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ObjectivesThis study aimed to confirm the co-infection with HIV-1 and HIV-2, among West African patients using in-house HIV type/group enzyme-immuno assays and molecular diagnosis.DesignA cross-sectional survey was conducted from April 2016 to October 2017 in the biggest HIV clinics of Côte d'Ivoire and Burkina Faso.MethodA first serological confirmation was done in the referral laboratory using an in-house, indirect immuno-enzymatic essay allowing the qualitative detection of both HIV-1 and HIV-2 antibodies. In order to separately detect anti-HIV-1 and anti-HIV-2 antibodies, a type/group specific enzyme-immuno assay (HIV-GSEIA) was used. To confirm the co-infections, HIV-1 and HIV-2 DNA-qualitative PCR assays were performed.ResultsA total of 91 patients were enrolled in the study and provided blood sample for HIV type confirmatory testing including 13 (14.3%) HIV-2 mono-reactive and 78 (85.7%) HIV-1/HIV-2 dually-reactive based on the HIV testing National Algorithms. The first serological ELISA confirmatory test performed showed that 80 (78.9%) of the 91 participants were dually-reactive. The HIV-GSEIA performed on these 80 serum samples retrieve one 61 HIV-1/HIV-2 dually-reactive samples. HIV-1 and HIV-2 DNA PCR were performed on 54 of the 61 HIV-1/HIV-2 dually-reactive samples and 46 out of 61 (75.4%) samples were found HIV-1/HIV-2 coinfected.ConclusionThe contribution of type/group specific enzyme-immuno assay to accurately identify HIV-1/HIV-2 coinfections remain suboptimal, emphasizing the need for molecular diagnosis platforms in West Africa, to avail HIV DNA PCR test for the confirmation of HIV-1/HIV-2 co-infections.

Background. Hepatitis B virus (HBV) infection is a leading cause of liver disease worldwide. Hepatitis B surface antigen (HBsAg) rapid diagnostic tests (RDTs) could be an ideal tool for a large-scale HBV screening in settings with high endemicity but limited infrastructure. The aim of this study was to evaluate the diagnosis performance of such RDTs for screening HBV infection in Ivory Coast. Methods. From September 2018 to January 2019, a cross-sectional phase I evaluation study of RDTs was conducted in three laboratories of Abidjan (CeDReS, CNTS and IPCI), on a panel of 405 whole blood samples and 699 plasmas. Four HBsAg RDTs (Determine™ HBsAg, SD Bioline HBsAg WB®, Standard Q HBsAg® and Vikia HBsAg®) were evaluated. The diagnostic performance (sensitivity and specificity) was calculated in comparison to the reference sequential algorithms of two EIA tests (Dia.Pro HBsAg® one version ULTRA and Monolisa™ HBsAg ULTRA). Results. The Determine™ HBsAg and Vikia HBsAg® tests performed well, with 100% of sensitivity, specificity both on plasma and on whole blood. For SD Bioline HBsAg WB® and Standard Q HBsAg®, the specificities were 99.8% and the sensitivities 99.3% and 97.1% respectively. Finally, there were a total of 19 false negative results: 3 with SD Bioline HBsAg WB® and 16 with Standard Q HBsAg®. Conclusion. Determine HBsAg® from Alere and Vikia HBsAg® from Biomérieux are the most suitable RDTs for screening for HBV in Ivory Coast. A phase II evaluation must be initiated.

