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To determine the prevalence of HIV infection among pregnant women in Burkina Faso and to identify factors associated with HIV infection in this population, we performed in 4 antenatal clinics in 4 urban centres located in the centre, the north, the east and the south-west of the country cross-sectional serological surveys between 7 October 1994 and 7 February 1995 using unlinked anonymous HIV screening method. In the towns included in the study more than 94% of pregnant women attend at least 2 antenatal consultations. In each centre all pregnant women attending an antenatal consultation during a 2-week period were invited to take part in a study to measure the prevalence of syphilis. Women with positive syphilis serology were offered treatment free of charge. A total of 1294 pregnant women were recruited into the study. There were no refusals. Thirty-two women (2.5%) had positive syphilis serology. The overall seroprevalence of HIV infection was 8% (95% confidence interval [CI]: 6.6-9.6). There was no evidence that the prevalence of syphilis or HIV infection varied between the 4 towns ( P =0.12 and 0.52 respectively). In logistic regression analyses only the presence of syphilis infection was associated with risk of HIV (odds ratio=3.4; 95% CI: 1.4-7.9). The prevalence of syphilis among pregnant women in Burkina Faso is relatively low compared with that of HIV infection. These results suggest that HIV epidemic in Burkina Faso is important and that there is an urgent need to intensify HIVprevention activities. The need for HIV surveillance in this sentinel population is urgent to follow the course of the epidemic and to measure the impact of interventions. One of the consequences of the high prevalence of HIV infection among pregnant women which requires greater attention in Burkina Faso is the increasing number of children who will be infected with HIV by vertical transmission.

The medical inequalities between countries of the North and South (infrastructure, drug availability, medical techniques) are particularly marked in terms of the challenge posed by HIV infection. We propose a strategy for monitoring adult patients in West Africa that is appropriate to the situation in the field and to economic constraints. The aim of this strategy is to increase the quality of life and the life expectancy of HIV-infected adults and to prevent the overcrowding of hospital departments with patients in the terminal phase of AIDS. We analyzed the biological and clinical spectrum of HIV infection before the onset of the diseases that define AIDS (excluding pulmonary tuberculosis). We found that it was particularly important to diagnose B-stage diseases early, especially atypical chronic cutaneous and mucous diseases. Careful analysis of data from a routine hemogram (total lymphocyte count 2500/ml; paradoxical eosinopenia), even in the absence of a CD4 lymphocyte count, should also enable clinicians from a wide variety of health structures to identify the HIV-infected patients most likely to benefit from more detailed clinical follow up, prophylaxis of opportunistic infections using cotrimoxazole, nutritional checkups and prevention of wasting. Cachexia is the most common AIDS-associated disease in West African patients. It involves an overall decrease in calorific intake, diarrhea, immune system activation, an increase in TNFalpha production and greater energy expenditure when resting. Recent nutritional studies have shown that it is vital to optimize the calorific intake of HIV-infected patients presenting with chronic diarrhea, before the onset of severe immune deficiency, to prevent wasting. So, spontaneous calorific intake should de routinely determined in HIV-infected patients and an optimal diet provided. Specific training in nutrition is required for doctors and nurses, as is consideration of the logistic organization required to provide nutritional support to HIV-infected adults. Despite the large number of individuals infected and the lack of sophisticated paraclinical facilities, we feel that it is possible to establish rational management "a minima" of HIV infection in West Africa, whilst waiting for antiretroviral drugs to become more widely available. This strategy could be of direct benefit to patients without swallowing up the financial resources of the health system in expensive biological follow up. Such basic management is also required before the new antiretroviral drugs become widely available. Research should be carried out in parallel in several reference centers in West Africa to determine the most effective associations of antiretroviral drugs and the optimal timing of treatment during the course of infection and to assess the potential side effects of these drugs in HIV patients exposed to recurrent antigenic stimulation by a wide diversity of pathogens.

