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Background Lymphatic filariasis or bancroftosis is a neglected tropical parasitic disease that the world has resolved to eliminate by 2020. From 2001 to 2017, Burkina Faso has initiated a program to eliminate the disease. The objective of this study is then to describe the impact of annual mass drug administration (MDA) with ivermectin and albendazole on the transmission of lymphatic filariasis. Methods This was a descriptive ecological observational study that took place from January 1st to 31st December 2017 and covered the period from 2001 to 2017. All health districts implementing MDA with ivermectin and albendazole in Burkina Faso were included in the survey. Data related to treatment and transmission assessment surveys were collected and analyzed using STATA version 15. QGIS software version 2.18.25 was used to create the maps. Results During the 16 years of the program’s implementation, the geographic coverage of health districts was entirely completed (100%). The average treatment coverage rate was 80%. Microfilaremia was less than 1% in 21 of the 30 sentinel sites. Continuing endemic sites had a higher prevalence of filarial antigen and initial microfilaremia. Post-treatment surveillance showed a prevalence of filarial antigen of 0.28% at 2 years, 0.08% at 4 years and 0.02% at 6 years respectively. Out of a total of 70 health districts that were endemic, 87% (61/70) interrupted transmission of lymphatic filariasis. Conclusion Filariasis transmission was interrupted in several health districts. Evaluations showed a significant decrease of immuno-parasitological indicators during the implementation of the program, but the country did not achieve the goal.

PURPOSE Major improvements have occurred in access to invasive cervical cancer (ICC) screening in HIV-infected women over the past decade in sub-Saharan Africa. However, there is limited information on changes in the burden of HIV-related ICC at a population level. Our objective was to compare HIV-related ICC over a decade and document factors associated with HIV infection in women with ICC in Côte d'Ivoire. METHODS A repeated cross-sectional study was conducted in referral hospitals of Abidjan, Côte d'Ivoire, through the 2009-2011 and 2018-2020 periods. Women diagnosed with ICC were systematically tested for HIV. Demographics, ICC risk factors, cancer stage (International Federation of Gynecology and Obstetrics), and HIV characteristics were collected through questionnaires. Characteristics of HIV-related ICC were compared between the periods, and factors associated with HIV in women diagnosed with ICC in 2018-2020 were documented through a multivariable logistic model. RESULTS During the 2009-2011 and 2018-2020 periods, 147 and 297 women with ICC were diagnosed with estimated HIV prevalence of 24.5% and 21.9% ( P = .53), respectively. In HIV-infected women, access to antiretroviral treatment increased from 2.8% to 73.8% ( P < 10−4) and median CD4 cell count from 285 (IQR, 250-441) to 492 (IQR, 377-833) cells/mm3 ( P = .03). In women diagnosed with ICC during the 2018-2020 period, HIV infection was associated with a less advanced clinical stage (International Federation of Gynecology and Obstetrics I or II stage) (adjusted OR, 2.2 [95% CI, 1.1 to 4.4]) and with ICC diagnosis through a systematic screening (adjusted OR, 10.5 [95% CI, 2.5 to 45.5]). CONCLUSION Despite a persistently high proportion of HIV-related ICC over time in Côte d'Ivoire, HIV was associated with less advanced clinical stage at ICC diagnosis. Recent improvements in ICC screening services across HIV clinics might explain this association and support their implementation across non-HIV health facilities.

Background Treat-All guidelines recommend initiation of antiretroviral therapy (ART) for all people with HIV (PWH) on the day of diagnosis when possible, yet uncertainty exists about the impact of same-day ART initiation on subsequent care engagement. We examined the association of same-day ART initiation with loss to follow-up and viral suppression among patients in 11 sub-Saharan African countries. Methods We included ART-naive adult PWH from sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium who enrolled in care after Treat-All implementation and prior to January 2019. We used multivariable Cox regression to estimate the association between same-day ART initiation and loss to follow-up and Poisson regression to estimate the association between same-day ART initiation and 6-month viral suppression. Results Among 29 017 patients from 63 sites, 18 584 (64.0%) initiated ART on the day of enrollment. Same-day ART initiation was less likely among those with advanced HIV disease versus early-stage disease. Loss to follow-up was significantly lower among those initiating ART ≥1 day of enrollment, compared with same-day ART initiators (20.6% vs 27.7%; adjusted hazard ratio: .66; 95% CI .57–.76). No difference in viral suppression was observed by time to ART initiation (adjusted rate ratio: 1.00; 95% CI: .98–1.02). Conclusions Patients initiating ART on the day of enrollment were more frequently lost to follow-up than those initiating later but were equally likely to be virally suppressed. Our findings support recent World Health Organization recommendations for providing tailored counseling and support to patients who accept an offer of same-day ART.

