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14. Elaboration et évaluation d'algorithmes de dépistage des MST chez la femme enceinte à Libreville, Gabon

Author

Bourgeois, A., Henzel, D., Dibanga, G., Ndong Minko, N., Peeters, Martine, Coulaud, J.P., Fransen, L., and Delaporte, Eric

Subjects
EPIDEMIOLOGIE, DIAGNOSTIC, DEPISTAGE, SIDA, GROSSESSE, ALGORITHME, FACTEUR DE RISQUE, MALADIE SEXUELLEMENT TRANSMISSIBLE
Abstract

La lutte contre les MST constitue une priorité de santé publique des pays en développement de par leurs complications propres, en particulier chez la femme, et de par leur rôle facilitant la transmission du VIH. Une des stratégies de lutte contre les MST est le diagnostic et le traitement précoces de ces infections. Les MST, en particulier les infections à gonocoques et à #Chlamydiae trachomatis$ sont d'un diagnostic difficile chez la femme en l'absence d'examens complémentaires, ceux-ci faisant souvent défaut au niveau des structures de soins de santé primaire. Dans ce contexte, l'approche syndromique, basée sur la prise en compte de signes et symptômes, peut permettre de standardiser et d'améliorer la prise en charge des patientes. Une étude de prévalence et de facteurs de risque des MST, effectuées chez 192 femmes enceintes consultant en PMI à Libreville (Gabon), en septembre 1993, a confirmé la prévalence des MST dans cette population (13,5% de cervicites à gonocoques et/ou #Chlamydiae trachomatis$). L'évaluation de différentes stratégies diagnostiques et d'algorithmes montre que, quel que soit le niveau d'examen (données d'interrogatoire, examen clinique simple, examen au spéculum), l'utilisation de scores intégrant des facteurs de risque, des symptômes et des signes cliniques est plus performante que les algorithmes hiérarchiques. Ces scores présentent des sensibilités et des spécificités élevées et sont d'une mise en oeuvre facile. Leur application pourrait donc permettre le dépistage efficace des MST et éviter, ainsi, une grande partie des complications maternelles et infantiles. (Résumé d'auteur)

Published
1996

15. A simple clinical and paraclinical score predictive of CD4 cell counts below 400/mm3 in HIV-infected adults in Dakar University Hospital, Senegal

Author

Pistone, T., primary, Kony, S., additional, Faye-Niang, M.A., additional, Ndour, C.T., additional, Gueye, P.M., additional, Henzel, D., additional, Delaporte, E., additional, Badiane, S., additional, N'Doye, I., additional, Coulaud, J.P., additional, Larouzé, B., additional, and Bouchaud, O., additional

Published
2002
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17. Hepatitis A among health workers in Paris hospitals

Author

Domart, M., primary, Mlika‐Cabanne, N., additional, Henzel, D., additional, Pouliquen, A., additional, Florentin, A., additional, Marande, J.L., additional, Xerri, B., additional, Aufrere, A., additional, and Larouzé, B., additional

Published
1999
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44. A simple clinical and paraclinical score predictive of CD4 cell counts below 400/mm3 in HIV-infected adults in Dakar University Hospital, Senegal

Author

Pistone, T., Kony, S., Faye-Niang, M.A., Ndour, C.T., Gueye, P.M., Henzel, D., Delaporte, E., Badiane, S., N'Doye, I., Coulaud, J.P., Larouzé, B., and Bouchaud, O.

Subjects
HIV infections, ANTIBACTERIAL agents, T cells, LEUCOCYTES
Abstract

In industrialized countries the decision to start co-trimoxazole (CMX) prophylaxis of HIV-related opportunistic infections is based on the CD4+ cell count. The value of CMX prophylaxis has also been demonstrated in Africa, where CD4+ cell counts are rarely available. We therefore developed a simple score predictive of a threshold CD4+ cell count (400/mm3) below which CMX prophylaxis is indicated. In a retrospective cross-sectional study, we collected clinical and biological data on 211 HIV-infected patients recruited from January 1996 through January 1998 at Fann University Hospital in Dakar, Senegal. Several variables were identified as being predictive of a CD4+ cell count below 400/mm3 by stepwise logistic regression. Each variable was weighted according to its regression coefficient, as follows: male sex (+1), weight loss (+2), body mass index < 22 (+2), herpes zoster (+4), tuberculin induration < 5 mm (+3) and haemoglobin ≤ 10 g/dL (+1). A score of ≥ 4 (sum of weights) selected patients with CD4+ cell counts below 400/mm3 with a sensitivity of 98% and a negative predictive value of 83%. Such a score should be applicable in the African context and should facilitate the management of HIV-infected patients, especially the prescription of CMX prophylaxis. [Copyright &y& Elsevier]

Published
2002
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45. Prevalence and risk factors of cervicovaginal HIV shedding among HIV-1 and HIV-2 infected women in Dakar, Senegal.

Author

Seck, K, Samb, N, Tempesta, S, Mulanga-Kabeya, C, Henzel, D, Sow, P S, Coll-Seck, A, Mboup, S, Ndoye, I, and Delaporte, E

Subjects
RNA analysis, CERVIX uteri, COMPARATIVE studies, HIV, RESEARCH methodology, MEDICAL cooperation, REGRESSION analysis, RESEARCH, VAGINA, VIRAL physiology, EVALUATION research, DISEASE prevalence, CROSS-sectional method, HIV seroconversion, DISEASE progression, ODDS ratio
Abstract

Objectives: To assess the risk determinants and prevalence of cervicovaginal shedding of HIV-1 and HIV-2 among women in Dakar, Senegal.Methods: We conducted a cross sectional study of 153 HIV seropositive female sex workers (FSW) and another 142 HIV seropositive women attending an infectious diseases unit, based on an interview, physical examination, and laboratory screening for major sexually transmitted infections (STI). Cervicovaginal lavage fluid was tested for HIV-RNA by means of nested PCR. Links between cervicovaginal shedding of HIV-1 and HIV-2 and sociodemographic, clinical, and laboratory variables were identified by using odd ratios and 95% confidence intervals. Logistic regression analysis was used to identify independent links with HIV shedding.Results: The detection rate of HIV-RNA in cervicovaginal lavage fluid was low among FSW, with no difference between HIV-1 (7/90: 8%) and HIV-2 (3/48: 6%). The rate was far higher among the other women (41%, 48/117; 33%, 7/21 for HIV-1 and HIV-2, respectively). In multivariate analysis, high plasma viral load (>40 000 copies/ml) (AOR = 2.4 (1.0-5.6) p = 0.04) and basic vaginal pH (AOR = 2.2 (1.3-3.7) p = 0.002) were independently associated with HIV-1 shedding. For HIV-2 a CD4 count < 200 cells x 10(6)/l was the only factor associated with the shedding of HIV-2 (AOR = 9.0 (0.9-93)). The genital shedding rate was higher with HIV-1 than with HIV-2 (OR = 2.1 (0.9-4.8), but this difference disappeared after adjustment for the CD4+ cell count (AOR = 1.2 (0.5-2.9)).Conclusion: Advanced disease stage and immunosuppression are the major risk determinants for shedding of both HIV-1 and HIV-2. Basic vaginal pH is also a risk determinant for HIV-1 shedding. [ABSTRACT FROM AUTHOR]

Published
2001
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