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The ACE2 gene polymorphisms (rs143936283, rs146676783, and rs4646116) in infected and noninfected persons by SARS-CoV-2 in Burkina Faso. Our cross-sectional study population comprised 137 SARS-CoV-2 infected persons and 181 non-infected persons. Three ACE2 gene polymorphisms, rs143936283, rs146676783, and rs4646116, were genotyped using the realtime PCR standard TaqMan allelic discrimination technique. The association between SARSCoV-2 infection and the polymorphisms were evaluated by a binary logistic regression. There was no association between the polymorphisms rs143936283 rs4646116 haplotypes, and SARS-CoV-2 infection in our study population. However, in the female population, the heterozygous genotype CT of rs146676783 increased by two and half the risk (OR=2.58 95%CI (1.2-5.48), p= 0.014) of being infected by SARS-CoV-2. Additionally, carrying the homozygous minor allele (genotype TT) of rs146676783 increased by more than five and half the risk (OR=5.57 95%CI (1.64-18.78), p=0.006) of being infected by SARS-CoV-2 among females. This study showed that the ACE2 gene variant rs146676783 was associated with an increased risk of being infected by SARS-CoV-2 in females, suggesting a need for further investigation to contribute to a better understanding of the African COVID-19 enigma. [ABSTRACT FROM AUTHOR]

Background: In Sub-Saharan Africa (SSA), febrile illnesses remain a major public health problem in children. However, the persistence of hrp2 antigen and the low sensitivity of pLDH RDT negatively affect antimalarials and antibiotics prescription practices. These limitations lead to poor management of febrile diseases and antimicrobial resistance (AMR). To improve the diagnosis of these febrile diseases and subsequent prescription of antimicrobials, it is hypothesized that the implementation of an algorithm including a two-step malaria RDT PfHRP2/pLDH supported by point-of-care (PoC) tests for bacterial infections could significantly improve the management of febrile diseases and thereby tackling AMR.Methods: To assess the value of the proposed algorithm, an open-label randomized controlled trial with three arms, enrolling febrile children from 6 to 59 months is proposed. In the control arm, febrile children will be managed according to the Integrated Management of Childhood Illnesses (IMCI), which is part of the standard of care in Burkina Faso. Treatment will be done according to national guidelines. In the RDT decisional algorithm (RDT-DA) arm (intervention), the clinical examination based on IMIC will be supported by a two-step malaria RDT and bacterial infections RDTs. Prescription will be left to the discretion of the healthcare workers based on clinical examination and PoC test results. In the e-algorithm arm (intervention), artificial intelligence integrating multiple layers of clinical information such as clinical examination, signs/symptoms and medical history, and biological information such as biomarkers (CRP and WBC) and pathogen-specific PoC tests, and oximetry will be developed. The e-algorithm will serve to guide the diagnostic and management of febrile infections in children. In the 3 arms, the case report forms will be digitalized. A final follow-up visit (day 7) will be scheduled for all participants. Patients will be asked to come back to the health facilities before the scheduled visit if the symptoms persist or in case of health condition worsening.Discussion: If successful, this study could contribute to improve the management of febrile diseases and reduce inappropriate use of antimicrobials.Trial Registration: The trial is registered at ClinicalTrial.gov, NCT05285657. Enrolment started on 4 March 2022 with long-term outcome being assessed completely by 2023. [ABSTRACT FROM AUTHOR]

Low enrolment in micro-health insurance (MHI) schemes is a recurring issue affecting the viability of such schemes. Beyond the efforts addressing low subscription and retention in these schemes, little is known on how social representations are related to micro-health insurance schemes enrolment and retention. This scoping review aimed at exploring the role of social representations in shaping enrollment and retention in MHI in sub-Saharan Africa. We reviewed qualitative, quantitative and mixed methods studies conducted between 2004 and 2019 in sub-Saharan Africa. We limited our search to peer-reviewed and grey literature in English and French reporting on social representations of MHI. We defined social representations as conventions, cultural and religious beliefs, local rules and norms, local solidarity practices, political landscape and social cohesion. We applied the framework developed by Arksey and O'Malley and modified by Levac et al. to identify and extract data from relevant studies. We extracted information from a total of 78 studies written in English (60%) and in French (40%) of which 56% were conducted in West Africa. More than half of all studies explored either cultural and religious beliefs (56%) or social conventions (55%) whereas only 37% focused on social cohesion (37%). Only six papers (8%) touched upon all six categories of social representation considered in this study whereas 25% of the papers studied more than three categories. We found that all the studied social representations influence enrollment and retention in MHI schemes. Our findings highlight the paucity of evidence on social representations in relation to MHI schemes. This initial attempt to compile evidence on social representations invites more research on the role those social representations play on the viability of MHI schemes. Our findings call for program design and implementation strategies to consider and adjust to local social representations in order to enhance scheme attractiveness. [ABSTRACT FROM AUTHOR]

