Performance of Mali's biosafety level 3 laboratory in the external quality assessment in preparedness of laboratory accreditation and support to clinical trials.

Background: The external quality assessment (EQA) or external quality control is an evaluation conducted by a certified external organization to inquire about the quality of the results provided by a laboratory. The primary role of EQA is to verify the accuracy of laboratory results. This is essential in research because research data should be published in international peer-reviewed journals, and laboratory results must be repeatable. In 2007, the University Clinical Research Center (UCRC's) biosafety level 3 (BSL-3) laboratory joined the EQA program with the College of American Pathologists in acid-fast staining and culture and identification of mycobacteria as per laboratory accreditation preparedness. Thus, after 11 years of participation, the goal of our study was to evaluate the performance of our laboratory during the different interlaboratory surveys. Methods: We conducted a descriptive retrospective study to evaluate the results of UCRC mycobacteriology laboratory from surveys conducted during 2007 and 2017. Results: Of the 22 evaluations, the laboratory had satisfactory (100% of concordance results) in 18 (81.8%) and good (80% of concordance results) in 4 (18.2%). Overall, the laboratory was above the commended/accepted limits of 75%. Conclusion: So far, UCRC's BSL-3 performed well during the first 11 years of survey participation, and efforts should be deployed to maintain this high quality in the preparedness for laboratory accreditation and support to clinical trials.

Diabetes Mellitus among new tuberculosis patients in Bamako, Mali.

INTRODUCTION: Diabetes Mellitus (DM) increases worldwide, mostly in low- and middle-income countries. In Mali, the prevalence in the adult population is estimated at 1.8%, but tuberculosis (TB) patients are not systematically screened. The goal of our study was to determine the prevalence of DM among newly diagnosed TB patients. METHODS: We conducted a cross sectional study and a pilot prospective cohort study in four health centers in Bamako. All patients underwent fasting capillary-blood glucose (FCBG) test at Day 0, and repeated after one-week of TB treatment. Venous FBG test was performed for discrepancies between the two FCBG results. Thereafter, FCBG was performed for pilot study at month-2 (M2) and M5 of TB treatment. RESULTS: Two hundred and one patients were enrolled in this study. Impaired fasting blood glucose was identified in 17 (8.5%), of whom 11 (5.5%) had DM (VFBG >7 mmol/L). Among patients with DM, seven (63.6%) had successful TB treatment outcome, versus 142 (74.7%) of those without DM (p = 0.64), and (OR: 1.69, 95%CI 0.47-6.02). CONCLUSION: The prevalence of DM among TB patients in Bamako exceeds that of the general population and screening at TB diagnosis suffices to identify those with DM. Systematic screening of both diseases will allow better treatment.

Tuberculosis specific responses following therapy for TB: Impact of HIV co-infection.

Characterizing perturbations in the immune response to tuberculosis in HIV can develop insights into the pathogenesis of coinfection. HIV+ TB+ and TB monoinfected (TB+) subjects recruited from clinics in Bamako prior to initiation of TB treatment were evaluated at time-points following initiation of therapy. Flow cytometry assessed CD4+/CD8+ T cell subsets and activation markers CD38/HLA-DR. Antigen specific responses to TB proteins were assessed by intracellular cytokine detection and proliferation. HIV+ TB+ subjects had significantly higher markers of immune activation in the CD4+ and CD8+ T cells compared to TB+ subjects. HIV+ TB+ had lower numbers of TB-specific CD4+ T cells at baseline. Plasma IFNγ levels were similar between HIV+ TB+ and TB+ subjects. No differences were observed in in-vitro proliferative capacity to TB antigens between HIV+ TB+ and TB+ subjects. Subjects with HIV+ TB+ coinfection demonstrate in vivo expansion of TB-specific CD4+ T cells. Immunodeficiency associated with CD4+ T cell depletion may be less significant compared to immunosuppression associated with HIV viremia or untreated TB infection.

Male circumcision and HIV in the Malian military.

