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Background Integrase inhibitors (INIs) are a key component of antiretroviral therapy for human immunodeficiency virus-1 (HIV-1) and HIV-2 infection. Although INI resistance pathways are well-defined for HIV-1, mutations that emerge in HIV-2 in response to INIs are incompletely characterized. Methods We performed systematic searches of GenBank and HIV-2 drug resistance literature to identify treatment-associated mutations for phenotypic evaluation. We then constructed a library of 95 mutants of HIV-2ROD9 that contained single or multiple amino acid changes in the integrase protein. Each variant was tested for susceptibility to raltegravir and dolutegravir using a single-cycle indicator cell assay. Results We observed extensive cross-resistance between raltegravir and dolutegravir in HIV-2ROD9. HIV-2–specific integrase mutations Q91R, E92A, A153G, and H157Q/S, which have not been previously characterized, significantly increased the half maximum effective concentration (EC50) for raltegravir when introduced into 1 or more mutational backgrounds; mutations E92A/Q, T97A, and G140A/S conferred similar enhancements of dolutegravir resistance. HIV-2ROD9 variants encoding G118R alone, or insertions of residues SREGK or SREGR at position 231, were resistant to both INIs. Conclusions Our analysis demonstrates the contributions of novel INI-associated mutations to raltegravir and dolutegravir resistance in HIV-2. These findings should help to improve algorithms for genotypic drug resistance testing in HIV-2–infected individuals.

Background The novel coronavirus disease 2019 (COVID-19) pandemic has spread from China to the rest of the world. Africa seems less impacted with lower number of cases and deaths than other continents. Senegal recorded its first case on March 2, 2020. We present here data collected from March 2 to October 31, 2020 in Senegal. Methods Socio-demographic, epidemiological, clinical and virological information were collected on suspected cases. To determine factors associated with diagnosed infection, symptomatic disease and death, multivariable binary logistic regression and log binomial models were used. Epidemiological parameters such as the reproduction number and growth rate were estimated. Results 67,608 suspected cases were tested by the IPD laboratories (13,031 positive and 54,577 negative). All age categories were associated with SARS-CoV-2 infection, but also patients having diabetes or hypertension or other cardiovascular diseases. With diagnosed infection, patients over 65 years and those with hypertension and cardiovascular disease and diabetes were highly associated with death. Patients with co-morbidities were associated with symptomatic disease, but only the under 15 years were not associated with. Among infected, 27.67% were asymptomatic (40.9% when contacts were systematically tested; 12.11% when only symptomatic or high-risk contacts were tested). Less than 15 years-old were mostly asymptomatic (63.2%). Dakar accounted for 81.4% of confirmed cases. The estimated mean serial interval was 5.57 (± 5.14) days. The average reproduction number was estimated at 1.161 (95%CI: 1.159–1.162), the growth rate was 0.031 (95%CI: 0.028–0.034) per day. Conclusions Our findings indicated that factors associated with symptomatic COVID-19 and death are advanced age (over 65 years-old) and comorbidities such as diabetes and hypertension and cardiovascular disease.

The spread of severe acute respiratory syndrome coronavirus 2 began later in Africa than in Asia and Europe. Senegal confirmed its first case of coronavirus disease on March 2, 2020. By March 4, a total of 4 cases had been confirmed, all in patients who traveled from Europe.