Our objective was to propose a strategy to screen HIV-infected African people for biological immunodeficiency easily. In a cross-sectional study, we analysed the patterns of diseases and of CD4 counts among 266 HIV-infected adults. Peripheral facial paralysis and chronic cutaneo-mucous diseases were the earlier B-stage diseases. Pulmonary tuberculosis was close to B-stage diseases, and chronic diarrhoea was borderline between B and C stages. Cachexia was the most frequent C-stage symptom (47.8%). Ninety per cent of CDC-C stage people had CD4 counts below 350/microliter, whereas only 75% had CD4 counts below 200/microliter. Regression analysis identified the lymphocyte count, clinical stage and platelet count as predictors of CD4 count below 350/microliter. A simple score (lymphocyte countor = 2500/microliter and clinical stageor = B) is proposed to determine this CD4 threshold (positive predictive value: 83%) and to determine those patients needing treatment to prevent wasting and opportunistic infections.Findings are presented from a cross-sectional study conducted in 1995 in Bobo-Dioulasso, Burkina Faso, in which the patterns of diseases and CD4 counts among 266 HIV-infected adults of mean age 33 years were analyzed. The bioclinical spectrum of subjects' HIV disease is described and a simple alternative proposed to CD4 enumeration for screening and monitoring HIV-infected Africans. Dermatological symptoms and diarrhea were the most frequent signs associated with B-stage disease, while cachexia and digestive candidosis were the most frequent AIDS-defining diseases (ADD). Peripheral facial paralysis and cutaneo-mucous diseases were associated with weak immune deficiency. Pulmonary tuberculosis (TB) was close to B-stage diseases, and chronic diarrhea was borderline between B and C stages. Cachexia was the most frequent C-stage symptom (47.8%). 90% of CDC C-stage subjects had CD4 counts of less than 350 per mcl, while only 75% had CD4 counts under 200/mcl. Regression analysis identified the lymphocyte count, clinical stage, and platelet count as predictors of CD4 count below 350/mcl. A lymphocyte count of less than or equal to 2500/mcl and clinical stage of B or higher is proposed to determine the CD4 threshold and to determine those patients in need of treatment to prevent wasting and opportunistic infections.

It is important for HIV/AIDS control programmes to determine population knowledge on AIDS in order to develop appropriate Information, Education and Communication (IEC) messages. The objectives of our study were to determine the seroprevalence of HIV and syphilis among pregnant women, female prostitutes and long-distance truck drivers and to evaluate knowledge, attitudes, beliefs, and practice (KABP) with respect to the HIV/AIDS epidemic in these three groups in Burkina Faso.We performed three cross-sectional serosurveys including face-to-face interviews on KABP between October 1994 and February 1995 in three population groups.Overall, 1,294 pregnant women, 236 long-distance truck drivers and 426 female prostitutes were recruited. HIV seroprevalence was 8% (95% Confidence Interval (CI): 6.6-9.6) among pregnant women, 18.6% (95% CI: 13.9-24.2) among long-distance truck drivers and 58.2% (95% CI: 53.4-62.9) in female prostitutes. The prevalence of syphilis was 2.5%, 9.3% and 15%, respectively. Most pregnant women (98%), long-distance truck drivers (96%) and female prostitutes (98%) had already heard of AIDS. However, the level of knowledge of HIV transmission routes, of risk factors for HIV transmission and of available preventive measures was very low. Consequently, 41% of pregnant women, 40% of long-distance truck drivers and an alarming 61% of female prostitutes reported that they did not feel themselves at risk for HIV. In each group, high levels of knowledge on AIDS were associated with increased awareness of AIDS risk and the adoption of preventive behaviours. Level of education was associated with knowledge of AIDS and condom use. However, in the 12 months preceding the surveys, condom use was very low among pregnant women (0.1%), long-distance truck drivers (18%) and among female prostitutes (42%).These results indicate that HIV is widespread in Burkina Faso and that there is an urgent need to develop and evaluate HIV prevention strategies in the general population and among core groups such as female prostitutes and long-distance truck drivers. Interventions must include information campaigns, condom promotion and distribution, and sexually transmitted diseases control.