There has been much talk about decolonizing global health lately. The movement, which has arisen in various communities around the world, suggests an interesting critique of the Western dominant model of representations. Building upon the 'decolonial thinking' movement from the perspective of Francophone African philosophers, we comment on its potential for inspiring the field of global healthinterventions. Using existing literature and personal reflections, we reflect on two widely known illustrations of global health interventions implemented in sub-Saharan Africa – distribution of contraceptives and dissemination of Ebola virus prevention and treatment devices – featuring different temporal backdrops. We show how these solutions have most often targeted the superficial dimensions of global health problems, sidestepping the structures and mental models that shape the actions and reactions of African populations. Lastly, we question the ways through which the decolonial approach might indeed offer a credible positioning for rethinking global health interventions. [ABSTRACT FROM AUTHOR]

Health financing policies are critical policy instruments to achieve Universal Health Coverage, and they constitute a key area in policy analysis literature for the health policy and systems research (HPSR) field. Previous reviews have shown that analyses of policy change in low- and middle-income countries are under-theorised. This study aims to explore which theories and conceptual frameworks have been used in research on policy processes of health financing policy in sub-Saharan Africa and to identify challenges and lessons learned from their use. We conducted a scoping review of literature published in English and French between 2000 and 2017. We analysed 23 papers selected as studies of health financing policies in sub-Saharan African countries using policy process or health policy-related theory or conceptual framework ex ante. Theories and frameworks used alone were from political science (35%), economics (9%) and HPSR field (17%). Thirty-five per cent of authors adopted a 'do-it-yourself' (bricolage) approach combining theories and frameworks from within political science or between political science and HPSR. Kingdon's multiple streams theory (22%), Grindle and Thomas' arenas of conflict (26%) and Walt and Gilson's policy triangle (30%) were the most used. Authors select theories for their empirical relevance, methodological rational (e.g. comparison), availability of examples in literature, accessibility and consensus. Authors cite few operational and analytical challenges in using theory. The hybridisation, diversification and expansion of mid-range policy theories and conceptual frameworks used deductively in health financing policy reform research are issues for HPSR to consider. We make three recommendations for researchers in the HPSR field. Future research on health financing policy change processes in sub-Saharan Africa should include reflection on learning and challenges for using policy theories and frameworks in the context of HPSR. [ABSTRACT FROM AUTHOR]

Background: Transnational networks such as Communities of Practice (CoPs) are flourishing, yet their role in diffusing health systems reforms has been seldom investigated. Over the past decade, performance-based financing (PBF) has rapidly spread in Africa. This study explores how, through the PBF Community of Practice's attributes, structure, and strategies, PBF diffusion was fostered in sub-Saharan Africa (SSA). Methods: Informed by the diffusion entrepreneurs' (DEs) framework dimensions, we used a mixed methods convergent design to investigate how the attributes, structure, and strategies of this community fostered the diffusion of PBF. The quantitative strand of work included firstly a semantic discourse analysis of textual data extracted from CoP's online discussion forum (n = 1346 posts). Secondly, the relational data extracted from these 1346 forum posts was examined using social network analysis (SNA). We confronted these quantitative results with a thematic analysis of qualitative interviews (n = 40) and data extracted from the CoP's key documentation (n = 17). Results: CoP members' attributes included: representation systems anchored in clinical and economic sciences, strong expectations that the CoP would boost professional visibility and career, and significant health systems knowledge and social resources. The CoP's core group, dominated by high-income country (HIC) members, critically matched PBF principles to major health systems issues in Africa. The broad consensus in online PBF thematic discussions created a strong sense of community, a breeding ground for emulation among CoP members. The CoP also sought to produce and promote experiential knowledge exchanges about PBF amongst African practitioners. Findings from network analyses showed that the promoted Africa-driven community was led by HIC members, although their prominence tended to decrease with time. Conclusion: This empirical research highlighted some of the constituting features, structure, and strategies of policy networks in influencing health policy diffusion. Despite good intentions to disrupt the established governance landscape, influential actors coming from HICs continued to drive the framing, and shaped health systems policy experimentation, emulation, and learning in African countries. Beyond mere knowledge exchange platforms, CoP can act as meaningful transnational policy networks pursuing the diffusion of health systems reforms, such as PBF. [ABSTRACT FROM AUTHOR]

