Challenges faced by the HIV testing system in low- and middle-income countries

Introduction: Determining the HIV status of some individuals remains challenging due to multidimensional factors such as flaws in diagnostic systems, technological challenges, and viral diversity. This report pinpoints challenges faced by the HIV testing system in Cameroon. Case presentation: A 53-year-old male received a positive HIV result by a rapid testing algorithm in July 2016. Not convinced of his HIV status, he requested additional tests. In February 2017, he received a positive result using ImmunoComb® II HIV 1 & 2 BiSpot and Roche cobas electrochemiluminescence assays. A sample sent to France in April 2017 was positive on the Bio-Rad GenScreen™ HIV 1/2, but serotyping was indeterminate, and viral load was < 20 copies/mL. The Roche electrochemiluminescence immunoassay and INNO-LIA HIV I/II Score were negative for samples collected in 2018. A sample collected in July 2019 and tested with VIDAS® HIV Duo Ultra enzyme-linked fluorescent assay and Geenius™ HIV 1/2 Confirmatory Assay was positive, but negative with Western blot; CD4 count was 1380 cells/mm3 and HIV proviral DNA tested in France was 'target-not-detected'. Some rapid tests were still positive in 2020 and 2021. Serotyping remained indeterminate, and viral load was 'target-not-detected'. There were no self-reported exposure to HIV risk factors, and his wife was HIV-seronegative.Management and outcome: Given that the patient remained asymptomatic with no evidence of viral replication, no antiretroviral therapy was initiated. Conclusion: This case highlights the struggles faced by some individuals in confirming their HIV status and the need to update existing technologies and develop an algorithm for managing exceptional cases.

Indications actuelles de l'adenoidectomie; de l'amygdalectomie et de l'adenoamygdalectomie a l'Hopital General de Douala

"Sur une serie de patients operes dans le service ORL de l'Hopital General de Douala; evaluer les indications de la chirurgie des vegetations adenoidiennes et de l'amygdale en fonction des criteres de l' "" Evidence Based Medecine "". MATeRIELS ET MeTHODES etude retrospective colligeant les cas d'amygdalectomie; d'adenoidectomie et d'adenoamygdalectomie sur une periode de six ans a ete entreprise. Ont ete inclus les enfants de 0 a 15 ans. Les indications operatoires ont ete repertoriees. Pour l'analyse l'utilisation de la grille standardisee d'evaluation selon les criteres de l' "" Evidence Based Medecine "" en quatre niveaux de preuve suivant le type d'etude effectue pour la pertinence des indications. ReSULTATS 100 dossiers ont ete colliges repartis en 43 adenoidectomies; 40 adenoamygdalectomies et 17 amygdalectomies. L'age moyen des adenoidectomies etait de 3;5 ans ; 5;4 ans pour l'adenoamygdalectomie et 9 ans pour l'amygdalectomie. Pour l'adenoidectomie 3 indications ont ete relevees; le syndrome d'apnee du sommeil (SAS) dans 48;8 des cas; les rhinopharyngites a repetition dans 34;8 des cas et l'otite des cas. L'adenoamygdalectomie a concerne dans 80 seromuqueuse dans 16;2 des cas le SAS et dans 20 une notion d'angine a repetition. L'amygdalectomie isolee etait plus rare que les deux autres interventions et a ete principalement realisee pour les angines a repetition. CONCLUSION Suivant les criteres de l'EBM le SAS; les rhinopharyngites a repetition et l'otite seromuqueuse sont des indications majeures des adenoamygdalectomies. Les angines a repetition sont en regression."