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Background: Hepatitis B is a major concern in Africa, especially in HIV-infected patients. Unfortunately, access to hepatitis B virus (HBV) testing and adequate treatment remains a challenge in the continent. We investigated HBV testing, treatment, and virologic suppression in HIV-infected patients followed up as part of Cameroon's national antiretroviral programme.Methods: A cross-sectional survey was performed in adult patients receiving antiretroviral therapy (ART) in 19 hospitals in the Centre and Littoral regions in Cameroon. The proportions of patients tested for hepatitis B surface antigen (HBsAg) prior to the study were compared among all study hospitals using the Chi-square test. The association of individual and hospital-related characteristics with HBV testing and virologic suppression was assessed using multilevel logistic regression models.Results: Of 1706 patients (women 74%, median age 42 years, median time on ART 3.9 years), 302 (17.7%) had been tested for HBsAg prior to the study. The proportion of HBV-tested patients ranged from 0.8 to 72.5% according to the individual hospital (p < 0.001). HBV testing was lower in women (adjusted odds ratio [aOR] 0.64, 95% confidence interval [CI] 0.46-0.89, p = 0.010) and higher in patients who initiated ART in 2010 or later (aOR 1.66, 95% CI 1.23-2.27, p < 0.001). Of 159 HBsAg-positive patients at the time of the study (9.3%), only 97 (61.0%) received Tenofovir + Lamivudine (or Emtricitabine). Of 157 coinfected patients, 114 (72.6%) had a HBV viral load < 10 IU/mL. HBV suppression was higher in patients with a HIV viral load < 300 copies/mL (aOR 3.46, 95% CI 1.48-8.09, p = 0.004) and lower in patients with increased ALT level (aOR 0.86 per 10 IU/mL increase, 95% CI 0.75-0.97, p = 0.019).Conclusions: A substantial proportion of HIV/HBV coinfected patients were at higher risk of liver disease progression. Improving the management of HBV infection in the routine healthcare setting in Africa is urgently required in order to achieve the 2030 elimination targets. Micro-elimination of HBV infection in people living with HIV could be an easier and cost-effective component than more widely scaling up HBV policies. [ABSTRACT FROM AUTHOR]

Objectives: In terms of HIV infection, western and central Africa is the second most affected region world‐wide, and the gap between the regional figures for the testing and treatment cascade and the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90–90–90 targets is particularly worrying. We assessed the prevalence of virological suppression in patients routinely treated in 19 hospitals in Cameroon. Methods: A cross‐sectional survey was performed in adult patients receiving antiretroviral therapy (ART) in the Centre and Littoral regions. The prevalences of virological suppression (<1000 HIV‐1 RNA copies/mL) were compared among all 19 hospitals using the χ2 test. Potential individual and health care‐related determinants of virological suppression were assessed using multivariate logistic regression models. Results: A total of 1700 patients (74% women; median age 41 years; median time on ART 3.7 years) were included in the study. The prevalence of virological suppression was 82.4% overall (95% confidence interval 80.5–84.2%). It ranged from 57.1 to 97.4% according to the individual hospital (P < 0.001). After adjustment, virological suppression was associated with age, CD4 cell count at ART initiation, disclosure of HIV status to family members, interruption of ART for more than two consecutive days, and location of patient's residence and hospital (rural/urban). These factors did not explain the heterogeneity of virological suppression between the study hospitals (P < 0.001). Conclusions: The overall prevalence of virological suppression was reassuring. Nevertheless, the heterogeneity of virological suppression among hospitals highlights that, in addition to programme‐level data, health facility‐level data are crucial in order to tailor the national AIDS programme's interventions with a view to achieving the third UNAIDS 90 target. [ABSTRACT FROM AUTHOR]