BackgroundCervical cancer prevention strategies recommend human papilloma virus (HPV) vaccination for female adolescents prior to their sexual debut. While HIV is a major risk factor for HPV infection in women of childbearing age, its prevalence among HIV-infected adolescent female is mostly unknown. This study aimed to describe the HPV prevalence and correlates among perinatally HIV-infected adolescent females prior to HPV immunisation.MethodsA cross-sectional survey was conducted from January to June 2016, in the four major paediatric HIV clinics of Abidjan, Côte d’Ivoire. All HIV-infected females aged 11–16 years were approached to participate in the study. A questionnaire assessing sexual behaviours and genital hygiene practices was administered to participants completed with a systematic vaginal swab collection. HPV genotyping was performed using the Anyplex II HPV28 Detection (Seegene). A logistic regression analysis was performed to identify factors associated with the presence of HPV infection. HPV immunisation was proposed free of charge to all participants.ResultsA total of 250 participants were included, with a median age of 13 years (IQR 11–14). Among them, 237 (94.8%) were on antiretroviral treatment with a median CD4 count of 660 (IQR 439–914) cells/mm3. The overall prevalence of at least one HPV was 3.6% (95% CI 1.6 to 6.7) and the prevalence of at least one carcinogenic HPV was 2.8% (95% CI 0.7 to 4.8). Vaginal cleansing was reported by 75 (30%) of participants, with a median age at initiation of 12 years (IQR 10–13). Sexual activity was self-reported by 12 (4.8%) participants with a median age at sexual debut of 11 years (IQR 10–14). HPV infection was associated with vaginal cleansing (adjusted OR=7.0 (95% CI 1.4 to 31.6)).ConclusionThe reported low prevalence of carcinogenic HPV infections supports the appropriateness of HPV immunisation in this population. The reported association between cleansing practices and HPV infection deserves further prospective longitudinal studies.

Background: With success and effective long-term antiretroviral treatment (ART), HIV-infected patients live longer and frequently developed non-communicable diseases (NCDs). Few studies have been conducted in low-income countries, particularly in West Africa. Methods: We carried out a cross-sectional study in the referral HIV centre of the Service des Maladies Infectieuses et Tropicales (SMIT) in Abidjan. From April to September 2015, we consecutively included HIV-1 infected patients aged 18 years and older, and on ART for a minimum of 12 months. Data were collected using a structured questionnaire, and entered into the centre’s computerised HIV database. Clinical assessment, laboratory tests, electrocardiogram, transthoracic echocardiography and vascular Doppler ultrasound were performed. The main outcome was the prevalence of patients with severe cardiovascular abnormalities (SCA). Univariate and multivariate logistic regressions were used to identify factors associated with SCA. Results: Out of 278 patients (median age 46 years, interquartile range [IQR: 41–52]), 74.5% were female. Overall, the median duration of ART was 84 months (IQR: 54–126). One hundred and ninety-nine (71.6%) patients were on first-line ART regimen and 229 (82.4%) were virologically suppressed with a median CD4 count of 511 cells/mm 3 (IQR: 347–529). Basically, cardiovascular abnormalities were mainly non-obstructive carotid plaques (19.1%) followed with left ventricular diastolic dysfunction (16.5%). The overall prevalence of SCA in the study population was 7.6% (95% Confidence Interval [95% CI]: 4.7–11.3). The prevalence of SCA 7.6% (95% Confidence Interval [95% CI]: 4.7–11.3). In multivariate analysis, age > 50 years and nadir CD4 count > 200 cells/mm 3 were significant predictors of SCA. Conclusion: The prevalence of SCA is high in West African HIV-treated patients. Given the high mortality associated with cardiovascular diseases in the general population, refining disease preventive strategies in HIV-positive subjects is essential to continue prolonging their life.