International audience; As of today, little data is available on COVID-19 in African countries, where the case management relied mainly on a treatment by association between hydroxychloroquine (HCQ) and azithromycin (AZM). This study aimed to understand the main clinical outcomes of COVID-19 hospitalized patients in Senegal from March to October 20202. We described the clinical characteristics of patients and analysed clinical status (alive and discharged versus hospitalized or died) at 15 days after Isolation and Treatment Centres (ITC) admission among adult patients who received HCQ plus AZM and those who did not receive this combination. A total of 926 patients were included in this analysis. Six hundred seventy-four (674) (72.8%) patients received a combination of HCQ and AZM. Results showed that the proportion of patient discharge at D15 was significantly higher for patients receiving HCQ plus AZM (OR: 1.63, IC 95% (1.09–2.43)). Factors associated with a lower proportion of patients discharged alive were: age ≥ 60 years (OR: 0.55, IC 95% (0.36–0.83)), having of at least one pre-existing disorder (OR: 0.61, IC 95% (0.42–0.90)), and a high clinical risk at admission following NEWS score (OR: 0.49, IC 95% (0.28–0.83)). Few side effects were reported including 2 cases of cardiac rhythmic disorders in the HCQ and AZM group versus 13 in without HCQ + AZM. An improvement of clinical status at 15 days was found for patients exposed to HCQ plus AZM combination

Background: Serology is a great tool to assess the level of immunity against SARS-CoV-2 in settings with limited access to molecular diagnostics. However, African populations displays a particular immunological profile with massive circulation of infectious agents from different aetiologies that can affect assays performance. Methods: We evaluated the OMEGA Diagnostics COVID-19 ELISA-IgG and the ID Screen® SARS-CoV-2-N IgG Indirect in Senegal using a panel of 636 blood samples covering several African-endemic diseases and healthy donors to determine test sensitivity and specificity. The sensitivity panel of sera includes 461 serum samples collected from 91 patients hospitalized for COVID-19 disease. COVID-19 cases were confirmed by qRT-PCR and samples were collected on an interval of three days until viral clearance. In addition, 272 sera obtained from COVID-19 negative individuals were selected from a well-documented biobank of sera collected before the COVID-19 outbreak. Finding: High-cross reactivity have been found in individuals with a history of exposure to Chikungunya, HIV, malaria (Plasmodium falciparum), rheumatoid factor as well as healthy donors with respective specificities of 55%, 41.8%, 70%, 70% and 75%. ELISA experiments with commercial assays targeting either SARS-CoV-2 Nucleocapsid protein and Spike 2 protein or nucleocapsid protein only suggest that cross-reactivity might be directed against Spike 2 protein and not Nucleocapsid protein. Further samples characterisation reveals that anti-malaria IgG is the leading cause of such poor specificities, but exposure to other diseases contributed as well. Interpretation: We anticipate that COVID-19 seroprevalence can be biased if assays are not contextualized. Since malaria is endemic in African settings, we propose that a particular attention must be given in serological surveillance of COVID-19 or anti-SARS-CoV-2 antibodies quantification as vaccines are being rolled out.FundingUK Foreign, Commonwealth and Development Office/Wellcome Trust Joint Initiative for Research in Epidemic Preparedness and Response (JIREP grant number 220764/Z/20/Z). Funding Information: UK Foreign, Commonwealth and Development Office/Wellcome Trust Joint Initiative for Research in Epidemic Preparedness and Response (JIREP grant number 220764/Z/20/Z). Declaration of Interests: JRAF was an employee of Mologic Ltd, which was the development partner of one of the ELISAs adopted in this study. The remaining authors declare no competing interest. Ethics Approval Statement: Pre-COVID-19 samples for malaria (PCR), dengue, yellow fever, Zika, Chikungunya, Influenza A/B, HIV, rheumatoid arthritis and samples tested negative for the same diseases and also Crimean Congo haemorrhagic fever, West Nile fever encephalitis and Rift Valley fever were part of national public health surveillance program of the Senegalese Ministry of Social Action and Health performed in collaboration with Institut Pasteur de Dakar. Therefore, consultation with ethics committee was not required. Pre-COVID-19 samples for malaria endemic areas were from a longitudinal cohort survey performed in Dielmo village and approved by the Senegalese National Ethics Committee for Research in Health (reference number 00000007/MSAS/CNERS/Sec 26 January 2021). Samples from COVID-19 RT-PCR positive patients were obtained from a multicentre cohort survey approved by the Senegalese National Ethics Committee for Research in Health (reference number 00000068/MSAS/CNERS/Sec, 10 April 2020).