Objective: To study the cardiac abnormalities in HIV infected patients in relation to the clinical stage of the disease and the immunological status of the patients.Methods: A total 75 consecutive patients tested for HIV on the basis of clinical suspicion of the disease from July to September 1996 at the University Hospital Centre, Yaounde, Cameroon were recruited. The patients were classified into AIDS, HIV positive non-AIDS, and HIV negative according to clinical findings and outcome of ELISA and western blot testing. Every patient underwent a clinical examination, two dimensional and M-mode echocardiography, and blood lymphocyte typing.Results: Dilated cardiomyopathy occurred in 7/30 (23.33%) AIDS patients, 1/24 (4.17%) HIV positive non-AIDS patient, but in none of the HIV negative patients. Other echocardiographic abnormalities included pericardial separation, effusion, thickening, and mitral valve prolapse. Although these abnormalities were more frequent in HIV infected patients, the differences did not reach levels of statistical significance. Dilated cardiomyopathy occurred in six (31.58%) of the patients with a CD4 cell count < or =100/mm(3) and two (6.06%) in those with absolute CD4 counts >100/mm(3) (chi(2) = 4.02, p = 0.03).Conclusions: Cardiovascular abnormalities are frequent in African HIV infected patients but clinically discrete. Low CD4 cell counts are associated with dilated cardiomyopathy. These abnormalities should be expected with greater frequency in cardiological clinical practice as management of opportunistic infections improves in a situation of continued high disease prevalence in Africa. [ABSTRACT FROM AUTHOR]

INTRODUCTION: the goal of asthma treatment is to obtain and maintain a good control of symptoms. Investigating factors associated with inadequately control asthma could help in strategies to improve asthma control. This study aimed to determine the prevalence and factors associated with inadequately controlled asthma in asthma patients under chest specialist care. METHODS: a cross-sectional study was conducted from November 2012 to May 2013. Physician-diagnosed asthma patients aged 12 years and above were included. A questionnaire was used to collect demographic data, comorbidities, and medical history of asthma. Asthma control was assessed using the Asthma Control Test (ACT), with a score less than 20 for inadequately controlled asthma and a score greater or equal to 20 for controlled asthma. A multivariate analysis was used to identify factors associated with inadequately controlled asthma. RESULTS: overall, 243 patients were included in this study. Asthma was controlled in 141 patients (58%) and inadequately controlled in 102 (42%). The mean duration of asthma was 8 years with an interquartile range of 4 and 18 years. Forty-three participants (17.7%) were not under any controller medication while the mean ACT score was 19.3 , 4.6. Independent associations were found between inadequately controlled asthma and female gender (OR 1.91; 95% CI 1.06-3.47) and obesity (OR 1.81; 1.01-3.27). CONCLUSION: asthma remains poorly controlled in a large proportion of asthma patients under specialist care in Cameroon. Educational programs for asthma patients targeting women and based on weight loss for obese patients may help in improving the control of asthma.

Introduction Le cotrimoxazole (CTMx) est un antibiotique largement utilisé chez les personnes vivant avec le VIH (PvVIH) pour la prophylaxie et le traitement de plusieurs infections opportunistes. L’objectif de cette étude était de déterminer la prévalence et identifier les déterminants de l’hypersensibilité au cotrimoxazole chez les PvVIH à l’hôpital Jamot de Yaoundé, Cameroun (HJY). Méthodes Cette étude transversale a été réalisée au centre de traitement agrée pour le traitement de l’infection à VIH (CTA) de l’HJY de février à mai 2016 (4 mois) et incluant les PvVIH âgées d’au moins 21 ans. L’hypersensibilité auto-déclarée au CTMx était retenue chez les sujets qui avaient déclaré avoir eu des réactions allergiques avec lésions cutanées au CTMx. Un sous-échantillon constitué des sujets qui avaient déclaré avoir une hypersensibilité au CTMx et des sujets qui n’avaient pas une hypersensibilité au CTMx a été secondairement formé pour la réalisation des tests cutanés allergologiques (prick-test et patch-test) au CTMx. Les proportions ont été comparées à l’aide du test de Chi 2 ou la probabilité exacte de Fischer. Résultats Au total, 1347 patients (68,2 % de sexe féminin) d’âge moyen (écart-type) de 42,9 (10,1) ans ont été inclus dans notre étude. La prévalence (intervalle de confiance à 95 %) de l’hypersensibilité auto-déclarée au cotrimoxazole était de 9,3 % (7,7–10,8 %). Les urticaires et l’érythème pigmenté fixe étaient retrouvés respectivement chez 31,2 % et 22,4 % des participants. Les antécédents de maladie allergique étaient plus fréquemment rapportés par les sujets qui avaient une hypersensibilité au CTMx (4,8 % versus 1,5 %, p = 0,019). De même, la sensibilisation cutanée au CTMx était plus fréquemment retrouvée chez les sujets avec hypersensibilité au CTMx (48,5 % versus 33,3 %, p = 0,035). Conclusion La prévalence de l’hypersensibilité au CTMx est élevée chez les sujets infectés par le VIH et la moitié des sujets déclarant avoir des réactions d’hypersensibilité au CTMx a des tests cutanés allergiques positifs. L’induction de la tolérance au CTMx devrait être envisagée chez les sujets n’ayant pas eu des réactions d’hypersensibilité sévère au CTMx. [ABSTRACT FROM AUTHOR]

