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Artisanal and small-scale gold mining (ASGM), energy production and other industrial inputs are a major source of anthropogenic mercury (Hg) to the aquatic environment globally, and these inputs have led to environmental contamination and human exposure. While studies have documented the effects of Hg inputs to rivers and marine waters of the West African region, estuarine waters of Cote d'Ivoire have been understudied, besides the waters surrounding Abidjan. To fill this gap, and to examine the potential for human exposure to methylmercury (MeHg), we measured the concentrations of total Hg, MeHg, and ancillary parameters in water (dissolved and particulate phases), sediment and fish to determine the extent of environmental impact and the potential for MeHg exposure for people consuming these fish. Levels of Hg and MeHg in sediment were elevated in the vicinity of the urban environment (up to 0.3 ng/g dry weight (dw) MeHg and 623 ng/g dw total Hg) and lowest in the more remote estuarine environments. Measurements of Hg in tuna and other larger pelagic coastal species indicated that levels were elevated but comparable to other North Atlantic regions. However, levels of Hg in fish, even smaller estuarine species, were such that the rural and urban populations are potentially being exposed to unsafe levels of MeHg, primarily as a result of the relatively high fish consumption in Cote d'Ivoire compared to other countries. Overall, both local point sources and the transport of Hg used in interior ASGM activities are the sources for Hg contamination to these coastal waters. [Display omitted] • Mercury levels in water and sediment were elevated near urban areas. • Fish mercury levels were sufficiently elevated to pose risk to frequent consumers. • Methylmercury levels in water did not correlate with those of sediment. • Sediment total mercury, but not methylmercury, correlated with organic content. • Mercury in tuna species were comparable to other studies in the North Atlantic. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, intermittent preventive treatment for pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) has become policy in much of sub-Saharan Africa. But resistance to SP has been spreading across sub-Saharan Africa and thus the effectiveness of IPTp-SP has been questioned. The present study therefore sought to assess the incidence of placental malaria, low birth weight, and anemia of two IPTp-SP approaches (directly observed treatment scheme versus no directly observed treatment) in Anonkoua-Kouté and Samo, Côte d'Ivoire where the reported prevalence of dfr single mutant 108 was 62% and 52.2%, respectively. Methods: The study was a longitudinal design involving pregnant women and was conducted in Anonkoua-Kouté, a suburban area, and Samo, a rural area, from January 2008 through March 2009. Women of a pregnancy less than 28 weeks duration were randomized to receive SP (1.5 g/0.075 g SP) in a single intake twice and were followed up monthly until delivery. Doses were administered under supervision in the controlled IPTp group, while SP was given free to women in the uncontrolled IPTp group with a recommendation to take it at home. The primary end point was the proportion of low birth weight infants (body weight < 2500 g) and the secondary end point was the rate of severe anemia and placental malaria detected at delivery. Results: A total of 420 pregnant women were enrolled (212 and 208, respectively, in the controlled and uncontrolled groups). Delivery outcome was available for 378 women. In the modified intention-to-treat analysis, low birth weight infants were born from 15.5% of women of the uncontrolled IPTp group and from 11.9% of women in the controlled IPTp group (P = 0.31). The per-protocol population analysis showed consistent results. The proportion of women with placental malaria infection, moderate anemia (hemoglobin < 11 g/dL), and severe anemia (hemoglobin < 8 g/dL) at delivery were similar between the two groups (P > 0.05). Conclusion: The study showed that the two approaches were equivalent, suggesting that unsupervised IPTp-SP free of charge should be used in areas where implementation of the directly observed treatment scheme suffers from many constraints. [ABSTRACT FROM AUTHOR]