Introduction To investigate the clinical characteristics of COVID-19 in pregnancy in Senegal. Methods This was a cross-sectional and descriptive study of all cases of COVID-19 including nine pregnant women who were admitted in COVID-19 treatment centers in Senegal from March 2 to May 15, 2020. SARS-COV-2 infection was confirmed by PCR. Patients’ characteristics, clinical features, treatment and outcome were obtained with a customized data collection form. Results The frequency of the association COVID-19 and pregnancy was 0.5%. The age range of the patients was 18-42 years with an average 28 years, and the range of gestational weeks at admission was 7 weeks to 32 weeks. None of the patients had underlying diseases. All the patients presented with a headache and only four of them had fever. Other symptoms were also observed: two patients had a cough, two had rhinorrhea, and two patients reported poor appetite. The median time to recovery was 13.6 days, corresponding to the number of days in hospital. None of the nine pregnant women developed severe COVID-19 pneumonia or died. Conclusion Pregnant women appear to have the same contamination predispositions and clinical features of SARS-COV-2 infection as the general population. This study shows no evidence that pregnant women are more susceptible to infection with coronavirus.

The breast tuberculosis accounts for 0.06 to 0.1% of extra-pulmonary localizations. Frequent in women, it remains exceptional in men. We report a rare case of primary breast tuberculosis occurring in a male patient. A 33-years-old patient presented with a chronic and fistulized non-inflammatory-right breast swelling with an atrophic cutaneous ulceration. The thoracic CT was in favor of a right breast abscess with a thick wall. The patient had received non-specific antibiotics (amoxicillin-clavulanate and metronidazole) for 10 days coupled with a surgical drainage before consulting us for persisting symptoms. The culture of the pus was sterile, the GeneXpert and the search for acid-fast bacilli (AFB) both performed on the swab of the ulceration were negative. Histopathological analysis of the lesion was in favor of a granulomatous mastitis. Given the chronic and atrophic nature of the ulceration, the histological aspect of granulomatous mastitis and the persisting symptoms despite the non-specific antibiotic therapy, we made a presumptive diagnostic of breast tuberculosis. The evolution was favorable with oral anti-tuberculosis treatment.

Background Programmatic treatment outcome data for people living with human immunodeficiency virus type 2 (HIV-2) in West Africa, where the virus is most prevalent, are scarce. Methods Adults with HIV-2 initiating or receiving antiretroviral therapy (ART) through the Senegalese national AIDS program were invited to participate in this prospective, longitudinal observational cohort study. We analyzed HIV-2 viral loads, CD4 cell counts, antiretroviral drug resistance, loss to follow-up, and mortality. We also examined changes in treatment guidelines over time and assessed progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets for HIV-2. Results We enrolled 291 participants at 2 sites for 926.0 person-years of follow-up over 13 years. Median follow-up time was 2.2 years per participant. There were 21 deaths reported (7.2%), and 117 individuals (40.2%) were lost to follow-up, including 43 (14.7%) who had an initial visit but never returned for follow-up. CD4 counts and HIV-2 viral suppression ( Conclusions Participants in the Senegalese national AIDS program are initiating ART earlier in the course of disease, and more modern therapeutic regimens have improved outcomes among those receiving therapy. Despite these achievements, HIV-2 treatment remains suboptimal, and significant challenges to improving care remain.

Introduction: Abscesses of the liver are due to an infection of bacterial, parasitic or fungal origin. Through amoebiological imaging and serology, their diagnosis was facilitated. The aim of this study was to determine the epidemiological, clinical, diagnostic and evolutionary aspects of these liver abscesses at the Department of Infectious and Tropical Diseases in Fann Teaching University Hospital. Patients and Methods: This was a retrospective and descriptive study, based on records of patients hospitalized for abscess of the liver over a period of 8 years, from January 1, 2008 to December 31, 2015. Results: We collected 20 cases of abscesses including 12 cases of confirmed amoebic abscesses and 5 cases of pyogenic abscesses. The mean age of the patients was 43.15 ± 15.12 years. There were 18 men and 2 women. The average hospital stay was 32 days. The most common clinical signs were abdominal pain (100%), fever (75%), hepatomegaly (80%). A leukocytosis greater than 12,000 Gb/mm3 was found in 13 patients. The amoebic serology was positive in 71% of cases and negative in 29% of cases. No germ was isolated from the blood culture. On hepatic ultrasound the abscess was unique in 90%. Treatment was exclusively medical in 11 patients (55%). The trend was favorable in 85% of cases. Conclusion: The incidence of liver abscesses has significantly decreased. It is important to develop diagnostic tools better in the case of pyogenic abscesses.