BACKGROUND: Major improvements have occurred in access to antiretroviral treatment (ART) and invasive cervical cancer (ICC) prevention of HIV-infected women over the past decade in sub-Saharan Africa. However, there is limited information on changes in the burden of HIV-related ICC at a population level. Our objective was to compare HIV-related ICC over a decade and document factors associate with HIV infection in women with ICC in Côte d’Ivoire.METHODS: A repeated cross-sectional study was conducted in referral hospitals of Abidjan, Côte d’Ivoire during the 2009-2011 and 2018-2020 periods. During both periods, women diagnosed with ICC were systematically tested for HIV. A common questionnaire was administered to collect demographic information, ICC risk factors, cancer stage (FIGO) and HIV characteristics (ART use, last known CD4 count) for those screened positive. Characteristics of HIV-related ICC were compared between the time periods and factors associated with HIV in women diagnosed with ICC in 2018-2020 were documented through a multivariate logistic model.RESULTS: During the 2009-2011 and 2018-2020 periods, 147 and 297 women with ICC were diagnosed, with median [IQR] age at ICC diagnosis of 49 [40-57] years and 51 [43-60] years (p=0.01), respectively. The estimated HIV prevalence was 24.5% and 21.9% (p=0.53), respectively. An advanced FIGO stage (III, IV) was documented in 74.5% and 76.2% of women during these two time periods (p=0.72). In HIV-infected women, access to ART increased from to 2.8% to 73.8% (p-4) and median CD4 cell count from 285 [IQR 250 – 441] to 492 [IQR 377 – 833] cells/mm3 (p=0.03) between the two time periods. In Women diagnosed with ICC during the 2018-2020 period, HIV infection was associated with a less advanced clinical stage (FIGO I/II stage) [aOR=2.2 (95%CI 1.1-4.4)] and with higher ICC diagnosis through a systematic screening [aOR=10.5 (95%CI 2.5-45.5)].CONCLUSIONS: Despite an improved access to ART in Côte d’Ivoire, the proportion of HIV-infected women diagnosed with ICC remains high in 2020. HIV-infected women diagnosed with ICC in 2018-2020 presented with less advanced stage and a higher access to ICC screening at diagnosis compared to their uninfected counterparts suggesting an enhanced access to early ICC diagnosis.

Depression is highly prevalent in people living with HIV (PLHIV) worldwide. As mental health specialists are scarce in sub-Saharan Africa (SSA), the World Health Organization (WHO) encourages task-shifting. We aimed to evaluate the barriers that could compromise task-shifting in front-line health care workers (HCWs) who provide HIV integrated care in West Africa. We collected knowledge, attitudes and practices (KAP) information on symptoms, causes and management of depression in PLHIV in care in four clinics in Senegal and Cote d'Ivoire (N = 168). The main barriers that could compromise task-shifting came from poor knowledge, particularly on symptoms and causes. Knowledge was more limited in HCWs other than medical doctors (good answers < 70%). The access to a depression training was limited (32.7%) and was the main factor associated to poor knowledge on depression. Even when social distance and barriers to practice were low (70.8% and 69.6%, respectively), some barriers persisted. More than half of respondents considered that diagnosis and management needed to be performed by a specialist. To guarantee the success of task-shifting, in the perspective of integrated care, efforts are needed to improve the access to specific training on depression considering screening, management, but also perceptions and attitudes, as some barriers subsist.

Background To encourage successful aging, the psychological domain must not be neglected. As depression, one of the most common psychiatric disorders in PLHIV, has negative impact on both mental and physical health, the prevalence and the factors associated with the presence of severe depressive symptoms in older PLHIV living in West Africa need to be well understood. Methods Data from PLHIV aged ≥50 years old and on ART since ≥6 months were collected in three clinics (two in Côte d’Ivoire, one in Senegal) participating to the West Africa International epidemiological Databases to Evaluate AIDS (IeDEA) collaboration. The severity of the depressive symptoms was measured using the Center for Epidemiological Studies Depression scale (CES-D) and associated factors were identified using logistic regression. Results The median age of the 334 PLHIV included in the study was 56.7 (53.5-61.1) years old, 57.8% were female and 87.1% had an undetectable viral load. The prevalence of severe depressive symptoms was 17.9% [95% Confidence Interval: 13.8 - 22.0]. PLHIV with severe depressive symptoms were more likely to have no professional activity, and to be current or former tobacco smokers but were less likely to be overweight or obese. Conclusions The prevalence of severe depressive symptoms is high among older PLHIV living in West Africa. How to integrate the measurement and the management of depressive symptoms in the standard of care should be investigated, both for older PLHIV on ART but also for newly diagnosed older patients, in order to achieve the 90-90-90 objectives.

Hepatocellular carcinoma (HCC) is a leading cause of cancer in West Africa where HBV infection is endemic. However, limited information is available on other risk factors such as alcohol use, HCV and HIV infection. A case-control study was conducted in referral hospitals of Abidjan (Cote d'Ivoire), Bamako (Mali) and Lome (Togo). Cases were matched with controls on age, gender and participating site. The diagnosis of HCC relied on the combination of one or more space-occupying lesions suggestive of an HCC on a standardized abdominal ultrasound and an α-fetoprotein level ≥400 ng/ml. HIV, HBV and HCV serology were performed. Hazardous alcohol use was assessed using the AUDIT questionnaire. A conditional logistic regression model was used to measure odds ratio (OR) with their 95% confidence intervals (CI). A total of 160 cases and 320 controls were included. Cases were predominantly men (80.0%) with a median age of 47 years (IQR 38-57). Hazardous alcohol use (OR = 4.5 [CI 1.1-18.5]), HBV infection (OR = 62.5 [CI 20.5-190.7]) and HCV infection OR = 35.9 [CI 10.0-130.3]) were independently associated with HCC. Combining the effect of HBV infection and alcohol, HBV-infected hazardous drinkers had an OR = 149.8 (CI 13.5-1 667.0), HBV mono-infected had an OR = 57.4 (CI 18.8-175.3) (ref: HBV-negative). Aside the independent association of alcohol use and HBV and HCV infection with HCC, a synergic effect between alcohol use and HBV infection was identified. Timely screening and care of HBV infection and hazardous drinking might prevent a significant number of HCC in West Africa.

