Need for standardization and compliance to treatment protocols for COVID-19 within the African Region of the World Health Organization

COVID-19 pandemic changed the face of global health and brought about new issues in global health security and economy. The World Health Organization published guidelines for clinical management of COVID-19 four months after declaration of COVID-19 as a pandemic. Scholarly reviews and studies from member states within WHO AFRO reveals significant deviation from the WHO published protocols on COVID-19. Assessment of national treatment protocols of 30 of 47 WHO AFRO member states showed widespread inappropriate use of antimicrobial agents for patients, which may worsen the global and concerning threat of antimicrobial resistance. There is need for adopting interventions that optimize antimicrobial use in the context of pre- and post-pandemic preparedness to ensure long-term effectiveness and sustainability for antimicrobials. Treatment guidelines are to be adopted or adapted depending on best clinical evidence available. Non-compliance with guidelines might lead to mismanagement of infectious diseases with attendant negative consequences including antimicrobial resistance and misdirection of critical resources and supplies amongst others.

La pandémie de COVID-19 a changé le visage de la santé mondiale et a soulevé de nouveaux problèmes en matière de sécurité sanitaire et d'économie mondiale. L'Organisation mondiale de la santé a publié des lignes directrices pour la gestion clinique du COVID-19 quatre mois après la déclaration du COVID-19 comme pandémie. Les revues scientifiques et les études des États membres de l'OMS AFRO révèlent un écart significatif par rapport aux protocoles publiés par l'OMS sur le COVID-19. L'évaluation des protocoles nationaux de traitement de 30 des 47 États membres de l'OMS AFRO a révélé une utilisation inappropriée et généralisée d'agents antimicrobiens chez les patients, ce qui pourrait aggraver la menace mondiale et préoccupante de résistance aux antimicrobiens. Il est nécessaire d'adopter des interventions qui optimisent l'utilisation des antimicrobiens dans le contexte de la préparation pré et post-pandémique afin de garantir l'efficacité et la durabilité à long terme des antimicrobiens. Les directives thérapeutiques doivent être adoptées ou adaptées en fonction des meilleures preuves cliniques disponibles. Le non-respect des directives pourrait conduire à une mauvaise gestion des maladies infectieuses avec des conséquences négatives qui en découlent, notamment la résistance aux antimicrobiens et une mauvaise orientation des ressources et fournitures essentielles, entre autres.

A rapid assessment of the National Regulatory Systems for medical products in the Southern African Development Community.

BACKGROUND: Access to quality-assured, safe and efficacious medical products is fundamental for Universal Health Coverage and attaining Sustainable Development Goal 3: Ensure Healthy Lives and Well-being for All. To guarantee this right, there is a need for robust and efficiently performing national regulatory systems for the regulation of medical products. Well-functioning regulatory systems apply globally accepted standards which ensure that the level of control is proportionate to the level of public health risk. OBJECTIVE OF THE STUDY: The study aimed at analysing the regulatory systems for medical products in the 16 Member States of the Southern African Development Community (SADC). It provides an overview of the national regulatory systems for medical products in the region in 2017 and outlines the institutional frameworks, which enable the implementation of regulatory functions. METHODOLOGY: A survey was conducted in March-December 2017 in English, French and Portuguese. National Regulatory Authorities for medical products (NMRAs) of the 16 Member States within SADC responded to the questions asked and sent in their answers. The survey was constructed around five themes instrumental for implementation of the Universal Health Coverage actions framework. Three of the themes are discussed in this article. RESULTS: The outcome of the survey demonstrates that within SADC, NMRAs vary in terms of organisational set-up and modalities of medical product regulation. The majority are within the Ministries of Health, and a few are either semi-autonomous or autonomous. Legal frameworks for medical products are in place for some of the SADC NMRAs, although they vary in the scope of products subject to regulation. Traditional medicines, biologicals and medical devices are regulated, however not uniformly across the region. CONCLUSION: Despite major progress over the years, the survey demonstrates variable levels of governance and regulatory framework among NMRAs in SADC. The survey supports the need for shifting from the broad strengthening of the regulatory systems which exist and are underpinned by the mandates, to more product-type focused approaches. This shift will ensure that medical products are quality-assured, safe and effective for a performant Health Systems attainment of the Universal Health Coverage and Sustainable Development Goals.

