Pneumocystis jirovecii colonisation in HIV-positive and HIV-negative subjects in Cameroon.

OBJECTIVE: To determine the prevalence of Pneumocystis pneumonia (PCP), a major opportunistic infection in AIDS patients in Europe and the USA, in Cameroon. MATERIALS AND METHODS: Induced sputum samples from 237 patients without pulmonary symptoms (126 HIV-positive and 111 HIV-negative outpatients) treated at a regional hospital in Cameroon were examined for the prevalence of Pneumocystis jirovecii by specific nested polymerase chain reaction (nPCR) and staining methods. CD4 counts and the history of antiretroviral therapy of the subjects were obtained through the ESOPE database system. RESULTS AND CONCLUSION: Seventy-five of 237 study participants (31.6%) were colonised with Pneumocystis, but none showed active PCP. The Pneumocystis colonisation rate in HIV-positive subjects was more than double that of HIV-negative subjects (42.9% vs. 18.9%, P < 0.001). In the HIV-positive group, the colonisation rate corresponds to the reduction in the CD4 lymphocyte counts. Subjects with CD4 counts >500 cells/µl were colonised at a rate of 20.0%, subjects with CD4 counts between 200 and 500 cells/µl of 42.5%, and subjects with CD4 counts <200 cells/µl of 57.1%. Colonisation with Pneumocystis in Cameroon seems to be comparable to rates found in Western Europe. Prophylactic and therapeutic measures against Pneumocystis should be taken into account in HIV care in western Africa.

Hepatitis B and C: neglected diseases among health care workers in Cameroon.

BACKGROUND: Healthcare workers (HCW) are at risk of acquiring blood-borne viral infections, particularly hepatitis B (HBV), hepatitis C (HCV), and HIV, especially in high endemic regions such as sub-Saharan Africa. METHODS: Sera from 237 hospital workers in Southwest Cameroon were tested for anti-hepatitis B core antigen (anti-HBc), hepatitis B surface antigen (HBsAg), anti-hepatitis B surface antigen (anti-HBs), anti-HCV and (on a voluntary basis) for anti-HIV. Information on pre-study testing for HBV, HCV and HIV and pre-study HBV vaccination status was collected from these individuals. RESULTS: The pre-study testing rate among participating hospital staff for HBV was 23.6% (56/237), for HCV 16% (38/237), and for HIV 91.6% (217/237). The pre-study HBV vaccination rate was 12.3% (29/237). Analysis of anti-HBc revealed that 73.4% (174/237) of the hospital staff had been infected by HBV. Active HBV infection (HBsAg positivity) was detected in 15 participants. Anti-HCV was found in four of 237 participants, HIV antibodies were detected in four of 200 participants tested. CONCLUSION: HBV and HCV are neglected diseases among HCW in sub-Saharan Africa. The vaccination rate against HBV was very low at 12.3%, and therefore anti-HBc testing should be mandatory to identify HCW requiring HBV vaccination. Testing for HBV and routine HBV vaccination for HBV-negative HCW should be strongly enforced in Cameroon.

Comparison of HIV-positive women with children and without children accessing HIV care and treatment in the IeDEA Central Africa cohort.

Globally, women comprise half of all people living with HIV, but in sub-Saharan Africa, women are disproportionately affected. Data were obtained from 8419 HIV-infected women at enrollment into 10 HIV treatment programs in Cameroon, Burundi, and the Democratic Republic of the Congo as part of the Central Africa region of the International Epidemiological Database to Evaluate AIDS. We used chi-squared tests to determine if distributions between women with children differed from those without children, in regards to socio-demographic, behavioral and clinical characteristics. Logistic regression was used to determine if motherhood was associated with medication adherence. Of 8419 women, 81.7% had living children. The majority entered care through voluntary testing, and very few entered care through prevention of mother-to-child transmission programs. Women with children were older and more likely to be widowed, more likely to have no formal education and less likely to have attended university than those without children (p<0.05). Women without children were more likely to live in a home with electricity and potable water (p<0.05). There was no difference in adherence between these groups. However, women older than 50 years, those who reported no drug, tobacco, or alcohol use, and those with higher levels of formal education were more likely to report adherence along with those who had been on treatment for more than two years (p<0.05). As women account for a substantial proportion of HIV cases in sub-Saharan Africa, a broader understanding of their characteristics will inform testing, treatment, and support services. Though we did not find differences in adherence between women with children and those without children, we were able to identify other characteristics that may affect adherence. Further inquiry into the nuances of women living with HIV in sub-Saharan Africa is necessary to further understand their needs.