Summary: Little information is available regarding human immunodeficiency virus (HIV) infection among female sex workers (FSW) in Burkina Faso, West Africa. A cross-sectional study was conducted in Ouagadougou and Bobo-Dioulasso, the 2 largest cities of the country, to determine the prevalence of HIV infection and other sexually transmitted diseases (STDs) among FSWs, and to investigate the factors which were associated with HIV infection in this population. From October to November 1994, 426 FSWs were recruited. The method of anonymous and unlinked HIV screening recommended by the World Health Organization (WHO) was used. The overall HIV seroprevalence was 58.2% (95% confidence interval: 53.4-62.9) and 52.6% of FSWs had at least one STD agent. The most common STDs were trichomoniasis (23%), syphilis (15%) and gonorrhoea (13%). In a logistic regression analysis, risk factors for HIV infection were high gravidity ( 2 pregnancies), low perception of personal risk of HIV infection, syphilis and the presence of genital warts. These results suggest that FSWs in Burkina Faso need better information about HIV transmission and prevention and then need better access to STD detection and management services.

To define a clinical profile indicative of HIV infection in a population of severely malnourished children in Burkina Faso. A total of 433 children (average age, 19 months) were recruited at the Sanou Souro National Hospital, Bobo Dioulasso, Burkina Faso.Sixty-three per cent presented with marasmus, 13% with kwashiorkor and 24% with both forms of malnutrition. The prevalence of HIV infection in children aged over 12 months was 13.8%, with a marked predominance of HIV-1 (95.8%). Mother-to-child transmission was proven in 77% of the cases; in 10% of the observed paediatric AIDS cases, transmission may have occurred through multi-injections with contaminated equipment. Marasmus was the form of malnutrition most frequently associated with HIV (P0.001); its severity was exacerbated by HIV infection. Adenopathy (P0.0001), oral candidiasis (P0.0006), skin disorders (P0.01) and hepatomegaly (P = 0.01) appeared to be significantly related to HIV infection. Discriminant analysis revealed that the presence of adenopathies was the strongest indicator symptom of HIV infection. Multivariate analysis revealed that a clinical profile of marasmus, adenopathies and oral candidiasis (specificity, 82%) was indicative of HIV infection in this population. The short-term clinical prognosis was poor and usually led to the death of the child when seropositive (P0.001).Among children exhibiting severe malnutrition, HIV-positive children are distinguished by a high horizontal transmission rate, a high specific clinical profile and a very poor prognosis.Clinically, malnutrition appears as the last stage in pediatric AIDS. It is, however, difficult to determine the causes of malnutrition without diagnostic facilities and in the absence of differentiating clinical criteria. The authors therefore set out to determine the prevalence of HIV in children, to assess the various modes of infection in children, and to define a clinical profile indicative of HIV infection in malnourished children. They found that among children exhibiting severe malnutrition, HIV-seropositive children are distinguished by a high horizontal transmission rate, a high specific clinical profile, and a very poor prognosis. The study population consisted of 433 severely malnourished children of average age 19 months, in the range 4-48 months, admitted to the Sanou Souro National Hospital in Burkina Faso. 63% presented with marasmus, 13%% with kwashiorkor, and 24% with both forms of malnutrition. 13.8% of children older than 12 months were infected with HIV; HIV-1 in 95.8% of these cases. Mother-to-child transmission was proved in 77% of cases; in 10% of the observed pediatric AIDS cases, transmission may have occurred through multi-injections with contaminated equipment. Marasmus was the form of malnutrition most frequently associated with HIV, with its severity exacerbated by HIV infection. Adenopathy, oral candidiasis, skin disorders, and hepatomegaly appeared to be significantly related to HIV infection. Discriminant analysis, however, revealed that the presence of adenopathies was the strongest indicator symptom of HIV infection. Multivariate analysis defined a clinical profile of marasmus, adenopathies, and oral candidiasis as indicative of HIV infection in the population. The short-term clinical prognosis for the infants was poor and usually led to the death of the child when seropositive.