Dried Blood Spots (DBS) are blood collection carriers that facilitate the storage and transport of samples. Used for quality control during sero-epidemiological investigations, DBS eluate are not the conventional specimen indicated by manufacturers for enzyme immunoassay method (EIA) for hepatitis B virus surface (HBs antigen). The aim of our study was to evaluate DBS eluates used as a matrix for EIA of HBs antigen in a reference laboratory. This study took place from August 2016 to November 2017 at the Centre for Diagnosis and Research on AIDS and other infectious diseases (CeDReS) in Abidjan, Côte d'Ivoire. We used a panel of 149 whole blood samples from blood donors. The DBS performed with these samples were analyzed after elution with the HBsAg (version ULTRA) ELISA, Dia.Pro Diagnostic Bioprobes S.R.L., Sesto San Giovanni, Italy. The technical performance (sensitivity and specificity and kappa coefficient) of the test performed on DBS was determined for different ratios (optical density/threshold value) compared to the results obtained on the plasma used as reference. We obtained a sensitivity of 100% with DBS for all ratios. The specificity increased according to the ratio of optical density of the individual EIA reaction to the threshold value, with 6.09%, 47.0%, and 83.0%, respectively, for ratios of 1.0, 3.0, and 5.0. Best performance was observed at ratio of 10.0 with a sensitivity and specificity of 100%. In conclusion, DBS eluate can be used for the diagnosis of viral hepatitis B and would be useful for conducting sero-epidemiological investigations. However, ratio giving best performance must be determined for each enzyme immunoassay method kits., Competing Interests: Declaration of Competing Interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective&#160;: Faced with the uncertainty about the acceptability of COVID-19 vaccination, we conducted this study to better guide communication strategies for health worker adherence to vaccination.Methods&#160;: We conducted a cross-sectional study for analytical purposes, from 15 to 26 February 2021 among health workers in health facilities in the Gb&#234;k&#234; health region.Results&#160;: Health workers were predominantly female (53.5&#160;%) and the 30-39 age group was the most represented (52&#160;%). Television was the main source of information (74.4&#160;%). The respondents knew that they were at risk of contracting COVID-19 (82.5&#160;%) and that people with co-morbidities were the most victim of severe forms (70.4&#160;%). The majority of respondents systematically wear a mask in hospital (91%). They said that 51.1&#160;% of them would get vaccinated. The majority of respondents would systematically wear a mask in hospital (91&#160;%). Multivariate analysis shows that vaccine acceptability was statistically associated with fear of dying from the disease (p=0.046) and case management (p=0.026).Conclusion&#160;: In order to achieve better adherence to COVID-19 vaccination, it would be necessary to strengthen the capacity of these agents.

Introduction: The detection of hypertension in African countries ranges from 15 to 40%, so more than half of hypertensive people are unaware of their condition. In C&#244;te d&#8217;Ivoire, very little work on the detection of hypertension exists., Purpose of Research: The objective was to analyze the detection and control of hypertension in the Ivorian peri-urban environment., Results: Three hundred and sixty (360) participants were interviewed. Among them, 47.8% (172 participants) had their BP measured in the past 12 months. Sixty-seven individuals were classified as hypertensive of whom 30 had already been detected (44.8%). The control of hypertension was 60%. Higher probabilities of detection were associated with participation in physical activity (OR = 3.27 95% CI: 1.08-10.54)., Conclusions: The detection of hypertension, although relatively high in Anonkoi 3, still concerned less than half of the hypertensives. Hence the interest in raising public awareness of systematic screening for hypertension.

Introduction: Cessation of care for financial reasons is an indicator of the affordability of care., Objective: The objective of this work was to identify the determinants of the renunciation of care for financial reasons among women in a peri-urban area of Abidjan., Method: This cross-sectional study was conducted from March to May 2019 among women aged 18 years and over in Anonkoi 3 in the north of Abidjan. The socio-demographic, economic, health status and health care abandonment characteristics were collected using a questionnaire. The associations between the renunciation of care for financial reasons and women&#8217;s characteristics were measured using logistic regression models with a 5% risk., Results: The sample consisted of 423 women with a median age of 28 &#177; 11 years. Only 30% of them had health insurance. The rate of financial reasons for discontinuing care was 59.1%. This renunciation was more pronounced for the purchase of drugs, biological examinations, dental care, and surgical procedures. The number of dependent (P&#160;=&#160;0.035), young age (P&#160;&#8804; 0.035), low level of education (P&#160;=&#160;0.024), low level of income (P&#160;&#8804;&#160;0.004) and the absence of an associative life (P&#160;=&#160;0.004) and perceived poor health (P&#160;=&#160;0.021) were identified as determinants of the renunciation of care for financial reasons., Conclusion: Empowerment, literacy, health education for women and adherence to universal health coverage should help to remove the financial barrier to women&#8217;s access to care.

