Search

The continuous rising of HIV drug resistance in low- and middle-income countries and its impact on treatment failure is a growing threat for the HIV treatment response. This review aimed to document preantiretroviral therapy (ART) CD4 counts, emerging drug resistance, and treatment failure in HIV-infected individuals initiating ART. We performed an online search in PubMed, Embase, Web of Science, African Index Medicus, Cochrane library, and The National Institute for Health Clinical Trials Registry of relevant articles published from January 1996 to June 2019. Of 1755 original studies retrieved, 28 were retained for final analysis. Treatment failure varied between 5% (95% confidence interval [CI]: 2.7-7.4) and 72% (95% CI: 55-89.6), while resistance varied between 1% (95% CI: 0.47-1.5) and 48% (95% CI: 28.4-67.6). Participants with a pre-ART CD4 count below 200 cell/µl and low adherence showed higher percentages of resistance and failure, while those with CD4 count above 200 showed lower resistance and failure regardless adherence levels. Most frequent resistance mutations included the M184I/V for the nucleoside reverse-transcriptase inhibitors (NRTIs), K103N, and Y181 for the non-NRTIs (NNRTIs), and L90M for the Protease inhibitors. Pre- ART CD4 count and adherence to treatment could play a key role in reducing drug resistance and treatment failure. The increased access to ART in resources limited settings should be accompanied by regular CD4 count testing, drug resistance monitoring, and continuous promotion of adherence. In addition, the rising of resistance mutations associated with NRTIs and NNRTIs, suggest that alternative ART regimens should be considered. [ABSTRACT FROM AUTHOR]

In Benin, consistent condom use among men who have sex with men (MSM) is relatively low and providing them with Pre-exposure prophylaxis (PrEP) could be of great relevance. We aimed to describe PrEP knowledge and intention to use it; identify key facilitators and barriers to PrEP; and describe the perceived impact of PrEP on unsafe sexual behavior. MSM, 18 years or older, HIV-negative or of unknown status, were enrolled in five cities of Benin. Intention to use PrEP was assessed through five focus groups (FG). Data were analyzed using manual thematic sorting. Thirty MSM (six per city) participated in the FG. Mean age (standard deviation) was 27.1 (5.0) years. All participants expressed the intention to use PrEP if made available. Facilitators of PrEP use were: availability of medication, safety, absence of constraints as well as freedom to have multiple sex partners and sex with HIV-positive friends. Barriers were: complex procedures for obtaining medication, size and taste of medication, cost of medication, poor PrEP awareness.. Eighteen men admitted that PrEP could lead to decrease in or even abandonment of condom use. In conclusion, MSM showed openness to use PrEP if available, although they recognized that it could lead to risk compensation. [ABSTRACT FROM AUTHOR]

Background: The causes of severe morbidity in health facilities implementing Antiretroviral Treatment (ART) programmes are poorly documented in sub-Saharan Africa. We aimed to describe severe morbidity among HIV-infected patients after ART initiation, based on data from an active surveillance system established within a network of specialized care facilities in West African cities. Methods: Within the International epidemiological Database to Evaluate AIDS (IeDEA)-West Africa collaboration, we conducted a prospective, multicenter data collection that involved two facilities in Abidjan, Côte d'Ivoire and one in Cotonou, Benin. Among HIV-infected adults receiving ART, events were recorded using a standardized form. A simple case-definition of severe morbidity (death, hospitalization, fever > 38°5C, Karnofsky index < 70%) was used at any patient contact point. Then a physician confirmed and classified the event as WHO stage 3 or 4 according to the WHO clinical classification or as degree 3 or 4 of the ANRS scale. Results: From December 2009 to December 2011, 978 adults (71% women, median age 39 years) presented with 1449 severe events. The main diagnoses were: non-AIDS-defining infections (33%), AIDS-defining illnesses (33%), suspected adverse drug reactions (7%), other illnesses (4%) and syndromic diagnoses (16%). The most common specific diagnoses were: malaria (25%), pneumonia (13%) and tuberculosis (8%). The diagnoses were reported as syndromic in one out of five events recorded during this study. Conclusions: This study highlights the ongoing importance of conventional infectious diseases among severe morbid events occurring in patients on ART in ambulatory HIV care facilities in West Africa. Meanwhile, additional studies are needed due to the undiagnosed aspect of severe morbidity in substantial proportion. [ABSTRACT FROM AUTHOR]