Introduction: Entero bacteria are mainly found in the gut of man and animals. The frequent acquisition of antibiotic resistance mechanisms explains why they are the bacteria most often implicated in human infectious pathology. It is estimated to be involved in 50% of sepsis, 60% of enteritis, 70% of urinary tract infection case. Objective: To determine the prevalence of enterobacterial infections diagnosed at Fann Infectious Diseases Clinic, and describe their epidemiological, clinical, therapeutic and evolutionary aspects. Patients and Methods: This is a retrospective and descriptive study, on patients hospitalized from January 2013 to December 2014, at Fann Infectious Diseases Clinic, with bacteriological confirmation of an enterobacteria infection. Results: A total of 129 cases were collected during the study period. The average age was 41 years, and female were predominant (60%) with a sex ratio of 0.67. Comorbidity was found in 88.4% of the cases, most of which were HIV infection. The most common clinical signs were infectious syndrome (53.49%) and general impairment (40.31%). The main gateway was urinary (55.8%). Samples were monomicrobial in 76.7% of cases. Klebsiella and Escherichia were the most common and 68.7% of the subjects had probabilistic treatment. Most enterobacterial strains were resistant to third generation cephalosporins (C3G), aminoglycosides to ciprofloxacin and cotrimoxazole. Aside from 4% of them, all were sensitive to imipenem. Conclusion: The advent of antibiotics has brought hope in the treatment of enterobacterial infections. However, an increase in their resistance to the usual antibiotics has been noted in recent years. As a result, the fight against antibiotic resistance must be a priority.

This retrospective, descriptive study carried out in the Infectious Diseases Department of CHNU, Fann from 1st January 2012 to 3st December 2016 aimed to describe the epidemiological aspects and the course of post-circumcision tetanus and to formulate public health recommendations. During our study period, 16 cases of post-circumcision tetanus were collected out of a total of 452 patients with tetanus, equivalent to a rate of 3.5%. The median age was 8 years (3-40). None of the patients had a vaccination card. In 63% of cases, circumcision was performed at home, by a practitioner whose qualification was not documented in 63% of cases. All signs of tetanus were found with trismus (100%), dysphagia (63%) and paroxysms (88%). These were mostly Mollaret stage II forms in 14 cases, and grade 3 Dakar score in 7 cases. The median duration of hospitalization was 10 days [6-15]. Mechanical or infectious complications were noted in two cases, with a lethality rate of 13%. Post-circumcision tetanus is a reality in Senegal. Good community awareness, continuous training of staff and implementation of vaccination catch-up strategies for children of circumcised age should eradicate this form of tetanus.

