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Summary Background One year after the coronavirus disease 2019 (COVID-19) pandemic, the focus of attention has shifted to the emergence and spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants of concern (VOCs). The aim of the study was to assess the frequency of VOCs in patients followed for COVID-19 at Kinshasa university hospital (KUH) during the 3rd and 4th waves of the pandemic in Kinshasa. Hospital mortality was compared to that of the first two waves. Method The present study included all patients in whom the diagnosis of SARS-CoV-2 infection was confirmed by the polymerase chain reaction (PCR). The laboratory team sequenced a subset of all SARS-CoV-2 positive samples with high viral loads define as Ct Results During the study period, the original strain of the virus was no longer circulating. The Delta VOC was predominant from June (92%) until November 2021 (3rd wave). The Omicron VOC, which appeared in December 2021, became largely predominant one month later (96%) corresponding the 4th wave. In-hospital mortality associated with COVID-19 fell during the 2nd wave (7% vs. 21% 1st wave), had risen during the 3rd (16%) wave before falling again during the 4th wave (7%) (p Conclusion The Delta (during the 3rd wave) and Omicron VOCs (during the 4th wave) were very predominant among patients followed for Covid-19 in our hospital. Contrary to data in the general population, hospital mortality associated with severe and critical forms of COVID-19 had increased during the 3rd wave of the pandemic in Kinshasa.

Dengue is a worldwide public health concern. The current study assessed the extent of human exposure to the dengue virus in relation to the distribution pattern of

BackgroundThe objective of our retrospective study was to establish a comparison between the first and the second waves of demographic and clinical characteristics as well as mortality and its determinants.MethodsA total of 411 COVID-19 patients were enrolled in Kinshasa University Hospital and categorized into two groups according to the pandemic pattern, demographics, and disease severity. The clinical characteristics were compared according to the two waves. To describe survival from the first day of hospitalization until death, we used Kaplan Meier’s method. We used the Log Rank test to compare the survival curves between the two waves. The Cox regression was used to identify independent predictors of mortality.ResultsDuring the study period, 411 patients with confirmed COVID-19 were admitted to the hospital. The average age of patients in the 2nd wave was higher than in the first wave (52.4 ±17.5 vs 58.1 ±15.7, p=0.026). The mean saturation was lower in the first wave than in the second. The death rate of patients in the first wave was higher than in the second wave (p=0.009). Survival was reduced in the first wave compared to the second wave. In the first wave, age over 60 years, respiratory distress, law oxygen saturation (≤89%) and severe stage of COVID-19 emerged as factors associated with death, while in the second wave it was mainly respiratory distress, law oxygen saturation (≤ 89%) and severe stage. The predictors of mortality present in both the first and second waves were respiratory distress and severe COVID-19 stage.ConclusionMortality decreased in the second wave. Age no longer emerged as a factor in mortality in the second wave. Health system strengthening and outreach to those at high risk of mortality should continue to maintain and improve gains.

Background Malaria is one of the most severe public health issues that result in massive morbidity and mortality in most countries of the sub-Saharan Africa (SSA). This study aimed to determine the scope of household, accessibility to malaria care and factors associated with household malaria in the Democratic Republic of Congo (DRC). Methods This was a community-based cross-sectional study conducted in an urban and a rural sites in which 152 households participated, including 82 urban and 70 rural households (1029 members in total). The ‘malaria indicator questionnaire’ (MIQ) was anonymously answered by household heads (respondents), reporting on malaria status of household members in the last 12 months. Results There were 67.8% of households using insecticide-treated bed nets (ITN) only, 14.0% used indoor residual spraying (IRS) only, 7.3% used ordinary bed nets (without insecticide treatment), 1.4% used mosquito repelling cream, 2.2% combined ITN and IRS, whereas 7.3% of households did not employ any preventive measure; p

Background Sub-Saharan Africans exhibit a higher frequency of chronic kidney disease (CKD) than other populations. In this study, we sought to determine the frequency of apolipoprotein L1 (APOL1) genotypes in hypertension-attributed CKD in Kinshasa, Democratic Republic of the Congo. Methods We performed a case-control study identifying 162 subjects: 79 with hypertension-attributed CKD and 83 controls living in Kinshasa who were genotyped for APOL1 risk variants between July 2013 and November 2016. We selected control subjects from the general population and matched them with the cases according to age. Logistic regression analysis was used to examine the relationship between APOL1 high-risk genotypes and CKD. Results The frequencies of the APOL1 G1 and G2 alleles were 19.1 and 7.1%, respectively. The number of individuals with the G1 and G2 risk alleles was significantly higher in the CKD group (12.7%) than in the control group (2.4%), particularly in individuals with end-stage kidney disease (14.3%). Subjects carrying two risk alleles was strongly and independently associated with hypertension-attributed nephropathy, with an adjusted odds ratio of 7.7 (95% confidence interval 1.5-39.7; P = 0.014). The high-risk APOL1 genotypes were G1/G1 and G1/G2, whereas G2/G2 was not found in the study population. Conclusions The results of this study demonstrate the association of high-risk APOL1 genotypes with kidney disease in Kinshasa. The absence of G2/G2 may be consistent with powerful selective sweeps induced by Trypanosoma brucei gambiense infection. In contrast, the presence of APOL1 G2/G2 among individuals of African ancestry in the USA may indicate relaxation of natural selection in a trypanosome-free environment.

