[Evaluation of antiretroviral treatment in HIV infected adult in the department of dermatology venereology of the Donka national hospital]. / Evaluation du traitement antiretroviral chez l'adulte infecte par le VIH au service de dermatologie venereologie de l'hopital national Donka.

If the use of highly active antiretroviral therapies (HAART) have largely improved survival, morbidity and the quality of life of the people living with HIV in Northern countries as well as Southern countries and particularly in Africa, many obstacles have slowed down their use. Thus the follow-up of the patients under HAART in certain developing countries is still limited even non-existent. OBJECTIVE: The objective of this work was to bring the therapeutic outcomes obtained after a minimal six months period of follow-up among HIV+ patients admitted in external consultations or following hospitalizations. MATERIAL AND METHODS: We carried out a retrospective and descriptive study concerning patients followed from January 1st, 2004 to December 31st, 2008 (5 years). RESULTS: Our study concerned 275 patients including 61.41% women with a sex-ratio (M/W) of 0.62. The average age of our patients was of 36.83 [rage: 18-70]. The initial average weight of our patients was 59.88 kg [range: 30-107] with the majority (66.91%) at the stage III of the WHO clinical classification. The serologic profile was dominated by HIV1 (97.09%) with a number of average CD4 of 210.99 cells/mm3 at the initiation of the ARV treatment. The evolution under treatment was marked clinically by an average ponderal gain of 7,45kg, with weight increasing from 59.88 kg to 67.33 kg between M0 and M54. Biologically, the number of average CD4 increased from 210.99 to 643 between M0 and M48 with an average gain of 432.01 cells/mm3. On the virological level, the plasmatic viral load was carried out for 64 patients out of 275. It was undetectable in 31 patients, be it 48.44%. CONCLUSION: In conclusion, the therapeutic outcomes of the patients under HAART was good at the end of this study with a satisfactory clinical issue, marked by an increase in the average weight which corroborates a good immunological and virological response.

Si l'utilisation des multithérapies antirétro-virales (ARV) a grandement amélioré la survie, la morbidité et la qualité de vie des PVVIH dans les pays du Nord, dans les pays du Sud, et notamment en Afrique, de nombreux obstacles ont freiné leur utilisation. C'est ainsi que le suivi des patients sous ARV dans certains pays en voie de développement est encore timide voir inexistant. OBJECTIF: L'objectif de ce travail était de rapporter les réponses thérapeutiques obtenues après une période minimale de six mois de suivi chez des patients VIH+ admis en consultations externes ou à la suite d'hospitalisations. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude rétrospective de type descriptif concernant les patients suivis dans la période du 1er janvier 2004 au 31 décembre 2008, soit 5 ans. RÉSULTATS: Notre étude a concernée 275 patients dont 61,41% de femmes avec un sex-ratio (H/F) de 0,62. L'âge moyen de nos patients était de 36,83 [18 70]. Le poids moyen initial de nos patients était de 59,88 kg [30 ­107] avec la majorité (66,91%) au stade III de la classification clinique de l'OMS. Le profil sérologique était dominé par le VIH1 (97,09%) avec un nombre de CD4 moyen à 210,99 cellules/mm3à l'initiation du traitement ARV. L'évolution sous traitement a été marquée cliniquement par un gain pondéral moyen de 7,45kg, le poids moyen passant de 59,88 kg à 67,33 kg entre M0 et M54. Biologiquement, le nombre de CD4 moyen est passé de 210,99 à 643 entre M0 et M48 soit un gain moyen de 432,01 cellules/mm3. Sur le plan virologique, la charge virale plasmatique réalisée chez 64 patients sur 275 était indétectable chez 31 patients soit 48,44%. CONCLUSION: Globalement, la réponse thérapeutique était bonne au terme de cette étude avec une réponse clinique satisfaisante, marquée par une augmentation du poids moyen qui corrobore une bonne réponse immunologique et virologique.

[Evaluation of antiretroviral treatment in HIV infected adult in the department of dermatological venereology of the Donka National Hospital]. / Evaluation du traitement antiretroviral chez l'adulte infecte par le VIH au service de dermatologie venereologie de l'Hopital National Donka.

