[Association of urinary tract infections and HIV infection in an internal medicine ward of Hospital of Point G-Bamako-Mali]. / L'association infection urinairie st infection VIH a dans le service de medicine interne de l'Hopital du Point G-Bamako-Mali.

We gathered 14 clinical observations of urinary track infections in AIDS patients in Internal Medicine wards from August 1, 1998 to July 31, 1999. Urinary track infection and HIV were both present in 1.75% of 797 hospitalized patients. The specific prevalence was 14.43% among AIDS patients. The sex ratio (female/male) was 1.33. The mean age of patients was 37.2 years with ranges between 25 years and 59 years. Urinary symptoms were discret. Urinary tract infection was primarily evidenced by urine leucocytes > 10(4) organism/ml and a bacteriuria > 10(5) colony-forming units/ml. The main pathogenswere Escherichia coli (42.85%), Klebsiella pneumoniae (28.57%), Colibacilles app. (21.42%) and Enterobacter cloacae (7.14%). All isolated germs were sensible to the gentamicin, to the amikacin, to the nalidixic acid, to the cefoxitine, to the ceftazidime to the cefotaxime and the ciprofloxacin. Cephalosporin of 3rd generation, aminoglycosides, and fluoroquinolone can be used like treatment of first line in urinary tract infection suspicion case in Bamako. Our patients were highly immunosuppressed with the majority of them being in class IV C of CDC of Atlanta (90%) and CD4 count constantly bellow 200 cells/mm3. The main opportunistic affections were non bacilar bacterial pneumopathies (28.57%), oesophagal mycosis (71.42%), the association of cerebral toxoplasmosis and pulmonary tuberculosis (35.71%). All urinary infections were cured by mean of 5 days of treatment. Very few recidivism was found (1 case).

[Frequency, risk factors and prognostic value of anemia associated with HIV/AIDS in the adult in Mali]. / Fréquence, facteurs de risque et valeur pronostique de l'anémie associée au VIH/SIDA chez l'adulte au Mali.

Anaemia is a common complication of the HIV infection. To understand the mechanism of HIV associated anaemia and to suggest a consequent therapeutic approach in adults in Mali, we undertook a prospective case/control study in two services of reference with essentially adults recruitment in Bamako. We studied the frequency, the risk factors and the prognosis value of this complication in 133 patients with HIV infection matched to 133 others non HIV infected. The average age of our patients was 36.08 +/- 8.80 years (age range: 19 to 66 years). The frequency of anaemia was significantly higher in patients with HIV infection compared to the controls (78.9% vs. 51.9%; OR = 2.46; 95% CI [1.56-3.92]). Anaemia was more frequent in women than in men (p = 0.00003). A significant association between anaemia and thrombopenia or lymphopenia was observed only in patients with HIV infection. The severity of anemia was positively associated with the HIV2 infection and the progression of the HIV disease. Mortality was more frequently associated to the anaemia (p < 10(-5)) in patients infected by HIV. These findings suggest that bone marrow depression leading to a decreased red blood cells production is the main mechanism of HIV associated anaemia in adult in Mali. Therefore, without evidence of a best cost-effectiveness ratio of a human recombinant erythropoietin treatment in the context of countries with a low income, the therapy of this haematological complication must be an emergency focusing on red blood cells transfusions.