Background Malaria is one of the most prevalent and deadliest illnesses in sub-Saharan Africa. Despite recent gains made towards its control, many African countries still have endemic malaria transmission. This study aimed to assess malaria burden at household level in Kongo central province, Democratic Republic of Congo (DRC), and the impact of community participatory Water, Sanitation and Hygiene (WASH) Action programme. Methods Mixed method research was conducted in two semi-rural towns, Mbanza-Ngungu (a WASH action site) and Kasangulu (a WASH control site) in DRC between 1 January 2017 through March 2018, involving 625 households (3,712 household members). Baseline and post-intervention malaria surveys were conducted with the use of World Bank/WHO Malaria Indicator Questionnaire. An action research consisting of a six-month study was carried out which comprised two interventions: a community participatory WASH action programme aiming at eliminating mosquito breeding areas in the residential environment and a community anti-malaria education campaign. The latter was implemented at both study sites. In addition, baseline and post-intervention malaria rapid diagnostic test (RDT) was performed among the respondents. Furthermore, a six-month hospital-based epidemiological study was conducted at selected referral hospitals at each site from 1 January through June 2017 to determine malaria trend. Results Long-lasting insecticide-treated net (LLIN) was the most commonly used preventive measure (55%); 24% of households did not use any measures. Baseline malaria survey showed that 96% of respondents (heads of households) reported at least one episode occurring in the previous six months; of them only 66.5% received malaria care at a health setting. In the Action Research, mean incident household malaria cases decreased significantly at WASH action site (2.3 ± 2.2 cases vs. 1.2 ± 0.7 cases, respectively; p Conclusion This research showed high prevalence of positive malaria RDT among the responders and high household malaria incidence, which were reduced by a 6-month WASH intervention. DRC government should scale up malaria control strategy by integrating efficient indoor and outdoor preventive measures and improve malaria care accessibility.

Background Malaria is one of the most prevalent and deadliest illnesses in sub Saharan Africa. Despite recent gains made towards its control or elimination in past decades, many African countries still have endemic malaria transmission. Thus, the search for disease control strategies is indispensable. This study aimed to assess malaria burden at household level in Kongo central province, Democratic Republic of Congo (DRC), and the impact of community participatory water, sanitation and hygiene (WASH) action. Methods Mixed method research was conducted in two semi-rural towns, Mbanza-Ngungu (WASH action site) and Kasangulu (WASH control site) between 1 January 2017 through March 2018, involving 625 households (3,712 household members). Baseline and post-intervention malaria surveys focusing on malaria episodes and preventive measures in previous six-month period using the World Bank/WHO Malaria Indicator Questionnaire. An action research consisting of a six-month study was carried out which comprised two interventions: a community participatory WASH action aiming at eliminating mosquito breeding areas in the residential environment and a community anti-malaria education campaign. The latter was implemented at both the WASH action and Control sites. In addition, baseline and post-intervention malaria rapid diagnostic test (RDT) was performed among respondents. Furthermore, a six-month hospital-based epidemiological study was conducted from 1 January through June 2017. Medical records of patients admitted at selected referral hospitals (one hospital per study site) were used to determine malaria trend in the sites. Results Long-lasting insecticide-treated net (LLIN) was the most commonly used preventive measure (55%), followed by mosquito repellent (15%), indoor residual spraying (2%), LLIN and indoor residual spraying combination (2%); however, 24% of households did not use any measures. Baseline malaria survey showed that 96% of respondents (heads of households) have reported at least one malaria episode occurring in the previous six-month period (January-June 2017); of them only 66.5% of them received malaria care at a health setting. In the Action Research, at household level, mean number of self-reported incident malaria cases decreased at WASH action site (2.3±2.2 cases vs. 1.2±0.7 cases, respectively; p