Transfusion in the WHO African Region.

INTRODUCTION: Different evaluations conducted on blood safety between 2004 and 2013 in Africa showed some progress in most countries. This paper describes the current status of the availability and access to safe blood in the Region. METHODS: A cross-sectional survey was conducted from January to December 2018. Data were collected through a questionnaire prepared using key indicators of blood safety and analysis was done using Excel 2010 and results were compared to those of the 2013. RESULTS: A total of 2,678 blood centres were reported including 244 (9%) stand-alone and 2,434 (91%) hospital based. Amongst these countries, 90.2% had a blood policy, 60.1% participated in an External Quality Assessment Scheme for Transfusion Transmissible Infections screening, 12% had accredited blood services, 73.2% had national guidelines on clinical use of blood and 78% had a government budget. The total number of blood units collected was 4,899,913 and the average proportion of voluntary blood donations was 71%. Plasma-derived medicinal products were included in the national essential medicines list in 52.6% of countries. The average proportion of units of blood tested for infections was 99.5% for HIV, 92.3% for HBV, 98.9% for HCV, 98.8% for syphilis. The percentage of whole blood separated into blood components was 63.4%. CONCLUSION: Countries in the region continue to improve availability and access to safe blood, but challenges still remain and call for concrete actions required to reach universal access to quality and safe blood for transfusion throughout the region.

The contribution of the French Muskoka Fund to improving access to essential medicines and priority health products for mothers and children.

One objective of the French Muskoka Fund since 2011 has been to improve the availability of quality healthcare services for mothers and children and thus to contribute to the continued presence of essential drugs and affordable quality health products and to their rational use by healthcare personnel. This project thus contributed to reinforcing the work of the national regulatory authorities, guarantor of the quality of the products supplied to the populations, but also to strengthening the coordination of supplies at the country level. It also enabled the provision of support for the implementation of drug price controls and helped to strengthen the ability of healthcare staff to optimize their use of the products available to them. This work should be continued in these countries as they meet the agenda of the Sustainable Development Goals, which require the establishment of universal healthcare coverage.

Evaluation of the Antiplasmodial Activity and Lethality of the Leaf Extract of Cassia alata L. (Fabaceae).

OBJECTIVE: Cassia alata L. (Fabaceae), one of the three plants contained in Saye, a polyherbal antimalarial remedy was assessed for its antimalarial potential and safety in mice. METHODOLOGY: Organic extracts were prepared from the leaves and tested on the D 10 chloroquine-sensitive strain of Plasmodium falciparum using the parasite lactate dehydrogenase assay. The 4 days suppressive test using Plasmodium berghei in mice was used to evaluate the in vivo antiplasmodial activity of the extracts. Animals were treated by oral route, once a day with 50, 100, 250 and 400 mg kg -1 b.wt., of the extracts. The acute toxicity of the extracts was assessed in mice according to Thompson and Weil method. The lethal effects of the extracts on animal's body weight, tissues, biochemical and haematological parameters were determined at 823.5, 1235.5, 1853 and 2779.5 mg kg -1 b.wt., respectively. RESULTS: The dichloromethane/methane (1:1, v/v) extract of Cassia alata was the most active against Plasmodium falciparum. The mean percent suppression of parasitemia in mice was equal to 22.5, 41.8 and 45.2% at 50, 250 and 400 mg kg -1 b.wt., respectively. No death and no clinically significant changes were recorded in mice. The maximum non-lethal dose was more than 16875 mg kg -1 in animals. No significant changes were observed in body weight, tissues morphology, biochemical and hematological parameters at doses above or equal to 2779.5 mg kg -1 b.wt. CONCLUSION: The dichloromethane/methanol leaf extract of Cassia alata had a good to moderate in vitro and in vivo antiplasmodial activity and was found to have low toxicity at high doses in tested animals.

[Prevalence of intestinal parasites at Saint-Camille medical center in Ouagadougou (Burkina Faso), 1991 to 2010]. / Prévalence des parasites intestinaux de 1991 à 2010 au centre médical Saint-Camille de Ouagadougou (Burkina Faso).

