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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.

The prevalence of epilepsy in Sub-Saharan Africa is about 15 per thousand; against 6 to 8 per thousand in industrialized countries. Health, social, economic conditions and misknowledge could explain this situation. The objective of this survey was to study the knowledge of parents of children with or without epilepsy about this disease in Mali. 423 adults were interviewed, 15% children with epilepsy. The mean age was 34 ± 9,3 years; females represents 60% of the population. 26% of interviewed subjects heard about epilepsy from their neighbourhood, 20% from traditional healers, 11% from health care professional; the tonic-clonic crisis was the most known form of the disease. 59% thought epilepsy to be contagious. The organicity of the disease was known by 51% of the population. 23 % of the population believed there was a link between the onset of the crisis and the presence of the hole moon. 78% of subjects have already seen at least one crisis of epilepsy, but only 33% have got an attitude of first help that was to pour fresh water on the face of the patient in 22% of cases. 57% of subject's acknowledge having as first recourse traditional medicine. The fight against epilepsy in Mali as in the others countries of the third world should go through information and education of the population, in particular parents.

Since the advent of HIV, Kaposi's sarcoma has become one of the most common opportunistic infections and the first cancer in patients with HIV. This cancerous disease occurs most often on the skin but also the viscera. Digestive localization was often observed during the search for other locations before the cutaneous form. No studies in Mali has focused on the upper gastrointestinal location.To describe the epidemiological and clinical aspects of Kaposi's sarcoma in the upper gastrointestinal endoscopy.This was a retrospective descriptive study from June 2005 to February 2009 in the center of endoscopy of the Point G Hospital including all patients seen in upper gastrointestinal endoscopy during the study period.20 cases were reported from a total of 5068 endoscopy performed during this period a frequency of 0.39% hospital. These 20 cases were identified in all 31 patients with cutaneous localization of Kaposi's sarcoma is a frequency of 64.5%. The sex ratio was equal to 0.81. The average age was 36.8 years ± 8.92 years. The stomach and esophagus were found most locations. All patients were HIV positive. The CD4 count below 200 cells/mm3 was observed in 95% of patients.

Cryptococcal meningitis is the most common fatal central nervous system infection in AIDS patients in Sub-Saharan Africa. The purpose of this prospective study conducted from March 2003 to February 2004 in the internal medicine and infectious diseases departments of the Point G University Hospital Center was to investigate the clinical, prognostic and epidemiological profile of Cryptococcus neoformans infection in patients hospitalized for brain and meningeale infection (BMI). Diagnosis of neuromeningeal cryptococcosis (NMC) was based on positive identification of Cryptococcus by direct exam of the cebrospinal fluid (CSF) after India ink staining and/or culture on Sabouraud medium without actidione. During the study period, a total of 569 patients were hospitalized including 235 (41.3%) with HIV infection. Overall C. neoformans was identified in 14 patients. Median patient age was 39 +/- 8 years. There was a male preponderance with a sex ratio of 1.8 (9 men/5 women). Patients with BMI were HIV-positive in 85.7% of cases (n=12) and HIV-negative in 14.3% (n=2). The overall and HIV-specific prevalence of BMI was 2.5% and 5.1% respectively. The CD4 lymphocyte count was between I and 49 cells/mm3 in 64.3% of cases. The main clinical symptoms were cephalea in 85.7% of cases, altered consciousness in 50% and nausea/vomiting in 35.7%. Neurological manifestations (hemiparesis and cranial nerve deficit) were noted in 14.3%. HIV infection is the main purveyor of NMC in Mali. The actual incidence of cryptococcosis is unclear due to the poor sensitivity of diagnostic techniques. This study highlights diagnostic difficulties related to clinical polymorphism and poor technical facilities. Agglutination testing of blood and CSF is recommended, but mortality remains.

