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Voluntary or accidental ingestion of a caustic product is increasingly encountered in our country. Caustic esophageal stenosis is the most common sequel. Its treatment involves instrumental dilation and/or surgery which is particularly heavy. The aim of this study was to study the epidemiological, clinical and therapeutic aspects of caustic esophageal strictures in our context. The retrospective study took place from December 2013 to December 2017 in the Hepato-Gastroenterology department of the Gabriel Toure university hospital in Bamako. We included patients with caustic esophageal stenosis referred to the gastrointestinal endoscopy unit for dilation. 67 patients admitted for caustic stenosis were included. The mean age of our patients was 20.76 ± 19.9 years with extremes of 1 and 70 years and a sex ratio of 1.9. In 50.7% of cases, the product ingested was basic in nature. The clinical symptomatology was dominated by dysphagia (100%), vomiting (100%), the emaciated (60%) and cough (40%). In 59 (88%) patients, the stenosis was unique and multiple in 8 (12%). The KILLIAN mouth as the sole site of the stenosis was found in 40.3% of patients. The number of sessions was ≤ 3 in 16.4% and >3 in 83.6% with a mean of 4.59 ± 1.57 sessions. The evolution was favorable in 95.5% of our patients. However, we recorded three (3) cases of death all following a perforation. Conclusion: Caustic esophageal stenosis, a consequence of ingestion of caustics, is increasingly observed in our context. Endoscopic dilation occupies an important place in its management.

Digestive hemorrhage by rupture of esophageal Varices is common and has a pejorative prognosis in our context. Purpose: The main purpose of this work was to study the digestive bleeding by esophageal varices and prognosis value of blood transfusion in the Hospital of Gabriel Toure. Methodology: It was a prospective study that took place in the service of Hepato-gastroenterology of Gabriel Toure Hospital from June 2016 to May 2017 and from November 2017 to August 2018. Results: At the end of the study, 77 patients met the inclusion criteria out of 1396 patients hospitalized during the same period. Varices bleeding represented a prevalence of 5.5% among hospitalized patients during the same period. The average age of our patients was 46.58 ± 15.09 years. The male sex was more reported in our study with a prevalence of 67.5%. At admission, 63.2% had clinical anemia, 58.4% low arterial pressure and 50.6% hemoglobin rate less than 7 g/dL. Blood transfusion was indicated in 47 patients (61%). The mortality rate was 23.4% and was comparable in both groups (p = 0.0990). Early rebleeding was significantly observed in the case of transfusion (p = 0.0452). Hepatic encephalopathy was the leading cause of death of our patients with 72.2%. Conclusion: Digestive bleeding by esophageal varices is a worsen complication in cirrhosis in hospital setting. Transfusion has not significantly improved the prognosis of our patients.

Aggression to the liver by xenobiotic and endogenous agents essentially results in an increase in serum aminotransferases related to hepatic cytolysis, the diagnosis of which is not always easy due to the diversity of its causes. This was a cross-sectional study from April 2019 to March 2020 that took place in the Department of Hepato-gastroenterology of the Gabriel Toure University Hospital Center. This was a cross-sectional study from April 2019 to March 2020 which took place in the Hepato Gastroenterology department of the Gabriel Toure university hospital whose objective of which was to study the etiology of hepatic cytolysis. We included all patients with hepatic cytolysis resulting in increased aminotransferase alanine at a rate higher than the normal upper limit with or without an increase of aspartate aminotransferase. We collected 199/2800 patients who met our inclusion criteria, i.e., a frequency of 7.1%. The mean age was 44.06 years ± 16.4 years, the sex ratio was 1.73. The most common clinical signs were jaundice, ascites, hepatomegaly, asthenia and anorexia. Biologically, chronic cytolysis was noted with a moderate elevation of aminotransferase alanine in 77.9% and a significant elevation in 15.5% of cases. HBs antigen (HBsAg) was positive in 80 patients (40.2%) and anti-hepatitis C virus (HCV) antibody in 18 patients (9%). Abdominal ultrasound was the first-line morphological examination and hepatomegaly alone or associated with splenomegaly was the most common abnormality. The main causes of acute cytolysis were viral hepatitis B, bile duct obstructions, drug-induced hepatitis and malaria while chronic cytolysis was mainly due to cirrhosis and hepatocellular carcinoma (HCC).