Objective: To describe the epidemiological, clinical and prognosis aspects of tetanus in patients hospitalized at the Infectious and Tropical Diseases Unit of Treichville Teaching Hospital. Methods: A retrospective study of the medical records of all patients hospitalized between 2005 and 2014. The “Dakar prognosis score” was established on the basis of six parameters: incubation period, duration of invasion, site of entry, presence of paroxysms, body temperature and pulse rate. A logistic regression model was used to identify the factors associated with death. Results: Overall, 455 cases of tetanus were included, with a predominance of males (86%). Most patients lived in Abidjan (77%). A very high proportion of cases were generalized tetanus (96%), and 137 patients (30%) died. The factors associated with death were age >60 years (aOR 2.76; 95% CI 1.07 to 9.91), being a labourer (aOR 2.83 95% CI 1.07-9.39), a severe Dakar prognostic score (aOR 5.76; 95% CI 2.26-14.72), no intrathecal serotherapy (aOR = 15.6; 95% CI 5.40- 44.84), no penicillin-therapy (aOR 2.33; 95% CI 1.11-4.87) and the presence of complications (aOR 8.53, 95% CI 4.83-15.09). Conclusion: This study identifies a number of factors for a poor prognosis among patients with tetanus admitted to our hospital, indicating that measures to reduce morbidity and mortality due to tetanus should be strengthened and prevention improved in resource limited settings. The prognostic parameters in “the Dakar score” should therefore be adapted to the current epidemiological and clinical contexts in Cote d’Ivoire.

ObjectivesDespite the increasing number of interventions aiming to integrate cervical cancer screening into HIV clinics in sub-Saharan Africa, Women living with HIV (WLHIV) still have a high risk of developing cervical cancer. The aim of this study was to estimate the coverage of cervical cancer screening and associated factors among WLHIV in Abidjan, Côte d’Ivoire.DesignCross-sectional survey conducted from May to August 2017.SettingsOutpatient setting in the four highest volume urban HIV clinics of government’s or non-governmental organisation’s sector in Côte d’Ivoire.ParticipantsAll WLHIV, aged 25–55 years, followed since at least 1 year, selected through a systematic sampling procedure.InterventionA standardised questionnaire administered to each participant by trained healthcare workers.OutcomeCervical cancer screening uptake.ResultsA total of 1991 WLHIV were included in the study, aged in median 42 years (IQR 37–47), and a median CD4 count (last known) of 563 (378-773) cells/mm3. Among the participants, 1913 (96.1%) had ever heard about cervical cancer, 1444 (72.5%) had been offered cervical cancer screening, mainly in the HIV clinic for 1284 (88.9%), and 1188 reported a personal history of cervical cancer screening for an overall coverage of 59.7% (95% CI 57.6 to 62.0). In multivariable analysis, university level (adjusted OR (aOR) 2.1; 95% CI 1.4 to 3.1, pConclusionInitiatives to support cervical cancer screening in HIV care programmes resulted in effective access to more than half of the WLHIV in Abidjan. Efforts are still needed to provide universal access to cervical cancer screening, especially among socioeconomically disadvantaged WLHIV.

INTRODUCTION Excessive alcohol consumption leads to unfavourable outcomes in people living with HIV (PLHIV), including reduced adherence to antiretroviral therapy (ART) and engagement into care. However, there is limited information on alcohol consumption patterns among PLHIV in sub-Saharan Africa. METHODS Using a cross-sectional approach, the Alcohol Use Disorders Identification Test (AUDIT-C) was administered to PLHIV attending HIV clinics in Cote d'Ivoire, Togo, Senegal and Zambia (2013 to 2015). Hazardous drinking was defined as an AUDIT-C score ≥4 for men or ≥3 for women, and binge drinking as ≥6 drinks at least once per month. The prevalence of binge drinking was compared to estimates from the general population using data from the World Health Organization. Factors associated with binge drinking among persons declaring any alcohol use in the past year were assessed using a logistic regression model to estimate odds ratio (OR) and their corresponding 95% confidence intervals (CI). RESULTS Among 1824 PLHIV (median age 39 years, 62.8% female), the prevalence of hazardous alcohol use ranged from 0.9% in Senegal to 38.4% in Zambia. The prevalence of binge drinking ranged from 14.3% among drinkers in Senegal to 81.8% in Zambia, with higher estimates among PLHIV than in the general population. Male sex (OR 2.4, 95% CI 1.6 to 3.7), tobacco use (OR 1.7, 95% CI 1.0 to 2.9) and living in Zambia were associated with binge drinking. CONCLUSIONS Alcohol consumption patterns varied widely across settings and binge drinking was more frequent in HIV-positive individuals compared to the general population. Interventions to reduce excessive alcohol use are urgently needed to optimize adherence in the era of universal ART.