Background Mosquito-borne viral infections have in recent years, become a public health threat globally. This review aimed to provide an overview of the ecological and epidemiological profiles of mosquito-borne viral infections in the Democratic Republic of the Congo (DRC). Methods A search of literature was conducted using Google Scholar, PubMed and the WHO website using the following keywords: “Democratic Republic of the Congo”, “Zaire”, “Belgian Congo” and either of the following: “mosquito-borne virus”, “arbovirus”, “yellow fever”, “dengue”, “chikungunya”, “West Nile”, “Rift Valley fever”, “O’nyong’nyong”, “Zika”, “epidemiology”, “ecology”, “morbidity”, “mortality”. Published articles in English or French covering a period between 1912 and October 2018 were reviewed. Results A total of 37 articles were included in the review. The findings indicate that the burden of mosquito-borne viral infections in DRC is increasing over time and space. The north-western, north-eastern, western and central regions have the highest burden of mosquito-borne viral infections compared to south and eastern highland regions. Yellow fever, chikungunya, dengue, Zika, Rift Valley fever, West Nile and O’nyong’nyong have been reported in the country. These mosquito-borne viruses were found circulating in human, wildlife and domestic animals. Yellow fever and chikungunya outbreaks have been frequently reported. Aedes aegypti and Ae. simpsoni were documented as the main vectors of most of the mosquito-borne viral infections. Heavy rains, human movements, forest encroachment and deforestation were identified as drivers of mosquito-borne viruses occurrence in DRC. Conclusions Mosquito-borne viral infections are becoming common and a serious public health problem in DRC. In the current context of climate change, there is urgent need to improve understanding on ecological and epidemiology of the diseases and strengthen surveillance systems for prompt response to epidemics in DRC.

Summary: Malaria is one of the most prevalent and deadliest illnesses in the Sub-Saharan Africa. Despite recent gains made towards its control or elimination in past decades, many African countries still have endemic malaria transmission. Therefore, the search for novel disease control strategies and approaches are in progress. This study aimed to evaluate household malaria burden in Kongo central province, Democratic Republic of Congo (DRC), and the impact of community participatory water, sanitation and hygiene (WASH) action. Methods: Mixed method study was conducted in two semi-rural towns, Mbanza-Ngungu (WASH action site) and Kasangulu (control site), involving 625 households (3,712 individuals). Baseline and post-intervention surveys were conducted; an action research consisting of six-month prospective study was carried out which comprised two interventions: (1) community participatory WASH action and (2) anti-malaria education campaign. The latter was implemented in both study sites. In addition, rapid diagnostic test (RDT) for malaria was performed in respondents. Findings: Prevalence of positive malaria RDT among respondents decreased (38% vs. 20%) at WASH-action site, whereas it increased at the control site but not significantly. Of 96% of respondents who reported at least one malaria event occurring in the previous six-month period, only 66.5% of them received malaria care at a health setting. At household level, long-lasting insecticide-treated net (LLIN) was the most commonly used preventive measure (55%), followed by mosquito repellent (15%), indoor residual spraying (IRS) (2%), LLIN-IRS combination (2%); however, 24% of households did not use any measures. Mean household malaria incidence decreased in WASH action site; 2.3±2.2 cases vs. 1.2±0.7 cases, whereas no significant change was noted in control site. Moreover, malaria incidence rate was highest (60.9%) among households living in proximity to grassy and stagnant water spots. Proximity to high risk area (grassy/stagnant water spots) for malaria (ORa=5.13; 95%CI: 2-29-8.07; p

Ebolavirus disease (EVD) is a severe contagious disease in humans, and health care workers (HCW) are at risk of infection when caring for EVD patients. This paper highlights the epidemiologic profile of EVD and its impact on the health care workforce in Africa. A documentary study was conducted which consisted of a review of available literature regarding the epidemiology of EVD, occupational EVD (OEVD), and work safety issues in Sub-Saharan Africa; the literature findings are enriched by field experiences from the authors. EVD outbreaks have already caused 30,500 cases in humans of whom 12,933 died (as of September 9, 2015), and the number of infected HCW has dramatically increased. All eight HCW infected during the 2014 outbreak in Democratic Republic of the Congo died, whereas during the recent West African EVD epidemic more than 890 HCW were infected, with a case fatality rate of 57%. Occupational exposure to blood and other body fluids due to inadequate use of personal protective equipment and needle stick or sharp injuries are among factors that contribute to the occurrence of OEVD. Prevention of OEVD should be one of the top priorities in EVD outbreak preparedness and management, and research should be conducted to elucidate occupational and other factors that expose HCW to EVD. In addition to regularly training HCW to be adequately prepared to care for patients with EVD, it is critical to strengthen the general health care system and improve occupational safety in medical settings of countries at risk., Highlights • Recent EVD outbreaks in Africa (as of September 2015) claimed 12,933 lives. • Health care workers (HCW) were severely impacted. • We observed 890 cases of occupational EVD in HCW and a case fatality rate of 57%. • Use of protective and safety-engineered medical devices should be expanded. • Periodic training and improving EVD risk communication would enhance preparedness.