Background: Temprano ANRS 12136 was a factorial 2 × 2 trial that assessed the benefits of early antiretroviral therapy (ART; ie, in patients who had not reached the CD4 cell count threshold used to recommend starting ART, as per the WHO guidelines that were the standard during the study period) and 6-month isoniazid preventive therapy (IPT) in HIV-infected adults in Côte d'Ivoire. Early ART and IPT were shown to independently reduce the risk of severe morbidity at 30 months. Here, we present the efficacy of IPT in reducing mortality from the long-term follow-up of Temprano. Methods: For Temprano, participants were randomly assigned to four groups (deferred ART, deferred ART plus IPT, early ART, or early ART plus IPT). Participants who completed the trial follow-up were invited to participate in a post-trial phase. The primary post-trial phase endpoint was death, as analysed by the intention-to-treat principle. We used Cox proportional models to compare all-cause mortality between the IPT and no IPT strategies from inclusion in Temprano to the end of the follow-up period. Findings: Between March 18, 2008, and Jan 5, 2015, 2056 patients (mean baseline CD4 count 477 cells per μL) were followed up for 9404 patient-years (Temprano 4757; post-trial phase 4647). The median follow-up time was 4·9 years (IQR 3·3–5·8). 86 deaths were recorded (Temprano 47 deaths; post-trial phase 39 deaths), of which 34 were in patients randomly assigned IPT (6-year probability 4·1%, 95% CI 2·9–5·7) and 52 were in those randomly assigned no IPT (6·9%, 5·1–9·2). The hazard ratio of death in patients who had IPT compared with those who did not have IPT was 0·63 (95% CI, 0·41 to 0·97) after adjusting for the ART strategy (early vs deferred), and 0·61 (0·39–0·94) after adjustment for the ART strategy, baseline CD4 cell count, and other key characteristics. There was no evidence for statistical interaction between IPT and ART (pinteraction=0·77) or between IPT and time (pinteraction=0·94) on mortality. Interpretation: In Côte d'Ivoire, where the incidence of tuberculosis was last reported as 159 per 100 000 people, 6 months of IPT has a durable protective effect in reducing mortality in HIV-infected people, even in people with high CD4 cell counts and who have started ART. Funding: National Research Agency on AIDS and Viral Hepatitis (ANRS).

OBJECTIVE: The 6 month assessment of the response to antiretroviral therapy (ART) is a critical step. In sub-Saharan Africa, few people have access to plasma viral-load measurement. We assessed the gain or loss in body mass index (BMI), alone or in combination with the gain or loss in CD4+ T-cell count (CD4), as a tool for predicting the response to ART. METHODS: In a cohort of 622 adults in Abidjan, Côte d'Ivoire, we calculated the sensitivity, specificity and predictive values of BMI and CD4 for treatment success defined as viral-load undetectability (< 300 copies/ml) as gold standard. FINDINGS: After 6 months of ART, the median change in BMI was an increase of 1.0 kg/m² (interquartile range, IQR: 0.0-2.1), the median change in CD4 an increase of 148/ml (IQR: 54-230) and 84% of patients reached viral-load undetectability. The distribution of change in BMI was similar among patients who reached undetectability and those who did not (increases of 1.06 kg/m² versus 0.99 kg/m², P = 0.51). With larger changes in BMI, the specificity for treatment success increased but its sensitivity decreased and its positive predictive value was stable around 85%. All results remained similar when combining changes in BMI with those in CD4 and when stratifying by groups of baseline BMI or CD4. CONCLUSION: In settings where viral-load measurement is not available, a high BMI gain does not reflect virological success, even when combined with a high CD4 gain. In our population, most patients with detectable viral-load had probably adhered to the drug regimen sufficiently to reach significant gains in body mass and CD4 count but had adhered insufficiently to reach viral suppression.

Introduction West Africa is characterized by the circulation of HIV‐1 and HIV‐2. The laboratory diagnosis of these two infections as well as the choice of a first‐line antiretroviral therapy (ART) is challenging, considering the limited access to second‐line regimens. This study aimed at confirming the classification of HIV‐2 and HIV‐1&2 dually reactive patients followed up in the HIV‐2 cohort of the West African Database to evaluate AIDS collaboration. Method A cross‐sectional survey was conducted from March to December 2012 in Burkina Faso, Côte d’Ivoire and Mali among patients classified as HIV‐2 or HIV‐1&2 dually reactive according to the national HIV testing algorithms. A 5‐ml blood sample was collected from each patient and tested in a single reference laboratory in Côte d’Ivoire (CeDReS, Abidjan) with two immuno‐enzymatic tests: ImmunoCombII® (HIV‐1&2 ImmunoComb BiSpot – Alere) and an in‐house ELISA test, approved by the French National AIDS and hepatitis Research Agency (ANRS). Results A total of 547 patients were included; 57% of them were initially classified as HIV‐2 and 43% as HIV‐1&2 dually reactive. Half of the patients had CD4≥500 cells/mm3 and 68.6% were on ART. Of the 312 patients initially classified as HIV‐2, 267 (85.7%) were confirmed as HIV‐2 with ImmunoCombII® and in‐house ELISA while 16 (5.1%) and 9 (2.9%) were reclassified as HIV‐1 and HIV‐1&2, respectively (Kappa=0.69; p

