency syndrome.

Admissions and deaths in a pulmonary medicine ward in Abidjan, Cote d'Ivoire, West Africa, were evaluated over a 6-month period in 1989 with systematic autopsies on all patients who died. Of 473 patients admitted, 38% were HIV-1 seropositive, 4% were HIV-2 seropositive, and 14% reacted to both viruses. A total of 100 patients (21%) died, and deaths were twice as frequent in HIV-seropositive compared with HIV-negative patients. The pathology of 78 autopsies showed that the predominant cause of death in HIV-seropositive patients was disseminated tuberculosis (40%). Cancer was the cause of death in 64% of HIV-negative patients. Pneumocystosis was found in only 9% of HIV-seropositive autopsies. Since Pneumocystis carinii is an uncommon cause of death in this population, prophylaxis for P. carinii pneumonia is not warranted for HIV-infected patients in Africa. In contrast, research on chemoprophylaxis for tuberculosis is urgently required.

PIP: Between January-June 1989, researchers evaluated 473 admissions and 100 deaths at the Pulmonary Medicine Service at the University Hospital in Abidjan, Ivory Coast to determine prevalence of HIV-1 and HIV-2 infections, to look at death rates in relation to HIV status, and to examine the pulmonary pathology associated with these infections compared with deaths in HIV negative patients. HIV-1 seroprevalence was 38%, HIV-2 4%, and dual HIV reactive 14%. The death rate for the entire sample was 21%. It was higher in HIV seropositive patients than HIV seronegative patients (27% vs. 14%; relative risk=1.95 times). HIV seropositive patients regardless of HIV group essentially died from the same diseases: 40% from pulmonary tuberculosis (disseminated nonreactive multibacillary pattern), 34% from nonspecific pneumonia, 8% from Pneumocystis pneumonia, 6% from Kaposi's sarcoma, and 4% from lung cancer. Among only HIV-1 seropositive cases, Pneumocystis carinii was the cause of death in only 95 of cases. The leading causes of death for HIV seronegative patients included lung cancer (64%), nonspecific pneumonia (28%), and pulmonary tuberculosis (4%). Researchers should be pressed to develop more sensitive means to diagnosis tuberculosis as well as prophylaxis against reactivation of tuberculosis among HIV seropositive people in Africa. Since Pneumocystis carinii infection is uncommon among HIV seropositive people in Africa, prophylaxis for it is not needed.