Objective: The objective of this socio-anthropological study was to establish a foundation for communication recommendations with the potential to increase the demand for tuberculosis (TB) screening in Ivory Coast. The study therefore focused on perceptions of TB likely to be influenced via communication campaigns., Method: The study design included a qualitative approach, with semi-structured interviews of 54 persons and 28 focus groups each comprised of 8 persons, as well as a quantitative approach, with a questionnaire distributed to 400 respondents. The study was undertaken in Abidjan, Bouaké, Korhogo and San Pédro, Ivory Coast., Results: Amongst the results, this study showed that the population has a robust understanding of the existence and severity of TB and a good understanding of TB symptoms. There is little confidence in traditional medicine to treat TB and there is an awareness that TB can be treated by modern medicine and medications. On the other hand, only half of the population knew that TB treatment is free-of-charge, which could be a contributing factor to patients not seeking treatment. For the vast majority of respondents, there is an association between TB and HIV or AIDS. Fears related to this association are likely to present a significant obstacle to seeking treatment in cases of presumed TB., Conclusion: Based on these findings, we think it is essential to reinforce communication around the availability of free treatment for TB, and to disassociate TB from HIV in communication and awareness-raising tools both for TB and for HIV.

Rabies affects more than 150 countries worldwide. Côte d'Ivoire is one of the rabies-endemic countries that has recorded deaths every year since 2006. The evolution of these deaths is almost constant with an average of 18 annual deaths (annual incidence = 0.06-0.08 per 100,000). Children predominate among these victims. However, prevention measures exist in anti-rabies centers distributed throughout the country. The objective of this study was to determine the factors related to rabies risk in Côte d'Ivoire through Gavi rabies project entitled 'Impact of rabies and immunization in Central and West Africa'. The implementation was conducted from 2016 to 2018 in two departments of Côte d'Ivoire (Bouake and San Pedro). The study population was dog-bite victims vaccinated in anti-rabies centers of project sites from January to December 2016. Two non-free rabies immunization protocols are used in the country (Essen and Zagreb). Information was collected from bites victims for an adequate follow-up. It was to apprciate the risk of developing rabies through access to care, the immunization status of biting animal, the category of exposure and the result of rabies post exposure prophylaxis (compliance). Local program implementers responsible for these bite-management activities and veterinary staff had receved training and the necessary material. The public health education and information dissemination activities were carried out in support of promoting a wide spread of rabies prevention messages. Household surveys were conducted by sociology students in 4002 households each in urban and in rural areas. This activity helped to find people exposed by dogs and who did not receive any Post Exposure Prophylaxis (PEP). The study registered 1,263 bite victims in pilot anti-rabies centers in 2016, 51% of them were children. People living in urban areas were strongly represented (87%) because of anti-rabies centers proximity. Dog was the most animal associated to exposure (94%). Seventy-two percent (72%) of them had owners, but only 14% were vaccinated against rabies. More than half of dog bite victims had category III of exposure (58%). PEP compliance record was very low (37%), which means that 63% of bite victims have not completed the protocol. This study conducted in Bouaké and San Pedro showed somes factors responsible for rabies deaths evolution in Côte d'Ivoire. Main issues identified are the geographical accessibility of anti-rabies centers, frequent bites caused by unvaccinated dogs, often category III of exposure and many non-completions of rabies PEP in ignorance context. The establishment of national comprehensive and integrated rabies control program is needed in Côte d'Ivoire. It must take into account all these factors by focusing on public awareness, dog vaccination and adoption of modern intradermal vaccination regimens to better manage rabies situation in Côte d'Ivoire., (Copyright © 2020. Published by Elsevier B.V.)