Introduction: Upper gastrointestinal (GI) endoscopy is an examination that involves exploring the upper part of the digestive tract using an endoscope. Our study was aimed to evaluate the practice of Upper GI endoscopy at the mother-child hospital in Mali. Patients and Methods: This was a descriptive retrospective study on reports of Upper GI endoscopy results in the digestive endoscopy unit at the mother-child hospital in Bamako from January to December 2018. Results: Endoscopy was performed in 465 patients including 231 males and 234 females. The sex ratio was 0.98. Patients were aged 46.69 years old on average with the extremes of 8 and 90 years old. Epigastralgia was the main referral in 50.5%. Endoscopy was normal in 24.7%. The main diagnostics were duodenogastric reflux in 32.5% and gastritis in 14.4%. Conclusion: The practice of Upper GI endoscopy at the mother-child hospital in Mali has allowed the exploration of the upper digestive tract to contribute to the diagnosis of esogastroduodenal lesions.

Autoimmune pancreatitis is a distinct form of chronic pancreatitis. It is a chronic pancreatitis distinct from alcohol, genetic or idiopathic impairment and involves possible autoimmune mechanisms. The diagnosis of autoimmune pancreatitis is based on a body of biological, histological and radiological arguments. Also called sclerosing lymphoplasmacytic pancreatitis, it is one of the causes of chronic pancreatitis. The risk factor for the onset of cancer that it represents and its sensitivity to corticosteroids make it a pathology requiring special management. We report a case of autoimmune pancreatitis in a 35-year-old patient.

The objective of our study was to evaluate hepatitis B virus (HBV) infection in an urban population. This longitudinal study was conducted in Bamako District and Kati Commune. After a preparatory phase, the persons who accepted the protocol were assessed for HBsAg. HBsAg carriers had blood collection for HBeAg assay, viral load assessment, genotyping, DNA mutation testing, and severity of hepatic fibrosis and necrosis. At the end of this study, 1475 persons were included, of which 195 had HBsAg positive confirmed, that is to say 13.97%. The mean age of HBsAg positive patients was 35.11 ± 11.12 years with a sex ratio of 2.68. HBeAg was found in 8.9% of the patients tested for this antigen. The viral load was undetectable in 10.52% of patients and greater than 2000 IU/mL in 32.24% of cases. Fibrosis ≥ F2 and necrosis ≥ A2 were found in respectively 19.72% and 6.80% of cases. Genotype E was found in 91.6 patients and an R249S mutation observed in 39.04% of cases. Conclusion: HBV infection has a serious impact on socio-economic development in Mali because it affects mainly the young male population, hence the need to organize preventive measures effectively.

Tenofovir reduces viral load during viral cirrhosis B and improves prognosis. The aim of this study was to evaluate the effectiveness and safety of Tenofovir during the treatment of viral B cirrhosis. The study was retrospective and prospective on patients with viral B cirrhosis treated with Tenofovir in the Hepato-Gastroenterology Department of University Hospital Gabriel Toure in Bamako (Mali) and evaluated between three and six months after the start of treatment. We included 89 patients. The mean age was 44.5 ± 16 years with extremes of 18 and 90 years. The sex ratio was 1.2. At inclusion all patients had a detectable viral load with an average of 2651.96 ± 1495.85 IU/ml. Follow-up viral load was undetectable in 84.3% with patients between 3 and 6 months of treatment. The average detectable viral load was only 27.04 ± 21.05 IU/ml. There was also an improvement in hepatocellular function and few side effects. Conclusion: This study shows the interest of Tenofovir in the treatment of viral cirrhosis B with very few adverse effects.

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.