Background Despite the adoption of the provider-initiated HIV testing strategy, the rate of HIV testing is still very low in sub-Saharan Africa. The aim of this study was to assess the factors associated with HIV testing among sexually active women and men in Senegal. Knowledge of HIV status is the gateway to antiretroviral treatment. Methods A secondary analysis of the 2017 Senegal Demographic and Health Survey (DHS) was performed, using data on sexually active women aged 15–49 and men aged 15–59. The outcome variable was the proportion of women and men who reported ever being tested for HIV in the last 12 months before the survey. Descriptive, bivariate, and multivariable logistic regression analyses were performed to identify the socio-demographic, HIV-knowledge, media exposure, and behavioral factors associated with HIV testing in Senegal. Results The study found that 61.1% (95%CI: 59.2–62.9) of women and 26.2% (95%CI: 24.2–28.3) of men were tested for HIV at the last 12 months. In multivariate analysis, among men the factors independently associated with being tested for HIV were: age groups 20–24 to 40–44 and age group 50–54; a higher level of education; being in the richest household wealth quintile; being married; knowing about the efficacy of HAART during pregnancy; having 2 or more lifetime sex partners and owning a mobile phone. Among women factors independently associated with HIV testing were: being in any age groups versus 15–19; a higher level of education; being in the richest household wealth quintile; being married; knowing about the efficacy of HAART during pregnancy; having any STI in last 12 months; fearing stigma; owning a mobile phone; and having any number of ANC visits, versus none. Conclusion Although HIV remains a public health threat, HIV testing’s prevalence is still low in Senegal, making it difficult to interrupt the transmission chain within the community and to reach the UNAIDS goal for 2020 of “90–90-90”. Innovative community-based strategies are needed to address barriers and improve access to HIV testing in Senegal, particularly for men and for the youngest and poorest populations.

We compared the activity of the integrase inhibitor bictegravir against HIV-1 and HIV-2 using a culture-based, single-cycle assay. Values of 50% effective concentrations ranged from 1.2 to 2.5 nM for 9 HIV-1 isolates and 1.4 to 5.6 nM for 15 HIV-2 isolates. HIV-2 integrase mutants G140S/Q148R and G140S/Q148H were 34- and 110-fold resistant to bictegravir, respectively; other resistance-associated mutations conferred ≤5-fold changes in bictegravir susceptibility. Our findings indicate that bictegravir-based antiretroviral therapy should be evaluated in HIV-2-infected individuals.

The main objective of our study was to perform a situational analysis of bacteremia diagnosed at the Clinic of Infectious Diseases Fann University Hospital in Dakar. This was a retrospective, descriptive study based on the records of patients hospitalized for bacteremia from January 1, 2013 to December 31, 2014. Epidemiological, clinical, biological, therapeutic and evolutionary variables were collected. Data analysis was done using Stata/SE software version 12.1. Seventy-nine cases of bacteremia were reported in 1922 hospitalized patients at a proportion of 4.1%, and 86 bacterial strains were isolated. The median age was 43 years [IQR: 32; 53]. The main comorbidities found were HIV infection (73%) and high blood pressure (22.2%). Hyperleukocytosis was found in 20 cases (25.32%). The average level of Protein C Reactive was 83.90 ± 56.08 mg/L. Blood culture was monomicrobial in 74 cases (93.7%). The most common isolated bacteria were coagulase-negative staphylococci (23.1%), followed by Pseudomonas aeruginosa/spp (15.1%), Staphylococcus aureus (10.5%), Escherichia coli and Acinetobacter spp (8.1%). Isolated strains had low resistance to Imipenem, Vancomycin and Fusidic Acid. In monotherapy or in combination, the mostly used antibiotic was Ceftriaxone. The average duration of antibiotherapy was 10.40 ± 5.39 days. Thirty-three patients (41.8%) had died. Cases of bacteremia present a high mortality. Isolated bacterial strains are becoming more resistant to the antibiotics available in our clinic. As a result, the rationalization of their use is adamant.

L'hépatite B occulte correspond à la présence de l'ADN du virus de l'hépatite B dans le sérum et/ou dans le foie d'un patient malgré la négativité de l'AgHBs. C'est une forme clinique habituellement asymptomatique. Sa réactivation est rare et survient en général chez le sujet immunodéprimé. Nous rapportons un cas d'un patient sénégalais de 21 ans, drépanocytaire homozygote, qui présentait un ictère de type cholestatique chez qui l'exploration biologique concluait a une réactivation d'une hépatite B occulte. Cette observation souligne la nécessité de rechercher systématiquement une réactivation d'une hépatite B occulte devant toute hépatopathie aigue chez le drépanocytaire.