Rabies is a public health problem in the world especially in Côte d'Ivoire. The epidemiological surveillance of rabies revealed 10,197 exposures with 17 deaths in 2015 and 11,481 exposures with 18 deaths in 2016. The management of exposed people was based on WHO's intramuscular (IM) protocols (Essen and Zagreb). The usual results from these anti-rabies protocols showed low compliance corresponding to 45-50% exposed people who did not complete the Post Exposure Prophylaxis (PEP) schedule,mainly due to the cost of vaccines. The main objective of the project was to test the feasibility of a free rabies PEP based on the Thai Red Cross (TRC) protocol used by intradermal route. The study population was exposed people (patients) vaccinated in the anti-rabies center of Bouake and San Pédro which were two departments selected for this study. The TRC protocol was implemented in y ear 2017. Patients have been vaccinated according to IM post exposure protocols or by the TRC schedule.This new protocol was administered free of charge to exposed people with their consent. Patients who did not complete the PEP schedule were researched and interviewed for having the reasons related to this non-completion. In 2017, 1625 exposures were registered including 1121 in Bouaké and 504 in San Pedro. Overall immunization compliance was 63%. Patients who received the TRC schedule were 829 (52%)With 70% PEP compliance The PEP compliance of Zagreb protocol was 67%%and the Essen protocol recorded 38% of PEP compliance. The research of exposed people who did not complete the PEP schedule has shown that cost effectively remains the major limiting factor among exposed people vaccinated by Essen or Zagreb protocols. But negligencewas main cause for the non-completion PEP among exposed people who accepted the TRC schedule. Introduction of free rabies PEP through the TRC protocol has found the population support. This experience has been successful with a better PEP compliance, which means safe protection of people from rabies.This study has demonstrate that free rabies vaccine used by ID route is one of the best solutions to improve the PEP compliance in Côte d'Ivoire.Nevertheless, alternatives ways should be provided in order to minimize vaccine wastage rates in anti-rabies center receiving very few exposed persons.Community engagementwould be necessary for more rabies awareness raising and improving bite victim's follow-up., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: In C&#244;te d&#8217;Ivoire, national modern contraceptive prevalence remains low, at 21% in 2017.Purpose of research: The objective of this study was to identify socio-cultural obstacles related to the use of modern contraception among women of reproductive age., Methods: We conducted a descriptive and qualitative study in Dallas, in the Adjam&#233; commune, located in the center of Abidjan. The survey took place from 9th June to 7th July&#160;2018. In addition, we conducted four focus groups with men over 20 years old, women of reproductive age between 15 and 49 years old, and two religious leaders recruited according to a reasoned sampling. Group discussion guides and individual interview guides were used as data collection tools. Moreover, we analyzed data after recording and transcribing, following a thematic content analysis., Results: We interviewed thirty participants including 14 men, 14&#160;women, and two religious leaders. The main obstacles described were the lack of reliable and adequate information, misconceptions about contraception, fear of side effects, illiteracy, male decision-making power, religious prohibitions, and the socio-cultural contradictions. To circumvent these obstacles, women secretly used contraceptives, thereby exposing themselves to social risks., Conclusion: Our study highlighted the persistence of socio-cultural practices. For that reason, taking into account people&#8217;s perceptions is necessary to improve the use of modern contraception at the community level.