The main objective of this work was to update the data on the epidemiological, clinical, etiological and prognostic aspects of these acute upper digestive hemorrhages. It was a prospective study for a period of 11 months (from March 2013 to January 2014) at the digestive endoscopy center of Gabriel Toure University Hospital in Bamako. At the end of this study, 63 patients had acute upper digestive bleeding (AUDB) among 954 hospitalized patients, that is to say a frequency of 6.7%. The sex ratio was 3.5. The average age of our patients was 45 ± 16.57 years with extremes of 15 and 84 years. A notion of smoking, epigastralgia and none steroid anti-inflammatory drugs (NSAIDs) were more reported in the history with respectively 14 patients (22.3%), 10 patients (15.9%) and 4 patients (6.3%), but haematemesis had occurred in 24 (38.1%) patients without any antecedent. The main causes of hemorrhage were rupture of oesophageal varices in 34 (57.6%) patients and peptic ulcers in 18 (30.5%) patients. Early recurrence occurred in 7 (11.1%) patients resulting in the death of 5 patients for an overall mortality of 9 patients among 63 (14.3%). Acute high digestive hemorrhages are always serious. The correct management of the hemorrhagic episode by haemostatic gestures when available and the causes of haemorrhage improve the prognosis.

We describe the outcomes of second-line drug resistance profiles and predict the efficacy of drugs for third-line therapy in patients monitored without the benefit of plasma HIV-1 RNA viral load (VL) or resistance testing.We recruited 106 HIV-1-infected patients after second-line treatment failure in Mali. VL was determined by the Abbott RealTime system and the resistance by the ViroSeq HIV-1 genotyping system. The resistance testing was interpreted using the latest version of the Stanford algorithm.Among the 106 patients, 93 had isolates successfully sequenced. The median age, VL and CD4 cells were respectively 35 years, 72 000 copies/mL and 146 cells/mm(3). Patients were exposed to a median of 4 years of treatment and to six antiretrovirals. We found 20% of wild-type viruses. Resistance to etravirine was noted in 38%, to lopinavir in 25% and to darunavir in 12%. The duration of prior nucleos(t)ide reverse transcriptase inhibitor exposure was associated with resistance to abacavir (P 0.0001) and tenofovir (P = 0.0001), and duration of prior protease inhibitor treatment with resistance to lopinavir (P 0.0001) and darunavir (P = 0.06).Long duration of therapy prior to failure was associated with high levels of resistance and is directly related to limited access to VL monitoring and delayed switches to second-line treatment, precluding efficacy of drugs for third-line therapy. This study underlines the need for governments and public health organizations to recommend the use of VL monitoring and also the availability of darunavir and raltegravir for third-line therapies in the context of limited-resource settings.

Aim To investigate the association between alcohol use and adherence to highly active antiretroviral treatment (HAART) among human immunodeficiency virus (HIV)-infected patients in subSaharan Africa. Design and setting Cross-sectional survey conducted in eight adult HIV treatment centres from Benin, Cote d'Ivoire and Mali. Participants and measurements During a 4-week period, health workers administered the Alcohol Use Disorders Identification Test to HAART-treated patients and assessed treatment adherence using the AIDS Clinical Trials Group follow-upquestionnaire.Findings Atotalof 2920patientswereenrolledwithamedianageof 38years(interquartile range (IQR) 32-45 years) and a median duration on HAART of 3 years (IQR 1-4 years). Overall, 91.8% of patients were identified as adherent to HAART. Non-adherence was associated with current drinking (odds ratio (OR) 1.4; 95% confidence interval (CI) 1.1-2.0), hazardous drinking (OR 4.7; 95% CI 2.6-8.6) and was associated inversely with a history of counselling on adherence (OR 0.7; 95% CI 0.5-0.9). Conclusions Alcohol consumption and hazardous drinking is associated with non-adherence to HAART among HIV-infected patients from West Africa. Adult HIV care programmes should integrate programmes to reduce hazardous and harmful drinking.