To assess the performance of QuantiFERON-TB Gold In-Tube (QFT-GIT) test for active tuberculosis (TB) in HIV adults, and its variation over time in patients on antiretroviral therapy (ART) and/or isoniazide preventive therapy (IPT).Transversal study and cohort nested in the Temprano ANRS 12136 randomized controlled trial assessing benefits of initiating ART earlier than currently recommended by World Health Organization, with or without a 6-month IPT. Performance of QFT-GIT for detecting active TB at baseline in the first 50% participants, and 12-month incidence of conversion/reversion in the first 25% participants were assessed. QFT-GIT threshold for positivity was 0.35 IU/ml.Among the 975 first participants (median baseline CD4 count 383/mm3, positive QFT-GIT test 35%), 2.7% had active TB at baseline. QFT-GIT sensitivity, specificity, positive and negative predictive value for active TB were 88.0%, 66.6%, 6.5% and 99.5%. For the 444 patients with a second test at 12 months, rates for conversion and reversion were 9.3% and 14%. Reversion was more frequent in patients without ART and younger patients. IPT and early ART were not associated with reversion/conversion.A negative QFT-GIT could rule out active TB in HIV-infected adults not severely immunosuppressed, thus avoiding repeated TB testing and accelerating diagnosis and care for other diseases.ClinicalTrials.gov NCT00495651.

Background In Côte d’Ivoire, acute leukemias account for 12.5% of hematological malignancies. Acute leukemias are due to an anomaly of the stem cell characterized among other things by the expression of CD34+ CD38- surface markers. This CD34+ CD38- phenotype as well as other factors such as tumor syndrome, high leukocytosis and blasts are considered as important factors of poor prognosis. We therefore proposed to investigate the prognostic value of the expression of CD34+ CD38- markers in acute leukemias in Abidjan. Methods We selected 23 patients aged 33 years on whom we performed Complete Blood Count, bone marrow aspiration and immunophenotyping. To search for myeloperoxydase, smears of blood or bone marrow were stained with benzidine and revealed by the use of Hydrogen peroxide. Acute leukemias were then identified and distributed using the score proposed by the European Group for the Immunological characterization of Leukemias. The definitive diagnosis was made by combining morphological characters that serve as the basis for the French-American-British classification as well as cytochemical and immunophenotypic characters. Results According to the cytological and immunophenotypic classifications, the acute lymphoid leukemia 2 and B IV predominated. 52.2% (12/33) of patients were CD34+ CD38-. This phenotype was found in almost all cytological immunophenotypic types. The medullary invasion by blasts (reflection of the tumor mass) of the total sample of CD34+ , CD34+ CD38- patients and those not expressing CD34+ was respectively 79.4%, 81.25%, 83.3% and 74.8%. Conclusion There was therefore no correlation between medullary blasts and the expression of CD34+ CD38-. To the factors we selected it would have been necessary to associate the study ofcytogenetic and molecular anomalies to better understand the role of CD34+ CD38- phenotype, concerning prognosis.