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Abstract Over 90% of the rural population in sub-Saharan Africa still relies on fuelwood as their primary source of household energy. In this context, recent robust data on fuelwood consumption in rural areas are needed to conceive and implement appropriate energy policies. This paper identifies the factors that determine fuelwood consumption variability in two villages in Burkina Faso, based on a two-year survey of 60 rural households of different size and wealth status. The women who made up the panel were surveyed at five-day intervals over a period of three months in the rainy season, one month in the cold dry season and one month in the hot dry season. Our results corroborate some fuelwood consumption patterns in rural SSA: fuelwood consumption per adult equivalent decreases both with the size of the household and with local wood scarcity. Conversely, it challenges the idea that the level of consumption is correlated with the level of household wealth. Finally, the most important result is that the scarcity of wood resources leads people to buy fuelwood from outside and adopt strategies to reduce their consumption by reducing the number of cooking cycles and certainly by wasting less energy, whatever the level of household wealth. Highlights • Fuelwood consumption is analyzed in two villages in rural Burkina Faso. • Seven endogenous and exogenous factors are examined. • Four main factors explain fuelwood consumption. • Fuelwood consumption per person is highly dependent on household size. • Wood abundance significantly influences consumption and cooking habits. [ABSTRACT FROM AUTHOR]

There has been growing interest in the diffusion of policy innovations across countries. Research on policy diffusion is characterised by coherent explanatory models that assess the importance of diffusion mechanisms. This study takes a different perspective on diffusion studies and advances public policy literature by introducing the concept of “diffusion entrepreneurs”. These entrepreneurs represent (groups of) individuals, networks, and organisations promoting a certain policy innovation with a view to gain influence. First, drawing from the diffusion literature and linking it to studies investigating policy diffusion in polycentric contexts, we introduce analytical categories to study diffusion entrepreneurs’ key features and actions. Second, to illustrate the analytical value of the concept, we conduct an in-depth analysis of the literature on the diffusion entrepreneurs of health performance-based financing (PBF) in Sub-Saharan Africa. We show how and why this recently diffused policy innovation provides a unique case for demonstrating our conceptual notion: in PBF, a nexus of strongly dedicated diffusion entrepreneurs have strived to induce policy diffusion. Specifically, we explore how the features of PBF diffusion entrepreneurs and their actions affect the outcomes of diffusion processes. Lastly, we reflect on the relevance of our conceptual propositions and offer practical insights to guide future investigations. [ABSTRACT FROM AUTHOR]

Introduction: Sub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries.Methods and Findings: Respondent-driven sampling targeted cis-MSM for enrollment. Data collection took place at 14 sites across 8 countries: Burkina Faso (January-August 2013), Côte d'Ivoire (March 2015-February 2016), The Gambia (July-December 2011), Lesotho (February-September 2014), Malawi (July 2011-March 2012), Senegal (February-November 2015), Swaziland (August-December 2011), and Togo (January-June 2013). Surveys gathered information on sexual orientation, gender identity, stigma, mental health, sexual behavior, and HIV testing. Rapid tests for HIV were conducted. Data were merged, and mixed effects logistic regression models were used to estimate relationships between gender identity and HIV infection. Among 4,586 participants assigned male sex at birth, 937 (20%) identified as transgender or female, and 3,649 were cis-MSM. The mean age of study participants was approximately 24 years, with no difference between transgender participants and cis-MSM. Compared to cis-MSM participants, transgender women were more likely to experience family exclusion (odds ratio [OR] 1.75, 95% CI 1.42-2.16, p < 0.001), rape (OR 1.95, 95% CI 1.63-2.36, p < 0.001), and depressive symptoms (OR 1.30, 95% CI 1.12-1.52, p < 0.001). Transgender women were more likely to report condomless receptive anal sex in the prior 12 months (OR 2.44, 95% CI 2.05-2.90, p < 0.001) and to be currently living with HIV (OR 1.81, 95% CI 1.49-2.19, p < 0.001). Overall HIV prevalence was 25% (235/926) in transgender women and 14% (505/3,594) in cis-MSM. When adjusted for age, condomless receptive anal sex, depression, interpersonal stigma, law enforcement stigma, and violence, and the interaction of gender with condomless receptive anal sex, the odds of HIV infection for transgender women were 2.2 times greater than the odds for cis-MSM (95% CI 1.65-2.87, p < 0.001). Limitations of the study included sampling strategies tailored for cis-MSM and merging of datasets with non-identical survey instruments.Conclusions: In this study in sub-Saharan Africa, we found that HIV burden and stigma differed between transgender women and cis-MSM, indicating a need to address gender diversity within HIV research and programs. [ABSTRACT FROM AUTHOR]