Summary Objective To study factors associated with the probability of retention in antiretroviral therapy (ART) programmes in West Africa. Methods The International epidemiologic Databases to Evaluate AIDS (IeDEA) in West Africa is a prospective, operational, observational cohort study based on collaboration between 11 cohorts of HIV-infected adult patients in Benin, Cote d’Ivoire, Gambia, Mali and Senegal. All patients aged 16 and older at ART initiation, with documented gender and date of ART initiation, were included. For those with at least 1 day of follow-up, Kaplan–Meier method and Weibull regression model were used to estimate the 12-month probability of retention in care and the associated factors. Results In this data merger, 14 352 patients (61% female) on ART were included. Median age was 37 (interquartile range (IQR): 31–44 years) and median CD4 count at baseline was 131 cells/mm3 (IQR: 48–221 cells/mm3). The first-line regimen was NNRTI-based for 78% of patients, protease inhibitor-based for 17%, and three NRTIs for 3%. The probability of retention was 0.90 [95% confidence interval (CI): 0.89–0.90] at 3 months, 0.84 (95% CI: 0.83–0.85) at 6 months and 0.76 (95% CI: 0.75–0.77) at 12 months. The probability of retention in care was lower in patients with baseline CD4 count 200 cells/mm3, in men (aHR = 1.17; 95% CI: 1.10–1.24; P = 0.0002), in younger patients (

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.

As of 2007, it was estimated that the rapid scale-up of antiretroviral therapy (ART) in West and Central Africa had resulted in 430 000 patients with advanced HIV disease receiving treatment of a total in need of 1.7 million [1]. Although the prevalence seems to be declining [2-4], West Africa remains the epicentre of the HIV-2 epidemic. Compared to HIV-1, HIV-2 infection is characterised by a longer latency period [5] and a slower T Lymphocyte CD4+ (CD4) depletion with a lower plasma viral load [6, 7], but nonetheless leads to clinical AIDS in some instances [8, 9]. Unfortunately data on the ART response in HIV-2 and dually positive patients are sparse [10-19]. There is clear evidence that non nucleoside reverse transcriptase inhibitors (NNRTI) are inappropriate for the treatment of HIV-2 infection [20]. However, this type of regimen remains the first line treatment of choice in resource-limited countries [1]. Even where a protease inhibitor (PI) regimen has been used results have not always been encouraging [12, 14], perhaps due to HIV-2 having a decreased susceptibility to several, especially unboosted PIs, [21] or to the presence of viral resistance mutations prior to the onset of an effective PI-based therapy [13, 15, 22-25]. In Abidjan, a lower CD4 response at six months has been reported in HIV-2 and dually positive patients compared to HIV-1 infected patients [26]. In this context of a rapid scale-up of ART delivery, a consortium of leading clinicians and clinical epidemiologists from five major cities around West Africa, representing 11 adult clinic cohorts has been assembled in West Africa in the context of the global International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration of the US National Institutes of Health [27, 28]. Using this international database, we describe the case management of HIV-2 infected or dually positive patients and their response to treatment compared to HIV-1 infected patients in West Africa.

Background As access to antiretroviral drugs increases in developing countries, it will become increasingly important to monitor the emergence of resistance and to define the molecular pathways involved to identify optimal therapeutic regimens. Methods We performed genotypic resistance testing on plasma obtained from 101 HIV-infected treatment-naive individuals from Mali. Genotyping was carried out using the Virco protocols and HXB2 was used as the reference strain. Results CRF02_AG was the most common subtype, present in 71.3% of our patient population. Other subtypes included B, C, G, CRF06_CPX, CRF09_CPX, CRF01_AE, A2/CRF16_A2D, A1 and CRF13_CPX. A total of 9.9% [95% confidence interval (CI) 6.9–12.9%] of patients had at least one resistance mutation. The prevalences of mutations conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 5% (95% CI 0.7–9.2%), 6% (95% CI 1.3–10.6%) and 0%, respectively. The most frequent mutations were T215A/Y for NRTIs and K103N/T for NNRTIs. One patient harboured three NRTI resistance mutations and one NNRTI mutation. This is the first reported case of multi-drug-resistant viral transmission in Mali. Polymorphisms at protease codons 10I/V and 33F potentially associated with resistance were observed in 18.8% and 1% of patients, respectively. Several polymorphisms in the C-terminal domain of reverse transcriptase were observed: A371V (in 63.4% of patients), G335D (76.2%), E399D (10.9%) and G333E (1%). Conclusion Primary resistance was seen in 9.9% of subjects, which is higher than previously reported in Mali. Taking into consideration other polymorphisms in protease such as L10I/V and 33F, primary resistance could reach 28.7% (95% CI 19.9–37.5%). Our study reflects the need to monitor the evolution of resistance on a regular basis and trends of transmitted resistance.