Introduction: L'objectif de ce travail était d'évaluer les différents facteurs associés à la dissociation immunovirologique malgré un traitement antirétroviral hautement actif et efficace.Méthodes: Il s'agissait d'une étude de cohorte historique, descriptive et analytique faite à partir de dossiers de patients infectés par le VIH-1; sous traitement antirétroviral depuis au moins 12 mois, suivis dans la cohorte du CTA de 2001 à 2011 et ayant une charge virale indétectable depuis 6 mois.Résultats: Durant cette période d'étude de 10 ans, la prévalence de la DIV était de 19,3%. Le sexe féminin était prédominant avec un sexe ratio de 1,9. La dissociation immunovirologique a été plus fréquemment rencontrée chez les patients de sexe masculin (29,7% vs 14,1%) avec une différence statistiquement significative (p = 0,00006). L'âge médian était de 44 ans ± 10 ans. Un antécédent de tuberculose a été retrouvé dans environ un tiers des cas (31,4%). La dissociation immunovirologique était significativement plus fréquente chez les patients ayant un antécédent de tuberculose (p = 0,00005). La plupart des patients (68%) était au stade SIDA 3 ou 4 de l'OMS. Les patients ayant une dissociation immunovirologique étaient plus souvent aux stades 3 et 4 de l'OMS (p = 0,0001). La dénutrition a été notée dans plus de la moitié des cas (56,2%) et la dissociation immunovirologique prédominait chez les patients dénutris (p=0,005). Le taux moyen de lymphocytes TCD4+ était de 86,7± 83 cellules / mm3. La dissociation immunovirologique était plus fréquente chez les patients ayant un taux de lymphocytes TCD4 bas à l'initiation avec une différence statistiquement significative (p = 0,00000). En analyse multivariée; Seuls l'âge supérieur ou égal à 43 ans, le taux de CD4 initial < 100 c/mm3 et le sexe masculin étaient significativement associés à cette dissociation immunovirologique.Conclusion: Les principaux facteurs associés à la dissociation immunovirologique étant évalués, d'autres études portant sur ce groupe mériteraient d'être envisagées afin de connaitre l'impact de cette réponse immunologique partielle sur la survenue d'infections opportunistes ou bien la mise en place d'une trithérapie spécifique uniquement dans le but d'avoir une restauration immunologique optimale.Mots clés: Dissociation, immunovirologique, VIH, DakarEnglish Title: Factors associated with immunovirologic dissociation in HIV-1-infected patients under highly active antiretroviral therapy in the Ambulatory Treatment Center (ATC) in DakarEnglish AbstractIntroduction: the objective of this work is to evaluate the different factors associated with immunovirologic dissociation despite highly active and effective antiretroviral treatment.Methods: we conducted a retrospective, cohort, descriptive and analytical study of the medical records of HIV-1 infected patients having received at least 12 months of antiretroviral therapy, followed in the ATC cohort from 2001 to 2011 and with undetectable viral load in the last 6 months.Results: during this 10-year study period, the prevalence of IVD was 19.3%. Female sex was predominant, with a sex ratio of 1.9. Immunovirologic dissociation was more frequent in male patients (29.7% vs 14.1%) with a statistically significant difference (p = 0,00006). The average age was 44 years ± 10 years. A history of tuberculosis was found in about a third of the cases (31.4%). Immunovirologic dissociation was significantly more frequent in patients with a history of tuberculosis (p = 0.00005). Most patients (68%) had AIDS at WHO clinical stages 3 or 4. Patients with immunovirologic dissociation were more often in WHO clinical stages 3 and 4 (p = 0.0001). More than half of the cases (56.2%) were found to be malnourished and immunovirologic dissociation was prevalent in malnourished patients (p=0.005). The mean CD4+ T lymphocytes counts was 86.7± 83 cells / mm3. Immunovirologic dissociation was more frequent in patients with initial low CD4+ T lymphocyte counts and with a statistically significant difference (p = 0.00000). By multivariate analysis, only age greater than or equal to 43 years, CD4 initial counts < 100 c/mm3 and male sex were significantly associated with this immunovirologic dissociation.Conclusion: our study assessed the main factors associated with immunovirologic dissociation. Other studies of this nature would also merit consideration in order to highlight the impact of this partial immune response on the emergence of opportunistic infections or the implementation of a specific tritherapy for the sole purpose of producing fully successful immune restoration.Keywords: Dissociation, immunovirologic, HIV, Dakar