BACKGROUND: Intestinal parasitoses continue to be a major public health problem in developing countries. OBJECTIVES: This study sought to evaluate the prevalence of intestinal parasites and their coinfection rates in patients attending the Saint-Camille medical center in Ouagadougou. Methodology. This retrospective study covers the period from 1991 through 2010. RESULTS: In all, 292,148 stool samples were analyzed, and 177,672 contained at least one parasite, for a prevalence rate of 60.82%. Protozoans accounted for 90.53% of the parasites identified (160,838) and helminthes 9.47% (16,834). The most common protozoans were Entamœba histolytica/dispar (39.88%), Trichomonas intestinalis (25.78%) and Giardia intestinalis (24.83%). The helminthes encountered most frequently were Hymenolepis nana (3.99%) and Ancylostoma spp (3.65%). Globally, the prevalence of parasites decreased over the 20-year study period. The prevalence of E. histolytica/dispar decreased while that of Giardia intestinalis became more frequent. The most common parasitic associations were E. histolytica/dispar-G. intestinalis (26.24%) and G. intestinalis-T. intestinalis (20.09%). CONCLUSION: Our results indicate that Burkina Faso is a zone at high prevalence of intestinal parasitosis, even though this prevalence appears to be decreasing. Appropriate strategies should be developed to accelerate the reduction in the incidence of these parasites.

Etude comparee des effets anti-hepatotoxiques d'extraits d'Argemone mexicana L. (Papaveraceae); une plante utilisee dans le traitement traditionnel de la jaunisse au Burkina Faso

Argemone mexicana L. (Papaveraceae) fait l'objet de nombreuses indications therapeutiques en medecine traditionnelle dans la region des Cascades au Burkina Faso. Dans une etude preliminaire de 2006; il a ete mis en evidence une activite anti-hepatotoxique du decocte aqueux lyophilise des feuilles chez le rat Wistar prealablement icterise par une administration de tetrachlorure de carbone CCl4 (0;5 mL/kg; i.p.). Dans la presente etude; les auteurs projettent de comparer les effets anti-hepatotoxiques de trois (03) extraits de la plante notamment deux extraits aqueux lyophilises (decocte et macere) et un extrait du totum alcaloidique; tous administres a differents lots de rats rendus initialement icteriques par injection de l'hepatotoxique. La silymarine (100 mg/kg) a ete utilisee comme produit de reference anti-hepatotoxique. Les trois extraits (250 mg/kg; p.o.) ont temoigne une action anti-hepatotoxique significative (p0;05) objectivee par un pourcentage de reduction notable des marqueurs biochimiques enzymatiques notamment les transaminases (ASAT/GOT; ALAT/GPT); la phosphatase alcaline (PAL) et la bilirubine directe (DBil). Les pourcentages moyens de reduction d'hepato-toxicite induite ont ete de 79;4 (silymarine); 69;73 (decocte lyophilise); 70;63 (macere lyophilise) et 72 (totum alcaloidique). Ces resultats illustrent d'une part la preeminence de l'action pharmacologique anti-hepatotoxique de l'extrait de totum alcaloidique compare aux extraits aqueux lyophilises et d'autre part; l'effet des extraits pris isolement reste en deca de celui de la silymarine

Dichloromethane-methanol extract from Borassus aethiopumn mart. (Arecaceae) induces apoptosis of human colon cancer HT-29 cells.

Borassus aetihiopum MART (Arecaceae) is a plant used in traditional herbal medicine for the treatment of various diseases (bronchitis, laryngitis, antiseptic). In particular, their male inflorcscences were reported to exhibit cicatrizing, antiseptic and fungicidal properties. In the present study, the biological activity of E2F2, an apolar extract from Borassus aethiopum male inflorescence was investigated on colon cancer HT29 cells. Phytochemical screening was carried according to methodology for chemical analysis for vegetable drugs. Cells proliferation was determined by the MTT assay and cells cycle distribution was analysed by using laser flow cytometer (Beckman coulter). The cytoskeleton organisation was examined under a laser scanning confocal microscope (Zess). Preliminary phytochemical analysis of E2F2 extract revealed the presence of sterols, triterpenes and saponosids. E2F2 extract (1 microg and 100 microg mL(-1)) significantly inhibited cell proliferation by blocking cell population in G0/G1 phase. Flow Cytometric analysis of E2F2-treated HT29 cells showed that hypoploïd cell population (sub G1 phase) increased with processing time exposures. Immunofluorescence confocal analysis revealed a disrupt actin microfilaments network in E2F2 treated-cells with a significant reduction in actin stress fibres and appearance of a random, non-oriented distribution of focal adhesion sites. These data indicate that E2F2 extract has anti-proliferative and pro-apoptotic activities. Further studies are required to unravel the mechanisms of action of E2F2 extract.