Objective The 6 month assessment of the response to antiretroviral therapy (ART) is a critical step. In sub-Saharan Africa, few people have access to plasma viral-load measurement. We assessed the gain or loss in body mass index (BMI), alone or in combination with the gain or loss in CD4+ T-cell count (CD4), as a tool for predicting the response to ART. Methods In a cohort of 622 adults in Abidjan, Cote d&apos;Ivoire, we calculated the sensitivity, specificity and predictive values of BMI and CD4 for treatment success defined as viral-load undetectability (< 300 copies/ml) as gold standard. Findings After 6 months of ART, the median change in BMI was an increase of 1.0 kg/[m.sup.2] (interquartile range, IQR: 0.0-2.1), the median change in CD4 an increase of 148/[micro]l (IQR: 54-230) and 84% of patients reached viral-load undetectability. The distribution of change in BMI was similar among patients who reached undetectability and those who dial not (increases of 1.06 kg/[m.sup.2] versus 0.99 kg/[m.sup.2], P = 0.51). With larger changes in BMI, the specificity for treatment success increased but its sensitivity decreased and its positive predictive value was stable around 85%. AII results remained similar when combining changes in BMI with those in CD4 and when stratifying by groups of baseline BMI or CD4. Conclusion In settings where viral-load measurement is not available, a high BMI gain does not reflect virological success, even when combined with a high CD4 gain. In our population, most patients with detectable viral-load had probably adhered to the drug regimen sufficiently to reach significant gains in body mass and CD4 count but had adhered insufficiently to reach viral suppression. Resume Objectif L&apos;evaluation sur 6 mois de la reponse au traitement antiretroviral (ART) est une etape critique. En Afrique subsaharienne, peu de personnes ont acces a la mesure de la charge virale plasmatique. Nous avons evalue le gain ou la perte d&apos;indice de masse corporelle (IMC), isolement ou en association avec le gain ou la perte de cellules T CD4+ (CD4), en tant qu&apos;outils pour predire la reponse au traitement ART. Methodes Parmi une cohorte de 622 adultes d&apos;Abidjan, en Cote d&apos;lvoire, nous avons calcule la sensibilite, la specificite et les valeurs predictives de I&apos;IMC et des CD4 pour le succes du traitement, defini comme l&apos;impossibilite de detecter une charge virale (< 300 copies/ml), a titre normatif. Resultats Apres 6 mois de traitement ART, on obtenait comme valeur mediane de la variation de I&apos;IMC une augmentation de 1,0 kg/[m.sup.2] (intervalle interquartile, IIQ : 0,0-2,1) et comme mediane de la variation des CD4 une augmentation de 148/pl (IIQ : 54-230), ainsi qu&apos;une indetectabilite de la charge virale chez 84 % des patients. La distribution de la variation de I&apos;IMC etait similaire chez les patients ayant atteint I&apos;indetectabilite et chez ceux ne I&apos;ayant pas atteint (augmentation de 1,06 kg/[m.sup.2] au lieu de 0,99 kg/[m.sup.2], p < 0,51). Lorsque la variation de I&apos;IMC augmente, sa specificite a I&apos;egard du succes therapeutique diminue et sa valeur predictive positive reste stable autour de 85 %. Les resultats ne varient guere Iorsqu&apos;on combine les variations de I&apos;IMC, dans leur ensemble, et celles des CD4 et qu&apos;on opere une stratification par groupes d&apos;IMC ou de CD4 de depart. Conclusion Dans les situations ou I&apos;on ne dispose pas de mesure de la charge virale, un fort gain d&apos;IMC n&apos;implique pas un succes virologique, meme s&apos;il s&apos;accompagne d&apos;une importante elevation des CD4. Dans la population etudiee, la plupart des patients presentant une charge virale detectable avaient probablement respecte assez longtemps le schema therapeutique pour beneficier d&apos;augmentations notables de la masse corporelle et de la numeration des CD4, mais pas suffisamment pour atteindre la suppression virale. Resumen Objetivo La evaluacion a los 6 meses de la respuesta a la terapia antirretroviral (TAR) es una medida esencial, pero en el Africa subsahariana son muy pocas las personas con acceso a analisis de la carga viral en plasma. Evaluamos el aumento o disminucion del indice de masa corporal (IMC), aisladamente o en combinacion con el aumento o disminucion del recuento de linfocitos T CD4+ (CD4), como estrategia para predecir la respuesta a la TAR. Metodos En una cohorte de 622 adultos de Abidjan, Cote d&apos;lvoire, calculamos la sensibilidad, la especificidad y los valores predictivos del IMC y los niveles de CD4 como indicadores de la eficacia terapeutica, definida como una carga viral indetectable (< 300 copias/ml). Resultados A los 6 meses de iniciada la TAR, el IMC mediano habia aumentado en 1,0 kg/[m.sup.2] (intervalo intercuartilico, IIC: 0,0-2,1) y el nivel mediano de CD4, en 148/[micro]l (IIC: 54-230), y la carga viral habia pasado a ser indetectable en un 84% de los pacientes. La distribucion de la variacion del IMC fue similar en los pacientes que alcanzaron niveles indetectables y en los demas (aumento de 1,06 kg/[m.sup.2] frente a 0,99 kg/[m.sup.2], p = 0,51). Conforme aumentaba la variacion del IMC, la especificidad respecto de la eficacia terapeutica aumentaba, pero su sensibilidad disminuia, y su valor predictivo positivo se mantenia estable, en torno al 85%. Se obtenian siempre resultados similares al combinar distintos cambios del IMC y del recuento de CD4, asi como al estratificar los grupos en funcion de los valores basales de IMC o CD4. Conclusion En los entornos donde no es posible medir la carga viral, un gran aumento del IMC no refleja la eficacia virologica, aun cuando se combine con un incremento importante de los niveles de CD4. En la poblacion aqui estudiada, la mayoria de los pacientes con carga viral detectable probablemente habian seguido el tratamiento en la medida suficiente para conseguir aumentos importantes de la masa corporal y del recuento de CD4, pero no en la medida necesaria para lograr la supresion viral. [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction International guidelines recommend that plasma viral load undetectability should be reached within the first 6 months of antiretroviral therapy (ART). (1) In patients with plasma viral load still detectable [...]