Eight in 1,000 people in the world suffer from epilepsy, and 80 % of them are in the developing countries [1]. Sub-Saharan Africa and Latin America have higher median prevalence's 15.4 % and 12.4 %, respectively, compared to the prevalence in Europe, 5.4 %, and in North America, 5-10 % [2]. On this epidemiological inequality overlays a considerable disparity in the quality of care given to people with epilepsy, between developed and developing countries, and rural and urban areas. In this context, one of the most controversial subject regarding epilepsy is the care given to epileptic patients and their offspring. In fact, being a woman with epilepsy is not as being a man. The specific concerns about women with epilepsy are essentially sexual development, contraception, reproduction, fertility, and anatomic and cognitive teratogenicity of anti-epileptic drugs. The awareness campaign of women with epilepsy starts from puberty until menopause. About one third of epileptic women experience variations in their disease linked to menses, probably due to the neurotoxicity of oestrogens (not counterbalanced by progestatives). The problem with the teratogenicity of anti-epileptic drugs is not resolved yet despite the availability of new molecules. A close collaboration between health practitioners (obstetricians and neurologists) and an awareness of health professionals are essential for a global care of pregnant epileptic women or at age to conceive.

The main goal of our study was to evaluate cirrhosis course on one year. The study was prospective and longitudinal from January 2005 to December 2006 in the center of hepatology and gastro-enterology of CHU Gabriel Touré. The patients had one year follow up and examinated every three months. In this study 57 patients were included. Mean age was 41,5 + 15,3 years. Ascite and jaundice were the main clinical signs respectively 70.2% and 54.4%. Ascite or its increase was the most complication in 67.5% of cases (p = 0.002). The global mortality was 82.5% and it was high in the three first months, caused by hepatocellular carcinoma, digestive bleeding and hepatic encephalopathy respectively 33.3%, 27.3% and 15.2%. Abdomen pain, ascite and jaundice have an predictive value for high mortality (p between 3.10-3 et 10-7). Early examination, therapeutic observance and good management of cirrhosis complications could reduce the mortality.

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.

The goal of our study was to describe the epidemiologic , clinical and endoscopic aspects of gastroduodenal ulcers at the regional hospital of sikasso (HRS). This prospective study was held from january 2002 to december 2003.All of the patients underwent an upper digestive tract endoscopy. Gastroduodenal ulcers comprised 10.88% of all of the digestive tract endoscopies. The average age of patients was 42.51 + 14.60 years with a gender ratio of 1.88 in favor of men. The overwhelm patients were lower middle class income. The main clinical symptoms were epigastric pain and dyspepsia. The ulcers were most often found in the duodenum (DI).

We conducted a prospective study in internal medicine and infectious diseases wards of the hospital of Point " G " in Bamako, Mali from January to December 2002. Overall 112 patients HIV positive, thirty-five patients (31,25%) had at least a digestive parasitic disease. We found that the most frequent parasite in stools sample were protozoa (82,85%). The second most frequent parasites were helminthes (20,33%). HIV/AIDS opportunistic parasites represented 40% of all parasites found. These included 25,71% cases of Cryptosporidium sp, 8,57% cases of Isospora belli and 5,71 % for microsporidia. The functional signs of our patients were mostly asthenia and weight loss. The physical signs were conjunctive pallor (71, 42%) and diarrhea (85, 71%). Generalized itching was present in 54, 28% of cases and abdominal pains in 25, 71% of cases. The global lethality was 37, 14% (13/35). The deaths were due to the HIV infection. The parasites appear even frequent at patients infected by HIV/AIDS, in spite of the advent of antiretroviral therapy. The efficient molecule research against the opportunist parasite must constitute one of our priorities in tropical area.

The objective of this work was to evaluate peritoneum attack in AIDS affected patients. IT was a cross sectional descriptive study from October 2000 to May 2003 in services of Internal Medicine of the Hospital of the Point G and Hepato-Gastro-enterology of the Hospital Gabriel Touré and that concerned patient hospitalization files, registers of laparoscopy and registers of anatomopathology results. Have been included in this study, patients HIV positive presenting an abdominal symptomatology as abdominal pain, ascite, hepatomegaly, splenomegaly and that benefitted a laparoscopy with oriented biopsies of lesions. Anatomopathology exam of biopsy fragments has been made in the National institute of Research in Public Health (INRSP) of Bamako, Mali and in Pharo, Marseille in France. In term of this study 20 patients have been included. The mean age of our patients was 40.1 +/- 11 years with a sex ratio equal 1. Married women were the socio-professional category the most affected (45%). The clinical symptomatology was dominated by ascite (70%), abdominal pain (45%), abdominal meteorism (40%), hepatomegaly (35%), splenomegaly (30%). Peritoneal localization was the most frequent (50%). Granulations were the laparoscopic aspect the most met (80%) and confirmed in 80% cases by histology. Hepato-peritoneal tuberculosis was the most frequent etiology (60%) come then the non specific inflammations (30%), the lipophagic granulome (5%), and non specific granulomatose inflammations (5%). This study is characterized by an increased frequency of hepato-peritoneal tuberculosis during the pathology of peritoneum in AIDS affected patients. It deserves to be searched and treated for patients' survival.