[Epidemiology, characterization of genotypes of human papillomavirus in a population of women in Ouagadougou]. / Épidémiologie et caractérisation des génotypes de papillomavirus humain dans une population de femmes à Ouagadougou.

OBJECTIVES: This work was carried out in order to determine the prevalence of different HPV genotypes in a population of women attending gynecological consultation. MATERIAL AND METHODS: From May to June 2010, cervical samples were obtained from 300 women attending gynecological consultation in two health centers in Ouagadougou. The strains of HPV genotyping was done using the technique of polymerase chain reaction (PCR) followed by reverse hybridization on nitrocellulose strips. RESULTS: Among the 73 women(24.3%) infected with HPV, only 27.4% (20/73) of them were infected with a HPV low risk (BR), the 72.6% (53/73). Other women were infected with at least one high risk HPV (HR). By combining the HPV genotypes found without taking into account the number of infected women, we found a total of 84 HPV among whom we have high-risk HPV : HPV-50'S(26/84 or 31.0%), HPV-18 (12/84 or 14.3%), HPV-16 (9/84 or 10.7%), HPV-30'S (5/84 or 5.9%), HPV-HR (5/84 or 5.9%) and HPV-45 (3/84 or 3.6%) and low-risk HPV: HPV-6 (15/84 or 17.9%) and HPV-BR (9/84 or 10.7%). We have found no HPV-11. DISCUSSION AND CONCLUSION: The prevalence of HPV found in our series is comparable to that found in the world. To complete this study, it would be necessary to investigate the prevalence of HPV found in cervical lesions in Burkina Faso.

Prevalence and genotype characterization of human papillomaviruses among HIV-seropositive in Ouagadougou, Burkina Faso.

BACKGROUND: Approximately, 15-20 of 40 HPVs that infect the female genital tract confer a high-risk of invasive cancer, thus HPVs account for 95% of cervix cancers. The objectives of this study were to: (i) estimate the prevalence of HPV infection in women infected with HIV in Ouagadougou, (ii) identify potential carcinogenic HPV strains and (iii) determine whether existing HPV vaccines match the isolated strains. METHODS: From May 2009 to April 2010, 250 HIV-infected women were included in this study. Each woman was screened for the presence of HPV and for HPV genotype using PCR/hybridization technique. RESULTS: Of the 250 HIV-infected women, 59.6% were infected with at least one type of HPV. High-risk HPVs were identified with the following prevalence: HPV-18 (25.0%); HPV-50'S (25.5%); HPV-30'S (20.8%); HPV-16 (4.7%); HPV-45 (3.7%). Low-risk HPVs were represented by HPV-6 (5.7%) and HPV-11 (0.9%). CONCLUSION: The issue of the study showed that the existing vaccines: Gardasil and Cervarix may be used in the country although they match only HPV-16, HPV-18, HPV-6 and HPV-11. Further investigations should be continued for the establishment of vaccine that matches all genotypes circulating in the country.

Evaluation of 13 selected medicinal plants from Burkina Faso for their antiplasmodial properties.

AIM OF THE STUDY: The aim of this study was to evaluate the antiplasmodial properties of 13 plants used against malaria in traditional medicine in Burkina Faso. MATERIALS AND METHODS: In vitro antiplasmodial activity of dichloromethane, methanol and aqueous crude extracts obtained from vegetal samples collected in Burkina Faso was first evaluated on the Plasmodium falciparum 3D7 chloroquine-sensitive strain using a colorimetric method. RESULTS: Thirteen extracts obtained from 8 different species were found to exhibit antiplasmodial activity (IC(50)<50 microg/ml). Five species demonstrated a moderate activity (15 microg/ml

Human papillomaviruses prevalence and genital co-infections in HIV-seropositive women in Ouagadougou (Burkina Faso).

