[Interventional study on Dolutegravir and other antiretrovirals in patients with subclinical atherosclerosis in the Kinshasa Hospital]. / Étude interventionnelle sur le dolutégravir et les autres antirétroviraux dans l'athérosclérosclérose infra-clinique en milieu hospitalier de Kinshasa.

Introduction: After 2016, the World Health Organization (WHO) proposed Dolutegravir (DTG) as an alternative first-line treatment for adults. Thus, the purpose of this study was to identify biomarkers of cardiometabolic risk capable of demonstrating the beneficial effect of Dolutegravir (DTG) compared to other antiretrovirals in predicting atherosclerosis in people living with HIV (PLHIV) and hospitalized in Kinshasa Hospital. Methods: we conducted an interventional study of people living with HIV who had received antiretroviral therapy (ART) for at least 6 months and were treated in the structures of the network coordinated by the Catholic Church (BDOM-Bureau Diocésain des Oeuvres Médicales) and of the University Clinics of Kinshasa (CUK) between January 2017 and December 2021. Subclinical atherosclerosis was defined as Pulsed Pressure (PP) ≥60 mm Hg; Carotid Intima-Media Thickness (CIMT) > 0.8 mm; and Systolic Pressure Index (SPI) < 0.9. Logistic regression was used in the statistical analysis of associations. Results: a total of 334 PLHIV were recruited, of whom 96.1% (n=321) were on ART and 13.9% (n=13) were ART naïve patients. The mean age of PLHIV was 51±12 years with a female predominance (70.4%; n=235); the independent determinants of subclinical atherosclerosis were marital status (aOR: 4. 95% CI 1.5-10.5; p<0.006), low socioeconomic level (aOR: 10.7, 95% CI 2.3-48.7 p<0.002), duration of HIV infection (aOR: 6.6, 95% CI 2.8-16; p<0.0001), duration of antiretroviral therapy ≥9 years (aOR: 0.3, 95% CI 0.2-0.7; p<0.005) and total cholesterol ratio/high-density lipoprotein-cholesterol (CT/HDL-c)(aOR: 2, 95% CI 1.1-3.6; p= 0.034). The mean values of traditional and emergent variables were significantly higher in the previous ART regimen without DTG than in the new regimen with DTG. However, dyslipidemia was detected during the new DTG-based regimen. Conclusion: dyslipidemia was common during the DTG-based regimen. Marital status, low socioeconomic level, duration of HIV infection, duration of antiretroviral treatment beyond 9 years and the TC/HDL-c ratio were identified as determinants of subclinical atherosclerosis in PLHIV on ART hospitalized in the Kinshasa hospital.

Factors Associated with Liver Enzyme Abnormalities in HIV-HBV and/or HCV Co-infected Patients in Kinshasa, Democratic Republic of the Congo: Multicenter Cross-sectional Study.

BACKGROUND AND OBJECTIVE: Liver enzyme abnormalities (LEA) are extremely common and sometimes severe in individuals infected with human immunodeficiency virus (HIV), but data for this disorder are lacking in the developing countries. The objective of this study was to identify factors associated with LEA in HIV-hepatitis B virus (HBV)/hepatitis C virus (HCV) co-infected patients in Kinshasa, Democratic Republic of the Congo. METHODS: This cross-sectional analytical study included 180 people living with HIV (PLWHIV) mono-infected or co-infected with HBV/HCV between November 10, 2013 and January 10, 2014 in Kinshasa. Sociodemographic, clinical, biological, serological, and immunological data were analyzed. Levels of serum glutamate oxaloacetate transferase (SGOT) and serum glutamate pyruvate transaminase (SGPT) were determined. Antibody levels were determined using enzyme-linked immunosorbent assay (ELISA). RESULTS: The mean age of patients was 44.2±11.0 years; female sex was predominant (76.7%). Co-infection, mainly with HBV, but also HCV, was found in 43 (23.9%) patients. Elevated liver enzymes were found in 77 (42.8%) of the patients. No difference was found in the rate of liver enzyme abnormalities between patients with HIV mono-infection or HIV co-infection (46.7% versus 30.2%, respectively; P=0.08). Factors associated with LEA were age ≥50 years (adjusted odds ratio [OR] 2.7; 95% CI 1.4-5.5), duration of HIV infection >3 years (adjusted OR 2.7; 95% CI 1.4-5.5), and CD4 T cells count ≤303 cells/mm3 (adjusted OR 2.2; 95% CI 1.1-4.5). CONCLUSIONS: Liver enzyme abnormalities are frequent in patients co-infected with HIV-HBV/HCV as well as in HIV patients without co-infection. Diagnosis is determined based on age, immunodeficiency, and length of illness.

[Lesions on CT scan in patients hospitalized for coronavirus pneumonia during the first wave of the SARS-CoV-2 pandemic at the University Clinics in Kinshasa (DRC)]. / Lésions tomodensitométriques chez les patients hospitalisés pour pneumonie à COVID-19 lors de la première vague de la pandémie à SARS-CoV-2 aux Cliniques Universitaires de Kinshasa (RDC).