Objective: In Cameroon, tuberculosis (TB) cases are diagnosed and treated within a nationwide network of 248 diagnostic and treatment centres. In 2016, the centers notified a total of 175 multidrug-resistant (MDR-)TB cases, most of them retreatment cases. According to the WHO, the expected number of MDR-TB cases was estimated to be 1200 (1000–2200) corresponding to a rate of 6.8 (4.3–9.4) per 100,000 population. This indicates a notification gap of more than 80%. The objective of this study was to estimate the prevalence of MDR-TB in new bacteriologically confirmed pulmonary TB cases. We undertook a nationwide cross sectional survey during 6 weeks. Results: During the study period, the NTP notified 1478 new bacteriologically confirmed pulmonary TB cases. Among them, 1029 (70%) had a valid Xpert result and 16 were identified with rifampicin resistant (RR-TB), a tracer of MDR-TB. This gives a prevalence of 1.6% (95% CI 0.8–2.3) among incident cases. The rate of RR-TB in the regions varied between 0 and 3.3%. If the results of this study are confirmed, the incidence rate given by WHO (2.8%, 95% CI 2.1–3.4) might be an over-estimation. [ABSTRACT FROM AUTHOR]

Abstract Background Human immuno-deficiency virus (HIV) infection and tuberculosis are common and often co-occurring conditions in sub-Saharan Africa (SSA). We investigated the effects of HIV testing and HIV status on the outcomes of tuberculosis treatment in a major diagnosis and treatment centre in Yaounde, Cameroon. Methods Participants were 1647 adults with tuberculosis registered at the Yaounde Jamot’s Hospital between January and December 2009. Multinomial logistic regression models were used to relate HIV testing and HIV status to the outcomes of tuberculosis treatment during follow-up, with adjustment for potential covariates. Results Mean age of participants was 35.5 years (standard deviation: 13.2) and 938 (57%) were men. Clinical forms of tuberculosis were: smear-positive (73.8%), smear-negative (9.4%) and extra-pulmonary (16.8%). Outcomes of tuberculosis treatment were: cure/completion (68.1%), failure (0.4%), default (20.1%), death (5.2%) and transfer (6.3%). Using cure/completion as reference, not testing for HIV was associated with adjusted odds ratio of 2.30 (95% confidence interval: 1.65-3.21), 2.26 (1.29-3.97) and 2.69 (1.62-4.46) for the risk of failure/default, death and transfer respectively. The equivalents for a positive test among those tested (1419 participants) were 1.19 (0.88-1.59), 6.35 (3.53-11.45) and 1.14 (0.69-1.86). Conclusions Non-consent for HIV testing in this setting is associated with all unfavourable outcomes of tuberculosis treatment. However been tested positive was the strongest predictor of fatal outcome. Efforts are needed both to improve acceptance of HIV testing among patients with tuberculosis and optimise the care of those tested positive.