The vaginal swabs among HIV-positive women in Africa often revealed opportunistic infections such as human Papillomavirus (HPV) and Mycoplasma that induce respectively cervix cancer and diseases such as vaginosis, abortions, infertility in through salpingitis. The purposes of this study were to: (1) seek for, the prevalence of pathogens such as HPV and Mycoplasma; (2) characterize the strains of HPV and estimate their prevalence; (3) identify among these women, those who were co-infected by these pathogens in order to cure them. From February 2009 to January 2010, 156 HIV-positive women attending our medical centers and aged from 19-45 years (mean age 33.65 +/- 5.75 years) had voluntarily accepted vaginal specimen's tests. PCR, ELISA and molecular hybridization were used for the identification and characterization of these pathogens. The results revealed the presence of Mycoplasma and HPV in 25.64 and 58.33% cases, respectively. The following HPV genotypes and the following prevalence were recorded: HPV-50'S (24.11%), HPV-18 (21.28%), HPV-30'S (18.44%) and HPV-16 (5.67%). The study also enable the identification of co-infections such as HPV-18 strains with HPV-30'S (5.67%) and HPV-30'S with HPV-50'S (3.55%). Other germs infecting the female genital tract including Candida albicans (20.51%), Escherichia coli (12.18%), Treponema pallidum (3.85%), Streptococcus agalactiae (3.21%) and Staphylococcus aureus (1.92%) were isolated. This preliminary research work showed the incidence of several genital pathogens, this could be a springboard for nationwide epidemiological study on HPV strains circulating in Burkina Faso.

Co-infection of Toxoplasma gondii with HBV in HIV-infected and uninfected pregnant women in Burkina Faso.

Toxoplasma gondii infections can induce serious complications in HIV-infected pregnant women, leading to miscarriage; favour the mother-to-child transmission of HBV and HIV and birth defects. The purposes of this study were: (1) to quantify IgM and IgG antibodies to Toxoplasma gondii in HIV-seropositive and seronegative pregnant women, (2) to identify hepatitis B antigens (HBsAg) in pregnant women and (3) to determine T. gondii and HBV co-infections among these patients. The study was conducted at Centre Medical Saint Camille, in Burkina Faso from January to June 2009. A total of 276 HIV-infected and uninfected pregnant women were included. All women had less than 32 weeks of amenorrhoea and were aged from 19 to 42 years. Toxoplasma gondii antibodies and HBsAg were detected using ELISA method. In addition, women freely agreed to answer a questionnaire. The results of our investigations revealed that, among these pregnant women, 38.8% were illiterates, 50.4% were housewives and only 5.4% were civil servants. Positive T. gondii-specific IgM (4.7%) and IgG (27.2%) were detected. In this study, we found that HIV-seropositive status seem to be associated with great prevalence rates of both T. gondii (31.9 vs. 22.5%) and HBV (13.0 vs. 5.8%). The elevated co-infection rate in HIV-positive women suggested that they are exposed to T. gondii and HBV infections prevalently because of their immune depression. Therefore, to reduce the prevalence of T. gondii and HBV among HIV-seropositive pregnant women, lamivudine could be included in their HEART and women should follow healthy lifestyle formation.

Study of floristic diversity and the structural dynamics of some species providers of non woody forest products in the vegetable formations of the Centre East of Burkina Faso.

The goal of this study is to contribute to a better knowledge of certain species providing Non Woody Forest Products (NWFP) in the Centre East of Burkina Faso. This study aims to determine the state of the resources in Vitellaria paradoxa, Balanites aegyptiaca, Tamarindus indica and Lannea microcarpa. For this purpose, an inventory of the vegetation was carried out in circular pieces of land of 1250 m2, as a sample of the zone of work, based on the chart of occupation of the grounds. We are identified 158 species comprising 90 genera and 47 families. Those species represent more than 90% of the trees from which various parts are used in food, traditional pharmacopeia and the craft industry. We also showed that because of the strong anthropisation of the zone, the bad pedoclimatic conditions and the permanent bush fires, the regeneration and growth of Vitellaria paradoxa, Balanites aegyptiaca, Tamarindus indica and Lannea microcarpa are disturbed.