Introduction Au Sénégal, 85% de la population adulte ont été en contact avec le virus de l'hépatite B et environ 11% sont porteurs chroniques de l'antigène de surface de ce virus (AgHBs). Cette infection est peu documentée dans l'armée sénégalaise. L'objectif de cette étude était d'évaluer la prévalence de l'AgHBs chez des militaires sénégalais envoyés en mission au Darfour (Soudan) et d'identifier les facteurs associés. Méthodes Nous avons mené une étude transversale du 1er juillet 2014 au 31 juillet 2014 chez des militaires sénégalais en mission au Darfour. La recherche de l'AgHBs a été effectuée dans le sérum des participants par la méthode immunochromatographique. La recherche de facteurs associés a été réalisée à l'aide d'une régression logistique multivariée. Résultats Notre étude a porté sur 169 militaires de sexe masculin. L'âge moyen était de 36,6 ans ± 9,5. Des antécédents d'hépatopathie chronique au niveau familial, d'exposition sanguine et d'exposition sexuelle ont été retrouvés respectivement chez 12,4% ; 24,9% et 45,6% de la population d'étude. L'AgHBs a été retrouvé chez 24 participants [14,2% (IC95% = 8,9-19,5)]. Après ajustement sur les facteurs de confusion potentiels, l'âge (OR=0,9 IC95% =0,9-1,0), un niveau d'étude universitaire (OR= 9,5 IC95% =1,3-67,1) et l'exposition sexuelle (OR=3,3; IC95% =1,0-10,3) étaient apparus associés de façon indépendante à l'hépatite B. Conclusion Notre étude retrouve une prévalence élevée de l'AgHBs et souligne la nécessité d'une évaluation plus poussée de l'hépatite B chez cette population.

Introduction: In resource-limited countries, the number of available antiretroviral (ARV) drugs is relatively limited. Hence, caregivers face some caution and constraints in the changes of ARV treatment (ART) in people living with HIV (PLHIV). Our objective was to calculate the incidence, to describe the main causes and to identify the predictive factors of the first change of ARV treatment in Senegal. Methods: We conducted a retrospective cohort study on 331 HIV infected patients who initiated ART in 2009- 2011 and followed until March 2012. The incidence was estimated using Kaplan-Meier method. The causes have been grouped into five categories. The identification of predictive factors was done using a Cox proportional hazards model. Results: At inclusion, mean age, IMC and CD4 cell count were 41 years (interquartile range (IQR)=35-48), 18 kg/ m² (IQR=15.6-21.5) and 92 cells/μl (IQR=31-200), respectively. After an average ART duration of 11.4 months, 65 patients had experienced at least one treatment change resulting in an overall incidence rate of 10.5/100 person-years (95% CI=8.4-12.6). ARV drugs intolerance was the main cause of change in treatment (41/65) followed by therapeutic failures (5 cases) and pregnancy (three cases). The independent predictors of first ARV treatment change were female sex (hazard ratio (HR)=1.85: IC 95%=1.07-3.19), underweight (HR=2.20, IC 95%=1.24-3.88) and HIV-1 or HIV-dual infection (HR=3.57, IC 95%=1.11-11.46). Conclusion: In this cohort, the incidence of the first ARV treatment change was low. It was more frequent in women, underweight patients and HIV-1 infected patients. The main cause was ARV intolerance. A better pretherapeutic evaluation, the availability of ARVs compatible with pregnancy and anti-tuberculosis treatment appear to be relevant in this population.