The goal of this study was to appreciate principal affections and mortality and in gastroenterology service of Gabriel Touré Hospital. It is about a survey longitudinal that has permit to analyze patients who have been care. During study, 766 patients were unregistered. Mean age of patient was 45.17 years and a sex ratio (M/F) = 1.10. The rate of reference was 13.85%. The morbidity was dominated by HIV infection (29.90%) followed by Hepato-cellular Carcinoma (7.83%) and cirrhosis (4.05%). Mortality (18.41%) was dominated by the VIH infection, HCC and Cirrhosis. The precocious recourse to cares, the improvement of work conditions, the sensitization, the infectious illness prevention is factors that will permit a reduction of morbidity and hospital mortality.

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)

Our main objective consists in evaluating the frequency of digestive signs and digestive opportunistic infections in AIDS patients with diarrhea. The prospective study occurred from January 1997 to July 1998 in Bamako hospitals. The patients underwent a clinical examination, blood and stools tests, and sometimes upper digestive endoscopy. Among 434 cases of AIDS, 426 patients (98%) had at least one digestive sign. The main digestive signs were diarrhea (80.1%), abdominal pains (62.2%), vomiting (47.2%) and dysphagea (36.6%). Isospora belli and Cryptosporidium parvum have been pointed up in respectively 9% and 16.3% of examined specimen. Echerichia coli was found in 8.6% of stool cultures and in 2.9% in the case of Salmonella Arizonae. Twenty cases of Kaposi's sarcoma were diagnosed and mycosis was found in 71.9% of patients. In conclusion, digestive change is a constant phenomenon in AIDS patients. Patients survival could be improved by early management, improvement of diagnosis and provisioning of medicines.

We realized a clinical study in 65 patients with acquired immunodeficiency syndrome, aged from 3 to 62 years old (mean, 34 years) (34 males and 31 females) interned or showed in consultations at the hospital Gabriel Touré in Bamako, Mali (departments of ENT diseases and of internal medicine), in order to analyse and to state precisely different otorhinolaryngologic manifestations in AIDS. Oropharyngeal candidiasis was the most prevalent otorhinolaryngologic manifestation (57 %). Other less common lesions were suppurative otitis media (29 %), atrophic pharyngitis (18,5 %), sinusitis (11 %), Kaposi's sarcoma (5 %) localized above all on the palate: they are however a frequent sign of infection by HIV. The manifestations merit a particular attention by otorhinolaryngologist because, although they have few influence on the general evolution of the disease, they appear as additional manifestations of infectious risks in AIDS patients.

Our main objective has been geared toward the appreciation of the importance of the infection by human immunodeficiency virus in Mali. Our study was based on 3,496 sera deducted from March 1987 to January 1989. All positive sera at ELISA have been confirmed by Western Blot. The total seroprevalence of the study is 8.41%. This fact has been noticed higher in prostitutes, young men, more in women than in men in widows and divorced couples, in traders, in travellers of high endemic countries. The seropositivity is proportional to the number of sexual partners. The heterosexual way of transmission has been dominant. There has been no relationship between seropositivity and transfusion, antecedent of surgery, sexually transmitted diseases, of sexual intercourse type. The HIV2 has been more frequent than HIV1. Taking into account the importance of this infection, precautionary measures must be taken to avoid an evolution toward a catastrophic situation.

Our main objective has been to study the prevalence of oesophagitis by upper digestive endoscopy. Within 12 months, we have registered 228 cases of oesophagitis out of 612 oesophagean anomalies (37.25%) during 3019 fibroscopies. Oesophagitis has been found to 63.59% in cases in young adult men. Peptic oesophagitis has been most frequent and its congestive aspects most current. The main indication of endoscopy in patients suffering of oesophagitis has been epigastralgies.