Background: Sub-Saharan Africa has seen dramatic increases in the numbers of people treated with antiretroviral therapy (ART). Although standard ART regimens are now universally applied viral load measurement is not currently part of standard monitoring protocols in sub-Saharan Africa. Methods: We describe the prevalence of inadequate virological response (IVR) to ART (viral load $ 500 copies/mL) and identify factors associated with this outcome in 606 HIV-positive patients treated for at least 6 months. Recruitment took place in 7 hospitals and community-based sites in Bamako and Ouagadougou and information was collected using medical charts and interviews. Results: The overall prevalence of IVR in treatment-naive patients was 12.3% and 24.4% for pretreated patients. There were no differences in rates of IVR according to ART delivery sites and time on treatment. Patients living farther away [odds ratio (OR) = 2.48; 95% confidence interval (CI) 1.40 to 4.39] those on protease inhibitor or nucleoside reverse transcriptase inhibitor regimens (OR = 3.23; 95% CI 1.79 to 5.82) and those reporting treatment interruptions (OR = 2.36; 95% CI 1.35 to 4.15) had increased odds of IVR. Immune suppression (OR = 3.32 95% CI 1.94 to 5.70) and poor self-rated health (OR = 2.00; 95% CI 1.17 to 3.41) were also associated with IVR. Conclusions: Sufficient expertise and dedication exist in public hospital and community-based programs to achieve rates of treatment success comparable to better-resourced settings. (authors)

Introduction There are limited data on paediatric HIV care and treatment programmes in low-resource settings. Methods A standardized survey was completed by International epidemiologic Databases to Evaluate AIDS paediatric cohort sites in the regions of Asia-Pacific (AP), Central Africa (CA), East Africa (EA), Southern Africa (SA) and West Africa (WA) to understand operational resource availability and paediatric management practices. Data were collected through January 2010 using a secure, web-based software program (REDCap). Results A total of 64,552 children were under care at 63 clinics (AP, N=10; CA, N=4; EA, N=29; SA, N=10; WA, N=10). Most were in urban settings (N=41, 65%) and received funding from governments (N=51, 81%), PEPFAR (N=34, 54%), and/or the Global Fund (N=15, 24%). The majority were combined adult–paediatric clinics (N=36, 57%). Prevention of mother-to-child transmission was integrated at 35 (56%) sites; 89% (N=56) had access to DNA PCR for infant diagnosis. African (N=40/53) but not Asian sites recommended exclusive breastfeeding up until 4–6 months. Regular laboratory monitoring included CD4 (N=60, 95%), and viral load (N=24, 38%). Although 42 (67%) sites had the ability to conduct acid-fast bacilli (AFB) smears, 23 (37%) sites could conduct AFB cultures and 18 (29%) sites could conduct tuberculosis drug susceptibility testing. Loss to follow-up was defined as >3 months of lost contact for 25 (40%) sites, >6 months for 27 sites (43%) and >12 months for 6 sites (10%). Telephone calls (N=52, 83%) and outreach worker home visits to trace children lost to follow-up (N=45, 71%) were common. Conclusions In general, there was a high level of patient and laboratory monitoring within this multiregional paediatric cohort consortium that will facilitate detailed observational research studies. Practices will continue to be monitored as the WHO/UNAIDS Treatment 2.0 framework is implemented.