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1. 18-month effectiveness of short-course antiretroviral regimens combined with alternatives to breastfeeding to prevent HIV mother-to-child transmission.

Author

Valériane Leroy, Didier K Ekouevi, Renaud Becquet, Ida Viho, Laurence Dequae-Merchadou, Besigin Tonwe-Gold, François Rouet, Charlotte Sakarovitch, Appolinaire Horo, Marguerite Timité-Konan, Christine Rouzioux, François Dabis, and ANRS 1201/1202 DITRAME PLUS Study Group

Subjects
Medicine, Science
Abstract

OBJECTIVE: We assessed the 18-month effectiveness of short-course (sc) antiretroviral peripartum regimens combined with alternatives to prolonged breastfeeding to prevent mother-to-child transmission (MTCT) of HIV-1 in Abidjan, Côte d'Ivoire. METHODOLOGY: HIV-1 infected pregnant women received from >/=32-36 weeks of gestation scZidovudine (ZDV)+/-Lamivudine (3TC)+single-dose Nevirapine (sdNVP) at delivery within the ANRS 1201/1202 DITRAME-Plus cohort (2001-2003). Neonates received a sdNVP+7-day ZDV prophylaxis. Two infant-feeding interventions were systematically offered free of charge: formula-feeding or exclusive shortened breastfeeding with early cessation from four months. The reference group was the ANRS 049a DITRAME cohort (1994-2000) exposed to scZDV from 36 weeks, then to prolonged breastfeeding. Pediatric HIV infection was defined by a positive plasma HIV-1 RNA at any age, or if aged >/=18 months, a positive HIV-1 serology. Turnbull estimates of cumulative transmission risks (CTR) and effectiveness (HIV-free survival) were compared by exposure group using a Cox model. FINDINGS: Among 926 live-born children enrolled, 107 (11.6%) were HIV-infected at 18 months. CTRs were 22.3% (95% confidence interval[CI]:16-30%) in the 238 ZDV long-term breastfed reference group, 15.9% (CI:10-27%) in the 169 ZDV+sdNVP shortened breastfed group; 9.4% (CI:6-14%) in the 195 ZDV+sdNVP formula-fed group; 6.8% (CI:4-11%) in the 198 ZDV+3TC+sdNVP shortened breastfed group, and 5.6% (CI:2-10%) in the 126 ZDV+3TC+sdNVP formula-fed group. Each combination had a significantly higher effectiveness than the ZDV long-term breastfed group except for ZDV+sdNVP shortened breastfed children, ranging from 51% (CI:20-70%) for ZDV+sdNVP formula fed children to 63% (CI:40-80%) for ZDV+3TC+NVPsd shortened breastfed children, after adjustment for maternal eligibility for antiretroviral therapy (ART), home delivery and low birth-weight. Substantial MTCT risk reductions are reachable in Africa, even in short-term breastfed children. The two sc antiretroviral combinations associated to any of the two infant feeding interventions, formula-feeding and shortened breastfeeding, reduce significantly MTCT with long-term benefit until age 18 months and without increasing mortality.

Published
2008
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2. Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries

Author

I. Izabelle, F. Ello, H. Ssemuwemba, S. Phiri, J. Olasode, Marie-Sylvie N’Gbeche, S. Kouadio, Jesper Eugen-Olsen, M. Mpoudi-Etame, Cristin Q. Fritz, S. Dapiap, J. Zoungrana, Antoine Jaquet, Aristophane Tanon, Rasmata Ouédraogo, N. T. Loan, E. J. Carter, Obaseki, F. F. Diakité, H. X. Zhao, Kulkanya Chokephaibulkit, Z. J. da Silva, Peter Aaby, Dewi Kumara Wati, David da Silva, L. Ayangma, K. Jjingo, P. Kim, Romanee Chaiwarith, James Ndirangu, Valériane Leroy, L. P. P. Atmikasari, N. Zobo, H. Chenal, Rita Lyamuya, Catherine C. McGowan, Keswadee Lapphra, Wanatpreeya Phongsamart, B. B. Mwebesa, Théodore Niyongabo, D. Katile, B. Ba, Matthias Egger, L. Mofenson, A. Mounkaila-Harouna, Boris Tchounga, M. Moh, Elom Takassi, Haby Signaté Sy, G. Sagbo, F. Kaeser, Eduardo Gotuzzo, Guillaume Bado, C. C. McGowan, S. Karcher, Constantin T. Yiannoutsos, V. H. Bui, Christopher J. Hoffmann, Didier K. Ekouevi, J. Akakpo, I. Azinyue, S. Kiertiburanakul, S. O. Koule, W. Bishai, Mariam Guindo Traoré, C. Williams, Elise Arrivé, A. Tapsoba, S. Bessekon, Patrick A. Coffie, F. Yuliana, A. Gougounon-Houéto, Somnuek Sungkanuparph, Y. Abo, Q. Vo, Praphan Phanuphak, M. B. Kokora, Kouadio Kouakou, Fla Kouéta, M. E. Dainguy, O. Benson, I. Soré, W. Prasitsuebsai, Harry Moultrie, C. Guehi, Beatriz Grinsztejn, T. Q. Du, L. Diecket Ahoussou, Z. Diallo, N. Traoré, Firas Wehbe, C. V. Do, J. Tatwangire, A. Kotosso, F. Soppi, Amabelia Rodrigues, Juan Sierra Madero, P. S. Sow, Rodolphe Thiébaut, I. Y. Malino, Moussa Seydi, Helena Rabie, A. Dienderé, Geoffrey Somi, Emmanuel Bissagnene, Elizabeth A. Bukusi, H. C. Traoré, David A. Cooper, N. M. Manga, P. Osakede, S. Ajayi, J. Paulo, Marguerite Timite-Konan, Andrew Edmonds, B. Diop, A. M. Traoré, W. Hiembo, A. Koïta, M. Faye, A. Azon-Kouanou, Christian Wejse, Claudia P. Cortes, T. Pety, N. Durier, Thira Sirisanthana, Camille Ndondoki, Karl-Günter Technau, J. S. Elvis Diby, G. Alim, M. D'Almeida, A. Komi, J. Bashi, J. M. Tine, D. Hawerlander, R. Ditangco, Akouda Patassi, A. Kalle, F. J. Zhang, Lorna Renner, N. H. Chau, Janet Giddy, G. Clouet, Samwel O. Ayaya, A. Sohn, Lars Østergaard, Sylvie Ouédraogo, Clement Adebamowo, Azar Kariminia, John Ssali, Joseph Drabo, M. Dembelé, Nicola Maxwell, Albert Minga, M. D.N. Amego, Wilai Kotarathititum, Christian Erikstrup, H. A. Traore, Kapella Zacharia Ngonyani, E. Geng, Lukas Fenner, A. Diagne, Marcelo Wolff, A. I. Assi, A. Sackey, A. R. Yao, M. F. Sami, Edmond Addi Aka, H. Adjide, Pagakrong Lumbiganon, Karen Malateste, L. Diero, M. Gansonré, P. N. An, A. H. Sohn, D. Meless, D. Avit-Edi, D. Walker, L. Hardwicke, A. S. Kaya, Véronique Mea-Assande, G. S. Gottlieb, Denis Padgett, Eric Balestre, Candida Medina, D. Amani, C. Kouakou, C. Shiboski, E Messou, B. G. Kariyare, M. Ballif, W. Wester, J. M. Gonsan, G. Gbadamassi, A. Ba, M. Fomba, Denis Malvy, R. Bantique, S. N. Owiafe, Andrew Kambugu, Festus Igbinoba, M. Y. Maiga, C. Ahomadegbé, A. Berthé, R. D. Gueye, C. C. Bassabi, Djimon Marcel Zannou, Olivia Keiser, Kara Wools-Kaloustian, K. E. Mensah-Zukong, A. Doring, C. Chimbetete, J. Rivenc, V. Andavi, F. Alihonou, S. Datté, S. Pestilli, T. Mengthaisong, Kathryn Anastos, A. D. Mbaye, D. Lameck, Claire Graber, J. Lewis-Kulzer, G. Reubenson, B. Siloué, Marcel Yotebieng, K. T.K. Dung, C. Ahouada, Severin Lenaud, J. Welbeck, D. Dickinsonn, L. Zoungrana, A. Avihingsanon, T. T. Cao, V. K. Nguyen, Morten Sodemann, J. C. Dusingize, B. Okwara, C. Lewden, H. Traoré, Patrick MacPhail, David C Boettiger, G. Oka-Berete, H. K. Truong, F. Houngbé, Robin Wood, Venerandah Nhandu, J. C. Azani, G. Wandeler, K. L. Issouf, K. C. Anzan, Andrea L. Ciaranello, Awachana Jiamsakul, M. T. Ha, K. Brou, M. Maskew, L. Tossa-Bagnan, B. Zerbo, P. Pakpame, Xavier Anglaret, Jean W. Pape, J. B. Essanin, A. Petit, A. Kouakou, E. Rabourdin, Orasri Wittawatmongkol, Daniela Garone, S. El-Hadj Djibril, S. Duda, C. Twizere, K. C. Chan, Annie J. Sasco, N. Sanmeema, N. V. Lam, J. Conrad, Q. T. Du, P. Tharnprisan, Z. Yao, A. Djeha, Siriatou A. Koumakpai, Joachim Gnokoro, I. Hodonou, Sabine Hermans, Timothy R. Sterling, C. Nchot, D. Minta, E. Yunihastuti, T. F. Eboua, T. Cissé, Revathy Nallusamy, Jeffrey S. A. Stringer, Dabis F, F. Bohossou, Brian Eley, E. Traore, R. McKaig, Matthew Law, Manhattan Charurat, G. M. Kouakou, Madeleine Amorissani Folquet, A. Mandalakas, Sophie Desmonde, S. Eholié, J. K. Assouan, Andrew Boulle, Tuti Parwati Merati, A. Koko Lawson-Evi, Eugene Mutimura, C. A. Bosse, M Dosso, Fred Nalugoda, T. T. Pham, T. Udomphanit, H. L. Ha, N. Kancheya, N. Han, J. Sehonou, S. N. Kangah, R. Huebner, A. Gasser, C. Gilbert, Appolinaire Horo, J. C. Kouakou, D. Yé, P. Acquah, A. Héma, Pope Kosalaraksa, Hans Prozesky, J. James, Fatoumata Dicko, P. Cahn, Moussa Doumbia, I. Oliviera-Souto, Morna Cornell, Elenore Judy B. Uy, G. Hounhoui, J. E. Carter, V. A. Yao, Adrien Sawadogo, B. Petersen, S. E. Reid, B. Goka, G. Carriquiry, M. A. Davies, P. Nipathakosol, J. Le Carrou, M. L. Lindegren, H. Dior, P. Cegielski, E. Baramperanye, Mariam Sylla, Anders Fomsgaard, P. Braitstein, S. T. Coulibaly, D. D. Cuong, C. N'Diaye, M. Kone, Dewa Nyoman Wirawan, A. Gitembagara, Niaboula Koné, K. Ruxrungtham, R. Bognounou, Aissatou Touré, A. Ephoévi-gah, Alex Lund Laursen, and Y. Atakouma