Introduction: Helicobacter pylori (H. pylori) infection is common in developing countries such as Benin. This germ may cause the development of gastroduodenal diseases, ranging from gastritis to gastric cancer. Several studies on this bacterium carried out in Benin have used serology, anatomopathological examination of biopsies or antigen detection test on stool sample collections. The purpose of this study was to assess the prevalence of H. pylori infection and factors associated with H. pylori infection using a respiratory test. The bacterium could cause chronic inflammation of the gastric mucosa and peptic ulcer disease or, more rarely, gastric cancer or lymphoma., Methods: we conducted a prospective, descriptive study of 150 patients who performed carbon-14 urea breath test. Only patients admitted for respiratory test and who gave their consent were included. A survey was completed by all patients during the study. Simple univariate logistic regression analysis identified factors associated with H. pylori infection at a threshold of 0.05. Multivariate analysis included in the model all variables with a p-value less than 0.20. Manual top-down procedure was used until the final model was obtained, which allowed the retention of adjusted odds ratios for factors associated., Results: the average age of patients was 44.4±15.8 years, ranging from 5 to 84 years; men accounted for 54% of the study population. Of the 150 subjects, 82 (57.8%) had higher education level, compared with 8 (5.6%) who were not educated, 116 (80.6%) lived with a partner, 24 (36%) lived in a room with more than 10 people and 84 (59.6%) were christians. The main reasons why respiratory tests were performed were: poorly systematized abdominal pain (53.3%; 70/150), epigastric induced pain (35.3%; 53/150), epigastralgia (20.7%; 31/150), ulcer syndrome (16%; 24/150). Respiratory test showed that the prevalence of H. pylori in the study population was 34.7% (52/150). In multivariate analysis, the variables significantly associated with H. pylori infection were: mean age [aOR (95% CI) = 1.02; OR (95% CI) = 1.00-1.05 and p = 0.01] and prior treatment for H. pylori eradication [aOR (95% CI) = 4.79; OR (95% CI) = 1.50-13.86 and p = 0.006]. No comorbidity was associated with H. pylori infection in our series., Conclusion: the prevalence of H. pylori using this method was low (34.7%). It was significantly associated with mean age and prior treatment for H. pylori eradication., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts., (Copyright: Aboudou Raïmi Kpossou et al.)

Introduction: hepatitis C is a public health problem worldwide, in particular in sub-Saharan Africa. The purpose of this study is to determine the seroprevalence of hepatitis C virus antibodies and associated factors during a voluntary general population screening program in Benin., Method: we conducted a descriptive and analytical cross-sectional study in 4 big cities of 4 different departments in Benin in July 2016. All volunteers of all ages, residing in these targeted cities, who gave their informed consent were included in the study. ImuMed HCV Rapid Diagnostic Test (Healgen Scientific LLC, USA) was used. Logistic regression analysis was also used to identify factors associated with hepatitis C virus infection., Results: a total of 2809 volunteers with an average age of 25.9 ± 16.5 years (ranging from 0 to 86 years) were included in the study; 53.9% (1514/2809) of them were men and 46.1% (1295/2809) were women. More than half of the study population consisted of single (59.1%; 1612/2726); 41.3% (1074/2809) were pupils or students. VHC Seroprevalence was 1.5% (42/2809). In multivariate analysis, the variables significantly associated with anti-HCV carriage were: be 60 years old and older (aOR: 46.9, 95% CI 10.2-216.0; p<0.0001) and a history of alcoholism (aOR: 6.3; 95% CI 95% 3.3-12.1; p < 0.0001)., Conclusion: in the general population, the seroprevalence of anti-HCV antibodies was 1.5%. HCV infection mainly occurred in people aged 60 years and older and in those with a history of alcoholism., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts., (Copyright: Aboudou Raïmi Kpossou et al.)

Background: HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA)., Methods: We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d'Ivoire, Mali, and Senegal, in the West Africa region., Results: Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3-51.7) and 42.4 years, IQR (37.0-47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm(3), IQR (83-247) among HIV-2 infected patients and 146 cells/mm(3), IQR (55-249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm(3) after 24 months on ART for HIV-2 patients and 169 cells/mm(3) for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7-4.3)., Conclusions: This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population.