Abstract Background The impact of HIV infection on the evolution of acute community-acquired pneumonia (CAP) is still controversial. The aim of this study was to investigate possible differences in the clinical presentation and in-hospital outcomes of patients with CAP with and without HIV infection in a specialised service in Yaounde. Methods Medical files of 106 patients (51 men) aged 15 years and above, admitted to the Pneumology service of the Yaounde Jamot Hospital between January 2008 and May 2012, were retrospectively studied. Results Sixty-two (58.5%) patients were HIV infected. The median age of all patients was 40 years (interquartile range: 31.75-53) and there was no difference in the clinical and radiological profile of patients with and without HIV infection. The median leukocyte count (interquartile range) was 14,600/mm3 (10,900-20,600) and 10,450/mm3 (6,400-16,850) respectively in HIV negative and HIV positive patients (p = 0.002). Median haemoglobin level (interquartile range) was 10.8 g/dl (8.9-12) in HIV negative and 9.7 g/dl (8–11.6) in HIV positive patients (p = 0.025). In-hospital treatment failure on third day (39.5% vs. 25.5.1%, p = 0.137) and mortality rates (9% vs. 14.5%, p = 0.401) were similar between HIV negative and HIV positive patients. Conclusion Clinical and radiological features as well as response to treatment and in hospital fatal outcomes are similar in adult patients hospitalised with acute community-acquired pneumonia in Yaounde. In contrast, HIV infected patients tend to be more anaemic and have lower white cell counts than HIV negative patients. Larger prospective studies are needed to consolidate these findings.

Introduction Très peu de données sont disponibles sur la prévalence de l’asthme et de la rhinite allergique chez l’adulte en Afrique subsaharienne. Les objectifs de cette étude étaient de déterminer la prévalence de l’asthme et de la rhinite allergique, ainsi que les facteurs liés à l’hôte associés à ces deux affections à Yaoundé, Cameroun. Méthodes Cette enquête transversale communautaire incluant les sujets adultes âgés de 19 ans et plus a été réalisée de novembre 2013 à avril 2014 à Yaoundé, Cameroun. Un échantillonnage stratifié à 3 niveaux dans l’ensemble des sept arrondissements de la ville de Yaoundé a été utilisé pour l’inclusion des sujets dans l’étude. Résultats Des 2304 sujets inclus, 1321 (57,3 %) étaient de sexe féminin et leur âge moyen (écart-type) était de 34,9 (13,5) ans. Les prévalences de l’asthme-vie et de sifflement-vie étaient respectivement de 2,7 % (IC95 % : 2,1 %-3,4 %) et de 6,9 % (5,9 %–7,9 %). La prévalence des sifflements actuels étaient de 2,9 % (2,2 %–3,6 %). La prévalence de la rhinite allergique auto-déclarée au cours de la vie était de 11,4 % (10,1 %–12,7 %). Les symptômes de rhinite allergique actuelle étaient rapportés par 240 (10,4 %) sujets et 125 (5,4 %) sujets avaient une rhino-conjonctivite. En analyse multivariée, les facteurs indépendants associés aux sifflements actuels étaient la tranche d’âge de 31 à 40 ans [ odds ratio (IC95 %) : 0,27 (0,09–0,78), p = 0,016], les signes d’eczéma atopique [2,91 (1,09–7,74), p = 0,033] et les signes de rhinite allergique [3,24 (1,83–5,71), p < 0,001]. Les facteurs indépendants associés à la rhinite allergique étaient le tabagisme actif [2,20 (1,37–3,54), p < 0,001], les signes d’eczéma atopique [2,84 (1,48–5,46), p = 0,002] et les sifflements actuels [3,02 (1,70–5,39), p < 0,001]. Discussion En dehors de l’association classique entre les maladies allergiques retrouvées dans cette étude, le tabagisme actif était indépendamment associé aux symptômes de rhinite allergique. Conclusion Dans cette étude réalisée dans une métropole d’Afrique centrale, les prévalences de l’asthme et de la rhinite allergique chez les adultes se situent à la limite inférieure de celles rapportées dans d’autres régions du monde. [ABSTRACT FROM AUTHOR]