Artisanal and small-scale gold mining (ASGM) activities are an important source of mercury (Hg) to the atmosphere globally, and in most countries in West Africa, where gold production has increased dramatically in the last decade from both commercial and ASGM activities. This study focused on examining the concentrations of Hg and methylmercury (MeHg) in water, sediments and fish in four regions associated with gold mining activities in Cote d'Ivoire to assess the potential exposure of the local communities to MeHg from fish consumption. Concentrations of dissolved total Hg and MeHg in water and sediment were elevated at some locations sample and were indicative of local contamination. Several locations had sediment total Hg above 100 ng g -1 and sediment %MeHg ranged from 0.03 to 4.4%. Fish concentrations exceeded 0.3 μg/ g wet wt., especially for carnivores and fish caught in the western region of the country. Bioaccumulation factors, relative to dissolved MeHg, were higher for carnivores than omnivores and varied with region, suggesting other factors besides MeHg concentration alone were impacting uptake and trophic transfer. Given that people in Cote d'Ivoire consume fish at a higher level than other countries, the levels in fish were sufficient to exceed the US EPA's guidance criteria even at average consumption levels, and particularly for people consuming fish at a higher rate. Overall, this study provides compelling evidence that ASGM activities in Cote d'Ivoire are leading to elevated exposure and likely impacting the health of the local populations in regions where such activity is occurring., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The 2016 World Health Organization guidelines recommend all children <3 years start antiretroviral therapy (ART) on protease inhibitor-based regimens. But lopinavir/ritonavir (LPV/r) syrup has many challenges in low-income countries, including limited availability, requires refrigeration, interactions with anti-tuberculous drugs, twice-daily dosing, poor palatability in young children, and higher cost than non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs. Successfully initiating LPV/r-based ART in HIV-infected children aged <2 years raises operational challenges that could be simplified by switching to a protease inhibitor-sparing therapy based on efavirenz (EFV), although, to date, EFV is not recommended in children <3 years., Methods: The MONOD ANRS 12026 study is a phase 3 non-inferiority open-label randomised clinical trial conducted in Abidjan, Côte d'Ivoire, and Ouagadougou, Burkina Faso (ClinicalTrial.gov registry: NCT01127204). HIV-1-infected children who were tuberculosis-free and treated before the age of 2 years with 12-15 months of suppressive twice-daily LPV/r-based ART (HIV-1 RNA viral load (VL) <500 copies/mL, confirmed) were randomised to two arms: once-daily combination of abacavir (ABC) + lamivudine (3TC) + EFV (referred to as EFV) versus continuation of the twice-daily combination zidovudine (ZDV) or ABC + 3TC + LPV/r (referred to as LPV). The primary endpoint was the difference in the proportion of children with virological suppression by 12 months post-randomisation between arms (14% non-inferiority bound, Chi-squared test)., Results: Between May 2011 and January 2013, 156 children (median age 13.7 months) were initiated on ART. After 12-15 months on ART, 106 (68%) were randomised to one of the two treatment arms (54 LPV, 52 EFV); 97 (91%) were aged <3 years. At 12 months post-randomisation, 46 children (85.2%) from LPV versus 43 (82.7%) from EFV showed virological suppression (defined as a VL <500 copies/mL; difference, 2.5%; 95% confidence interval (CI), -11.5 to 16.5), whereas seven (13%) in LPV and seven (13.5%) in EFV were classed as having virological failure (secondary outcome, defined as a VL ≥1000 copies/mL; difference, 0.5%; 95% CI, -13.4 to 12.4). No significant differences in adverse events were observed, with two adverse events in LPV (3.7%) versus four (7.7%) in EFV (p = 0.43). On genotyping, 13 out of 14 children with virological failure (six out of seven EFV, seven out of seven LPV) had a drug-resistance mutation: nine (five out of six EFV, four out of seven LPV) had one or more major NNRTI-resistance mutations whereas none had an LPV/r-resistance mutation., Conclusions: At the VL threshold of 500 copies/mL, we could not conclusively demonstrate the non-inferiority of EFV on viral suppression compared to LPV because of low statistical power. However, non-inferiority was confirmed for a VL threshold of <1000 copies/mL. Resistance analyses highlighted a high frequency of NNRTI-resistance mutations. A switch to an EFV-based regimen as a simplification strategy around the age of 3 years needs to be closely monitored., Trial Registration: ClinicalTrial.gov registry n° NCT01127204 , 19 May 2010.

The purpose of this article is to report the results of a programme for prevention of mother-to-child transmission (PMCT) of HIV conducted from 1999 to 2002 by the PNLS in Abidjan, Ivory Coast. This programme was supported by grants from the Fonds de solidarité international (FSTI) and the Glaxo Smith Kline (GSK) Foundation. After pre- and posttest counselling, pregnant women from 4 PMI centres underwent screening for HIV. Seropositive women were offered short course AZT and the possibility of financial assistance for breast-feeding. All programme activities were carried out in close cooperation with association members. A total of 22466 tests were given and 18116 women returned for results. Among the 1829 seropositive women to whom PMCT intervention was proposed, 667 received short course AZT. The rate of transmission at 18 months was 162%. In addition 69 mothers and 28 children eligible for ARV therapy benefited from tritherapy. Limiting factors, at each phase, and efficacy of intervention were analyzed.

During the program MTCT+ set up in Abidjan by the national authorities with the assistance of the FSTI and FGSK, free screening and treatment of the syphilis infection were proposed to pregnant women. One test of agglutination on blades VDRL (Carbon Antigen Biotec the U.K.) and one TPHA test on plates for the positive VDRL (TPHA Nosticon Biomérieux F) were performed. Over the period from June 1999 to December 2001, 4 320 samples were taken. The laboratory observed 84 positive tests VDRL and 59 confirmed by TPHA, that is to say a syphilis seroprevalence (TPHA) of 1.4%. In addition 391 results were not available for various reasons (errors of numbering, haemolysed blood, absence of reagents, etc.) ie. 9.0%. Among the 59 positive women (TPHA), 30 came back for their result and 23 women were correctly treated (3 or 4 penicillin delay injections). In addition 7 partners received a complete treatment and 8 incomplete treatment. The cost of each detected and treated case rose approximately to 150 Euros, which is relatively low except in time/ staff and indirect costs for women. This study confirmed that all the activities of SMI must be integrated to have an efficient PTME programme. The biological assessment must be accessible as a whole, to minimize the additional costs and transportations. A training of all the personnel in 2002 helped to improve in an important way the results of the intervention in the center.