In the goal of determine the impact of circumcision in transmission of HIV in military area. A retrospective study has been carried out from January 2000 to December 2005 at the infirmary of Genie military garrison about all HIV positive serology registered in that structure. It was a study of circumcised militaries and uncircumcised militaries as control group. Among 1183 militaries, 1102 were men (93.2%). Among these 1102, 57 were HIV positive (5.1%). Among 1102 military, 154 were uncircumcised and among them 20 were HIV positive (12.9 %). Among 948 of circumcised militaries 37 were HIV positive (3.9%). Circumcision reduces the risk of infection by HIV; however it has to be considered as supplement among other prevention methods.

Male Circumcision and HIV in the Malian Military

In the goal of determine the impact of circumcision in transmission of HIV in military area. A retrospective study has been carried out from January 2000 to December 2005 at the infirmary of Genie military garrison about all HIV positive serology registered in that structure. It was a study of circumcised militaries and uncircumcised militaries as control group. Among 1183 militaries1102 were men (93.2). Among these 1102; 57 have were HIV positive (5.1). Among 1102 military 154 were uncircumcised and among them 20 were HIV positive (12.9). Among 948 of circumcised militaries 37 were HIV positive (3.9). Circumcision reduces the risk of infection by HIV; however it has to be considered as supplement among other prevention methods

Confirmation of immunogenic consensus sequence HIV-1 T-cell epitopes in Bamako, Mali and Providence, Rhode Island.

The design of epitope-driven vaccines for HIV has been significantly hampered by concerns about conservation of vaccine epitopes across clades of HIV. In previous work, we have described a computer-driven method for a cross-clade HIV vaccine comprised of overlapping, highly conserved helper T-cell epitopes or "immunogenic consensus sequence epitopes" (ICS epitopes). Here, we evaluated and compared the immunogenicity of 20 ICS HIV epitopes in ELISpot assays performed using peripheral blood monocytes (PBMC) from HIV-infected donors in Providence, Rhode Island, USA and in Bamako, Mali, West Africa. Each core 9-mer HIV sequence contained in a given consensus peptide was conserved in at least 105 to as many as 2,250 individual HIV-1 strains. Nineteen of the 20 ICS epitopes (95%) were confirmed in ELISpot assays using PBMC obtained from 13 healthy, HIV-1 infected subjects in Providence, and thirteen of the epitopes (65%) were confirmed in ELISpot assays using PBMC derived from 42 discarded blood units obtained at the Central Blood Bank in Bamako. Twelve of the epitopes were confirmed in ELISpot assays performed both in Providence and Bamako. These data confirm the utility of bioinformatics tools to select and design novel vaccines containing "immunogenic consensus sequence" T-cell epitopes for a globally relevant vaccine against HIV; a similar approach may also be useful for any pathogen that exhibits high variability (influenza, HCV, or variola for example). An HIV vaccine containing these immunogenic consensus sequences is currently under development.

Etude des epitopes-T immunogenes pour la mise au point d'un vaccin anti-VIH-1

Vingt ans apres la description du SIDA; la reponse a mediation cellulaire (CD4+; CD8+) constitue aujourd'hui l'espoir pour mettre au point un vaccin global contre toutes les souches du VIH-1. L'Obstacle majeur du developpement d'un tel vaccin est la grande diversite genetique du virus et le polymorphisme des genes du HLA. Cette etude prospec- tive menee entre Aout 2003 et Avril 2004 avait pour objectif d'evaluer la reponse immunitaire cellulaire induite par des epitopes (au nombre de 30 obtenus par des outils de Bioinformatiques) chez les donneurs benevoles de sang. Notre echantillon etait constitue 35 donneurs dont 30 seropositifs au VIH et 5 donneurs seronegatifs. Parmi les 30 epitopes testes 83;33induisait la liberation d'INF- chez au moins un de nos sujets d'etude seropositifs. Les peptides de Classe II (CD4+) ont ete reconnu par 53;33des donneurs VIH positifs. Par contre nos sujets ont moins reconnu les peptides A3 de Classe I (CD8+); seulement 18;18. Les peptides concus a partir de Gag et Pol etaient les plus immunogenes. Il y avait un chevauchement dans les sequences des deux epitopes de Gag les plus reconnu par nos sujets d'etude (HIV_VAX_GAG_ 1043 et ( HIV_VAX_ GAG_ 1044) c'est a dire qu'ils partageaient entre eux un motif qui pourrait etre a l'origine de leur immunogenicite