INTRODUCTION By 2020, 90% of all people diagnosed with HIV should receive long-term combination antiretroviral therapy (ART). In sub-Saharan Africa, this target is threatened by loss to follow-up in ART programmes. The proportion of people retained on ART long-term cannot be easily determined, because individuals classified as lost to follow-up, may have self-transferred to another HIV treatment programme, or may have died. We describe retention on ART in sub-Saharan Africa, first based on observed data as recorded in the clinic databases, and second adjusted for undocumented deaths and self-transfers. METHODS We analysed data from HIV-infected adults and children initiating ART between 2009 and 2014 at a sub-Saharan African HIV treatment programme participating in the International epidemiology Databases to Evaluate AIDS (IeDEA). We used the Kaplan-Meier method to calculate the cumulative incidence of retention on ART and the Aalen-Johansen method to calculate the cumulative incidences of death, loss to follow-up, and stopping ART. We used inverse probability weighting to adjust clinic data for undocumented mortality and self-transfer, based on estimates from a recent systematic review and meta-analysis. RESULTS We included 505,634 patients: 12,848 (2.5%) from Central Africa, 109,233 (21.6%) from East Africa, 347,343 (68.7%) from Southern Africa and 36,210 (7.2%) from West Africa. In crude analyses of observed clinic data, 52.1% of patients were retained on ART, 41.8% were lost to follow-up and 6.0% had died 5 years after ART initiation. After accounting for undocumented deaths and self-transfers, we estimated that 66.6% of patients were retained on ART, 18.8% had stopped ART and 14.7% had died at 5 years. CONCLUSIONS Improving long-term retention on ART will be crucial to attaining the 90% on ART target. Naive analyses of HIV cohort studies, which do not account for undocumented mortality and self-transfer of patients, may severely underestimate both mortality and retention on ART.

In HIV-infected patients thromboembolic disease is a complication linked to heightened risk. In Ivory Coast no study has been conducted on HIV-infected patients treated in HIV Services. The aim of our study is to describe HIV-associated thromboembolic manifestations in patients treated or untreated with antiretroviral drugs whose data were collected in the Infectious and Tropical Diseases Service (ITDS). We conducted a retrospective study by reviewing the medical records of HIV-infected patients hospitalized with deep vein thrombosis (DVT), arterial thrombosis and/or pulmonary embolism over the period January 2005-July 2015. Diagnosis was based on Doppler ultrasound of vessels and/or on thoracic angioscanner. Diagnostic, therapeutic and evolutionary features of thromboembolic manifestations in these patients were analyzed. The medical records of 36 patients, including 23 women (64%), with a sex-ratio M/F of 0.57 and an average age of 43±12 years were selected. Deep venous thrombosis (DVT) was found in 26 (72.2%) patients, pulmonary embolism (PE) in 9 (25%) patients and arterial thrombosis in 1 patient (2.8%). DVT was unilateral in 81% of cases and predominantly left-sided in 77% of cases. PE was unilateral and right-sided in 100% of cases while arterial thrombosis was bilateral in 2.7% of cases. In patients with DVT, the femoral vein (39%) and the popliteal vein (35%) were most commonly affected by thrombosis. PE involved the pulmonary arteries in 77.8% of cases while arterial thrombosis involved the left and right internal carotid. The majority of patients was under antiretroviral treatment (69%). The most commonly associated opportunistic infections included oral candidiasis (31%) and tuberculosis (33%). Nine patients died (25%). This study highlights high rates of DVT in HIV-infected patients. Other studies are necessary to better understand the role of HIV in the occurrence of thromboembolic disease.