To describe prevalence of antiretroviral (ARV) drug-resistant HIV-1 strains among patients with a history of earlier treatment with ARV drugs in Abidjan, Côte d'Ivoire, we determined mutations that confer HIV-1 ARV drug resistance by sequencing the viral reverse-transcriptase and protease genes derived from plasma viral RNA of 68 individuals consecutively enrolled in the Joint United Nations Program on AIDS Drug Access Initiative (UNAIDS-DAI) with a history of earlier ARV drug treatment in Abidjan between August 1998 and April 1999. Phenotypic ARV drug resistance was assessed using a recombinant virus assay. Primary mutations associated with ARV drug resistance to at least one of the reverse-transcriptase inhibitors or protease inhibitors were detected in 39 (57.4%) of the 68 patients. The prevalence of mutations associated with resistance to ARV drugs was: 29 (42.6%) to zidovudine, 10 (14.7%) to lamivudine, one (1.5%) to didanosine, one K103N mutation (associated with resistance to delavirdine, nevirapine, and efavirenz), one Y181C mutation (associated with resistance to delavirdine and nevirapine), two to both indinavir (M46I/L and V82A) and saquinavir (G48V and L90M), and one each to ritonavir (V82A) and nelfinavir (D30N). Phenotypic resistance to at least one nucleoside reverse transcriptase inhibitor (RTI) was seen in 25 (39.7%) patients, to nonnucleoside RTIs in 5 (8%) patients, and to protease inhibitors in 4 (6%) patients. The high prevalence we observed in this study may limit in future the effectiveness of ARV programs in the Côte d'Ivoire.

This study reports on the experience using antituberculosis drugs in a HIV/AIDS reference service in Abidjan during a 64 month period. Prevalence of tuberculosis is 1.9% out of a total of 23,957 patients. The annual incidence rate increased slowly from 0.9% in 1990 to 3.5% in 1995. Seropositivity to HIV is 90.8%. Predominant locations of tuberculosis are pulmonary (60.3%), extrapulmonary (19.7%) and multifocal or disseminated (20%). The average period of diagnosis (9.9 days) and average duration of antituberculosis treatment in hospital (11.8 days) are similar whatever the serological status and the location of the infection may be. However, the mortality rate is more important in HIV positive patients (39.7%) than in HIV negative (17.6%) p = 0.01. The decision to treat is taken by infectiologists only in 88% of the cases, by pneumologists only in 2.5%, and both by infectiologists and pneumologists in 9.5%. Side-effects due to antituberculosis drugs were noticed in 19 patients leading to an interruption of the treatment in 10 cases. The authors recommend that health personnel be trained for the management of tuberculosis.

Objectives: To describe the spectrum of opportunistic disease in HIV-infected patients admitted to hospital in Abidjan, Côte d'Ivoire, and to describe the level of immunosuppression at which these diseases occur., Design: Cross-sectional study., Setting: In-patient wards of the University Hospital Infectious Diseases Unit., Patients: A total of 250 adult patients recruited by systematic sampling at the point of hospital admission., Main Measures: HIV status; CD4 count; diagnoses, confirmed by microbiological/radiological investigations whenever possible; and outcome of hospitalization (death or discharge)., Results: Overall, 79% patients were HIV-positive. The most frequent diagnoses in HIV-positive patients were septicaemia (20%, with non-typhoid salmonellae, Escherichia coli and Streptococcus pneumoniae the most common organisms), HIV wasting (16%), meningitis (14%), tuberculosis (TB; 13%), isosporiasis (10%), cerebral toxoplasmosis (7%) and bacterial enteritis (7%). Most HIV-positive patients had evidence of severe immunosuppression: 39% had CD4 counts < 50 x 10(6)/l, 17% had 50-99 x 10(6)/l, and 20% had 100-199 x 10(6)/l. In-hospital mortality among HIV-positive patients was 38% compared with 27% among HIV-negative patients [age-adjusted odds ratio (OR), 1.5; 95% confidence interval (CI), 0.7-2.9]. Among HIV-positive patients, the highest case-fatality rates were among patients with meningitis, toxoplasmosis and TB: in a multivariate analysis the strongest independent risk factors for death were an abnormal level of consciousness (OR, 9.3; 95% CI, 3.5-24.6), a haemoglobin concentration below 8 g/dl (OR, 4.2; 95% CI, 1.4-12.8) and age > 40 years (OR, 3.9; 95% CI, 1.5-10.2)., Conclusions: Our data show that, as in industrialized countries, most HIV-infected individuals admitted to and dying in hospital in Abidjan are profoundly immunosuppressed. Potentially preventable infections are the main causes of in-hospital morbidity and mortality among HIV-infected persons in Abidjan, and the evaluation of appropriate primary prophylactic regimes is a priority.