Highlights • Adult mosquitoes collected in Kinshasa, the Democratic Republic of the Congo (DRC), were screened for viruses in this study. • Approximately 40% of mosquitoes were found to be infected with Alphavirus, Flavivirus, and/or Bunyaviridae. • Chikungunya, o’nyong’nyong, and Rift valley fever viruses were found in mosquitoes. • Habitats favouring mosquito breeding and viral transmission were found in Kinshasa. • Screening for mosquito-borne viruses in humans and livestock in DRC is recommended., Summary Background Diseases caused by mosquito-borne viruses are among the most important emerging diseases that threaten human and animal health, particularly in Africa. However, little attention has been paid to these diseases in the Democratic Republic of the Congo (DRC). The present cross-sectional study was undertaken between March and May 2014 to investigate the presence of mosquito-borne viruses in mosquitoes collected from five municipalities of Kinshasa, DRC. Methods Mosquitoes were collected using BG-Sentinel traps and battery-powered aspirators. Female mosquitoes were pooled according to their genera and sampling locations, preserved in RNAlater, and later screened for viruses using reverse transcription PCR (RT-PCR) assays. Results A total of 2922 mosquitoes were collected and 29 pools of female mosquitoes, containing approximately 30 mosquitoes each, were tested. Twelve of the 29 (41.4%) mosquito pools were found to be infected with at least one arbovirus, with eight (27.5%) pools positive for Alphavirus, nine (31%) for Flavivirus, and five (17.2%) for Bunyaviridae. Chikungunya, o’nyong’nyong, and Rift valley fever viruses were detected. Conclusions The present study shows that mosquitoes in Kinshasa carry mosquito-borne viruses that may have serious public health implications. Further investigations on the presence of mosquito-borne viruses in the human and livestock populations of Kinshasa and DRC are recommended.

Background Mosquito-borne viral diseases (MBVD) are among the important human and animal health threats globally. Gaining insights on behaviours and practices of local population on MBVD can improve understanding of socio-demographic and cultural factors to be addressed in intervention packages. This study was carried out to explore community knowledge, attitudes and practices regarding mosquitoes and MBVD in Kinshasa, the Democratic Republic of the Congo (DRC). Methods A cross sectional survey involving heads of household was carried out in Kinshasa, DRC, between January and April 2019. Information on socio-demographic characteristics, knowledge, attitudes and practices on mosquito and MBVD was collected through a questionnaire. Data analysis was performed using Epi Info 7. Results A total of 1,464 representatives were involved in the study. Of these, 69% were under 44 years of age, 60.7% were females and the majority (90.2%) were educated. One-third of the houses had insect window screens, 61.2% had open garbage cans, 33.4% had outdoor water storage units, 25.1% had stagnant water collection and 22.5% had water containers. The majority (80.3%) of the respondent mentioned polluted water bodies as the main mosquito breeding places. Yellow fever (86.6%) was the most commonly known MBVD. Overall, 12% of the respondents knew that mosquitoes are vectors of these viruses. Majority of respondents (72.5%) felt to be at risk of contracting MBVD. Blocked draining water channels, dirty, agriculture, house and road construction, animal rearing and automobile garages were associated with mosquito abundance. Health professionals, family member, radio/television and/or school/university were the main source of information. Cleaning environment (58%) and/or use of insecticides (25%) were the main measures implemented in controlling mosquitoes. Mosquito net ownership (87.4%) and use (67%) were high. The greater overall of knowledge score (OR: 1.4; p =0.1), attitude (OR: 1.22; p =0.1) were not predictor of good practice. Conclusion Most of the residents of Kinshasa had limited knowledge on the role of mosquitoes in the transmission of pathogenic viruses in both humans and animals. Raising awareness and educational sessions are essential in empowering the community on the correct attitudes and practices in order to effectively manage the risk posed by MBVD.

Sarcoptic skin disease (SSD), also called scabies or “itch mite,” is a cosmopolite itchy and contagious ectoparasitic infection of the skin caused by Sarcoptes scabiei var. hominis. According to the World Health Organization (WHO), SSD affects approximately 300,000,000 people annually, mostly in developing countries. In Asia, very high SSD prevalence rate has been reported in Australian aboriginal population, reaching up to 50%, and in the Pacific Rim islands such as Fiji (18.5%), Vanuatu (24%), and Solomon Islands (25%). Crowded houses and schools, poor hygiene, reduced access to medical or nursing care, and faulty application of treatment agents are among risk factors of SSD. Recent works have proposed the serodiagnostic approach for scabies, consisting of the detection of Sarcoptes scabiei protein tyrosine kinase (SsPTK), which is similar to PTK from rabbit ear mite Psoroptes ovis cuniculi and widely distributed at the front end of the Sarcoptes mite, legs, and mouthparts with the use of an indirect ELISA. Another novel diagnostic approach being studied consists of the use of immunofluorescence staining technique. Researchers found a novel inorganic pyrophosphatase Ssc-PYP-1 located in the tegument around the mite’s mouthparts, the cuticle, and the entire legs and then developed an indirect ELISA using recombinant Ssc-PYP-1 (rSsc-PYP-1) as the capture antigen to diagnose sarcoptic mite in naturally infected mammals, with high sensitivity and specificity, 92% and 93.6%, respectively. Raising awareness and providing financial support to program aiming at SSD control and elimination are among measures to be implemented to reduce global SSD burden.