INTRODUCTION: the main purpose of this study is to describe chest computed tomography (CT) findings in 26 patients hospitalized with COVID-19 pneumonia during the first wave of the SARS-CoV-2 pandemic at the University Clinics in Kinshasa (UCK). METHODS: we conducted a descriptive study of chest CT findings in 26 patients hospitalized with coronavirus pneumonia at the UCK over a 9-month period, from March 17 to November 17, 2020. Hitachi - CT-scanner 16 slice was used in all our patients. After analyzing lesions, these were divided into lesions suggestive and non-suggestive of SARS-CoV-2 infection. RESULTS: the average age of patients was 53.02 years. Male sex was the most affected (76.9%). Respiratory distress was the most common clinical symptom (61.5%). Arterial hypertension and renal failure were the most common comorbidities (3O% and 6%). Bilateral ground-glass opacities, with a predominantly peripheral distribution, accounted for 69.2% of cases, followed by condensations (57.7%) and crazy paving (19.2%). Severe COVID-19 was most frequently found (34.61%). Distal and proximal pulmonary embolism was the most common complication (11.5%). Among the associated diseases, pleurisy and pulmonary PAH were most frequently found (30.8%). The majority of our patients had parenchymal lung lesions, corresponding to early-stage disease on CT (50%). CONCLUSION: at the UCK, during the first wave of SARS-CoV-2 pandemic, lesions on CT suggestive of COVID-19 were dominated by plaque-like ground-glass opacities, followed by nonsystematized parenchymatous condensations and crazy paving. The less observed atypical lesions consisted of unilateral, peribronchovascular pseudo-nodular condensations and infection in the remodeled lung. Severe COVID-19 was the most common CT finding. Proximal and distal pulmonary embolism was the most common complication. This study highlights that these findings are consistent with those reported in the literature.

Manifestations cliniques de l'infection à Coronavirus SARS-Cov-2 (COVID-19)

La pandémie causée par le nouveau virus du coronavirus (SARS-CoV-2) à Wuhan, en Chine, en décembre 2019 est une maladie très contagieuse. L'Organisation mondiale de la Santé (OMS) a déclaré que l'épidémie en cours était une urgence mondiale de santé publique. Actuellement, les recherches sur ce nouveau coronavirus sont en cours et plusieurs publications sont disponibles. Les manifestations cliniques liées à l'infection au nouveau Corona-virus SARSCOV-2 semblent être très polymorphes et multi systémiques, dépassant largement le cadre nosologique typiquement respiratoire. Ces manifestations peuvent être cardiovasculaires, dermatologiques, ORL, hépatiques, rénales, ophtalmologiques et même neurologiques. Cette revue décrit les manifestations cliniques ainsi que de la pathogénie connues à ce jour du coronavirus 2019 (COVID19) ; le diagnostic et le traitement ne seront volontairement pas abordés

Molecular surveillance of Plasmodium falciparum resistance to artemisinin-based combination therapies in the Democratic Republic of Congo.

Malaria is a major public health problem in the Democratic Republic of Congo. Despite progress achieved over the past decade in the fight against malaria, further efforts have to be done such as in the surveillance and the containment of Plasmodium falciparum resistant strains. We investigated resistance to artemisinin-based combination therapies currently in use in Democratic Republic of Congo by surveying molecular polymorphisms in three genes: pfcrt, pfmdr1 and pfk13 to explore possible emergence of amodiaquine, lumefantrine or artemisinin resistance in Democratic Republic of Congo. This study essentially revealed that resistance to chloroquine is still decreasing while polymorphism related to amodiaquine resistance seems to be not present in Democratic Republic of Congo, that three samples, located in the east of the country, harbor Pfmdr1 amplification and that none of the mutations found in South-East Asia correlated with artemisinine resistance have been found in Democratic Republic of Congo. But new mutations have been identified, especially the M476K, occurred in the same position that the M476I previously identified in the F32-ART strain, strongly resistant to artemisinine. Antimalarial first-line treatments currently in use in Democratic Republic of Congo are not associated with emergence of molecular markers of resistance.

High Prevalence of Plasmodium falciparum Infection in Asymptomatic Individuals from the Democratic Republic of the Congo.

Malaria remains a major public health problem in the Democratic Republic of Congo (DRC) with 14 million cases reported by the WHO Malaria Report in 2014. Asymptomatic malaria cases are known to be prevalent in endemic areas and are generally untreated, resulting in a significant source of gametocytes that may serve as reservoir of disease transmission. Considering that microscopy certainly underestimates the prevalence of Plasmodium infections within asymptomatic carriers and that PCR assays are currently recognized as the most sensitive methods for Plasmodium identification, this study was conducted to weigh the asymptomatic carriage in DRC by a molecular method. Six provinces were randomly selected for blood collection in which 80 to 100 individuals were included in the study. Five hundred and eighty blood samples were collected and molecular diagnosis was performed. Globally, almost half of the samples collected from asymptomatic individuals (280/580; 48.2%) had Plasmodium infections and the most species identified was P. falciparum alone in combination with P. malariae. The high prevalence reported here should interpellate the bodies involved in malaria control in DR Congo to take into account asymptomatic carriers in actions taken and consider asymptomatic malaria as a major hurdle for malaria elimination.