During 1995, among 1105 HIV patients explored in our department, 64 presented a deep fungic infection (5.8%). The yeast was searched for in cerebrospinal fluid, blood, urine, and bronchoalveolar aspiration. Isolated germs were Cryptococcus neoformans (95%), Candida tropicalis (1 case), Saccharomyces cerevisiae (1 case) et Aspergillus fumigatus (1 case). Results of treatment with amphotericin B were: recovery (9%), clinical success (11%), out of sight (14%), letality (66%), relapse (23%) and side effects (19%). We emphasized diagnostical and therapeutical difficulties, and bad prognostic of mycoses in patients with AIDS.

Dual seroreactivity to the human immunodeficiency virus (HIV) types 1 and 2 is common in Côte d'Ivoire. To assess whether dual infection is the reason for dual seroreactivity, different methods for detection of HIV-1 and HIV-2 viruses were compared. PCR on primary uncultured lymphocytes of 56 dually seropositive samples revealed the presence of both HIV-1 and HIV-2 proviral DNA in 23 (41%) cases. In 7 other dual seropositive persons, PCR was carried out on the primary lymphocytes as well as on lymphocytes after 3 and 6 weeks of cocultivation. More cultures, 5/7 (71%), were positive for both viruses at 3 weeks compared to 0/7 at 6 weeks post cultivation. Moreover, 2 out of 3 samples, where only HIV-1 was detected in uncultured cells, were positive for both viruses after 3 weeks of cultivation. These data indicate that the sensitivity of HIV-2 detection can be increased by stimulation of patients' lymphocytes. A higher number of dual seropositive individuals (10/23 (48%)) had antibodies able to neutralize simultaneously both HIV-1 and HIV-2 prototype viruses than did HIV-1 antibody-positive sera (5/21 (24%)) or HIV-2 antibody positive sera (3/18 (17%)). The prevalence of dual seropositives being infected with both viruses is highly dependent on the method used to detect infection. There is a need to standardize virological markers in order to gain a better insight into the relative proportions of HIV-1, HIV-2 and HIV-1/HIV-2 dually infected persons.

A coprological study realized with 217 HIV adult subjects has allowed to evaluate the frequency of the cryptosporidiosis during this affection in Abidjan. Cryptosporidium sp. has been found in 8.7% of the subjects. Otherwise 78.9% of the patients had a chronic diarrhoea. 89.4% showed an abdominal pain and were dehydrated 94.7% had lost weight and 21% had nausea or vomiting.

Dual serological reactivity to the human immunodeficiency virus (HIV) types 1 and 2 is common in Côte d'Ivoire. To assess whether dual infection is the reason for dual seropositivity we sought HIV-1 and HIV-2 proviral DNA in primary uncultured peripheral blood mononuclear cells from selected seropositive patients in Côte d'Ivoire with the polymerase chain reaction (PCR). PCR on primary lymphocytes in 36 dually seropositive samples revealed the presence of both HIV-1 and HIV-2 proviral DNA in 12 cases and the presence of HIV-1 only in 24 cases. In 18 of these 36 samples a virus was isolated and identified by PCR. HIV-1 was isolated from the 9 specimens with only HIV-1 proviral DNA in the primary lymphocytes. Among dually PCR-positive samples, 2 viral isolates reacted with both HIV-1 and HIV-2 primers; and only HIV-2 (n = 1) or HIV-1 (n = 6) strains were isolated from the other samples. The findings show that surveys based on serology may overestimate the prevalence of mixed infections in areas where both HIV-1 and HIV-2 occur.

The prevalence of complications is 38% in 116 patients with varicella. Cutaneous surinfection is observed in 30 patients (26%), pneumopathy in 4 cases resulting in death of 3 patients, encephalitis in 3 patients (1.7%). The authors discuss about those complications and their treatment.