Work-related dermatitis (WRD) represents a broad range of skin conditions such as irritant (ICD) and allergic contact dermatitis (ACD), as well as atopic eczema, that are either caused by or exacerbated by activities at work. In 2010, WRD affected 15.2 million American workers, representing 9.8% of the US working population. In 2016, we conducted the first “Congo Coltan Miners’ Health Study.” The present report comprises findings related to WRD. Here, data from 398 workers (199 coltan miners matched to 199 unexposed office workers) are reported. Workstation air quality (PM2.5 and volatile organic compounds or VOC levels) was monitored using BRAMC Air Quality Monitor BR-AIR-329. Each participant answered two questionnaires related to skin and respiratory health. Higher PM2.5 levels were detected at coltan miners’ workstations as compared with control sites (range, 180–210 μg/m3 vs. 19–44 μg/m3, respectively; p < 0.001); similarly, higher VOC levels were also found in coltan miners’ workstations (range, 1.4–2.3 vs. 0.5–0.8, respectively; p < 0.05). Additionally, markedly higher proportion of miners reported dermatitis for the last 12-month period (37% vs. 7%) and in the previous years as compared with controls (36.2% vs. 7%, respectively; p < 0.001). Furthermore, coltan mining work was strongly associated with WRD in the last 12-month period (aOR = 4.88 ± 1.15; 95% CI, 2.06–11.33) and in the previous years (aOR = 9.48 ± 12.3; 95% CI, 3.74–120.49). This first study on African informal coltan miners’ health showed striking results, with high dust exposure levels (PM2.5, VOC) and high frequency of WRD, suggesting the necessity to implement dust control measures to improve occupational safety in coltan mining settings.

Background. Malaria and schistosomiasis remain life-threatening public health problems in sub-Saharan Africa. The infection pattern related to age indicates that preschool and school-age children are at the highest risk of malaria and schistosomiasis. Both parasitic infections, separately or combined, may have negative impacts on the haemoglobin concentration levels. The existing data revealed that artemisinin derivatives commonly used to cure malaria present also in antischistosomal activities. The current study investigated the impact of Artesunate-Amodiaquine (AS-AQ) on schistosomiasis when administered to treat malaria in rural area of Lemfu, DRC. Methodology. A prospective longitudinal study including 171 coinfected children screened for anaemia, Schistosoma mansoni, and Plasmodium falciparum infections. The egg reduction rate and haemoglobin concentration were assessed four weeks after the treatment with AS-AQ, of all coinfected children of this series. Results. One hundred and twenty-five (74.4%) out of 168 coinfected children treated and present during the assessment were found stool negative for S. mansoni eggs. Out of 43 (25.6%) children who remained positives, 37 (22%) showed a partial reduction of eggs amount, and no reduction was noted in 3.6% of coinfected. The mean of haemoglobin concentration and the prevalence of anaemia were, respectively, 10.74±1.5g/dl , 11.2±1.3g/dl, and 64.8%, 51.8%, respectively, before and after treatment, p Conclusion. The AS-AQ commonly used against Plasmodium allowed curing S. mansoni in coinfected children and increasing the Hb level. For the future, the randomized and multicentric clinical trials are needed for a better understanding of the effectiveness of AS-AQ against Schistosoma spp. The trial registration number was 3487183.

Background Rubella is an acute infectious disease caused by Rubella virus (RUBV). RUBV remains an important pathogen worldwide, causing approximately 100 000 cases of congenital rubella syndrome (CRS) every year; and the most severe consequence of rubella is teratogenicity. The aim of this study was to estimate the prevalence of RUBV IgG antibodies and determine RUBV genotypes in Congolese pregnant women in Kongo central province, Democratic Republic of Congo (DRC). Methods This was a prospective cross-sectional study that consisted of a laboratory analysis of blood samples from 78 pregnant women to check for the presence of RUBV IgG antibodies, and also determine RUBV genotypes in seropositive samples (using primers targeting RUBV nucleoprotein), with the use of serological and molecular methods, respectively. Participants were pregnant women attending antenatal care clinics (ANC) at two health zones of Kisantu town in DRC. They were followed-up from the first to third trimester. Those who were negative for RUBV antibodies at the initial assay (first trimester) were tested in the second and, eventually, the third trimester. Results An overall rubella seroprevalence of 58.97% was observed, whereas RUBV nucleoprotein was detected in 60% of randomly selected 30 blood samples among the 46 RUBV seropositive pregnant women. Five (27.77%) of positive samples were positive for both RUBV genotypes (RV8633/9112 and RV8945/9577), whereas 11 (61.11%) of them were positive for RV8633/9112 and two (11.11%) were positive for RV8945/9577 only. Regarding rubella clinical signs and complications, two subjects (2.56%) presented with fever, whereas five pregnant women (6.41%) had experienced abortion. None (0%) of the participants has been vaccinated against RUBV. Conclusions Findings from this study suggest that RUBV is prevalent in Congolese pregnant women. Further research is required to elucidate the molecular epidemiology of RUBV in order to design a rational rubella surveillance and control program in DRC.