Subjects
Male, Questionnaires, West African, Pediatrics, Asia Pacific, Antitubercular Agents, HIV Infections, Drug resistance, rifampicin, South Africa, drug resistant tuberculosis, Surveys and Questionnaires, Tuberculosis, Multidrug-Resistant, Central Africa, antiretrovirus agent, Human immunodeficiency virus infected patient, clinical practice, microbial sensitivity test, Infectious Diseases, priority journal, urban population, Female, anti human immunodeficiency virus agent, supply and distribution, medicine.drug, Pulmonary and Respiratory Medicine, Adult, isoniazid, medicine.medical_specialty, Tuberculosis, Asia, phenotype, Anti-HIV Agents, Developing country, MDR-TB, Microbial Sensitivity Tests, purl.org/pe-repo/ocde/ford#3.03.08 [https], preventive medicine, Article, South and Central America, socioeconomics, medicine, Humans, controlled study, human, rural population, drug sensitivity, Developing Countries, Directly Observed Therapy, Preventive healthcare, ART programs, Caribbean, business.industry, questionnaire, Drug resistant tuberculosis, developing country, CD4 lymphocyte count, Central africa, Central America, South America, medicine.disease, major clinical study, Latin America, purl.org/pe-repo/ocde/ford#3.02.07 [https], Africa, world health organization, tuberculostatic agent, business, Rifampicin
Abstract

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.

Published
2014

3. Indication for Doppler evaluation in the management of intrauterine growth restriction of vascular origin in Sub-Saharan Africa.

Author

Rémy, Konan Blé, Luc, Olou, Perel, Konan, Abdoul, Koffi, Stéphane, Adjoussou, Mohamed, Fanny, Appolinaire, Horo, and Mamourou, Koné

Subjects
FETAL development, FETAL growth retardation, DOPPLER ultrasonography, FLOW velocity, PERINATAL death
Abstract

Objective: To assess the contribution of Doppler in foetal monitoring and decision-making during delivery in case of in-utero vascular growth retardation. Design: We conducted a retrospective cohort study from January 2015 to December 2017 in the Gynaecology and Obstetrics Department of the Yopougon University Hospital (Abidjan, Ivory Coast). It included 130 patients who gave birth in a setting of pre-eclampsia with intrauterine growth restriction (IUGR) from 28 weeks of amenorrhoea. Results: The average age of patients was 31years. Nulliparous (33% of our patients) and pauciparous (41% of our patients) women were the group most affected. The mean gestational age at the first Doppler examination was 32 weeks of amenorrhoea. Doppler abnormalities were 65% in uterine Doppler and 90% in umbilical Doppler. The mean cerebrovascular ratio was reversed in 90% of the cases. Perinatal mortality was 22.3% (n = 29) with 21 foetal death in utero and 8 neonatal deaths. The time interval between absent end-diastolic or reverse flow velocity and in-utero foetal death was 3.8 days. Conclusion: Foetal and umbilical Doppler ultrasound greatly modified the management of intrauterine growth retardation related to hypertension. [ABSTRACT FROM AUTHOR]

Published
2019
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