Background: Worldwide there is an increased prevalence of metabolic syndrome mainly due to life-style modifications, and Africans are not saved of this situation. Many markers have been studied to predict the risk of this syndrome but the most used are leptin and adiponectin. Data on these metabolic markers are scare in Africa and this study aimed to assess the association between the leptin-to-adiponectin ratio (LAR) with metabolic syndrome in a Cameroonian population. Methods: This was a cross-sectional study that included 476 adults among a general population of Cameroon. Data collected concerned the body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, plasma lipids, adiponectin, leptin, insulin and homeostasis model for assessment of insulin resistance (HOMA-IR). To assess correlations we used Spearman's analyses and association of the studied variables with metabolic syndrome were done using binary logistic regression analysis. Results: The leptin to adiponectin ratio was significantly and positively correlated with the body mass index (r = 0.669, p < 0.0001), waist circumference (r = 0.595, p < 0.0001), triglycerides (r = 0.190, p = 0.001), insulin levels (r = 0.333, p < 0.0001) and HOMA-IR (r = 0.306, p < 0.0001). Binary logistic regression analysis revealed that leptin, adiponectin and LAR were significantly associated with metabolic syndrome with respective unadjusted OR of 1.429, 0.468 and 1.502. After adjustment, for age and sex, the associations remained significative; LAR was also found to be significantly associated with metabolic syndrome (OR = 1.573, p value =0.000) as well as lower levels of adiponectin (OR = 0.359, p value =0.000) and higher levels of leptin (OR = 1.469, p value =0.001). Conclusion: This study revealed that LAR is significantly associated with metabolic syndrome in sub-Saharan African population, independently to age and sex. [ABSTRACT FROM AUTHOR]

Background: In Sub-Saharan Africa (SSA), the production and use of woodfuel remains an important socio-economic activity with more than 70% of the population relying on woodfuel as their primary household energy source. Despite their socio-economic significance, woodfuel value chains are often viewed negatively due to their association with detrimental health and environmental impacts. However, the lack of sound evidence and limited understanding of the role of contextual factors in influencing the various impacts of woodfuel value chains have prevented the formulation of properly guided policy interventions. Thus the objective of this systematic map is to provide a comprehensive review of the environmental, socio-economic, and health impacts of woodfuel value chains across SSA. Methods: The search strategy for this review map was defined in a peer-reviewed protocol and refined by iterative testing. Search strings were composed of population, intervention, and location terms and combined using Boolean operators. The bibliographic databases Web of Science, Scopus, and CAB Abstracts were used as the main sources of literature for this review, and a total of 4728 results were initially retrieved. Following title and abstract screening, 659 entered full text screening. Critical appraisal of 219 articles led to the exclusion of studies that did not set meet quality criteria for this map, resulting in a final total of 131 articles for inclusion in data extraction and analysis. Results: From the 131 included articles, 152 individual studies were identified during data extraction. Studies came from 26 of the 49 Sub Saharan African countries, with a particular preponderance of articles published in the last 10 years. Critical appraisal found significant weaknesses in the experimental design of woodfuel value chain studies with the exception of health impact studies, which frequently utilized controls or other relevant comparators. Findings suggest that woodfuel value chains have environmental, socioeconomic and health consequences with the frequent presence of trade-offs. The reporting of contextual factors in the studies challenge the widespread perception of deforestation as being directly caused by bush fires, overgrazing and woodcutting. Instead, agricultural expansion (which often includes forest clearing) and pre-existing biophysical factors were the most frequently cited factors in shaping environmental outcomes. Conclusions: This systematic map suggests that there are environmental, socioeconomic and health consequences associated with woodfuel value chains in Sub-Saharan Africa. However, the literature also shows a weak and geographically limited evidence base to justify the above claims. We argue that policy formulation processes targeting woodfuels in SSA require more solid, coherent and broad body of knowledge, especially for such a vital sector in rural economies. Thus, there is an urgent need to design and undertake research using robust methodologies, at appropriate scales that further takes into account the interrelationships between environmental and socio-economic outcomes in order to generate substantial and reliable evidence for informed policy formulation. [ABSTRACT FROM AUTHOR]