Blood safety is a major element in the strategy to control the HIV epidemic. The aim of this study was to determine the prevalence and the associated factors of a positive HIV test among blood donors and its association between Human African Trypanosomiasis in Kikwit, the Democratic Republic of Congo. A cross-sectional study was conducted between November 2012 and May 2013. An anonymous questionnaire was designed to extract relevant data. The average mean age of participants was 30 years. The majority were man (67.8%). The overall prevalence of HIV, syphilis, hepatitis B, hepatitis C and human African trypanosomiasis was respectively 3.2%, 1.9%, 1.6%, 1.3% and 1.3%. Alcohol intake, casual unprotected sex, not using condoms during casual sex, sex after alcohol intake and seroprevalence of human African trypanosomiasis were significantly associated with a positive HIV test result ( p

The decision to initiate the antiretroviral therapy in HIV-infected children living in poor countries is compromised by lack of resources. The objective of this study is to identify simple clinical and biological markers other than CD4+ count and viral load measurement that could help the decision to introduce antiretroviral treatment and to monitor patients.A cross sectional study was conducted between January and March 2005 in Kinshasa, Democratic Republic of Congo.Eighty-four children infected with HIV were recruited. In this cohort, the lymphocytes (P = 0.001) and CD4 (P = 0.0001) were significantly lower in children with immunological stage 3 and viral load (P = 0.027) was significantly higher in children at the same immunological stage. Reticulocytes (r = +0.440), white blood cells count (r = +0.560), total lymphocytes (r = +0.675) and albumin (r = +0.381) showed positive significant correlations with CD4. Haemoglobin (r = - 0.372), Haematocrit (r = - 0.248), red blood cells (r = - 0.278) and CD4 (r = - 0.285) showed negative significant correlations with viral load. Neutropaenia (P = 0.02), enlarged nodes (P = 0.005) and oral candidiasis (P = 0.04) were associated with viral load10,000 copies/ml. Oral candidiasis (P = 0.02) was associated with CD4 level15%.Oral candidiasis, enlarged nodes, total lymphocytes count, neutropaenia and albumin predict severe immunodepression. These clinical and biological markers may guide the clinician in making the decision to initiate antiretroviral therapy in highly resource-scarce settings.

International audience; Background: HIV and malaria are among the leading causes of morbidity and mortality during pregnancy in Africa. However, data from Congolese pregnant women are lacking. The aim of the study was to determine the magnitude, predictive factors, clinical, biologic and anthropometric consequences of malaria infection, HIV infection, and interactions between malaria and HIV infections in pregnant women. Methods: A cross-sectional study was conducted among pregnant women admitted and followed up at Camp Kokolo Military Hospital from 2009 to 2012 in Kinshasa, the Democratic Republic of Congo. Differences in means between malaria-positive and malaria-negative cases or between HIV-positive and HIV-negative cases were compared using the Student's t-test or a non-parametric test, if appropriate. Categorical variables were compared using the Chi-square or Fisher's exact test, if appropriate. Backward multivariable analysis was used to evaluate the potential risk factors of malaria and HIV infections. The odds ratios with their 95% confidence interval (95% CI) were estimated to measure the strengths of the associations. Analyses resulting in values of P < 0.05 were considered significant. Results: A malaria infection was detected in 246/332 (74.1%) pregnant women, and 31.9% were anaemic. Overall, 7.5% (25/332) of mothers were infected by HIV, with a median CD4 count of 375 (191; 669) cells/μL. The mean (±SD) birth weight was 2,613 ± 227 g, with 35.7% of newborns weighing less than 2,500 g (low birth weight). Low birth weight, parity and occupation were significantly different between malaria-infected and uninfected women in adjusted models. However, fever, anemia, placenta previa, marital status and district of residence were significantly associated to HIV infection. Conclusion: The prevalence of malaria infection was high in pregnant women attending the antenatal facilities or hospitalized and increased when associated with HIV infection.