Chez les patients infectés par le VIH, la maladie thromboembolique est une complication dont le risque est accru. En Côte d'Ivoire, dans le service de référence de prise en charge médicale des personnes atteintes du VIH/SIDA, aucune étude n'a été menée sur la question. L'objectif de notre étude est de décrire les manifestations thromboemboliques colligées dans le Service des Maladies Infectieuses et Tropicales (SMIT) chez les patients infectés par le VIH, traités ou non par les antirétroviraux. Il s'est agi d'une étude rétrospective des dossiers de patients infectés par le VIH, hospitalisés, et présentant une thrombose veineuse profonde (TVP), artérielle et/ou une embolie pulmonaire de la période de janvier 2005 à juillet 2015. Le diagnostic a été posé par l'écho-Doppler des vaisseaux et/ou l'angioscanner thoracique. L'analyse a porté sur les aspects diagnostiques, thérapeutiques et évolutifs. Les dossiers de 36 patients dont 23 femmes (64%), sex-ratio H/F à 0,57, et âge moyen de 43±12 ans ont été retenus. Les thromboses veineuses profondes (TVP) ont été retrouvées chez 26 (72,2%) patients, des embolies pulmonaires (EP) chez neuf (25%) patients, une thrombose artérielle chez un patient (2,8%). La TVP était unilatérale dans 81% des cas et plus située à gauche (77%). L'EP était unilatérale et à droite dans 100% des cas et la thrombose artérielle était bilatérale dans 2,7% des cas. Chez les patients atteints de TVP, la veine fémorale (39%) et la veine poplitée (35%) étaient les sièges plus fréquents de thrombose. L'EP concernait les artères pulmonaires dans 77,8% des cas et la thrombose artérielle concernait les carotides internes gauche et droite. La majorité des patients était sous traitement antirétroviral (69%). Les infections opportunistes fréquemment associées étaient les candidoses orales (31%) et la tuberculose (33%). L'évolution a été marquée par neuf décès (25%). Cette étude rapporte une fréquence élevée des TVP au cours de l'infection à VIH. D'autres études s'avèrent nécessaires pour mieux appréhender le rôle du VIH dans la survenue de la maladie thromboembolique.

BACKGROUND & AIMS While universal screening of hepatitis B virus (HBV) is recommended in high burden countries, little is known about the proportion of HBV-infected persons in need of antiviral therapy in these settings. METHODS Prisoners in Senegal and Togo, as well as female sex workers and men who have sex with men in Cote d'Ivoire were screened for HBV infection. All HBsAg-positive participants underwent transient elastography, alanine aminotransferase (ALT) and HBV viral load quantification. Individuals with liver cirrhosis or those aged>30 years with an HBV replication ≥20 000 IU/ml and elevated ALT were considered eligible for antiviral therapy. RESULTS Of 1 256 participants, 110 (8.8%) were HBsAg-positive; their median age was 30 years [interquartile range: 25-33] and 96 (86.5%) were men. Three individuals (2.7%) had liver cirrhosis while 28 (29.5%) of 94 participants with available measurements had an HBV viral load ≥20 000 IU/ml. Overall, 11 (10.0%) subjects were considered eligible for immediate antiviral treatment; 2.1% of participants in Dakar, 7.7% in Abidjan and 21.6% in Lome (p=0.001) and 59 (53.4%) for close monitoring due to the presence of significant liver fibrosis, elevated ALT or significant HBV replication. CONCLUSIONS Among vulnerable populations in West Africa, a minority of HBV-infected individuals were eligible for immediate antiviral therapy. Prospective cohort studies are necessary to evaluate anti-HBV treatment eligibility facing the significant proportion of individuals with active chronic HBV infection. This article is protected by copyright. All rights reserved.

Introduction : Liver fibrosis is often the first stage of liver disease in people living with HIV (PLWHIV) in industrialized countries. However, little is known about liver fibrosis and its correlates among PLWHIV in sub-Saharan Africa. Methods : The study was undertaken in three HIV referral clinics in Cote d ’ Ivoire, Senegal and Togo. Enrolled PLWHIV underwent a non-invasive assessment of liver fibrosis combining liver stiffness measure (LSM) with transient elastography and the aspartate aminotransferase-to-platelet ratio index (APRI). Significant liver fibrosis was defined as LSM ≥ 7.1 kPa. Patients were screened for alcohol use (alcohol use disorder identification test (AUDIT)-C questionnaire), hepatitis B virus (HBV) antigen, hepatitis Delta virus (HDV) antibody and anti-hepatitis C (HCV) antibody. A logistic regression model was used to identify the factors associated with significant liver fibrosis. Results : A total of 807 PLWHIV were screened at a median age of 43 years (interquartile range (IQR): 36 – 50). Their median CD4 count was 393 cells/mm 3 (IQR: 234 – 563) and 682 (84.5%) were on antiretroviral therapy (ART). The prevalence of significant fibrosis was 5.3% (3.8 – 6.7). Infections with HBV and HCV were identified in 74 (9.2%) and nine (1.1%) participants. Main factors associated with liver fibrosis were alcohol use (AUDIT-C >6): (odds ratio (OR) = 4.0, confidence interval (CI): 1.2 – 14.0), (Ref. AUDIT-C