The African Plant Checklist and Database Project (APCD) provides botanists with the first angiosperm checklist and database for Sub-Saharan Africa. This was achieved by merging the existing datasets for Southern and Tropical Africa. The checklist is published as a one-off hardcopy publication. The database, with all attached additional information, is freely accessible via the internet and will be regularly updated. The APCD, for the first time, gives accurate statistics for the angiosperm flora of Sub-Saharan Africa. There are 50,136 current taxa (representing approximately 44,830 species) in the database, plus an additional 393 taxa where there are discrepancies in genus concept between the two original datasets. Taxa are classified into 274 families and 3,802 current genera. Several other important statistics can also be drawn from the database. Furthermore, by pointing out problems and discrepancies in taxonomic opinion, the APCD highlights taxa where further research is necessary. The APCD will be an invaluable tool to botanists working on the African flora. It also has an important role to play in greater projects such as the Global Plant Checklist Project and has already emerged as a nomenclatural standard for the African Plants Initiative. [ABSTRACT FROM AUTHOR]

Abstract Aims We aimed to characterize a cohort of ‘atypical’ diabetic patients of sub-Saharan African origin and to analyse possible determinants of long-term remission. Methods Over 6 years, we studied the clinical and therapeutic profile of 42 consecutive patients undiagnosed or untreated prior to inclusion presenting with cardinal features of diabetes mellitus. We measured insulin secretion and sensitivity at inclusion. Immunogenetic (anti-GAD, anti-ICA and HLA class II) markers of Type 1 diabetes were compared with a 90-non-diabetic unrelated adult African population. Results Twenty-one ketonuric patients (age 42 ± 9 (sd) years; body mass index (BMI) 26 ± 3 kg/m 2 ) were initially insulin-treated (IT), and 21 non-ketonuric patients (age 38 ± 8 years; BMI 26 ± 5 kg/m 2 ) had oral and/or diet therapy (NIT). Insulin could be discontinued in 47.6% (10/21) IT with adequate glycaemic control (HbA 1c 6.7 ± 1.3%), while insulin was secondarily started in 38.1% (8/21) NIT in expectation of better control. The initial basal (odds ratio (OR) 9.1, 95% confidence interval (CI) 1.3–64.4) and stimulated C-peptide (OR 8.17, 95% CI 1.5–44.1) were independently associated with remission. Insulin resistance was present in all the groups, more marked in the insulin-treated NIT. Anti-GAD antibodies and ICA were rare, but 38.1% IT vs. 1.1% controls had Type 1 diabetes HLA susceptibility haplotypes ( P < 0.001) without significant difference between the subgroups. Conclusion Prolonged discontinuation of insulin is frequent in African diabetic patients initially presenting with signs of insulinopenia. In our patients, long-term insulin therapy was not associated with immunogenetic markers of Type 1 diabetes. The initial measure of insulin secretion seemed a good predictor of long-term remission. [ABSTRACT FROM AUTHOR]