Cryptosporidium is an important protozoan parasite affecting HIV/AIDS patients. To determine the prevalence and the species of Cryptosporidium spp by developing a rapid and efficient real-time PCR-RFLP test. A cross-sectional study was conducted among HIV-infected adults from Kinshasa, the Democratic Republic of Congo. Stool specimens were examined by microscopic evaluation and real-time PCR-RFLP. Out of 242 HIV-infected adults, 10 (4.1%) cases of Cryptosporidium were identified by microscopic examination. Using PCR-RFLP, the prevalence of Cryptosporidium spp was 5.4% (n = 13). All the 13 cases of Cryptosporidium spp had the stage of AIDS of HIV infection. Extracted DNA was amplified by nested PCR targeting a 1030-bp fragment of the 18s RNA gene. RFLP analysis identified one C. parvum, four C. hominis and one non determined Cryptosporidium. The capacity to detect C. parvum, C. hominis and non-determined Cryptosporidium was present among our HIV-infected patients.

Madone Mandina Ndona,1 Benjamin Longo-Mbenza,2 Roger Wumba,3 Barthelemy Tandu Umba,4 Baudouin Buassa-bu-Tsumbu,5 Marcel Mbula Mambimbi,1 Thaddée Odio Wobin,1 Simon Mbungu Fuele61Department of Internal Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo; 2Walter Sisulu University, Faculty of Health Sciences, Mthatha, Eastern Cape, South Africa; 3Tropical Medicine Department, Infectious and Parasitic Diseases, University Clinic of Kinshasa and University of Kinshasa, Kinshasa, Democratic Republic of Congo; 4Department of Gynecology, 5Department of Biochemistry, University of Kinshasa, Kinshasa, Democratic Republic of Congo; 6Biostatistics Unit of Lomo Medical Center and Heart of Africa Center of Cardiology, Kinshasa, Democratic Republic of CongoBackground: The purpose of this study was to determine the cross-sectional association between some sociodemographic factors and antiretroviral therapy (ART), as well as the incidence and predictors of type 2 diabetes mellitus among Central Africans with human immunodeficiency virus (HIV) disease.Methods: This study had a cross-sectional design and was a prospective analysis of 102 patients with HIV disease (49 on ART versus 53 not on ART) in Kinshasa, Democratic Republic of Congo, between 2004 and 2008. A Cox regression model was used to assess for any relationship between type 2 diabetes and exposure to combination ART without protease inhibitors, after adjusting for known risk factors for type 2 diabetes, nadir CD4 and CD8 levels, viral load, marital status, and religion.Results: Unexpectedly elevated rates of smoking, excess alcohol intake, and ART-related total, abdominal, and peripheral obesity were observed in our study group of HIV patients. At the end of follow-up, five patients were diagnosed with type 2 diabetes (incidence rate 4.9%, 9.8 per 1000 person-years). Univariate risk factors for type 2 diabetes were male gender (relative risk [RR] 1.1, 95% confidence interval [CI] 1.01–1.4; P = 0.019), traditional religion versus new charismatic religion (RR 1.1, 95% CI 1.01–1.3; P = 0.046), exposure to ART (RR 1.1, 95% CI 1.002–1.3; P = 0.034), and single status (RR 6.2, 95% CI 1.5–15; P = 0.047). In multivariate analysis, strong significant independent predictors of type 2 diabetes were belonging to a traditional religion (HR 2.1, 95% CI 1.1–4.2; P = 0.036) and a relative increase in nadir CD4 cell count (beta coefficient 0.003; P < 0.0001).Conclusion: ART-related obesity and type 2 diabetes are becoming increasing problems in Central Africans with HIV disease. A relative increase in nadir CD4 count and traditional religion status appear to be the strongest independent predictors of type 2 diabetes.Keywords: human immunodeficiency virus, diabetes mellitus, risk factors, Africans, religion