Introduction L'objectif de ce travail était d'évaluer les différents facteurs associés à la dissociation immunovirologique malgré un traitement antirétroviral hautement actif et efficace. Méthodes Il s'agissait d'une étude de cohorte historique, descriptive et analytique faite à partir de dossiers de patients infectés par le VIH-1; sous traitement antirétroviral depuis au moins 12 mois, suivis dans la cohorte du CTA de 2001 à 2011 et ayant une charge virale indétectable depuis 6 mois. Résultats Durant cette période d'étude de 10 ans, la prévalence de la DIV était de 19,3%. Le sexe féminin était prédominant avec un sexe ratio de 1,9. La dissociation immunovirologique a été plus fréquemment rencontrée chez les patients de sexe masculin (29,7% vs 14,1%) avec une différence statistiquement significative (p = 0,00006). L'âge médian était de 44 ans ± 10 ans. Un antécédent de tuberculose a été retrouvé dans environ un tiers des cas (31,4%). La dissociation immunovirologique était significativement plus fréquente chez les patients ayant un antécédent de tuberculose (p = 0,00005). La plupart des patients (68%) était au stade SIDA 3 ou 4 de l'OMS. Les patients ayant une dissociation immunovirologique étaient plus souvent aux stades 3 et 4 de l'OMS (p = 0,0001). La dénutrition a été notée dans plus de la moitié des cas (56,2%) et la dissociation immunovirologique prédominait chez les patients dénutris (p=0,005). Le taux moyen de lymphocytes TCD4+ était de 86,7± 83 cellules / mm3. La dissociation immunovirologique était plus fréquente chez les patients ayant un taux de lymphocytes TCD4 bas à l'initiation avec une différence statistiquement significative (p = 0,00000). En analyse multivariée; Seuls l'âge supérieur ou égal à 43 ans, le taux de CD4 initial < 100 c/mm3 et le sexe masculin étaient significativement associés à cette dissociation immunovirologique. Conclusion Les principaux facteurs associés à la dissociation immunovirologique étant évalués, d'autres études portant sur ce groupe mériteraient d'être envisagées afin de connaitre l'impact de cette réponse immunologique partielle sur la survenue d'infections opportunistes ou bien la mise en place d'une trithérapie spécifique uniquement dans le but d'avoir une restauration immunologique optimale.

Background. Cervical cancer is a major public health problem for women in sub-Saharan Africa. Availability of a human papillomavirus (HPV) vaccine could have an important public health impact. Methods. In this phase IIIb, double-blind, randomized, placebo-controlled, multicenter trial (NCT00481767), healthy African girls and young women seronegative for human immunodeficiency virus (HIV) were stratified by age (10–14 or 15–25 years) and randomized (2:1) to receive either HPV-16/18 AS04-adjuvanted vaccine (n = 450) or placebo (n = 226) at 0, 1, and 6 months. The primary objective was to evaluate HPV-16/18 antibody responses at month 7. Seropositivity rates and corresponding geometric mean titers (GMTs) were measured by enzymelinked immunosorbent assay. Results. In the according-to-protocol analysis at month 7, 100% of initially seronegative participants in the vaccine group were seropositive for both anti–HPV-16 and anti–HPV-18 antibodies (n = 130 and n = 128 for 10– 14-year-olds, respectively; n = 190 and n = 212 for 15–25-year-olds). GMTs for HPV-16 and HPV-18 were higher in 10–14-year-olds (18 423 [95% confidence interval, 16 185–20 970] and 6487 [5590–7529] enzyme-linked immunosorbent assay units (EU)/mL, respectively) than in 15–25-year-olds (10 683 [9567–11 930] and 3743 [3400–4120] EU/mL, respectively). Seropositivity was maintained at month 12. No participant withdrew owing to adverse events. No vaccine-related serious adverse events were reported. Conclusions. The HPV-16/18 AS04-adjuvanted vaccine was highly immunogenic and had a clinically acceptable safety profile when administered to healthy HIV-seronegative African girls and young women.