Mother-to-child HIV and HHV-8 transmission in neonates at Saint Camille Medical Centre in Burkina Faso.

In Sub-Saharan Africa, many HIV infected people are co-infected with Human Herpes Virus 8 (HHV-8). Therefore, the present study aimed to: (1) identify the pregnant women co-infected by HIV and HHV-8 at Saint Camille Medical Centre; (2) use three molecules (Zidovudine, Nevirapine and Lamivudine) to interrupt the vertical transmission of HIV and (3) use the PCR technique to diagnose children, who were infected by these viruses, in order to offer them an early medical assistance. A total of 107 pregnant women, aged from 19 to 42 years were diagnosed to be HIV positive at Saint Camille Centre; among them 13 were co-infected with HHV-8. All included women received the HAART. Two to six months after childbirth their babies underwent PCR diagnosis for HIV and HHV-8. The results revealed that, among these mothers, 68.2% were housewives, 34.6% were illiterates and 60.7% did not have university degree. The prevalence of HHV-8 among these pregnant women was 12.15% and the rate of vertical transmission of both HIV and HHV-8, was 0.0%. The issue of this study revealed that the antiretroviral therapy increased the mother CD4 T-cells, prevented the transcription of the mRNA of HHV-8 and blocked HIV vertical transmission.

Aetiology of acute gastro-enteritis in children at Saint Camille Medical Centre, Ouagadougou, Burkina Faso.

UNLABELLED: The present study aims at identifying the infectious agents responsible for child Acute GastroEnteritis (AGE) in Ouagadougou. From May 5 2006 to June 22 2008, 648 children aged from 2 to 41 months, with at least an average of 3 loose stools per day have been enrolled for coproculture, parasitology and virology test. Among them, 34 (5.25%) were HIV seropositive. A single sample of faeces from each child was used to identify enteropathogens. An infectious aetiology was identified in 41.20% of cases. The pathogenic agents detected as responsible for the AGE are: Rotavirus 21.1%; Adenovirus 1.9%; Giardia 7.6% Entamoeba; 1.08%; entero-pathogenic E. coli 41.7%; Salmonella 3.40%; Shigella 1.85% and Yersinia 1.70%. CONCLUSION: Therefore, these AGE etiologic agents constitute a problem of public health in Burkina Faso. Their control for the child would require: (1) a regular paediatric and clinical follow up; (2) health education of the population for food hygiene and (3) in case of absence of HIV infection in the mother, a promotion of exclusive breast-feeding up to the age of 4 months.

Medicinal plants used in traditional medicine in the centre east region of Burkina Faso.

The present research focused on the inventory and the use of plants in traditional medicine for the treatment of diseases in this area. The method was based on ethnobotanical surveys with semi-directing interview, conducted from November 2006 to December 2007 among a sample of 50 people aged between 40 and 80 years and very experienced in traditional medicine in the municipalities of Bissiga, Lalgaye and Tenkodogo. We identify 73 phytogenetic species and 175 therapeutic indications used to treat 52 diseases and the principal ones are the gastrointestinal diseases, the malaria, the various fevers, the jaundice, the skin diseases, the respiratory affections, the reproduction diseases, the hemorrhoids and the infantile diseases. In traditional veterinary pharmacopoeia, 18 phytogenetic species are used with 33 therapeutic indications to treat diseases including trypanosomiasis, tuberculosis, diarrheas and wounds. The interest of people of this area for medicinal plants, command a special attention to organize the actors and preserve the plant genetic resources.

In vitro and in vivo antiplasmodial activity of 'saye', an herbal remedy used in Burkina Faso traditional medicine.

'Saye', a traditional medicine used in Burkina Faso, which consists of extracts of Cochlospermum planchonii (rhizome), Cassia alata (leaf) and Phyllanthus amarus (whole plant), showed a significant effect against Plasmodium falciparum and Plasmodium berghei parasites grown in vivo (IC(50) = 80.11 +/- 3.40 microg/mL; ED(50) = 112.78 +/- 32.32 mg/kg). In vitro the activity was lower.