Roger Wumba,1 Benjamin Longo-Mbenza,2 Jean Menotti,3,4 Madone Mandina,5 Fabien Kintoki,5 Nani Hippolyte Situakibanza,1,5 Marie Kapepela Kakicha,6 Josue Zanga,1 Kennedy Mbanzulu-Makola,1 Tommy Nseka,1 Jean Pierre Mukendi,1 Eric Kendjo,7 Jean Sala,1 Marc Thellier7,81Department of Tropical Medicine, Infectious and Parasitic Diseases, Department of Parasitology, University Clinic of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Congo; 2Faculty of Health Sciences, Walter Sisulu University, Eastern Cape, South Africa; 3Laboratory of Parasitology and Mycology, Saint-Louis Hospital, Public Assistance-Hospitals of Paris, Paris, France; 4Faculty of Medicine, Lariboisière-Saint-Louis, University of Paris VII, Paris, France; 5Department of Internal Medicine, University Clinic of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Congo; 6Department of Pediatrics, University Clinic of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Congo; 7National Center for Malaria Research, AP-HP, CHU Pitie Salpêtrière, Paris, France; 8Laboratory of Parasitology and Mycology, Pitié Salpêtrière Hospital, Public Assistance-Hospitals of Paris, Pierre and Marie Curie University, Paris, FranceBackground: The objective of this study was to determine the prevalence of intestinal parasites, with special emphasis on microsporidia and Cryptosporidium, as well as their association with human immunodeficiency virus (HIV) symptoms, risk factors, and other digestive parasites. We also wish to determine the molecular biology definitions of the species and genotypes of microsporidia and Cryptosporidium in HIV patients.Methods: In this cross-sectional study, carried out in Kinshasa, Democratic Republic of the Congo, stool samples were collected from 242 HIV patients (87 men and 155 women) with referred symptoms and risk factors for opportunistic intestinal parasites. The analysis of feces specimen were performed using Ziehl–Neelsen stainings, real-time polymerase chain reaction (PCR), immunofluorescence indirect monoclonal antibody, nested PCR-restriction fragment length polymorphism, and PCR amplification and sequencing. Odds ratio (OR) and 95% confidence intervals were used to quantify the risk.Results: Of the 242 HIV patients, 7.8%, 0.4%, 5.4%, 0.4%, 2%, 10.6%, and 2.8% had Enterocytozoon bieneusi, Encephalitozoon intestinalis, Cryptosporidium spp., Isospora belli, pathogenic intestinal protozoa, nonpathogenic intestinal protozoa, and helminths, respectively. We found five genotypes of E. bieneusi: two older, NIA1 and D, and three new, KIN1, KIN2, and KIN3. Only 0.4% and 1.6% had Cryptosporidium parvum and Cryptosporidium hominis, respectively. Of the patients, 36.4%, 34.3%, 31%, and 39% had asthenia, diarrhea, a CD4 count of

Objective. To determine the prevalence and the genotypes ofEnterocytozoon bieneusiin stool specimens from HIV patients.Methods. This cross-sectional study was carried out in Kinshasa hospitals between 2009 and 2012. Detection of microsporidia includingE. bieneusiandE. intestinaliswas performed in 242 HIV-infected patients. Typing was based on DNA polymorphism of the ribosomal DNA ITS region ofE. bieneusi. PCRRFLP generated with two restriction enzymes (Nla III and Fnu 4HI) in PCR-amplified ITS products for classifying strains into different lineages. The diagnosis performance of the indirect immune-fluorescence-monoclonal antibody (IFI-AcM) was defined in comparison with real-time PCR as the gold standard.Results. Out of 242 HIV-infected patients, using the real-time PCR, the prevalence ofE. bieneusiwas 7.9% (n=19) among the 19E. bieneusi, one was coinfected withE. intestinalis. In 19E. bieneusipersons using PCR-RFLP method, 5 type I strains ofE. bieneusi(26.3%) and 5 type IV strains ofE. bieneusi(26.3%) were identified. The sensitivity of IFI-AcM was poor as estimated 42.1%.Conclusion. Despite different PCR methods, there is possible association between HIVinfection, geographic location (France, Cameroun, Democratic Republic of Congo), and the concurrence of type I and type IV strains.

To determine the prevalence and the species spectrum of intestinal parasites (IP) involved in hospitalized AIDS patients, a prospective observational and cross-sectional study was carried out in the four main hospitals in Kinshasa, Democratic Republic of the Congo. From November 2006 through September 2007, a single stool sample was collected from 175 hospitalized AIDS patients older than 15 years. Parasites were detected by light microscopy, including Ziehl-Neelsen, Fungi-Fluor, modified trichrome stains, and by immunofluorescence antibody tests and PCR for species diagnosis of microsporidia. At baseline, 19 patients (10.8 %) were under antiretroviral therapy and 156 (89.2 %) were eligible for ART. The main diagnosis for justifying hospitalization was intestinal infection associated with diarrhea in 87 out of 175 (49.7 %). 47 out of 175 (26.9 %) were found to harbor an IP, and 27 out of 175 (15.4 %) were infected with at least one opportunistic IP (OIP). Prevalence rate for OIP were 9.7 %, 5.1 %, 1.7 % and 0.6 % for Cryptosporidium sp., Enterocytozoon bieneusi, Isospora belli and Encephalitozoon intestinalis respectively. Considering patients with diarrhea only, prevalence rate were 12.6 %, 4.6 %, 3.4 % and 1.1 % respectively. The other IP observed were Entamoeba histolytica/Entamoeba dispar in nine cases (5.1 %), Ascaris lumbricoïdes in seven cases (4.0 %), Giardia intestinalis in three cases (1.7 %), hookworm in two cases (1.1 %) and Trichiuris trichiura, Enterobius vermicularis, Schistosoma mansoni in one patient each (0.6 %). No significant relationship was established between any individual IP and diarrhea. These results underline the importance of OIP in symptomatic AIDS patients regardless of diarrhea at the time of the hospitalisation, and showed that routine microscopic examination using stains designed for Cryptosporidium spp. or the microsporidia should be considered due to the absence of clinical markers.