Objectif: L’objectif de notre étude était d’évaluer l’effet des laits corporels d’utilisation courante en Afrique subsaharienne sur les résultats des mesures de glycémie capillaire chez les personnes vivant avec le diabète. Matériels et méthodes: Il s’agit d’une étude expérimentale réalisée sur un groupe de 16 individus, repartis en 4 groupes, dont un groupe témoin compose de sujets normoglycémiques, et trois groupes de 4 patients diabétiques dont la glycémie était spontanément mesurée a 1,0±0,4g/L, 2,0±0,4g/L, et 3,0±0,4g/L. Chez tous les sujets, après lavage des mains, 4 types de laits corporels ont été appliques en fine couche sur 4 doigts d’une main et le cinquième doigt a été maintenu propre sans application de lait. La glycémie capillaire a ensuite été mesurée concomitamment sur les 5 doigts a l’aide du même lecteur de marque One Touch Ultra® et des bandelettes d’une série unique. Les mesures réalisées sur les doigts imprégnés de lait corporel ont été comparées à celle du doigt propre. Les laits utilises étaient à base d’amande douce, d’huile de palmiste, crème corticoïde, et a base d’hydroquinone. Résultats: Les variations glycémiques induites par la présence de lait à base d’huile de palmiste (236±150mg/dL vs 244±161mg/dL, p=0,06), d’huile d’amande douce (238±153 mg/dL vs 244±161mg/dL, p=0,39) et la crème corticoïde (247±152mg/dL vs 244±161mg/dL, p=0,69) n’étaient significatives par rapport à la glycémie capillaire de référence. Par contre, le lait à l’hydroquinone modifiait significativement les résultats de mesure de la glycémie capillaire (457±137mg/dL vs 244±161mg/dL, p<0,001). Conclusion: Les laits corporels à base d’hydroquinone modifient significativement à la hausse la mesure de glycémie capillaire à l’inverse des autres laits testes. Ces résultats confirment le rôle capital du lavage des mains préalable à la mesure de glycémie capillaire. [ABSTRACT FROM AUTHOR]

Introduction: Le diabète cétonurique (ketosis-prone diabetes -KPD) se caractérise par des épisodes de cétose ou d’acidocétose nécessitant une insulinothérapie le plus souvent transitoire. Il survient principalement chez des sujets originaires d’Afrique sub-Saharienne et sa physiopathologie n’est pas connue. Le glucagon étant la principale hormone cétogène, nous avons évalué la fonction alpha insulaire in vivo chez des patients KPD à distance d’une décompensation cétosique. Matériels et méthodes: Nous avons exploré 19 patients KPD en rémission (HbA1c ≤ 6,5 % depuis au moins 3 mois en l’absence d’insuline) comparativement à 19 sujets témoins normo-glycémiques appariés pour l’âge (44,5±2,4 (sem) vs 43,7±1,9 ans respectivement), le sexe et l’origine ethnique. Nous avons mesuré les concentrations de glucagon en réponse à l’insuline (clamp euglycémique hyperinsulinémique), au glucose oral (75g), au glucose IV (perfusion de glucose par paliers de 40 min de 2 à 10 mg.kg−1.min−1), et à l’arginine (5g IV). Le produit glucagon x glucose (10−3 pg.mmol.ml−2) a été utilisé comme indice de résistance à la suppression par le glucose de la sécrétion du glucagon. Résultats: Au cours de l’HGPO, l’indice de résistance était de 881,4±105,5 vs 614,5±48,7 (p=0,03) de base, 1576,9±138,7 vs 1188,4±130,2 (p=0,04) à 30 min, et 1680,8±147,2 vs 652,6±39,9 (p<0,001) à 120 min chez les patients et les témoins respectivement. Au cours du clamp euglycémique, la baisse des concentrations de glucagon était similaire dans les 2 groupes (patients : 119,9±10,7 à 81,3±7,1pg/ml ; témoins : 124,4±9,3 à 89,0±8,2 pg/ml). Au cours la perfusion de glucose par palier, chaque augmentation d’un mmol/l de glycémie faisait chuter les concentrations moyennes de glucagon de 1,75 % chez les patients contre 4,6 % chez les témoins (p<0,04). En réponse à l’arginine, aucune différence n’était observée entre les deux groupes. Conclusion: Les patients KPD en rémission présentent une altération de la suppression de la sécrétion de glucagon en réponse au glucose oral et intraveineux, comme cela a été décrit chez les patients diabétiques de type 2. Ces données plaident en faveur du KPD comme forme de diabète de type 2. [Copyright &y& Elsevier]