A study was conducted in Abidjan, Africa at five antenatal clinics with voluntary counseling and prenatal testing for HIV infection in pregnant women. It was noticed that antiretroviral intervention appeared to be independent of the maternal immune status.

Introduction: West Africa is characterized by the circulation of HIV‐1 and HIV‐2. The laboratory diagnosis of these two infections as well as the choice of a first‐line antiretroviral therapy (ART) is challenging, considering the limited access to second‐line regimens. This study aimed at confirming the classification of HIV‐2 and HIV‐1&2 dually reactive patients followed up in the HIV‐2 cohort of the West African Database to evaluate AIDS collaboration. Method: A cross‐sectional survey was conducted from March to December 2012 in Burkina Faso, Côte d’Ivoire and Mali among patients classified as HIV‐2 or HIV‐1&2 dually reactive according to the national HIV testing algorithms. A 5‐ml blood sample was collected from each patient and tested in a single reference laboratory in Côte d’Ivoire (CeDReS, Abidjan) with two immuno‐enzymatic tests: ImmunoCombII[sup.®] (HIV‐1&2 ImmunoComb BiSpot – Alere) and an in‐house ELISA test, approved by the French National AIDS and hepatitis Research Agency (ANRS). Results: A total of 547 patients were included; 57% of them were initially classified as HIV‐2 and 43% as HIV‐1&2 dually reactive. Half of the patients had CD4≥500 cells/mm[sup.3] and 68.6% were on ART. Of the 312 patients initially classified as HIV‐2, 267 (85.7%) were confirmed as HIV‐2 with ImmunoCombII[sup.®] and in‐house ELISA while 16 (5.1%) and 9 (2.9%) were reclassified as HIV‐1 and HIV‐1&2, respectively (Kappa=0.69; p Conclusions: Patients with HIV‐2 mono‐infection are correctly discriminated by the national algorithms used in West African countries. HIV‐1&2 dually reactive patients should be systematically investigated, with a standardized algorithm using more accurate tests, before initiating ART as at least 4 out of 10 of them could initiate an effective first‐line ART for HIV‐1 and optimize their second‐line treatment options., Introduction West Africa is characterized by the circulation of both HIV‐1 and HIV‐2, which leads to co‐infections with HIV‐1 and HIV‐2 (HIV‐1&2) [1–4]. The biological diagnosis of these co‐infections [5–7] [...]