Malaria and HIV are the most important infections in subSaharan Africa, in terms of the morbidity and mortality they cause. Current data suggest a possible interaction between the two diseases. Cellular immunodeficiency due to HIV infection might increase the frequency and severity of malaria, as local populations in endemic areas become less resistant. Likewise, the onset and repetition of malaria episodes might activate HIV replication and thus decrease the number of CD4 lymphocytes and accelerate the disease course. Despite their geographical coincidence, the epidemiological profiles of malaria and HIV differ considerably. The entanglement of these two diseases has epidemiological, clinical and therapeutic consequences in subSaharan Africa that raise concerns that HIV with malaria, as with tuberculosis, is a match made in Hell.

Quality of life and life span have considerably increased in human immunodeficiency virus (HIV) patients over the past years owing to the highly effective antiretroviral therapy. Consequently, the number of patients with end-stage renal disease (ESRD) has increased in dialysis centers. Several teams in the United States as well as in Europe have therefore proposed renal transplantation to this group of patients with encouraging results. From March 2015 to February 2016, four kidney transplantations have been conducted in the very first kidney transplantation program ever in French speaking black Africa. Three male and one female with a mean age of 50.75 years have been transplanted. One of them was HIV-2 positive. Before kidney transplantation, patients have exhibited diverse highly active antiretroviral therapy (HAART) regimen. They all have undetectable viremia and the mean value of the CD4 count was 454.5 cells/µL. Raltegravir, an integrase inhibitor, has systematically been added to the baseline HAART therapy at least 30 days before transplantation. Immunosuppression comprised basiliximab as induction therapy, tacrolimus, sodium mycophenolate and steroids. After a mean time of six months, all the patients are alive with a mean serum creatinine of 1.425±0.263mg/dl, and a mean proteinuria of 0.55±0.29 g/d. We present these results in full, and discuss them according to data retrieved from the literature. The conditions of access of human immunodeficiency virus positive patients to renal transplantation, the immunosuppression and the antiretroviral regimen, graft and patient survival have all been discussed accordingly.

ObjectifRapporter des cas de varicelle nosocomiale chez le personnel soignant, dans un service de maladies infectieuses a Abidjan.ObservationsLes quatre cas decrits concernaient des adultes jeunes (24, 25, 27 et 30 ans) etudiants en medecine, entres en contact les uns avec les autres a partir d’un cas index en visite dans le service. Les facteurs de risque retrouves etaient, pour tous, l’absence de vaccination et l’absence d’antecedent de varicelle. Le diagnostic de varicelle a ete essentiellement clinique, et le traitement symptomatique. L’evolution a ete favorable dans tous les cas.ConclusionLa varicelle nosocomiale chez l’adulte immunocompetent pose le probleme de l’hygiene hospitaliere et de la vaccination dans les pays en developpement.

The consequences of the HIV epidemic on cancer epidemiology are sparsely documented in Africa. We aimed to estimate the association between HIV infection and selected types of cancers among patients hospitalized for cancer in four West African countries. A case-referent study was conducted in referral hospitals of Benin, Côte d'Ivoire, Nigeria and Togo. Each participating clinical ward included all adult patients seeking care with a confirmed diagnosis of cancer. All patients were systematically screened for HIV infection. HIV prevalence of AIDS-defining and some non-AIDS defining cancers (Hodgkin lymphoma, leukaemia, liver, lung, skin, pharynx, larynx, oral cavity and anogenital cancers) were compared to a referent group of cancers reported in the literature as not associated with HIV. Odds ratios adjusted on age, gender and lifetime number of sexual partners (aOR) and their 95% confidence intervals (CI) were estimated. Among the 1,644 cancer patients enrolled, 184 (11.2%) were identified as HIV-infected. The HIV prevalence in the referent group (n=792) was 4.4% [CI 3.0–5.8]. HIV infection was associated with Kaposi sarcoma (aOR 34.6 [CI: 17.3–69.0]), non-Hodgkin lymphoma (aOR 3.6 [CI 1.9–6.8]), cervical cancer (aOR 4.3 [CI 2.2–8.3]), anogenital cancer (aOR 17.7 [CI 6.9–45.2]) and squamous cell skin carcinoma (aOR 5.2 [CI 2.0–14.4]). A strong association is now reported between HIV infection and Human Papillomavirus (HPV)-related cancers including cervical cancer and anogenital cancer. As these cancers are amenable to prevention strategies, screening of HPV-related cancers among HIV-infected persons is of paramount importance in this African context.

SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons.OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries.DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs.RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages.CONCLUSIONS: Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

Background In resource-limited settings where nevirapine-containing regimen is the preferred regimen in women, data on severe adverse events (SAEs) according to CD4 cell count are limited. We estimated the incidence of SAEs according to CD4 cell count and identify their risk factors in nevirapine-treated women. Methods All HIV-infected women who initiated nevirapine-containing regimen in the MTCT-Plus operational program in Abidjan, Côte d'Ivoire, were eligible for this study. Laboratory and clinical (rash) SAEs were classified as grade 3 and 4. Cox models were used to identify factors associated with the occurrence of SAEs. Results From August 2003 to October 2006, 290 women initiated a nevirapine-containing regimen at a median CD4 cell count of 186 cells/mm3 (IQR 124-266). During a median follow-up on treatment of 25 months, the incidence of all SAEs was 19.5/100 patient-years. The 24-month probability of occurrence of hepatotoxicity or rash was not different between women with a CD4 cell count >250 cells/mm3 and women with a CD4 cell count ≤250 cells/mm3 (8.3% vs. 9.9%, Log-rank test: p = 0.75). In a multivariate proportional hazard model, neither CD4 cell count >250 cells/mm3 at treatment initiation nor initiation NVP-based regimen initiated during pregnancy were associated with the occurrence of SAEs. Conclusion CD4 cell count >250 cells/mm3 was not associated with a higher risk of severe hepatotoxicity and/or rash, as well as initiation of ART during pregnancy. Pharmacovogilance data as well as meta-analysis on women receiving NVP in these settings are needed for better information about NVP toxicity.

Objectives: To estimate adherence to highly active antiretroviral therapy (HAART) and its determinants in HIV-infected adults followed in field conditions in Abidjan. Methods: A standardized questionnaire was administered to all consecutive adults on HAART who attended 3 urban HIV outpatient clinics. Patients were asked to self-report their pill intake during the previous 7 days, and, when necessary, to explain the reason(s) why they missed at least 1 intake. The adherence rate was estimated as the number of pills actually taken divided by the number of pills that should have been taken. The association of incomplete adherence (adherence rate

Background Cancer is a growing co-morbidity among HIV-infected patients worldwide. With the scale-up of antiretroviral therapy (ART) in developing countries, cancer will contribute more and more to the HIV/AIDS disease burden. Our objective was to estimate the association between HIV infection and selected types of cancers among patients hospitalized for diagnosis or treatment of cancer in West Africa. Methods A case-referent study was conducted in referral hospitals in Côte d’Ivoire and Benin. Each participating clinical ward enrolled all adult patients seeking care for a confirmed diagnosis of cancer and clinicians systematically proposed an HIV test. HIV prevalence was compared between AIDS-defining cancers and a subset of selected non-AIDS defining cancers to a referent group of non-AIDS defining cancers not reported in the literature to be positively or inversely associated with HIV. An unconditional logistic model was used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of the risk of being HIV-infected for selected cancers sites compared to a referent group of other cancers. Results The HIV overall prevalence was 12.3% (CI 10.3–14.4) among the 1,017 cancer cases included. A total of 442 patients constituted the referent group with an HIV prevalence of 4.7% (CI 2.8–6.7). In multivariate analysis, Kaposi sarcoma (OR 62.2 [CI 22.1–175.5]), non-Hodgkin lymphoma (4.0 [CI 2.0–8.0]), cervical cancer (OR 7.9 [CI 3.8–16.7]), anogenital cancer (OR 11.6 [CI 2.9–46.3]) and liver cancer (OR 2.7 [CI 1.1–7.7]) were all associated with HIV infection. Conclusions In a time of expanding access to ART, AIDS-defining cancers remain highly associated with HIV infection. This is to our knowledge, the first study reporting a significant association between HIV infection and liver cancer in sub-Saharan Africa.

Background Nutritional care is not optimally integrated into pediatric HIV care in sub-Saharan Africa. We assessed the 6-month effect of a nutritional support provided to children living with HIV, followed in a multicentric cohort in West Africa. Methods In 2014-2016, a nutritional intervention was carried out for children living with HIV, aged under 10 years, receiving antiretroviral therapy (ART) or not, in five HIV pediatric cohorts, in Benin, Togo and Côte d’Ivoire. Weight deficiency was assessed using two definitions: wasting (Weight for Height Z-score [WHZ] for children Results Overall, 326 children were included, 48% were girls. At baseline, 66% were aged 5-10 years, 91% were on ART, and 17% were severely immunodeficient (CD4 p=0.907), nor by intervention groups (p-value=0.767). Conclusions This intervention had a limited effect on nutritional recovery and dietary diversity improvement. Questions remain on determining appropriate nutritional products, in terms of adherence, proper use for families and adequate energy needs coverage for children living with HIV. Trial registration PACTR202001816232398, June 01, 2020, retrospectively registered.