Effective program against mother-to-child transmission of HIV at Saint Camille Medical Centre in Burkina Faso.

The present research was aimed to prevent mother-to-child transmission of HIV; to use RT-PCR in order to detect, 6 months after birth, infected children; and to test the antiretroviral resistance of both children and mothers in order to offer them a suitable therapy. At the Saint Camille Medical Centre, 3,127 pregnant women (aged 15-44 years) accepted to be enrolled in the mother-to-child transmission prevention protocol that envisages: (i) Voluntary Counselling and Testing for all the pregnant women; (ii) Antiretroviral therapy for HIV positive pregnant women and for their newborns; (iii) either powdered milk feeding or short breast-feeding and RT-PCR test for their children; (iv) finally, pol gene sequencing and antiretroviral resistance identifications among HIV positive mothers and children. Among the patients, 227/3,127 HIV seropositive women were found: 221/227 HIV-1, 4/227 HIV-2, and 2/227 mixed HIV infections. The RT-PCR test allowed the detection of 3/213 (1.4%) HIV infected children: 0/109 (0%) from mothers under ARV therapy and 3/104 (2.8%) from mothers treated with Nevirapine. All children had recombinant HIV-1 strain (CRF06_CPX) with: minor PR mutations (M36I, K20I) and RT mutations (R211K). Among them, two twins had Non-Nucleoside Reverse Transcriptase Inhibitor mutation (Y18CY). Both mothers acquired a major PR mutation (V8IV), investigated 6 months after a single-dose of Nevirapine. Prevention by single-dose of Nevirapine reduced significantly mother-to-child transmission of HIV, but caused many mutations and resistance to antiretroviral drugs. Based on present study the antiretroviral therapy protocol, together with the artificial-feeding, might represent the ideal strategy to avoid transmission of HIV from mother-to-child.

Characterization of drug-resistance mutations in HIV-1 isolates from non-HAART and HAART treated patients in Burkina Faso.

Non-B HIV subtypes have been estimated to account for 88% of HIV infections in the world. These subtypes are particularly relevant in view of the availability of antiretroviral (ARV) drugs, since subtype-specific mutations are associated with drug-resistance in developing countries. Therefore, the pol gene sequences in HIV-1 isolates were examined from the three distinct groups of 39 infected patients from Ouagadougou in Burkina Faso: 17 patients who had not received any antiretroviral therapy (ART); 16 patients received ART, and 6 HIV-infected children, from infected mothers, received a single Nevirapine dose prophylaxis during birth. HIV-1 pol sequencing was successful for 29 samples. As expected, all patients presented the common (non-B subtype) M36I polymorphism and 26/29 (90%) the K20I mutation. Phylogenetic studies showed high predominance of recombinant HIV-1 strains: CRF06_cpx 16/29 (55.17%), CRF02_AG 9/29 (31.03%), A1 2/29 (6.89%), G 1/29 (3.44%), and CRF09_cpx 1/29 (3.44%). Two twins showed, 6 months after birth, a NNRTI-mutation (Y181C/Y). During the same period, the twin mother presented a different NNRTI-mutation (V106I), thus suggesting that the different blood drug concentration may determine a different drug-resistance pathway. Among 17 non-highly active antiretroviral therapy (HAART) patients, 3/17 (17.64%) presented virus with reverse transcriptase (RT) mutations [V118I: 1/17 patients (5.88%), V179E: 2/17 patients (11.76%)]. 10/17 (58.82%) presented virus with minor protease (PR) mutations [L63P: 5/17 patients (29.41%), V77I: 3/17 patients (17.64%), L10I: 2/17 patients (11.76%)]. 4/17 patients did not show any PR and RT mutations (23.52%). Among six HAART-treated patients, 6/6 and 3/6 had M36I and L63LP protease minor subtypes, respectively; and only two (33.33%) presented virus with K103N mutation. The low prevalence of drug-resistant associated mutations in Burkina Faso is encouraging. However, further studies with a larger cohort with a high non-B subtype prevalence are necessary to optimize ART in developing countries.