Introduction: Le diabète de type 2 cétonurique (ketosis prone diabetes-KPD) est une forme atypique de diabète de type 2 révélé par une cétose voire une acidocétose, fréquemment observé chez des personnes originaires d’Afrique subsaharienne et nécessitant une insulinothérapie souvent transitoire. Son début aigu suggère l’existence d’un facteur déclenchant. Compte tenu de la distribution géographique du KPD, nous avons évalué l’implication possible de l’herpès virus humain de type 8 (HHV-8). Matériels et méthodes: Nous avons recherché par immunofluorescence des anticorps dirigés contre les antigènes latents et lytiques du HHV-8 chez 187 patients consécutifs, originaires d’Afrique subsaharienne et ayant migré en France à l’âge adulte, comprenant 81 patients KPD et 106 patients diabétiques de type 2 (T2D). Un groupe de 90 témoins non diabétiques de mêmes origines géographiques et appariées aux patients pour l’âge et le sexe a été évalué. La présence du HHV-8 dans l’ADN génomique a été recherchée chez 22 patients à la phase aiguë. Par ailleurs, nous avons évalué si le HHV-8 est capable d’infecter in vitro des cellules bêta humaines provenant d’un donneur non diabétique. Résultats: À l’inclusion, l’âge et l’IMC des patients étaient similaires : KPD 48±11 (DS) ans et 27,7±4,3 kg/m2 ; T2D 50±10 ans et 27,5±4,8 kg/m2. Les anticorps anti HHV-8 ont été retrouvés chez 87,7 % des KPD versus 15,1 % des T2D, OR=39,9 (17,1-93,4 ; p < 0,0001) et chez 40,0 % des sujets contrôles, OR=10,7 (4,9-23,4 ; p < 0,0001). L’ADN du HHV-8 était présent chez 6/13 KPD testés à la phase aiguë contre 0/9 T2D. De plus, nous avons mis en évidence in vitro des protéines virales HHV-8 (LANA1) dans le cytoplasme des cellules bêta humaines après 4 jours de culture en présence de HHV-8. Conclusion: Chez des patients KPD originaires d’Afrique subsaharienne, l’ADN du HHV-8 est retrouvé chez presque la moitié des patients à la phase aiguë et la prévalence de la séropositivité HHV-8 est très élevée. Ces données et la capacité du HHV-8 d’infecter des cellules bêta in vitro suggèrent que l’infection par le HHV-8 est responsable du phénotype KPD chez des individus autrement prédisposés au DT2. [Copyright &y& Elsevier]

Aim We investigated the association of HLA DRB1 and DQB1 alleles, haplotypes and genotypes with unprovoked antibody-negative ketosis-prone atypical diabetes (A − KPD) in comparison to type 2 diabetes (T2D). Methods A − KPD and T2D sub-Saharan African patients aged 19–63 years were consecutively recruited. Patients positive for cytoplasmic islet cell, insulin, glutamic acid decarboxylase or islet antigen-2 autoantibodies were excluded. Odds ratios were obtained via logistic regression after considering alleles with a minimum frequency of 5% in the study population. Bonferroni correction was used in the case of multiple comparisons. Results Among the 130 participants, 35 (27%) were women and 57 (44%) were A − KPD. DRB1 and DQB1 allele frequencies were similar for both A − KPD and T2D patients; they did not confer any substantial risk even after considering type 1 diabetes susceptibility and resistance alleles. We found no association between A − KPD and the derived DRB1*07-DQB1*02:02 (OR: 0.55 [95%CI: 0.17–1.85], P = 0.336); DRB1*11-DQB1*03:01 (OR: 2.42 [95%CI: 0.79–7.42], P = 0.123); DRB1*15-DQB1*06:02 (OR: 0.87 [95%CI: 0.39–1.95], P = 0.731) and DRB1*03:01-DQB1*02:01 (OR: 1.48 [95%CI: 0.55–3.96], P = 0.437) haplotypes. Overall, we did not find any evidence of susceptibility to ketosis associated with DRB1 and DQB1 genotypes (all P > 0.05) in A − KPD compared to T2D. Similar results were obtained after adjusting the analysis for age and sex. Conclusion Factors other than DRB1 and DQB1 genotype could explain the propensity to ketosis in A − KPD. These results need to be confirmed in a larger population with the perspective of improving the classification and understanding of the pathophysiology of A − KPD. [ABSTRACT FROM AUTHOR]