If the use of highly active antiretroviral therapies (HAART) have largely improved survival, morbidity and quality of life of the people living with HIV in Northern and Southern countries, and particularly in Africa, many obstacles have slowed down their use. Thus the monitoring of patients under HAART in certain developing countries is still very low, if not non-existent. OBJECTIVE: The objective of this study was to bring the therapeutic outcomes obtained after a minimal six months period of monitoring among HIV positive patients admitted in external consultations or following hospitalizations. MATERIAL AND METHODS: We carried out a retrospective descriptive study concerning patients monitored from January 1st, 2004 to December 31st, 2008, that is to say 5 years. RESULTS: Our study consisted of 275 patients including 61.41% women with a man:woman sex-ratio of 0.62. The average age of our patients was of 36.83 [ranging from 18 to 70]. The initial average weight of our patients was 59.88 kg [range: 30-107] with the majority (66.91%) at stage III of the WHO clinical classification. The serologic profile was dominated by the HIV1 (97.09%) with a CD4 average of 210.99 cellules/mm3, the the start of the HAART. The evolution under treatment was marked clinically by an average ponderal gain of 7,45kg, with average weight going from 59.88 kg to 67.33 kg between M0 and M54. Biologically, the CD4 average went from 210.99 to 643 between M0 and M48 or an average gain of 432.01 cells/mm3. On the virological level, the plasmatic viral load carried out on 64 patients out of 275, was undetectable in 31 patients or 48.44% of cases. CONCLUSION: Our findings show that the therapeutic outcomes for patients under HAART was good and with a satisfactory clinical response, marked by an increase in the average weight which indicates a good immunological and virological response.

Si l'utilisation des multithérapies antirétrovirales (ARV) a grandement amélioré la survie, la morbidité et la qualité de vie des PVVIH dans les pays du Nord, dans les pays du Sud, et notamment en Afrique, de nombreux obstacles ont freiné leur utilisation. C'est ainsi que le suivi des patients sous ARV dans certains pays en voie de développement est encore timide voir inexistant. OBJECTIF: L'objectif de ce travail était de rapporter les réponses thérapeutiques obtenues après une période minimale de six mois de suivi chez des patients VIH+ admis en consultations externes ou à la suite d'hospitalisations. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude rétrospective de type descriptif concernant les patients suivis dans la période du 1er janvier 2004 au 31 décembre 2008, soit 5 ans. RÉSULTATS: Notre étude a concernée 275 patients dont 61,41% de femmes avec un sex-ratio (H/F) de 0,62. L'âge moyen de nos patients était de 36,83 [18 70]. Le poids moyen initial de nos patients était de 59,88 kg [30 ­107] avec la majorité (66,91%) au stade III de la classification clinique de l'OMS. Le profil sérologique était dominé par le VIH1 (97,09%) avec un nombre de CD4 moyen à 210,99 cellules/mm3à l'initiation du traitement ARV. L'évolution sous traitement a été marquée cliniquement par un gain pondéral moyen de 7,45kg, le poids moyen passant de 59,88 kg à 67,33 kg entre M0 et M54. Biologiquement, le nombre de CD4 moyen est passé de 210,99 à 643 entre M0 et M48 soit un gain moyen de 432,01 cellules/mm3. Sur le plan virologique, la charge virale plasmatique réalisée chez 64 patients sur 275 était indétectable chez 31 patients soit 48,44%. CONCLUSION: Globalement, la réponse thérapeutique était bonne au terme de cette étude avec une réponse clinique satisfaisante, marquée par une augmentation du poids moyen qui corrobore une bonne réponse immunologique et virologique.

Evaluation du traitement antiretroviral chez l'adulte infecte par le VIH au service de dermatologie venereologie de l'hopital national Donka

Si l'utilisation des multitherapies antiretrovirales (ARV) a grandement ameliore la survie; la morbidite et la qualite de vie des PVVIH dans les pays du Nord; dans les pays du Sud; et notamment en Afrique; de nombreux obstacles ont freine leur utilisation. C'est ainsi que le suivi des patients sous ARV dans certains pays en voie de developpement est encore timide voir inexistant. Objectif : L'objectif de ce travail etait de rapporter les reponses therapeutiques obtenues apres une periode minimale de six mois de suivi chez des patients VIH+ admis en consultations externes ou a la suite d'hospitalisations. Materiel et methodes : Il s'agissait d'une etude retrospective de type descriptif concernant les patients suivis dans la periode du 1er janvier 2004 au 31 decembre 2008; soit 5 ans. Resultats : Notre etude a concernee 275 patients dont 61;41 de femmes avec un sex-ratio (H/F) de 0;62. L'age moyen de nos patients etait de 36;83 [18 70]. Le poids moyen initial de nos patients etait de 59;88 kg [30 -107] avec la majorite (66;91) au stade III de la classification clinique de l'OMS. Le profil serologique etait domine par le VIH1 (97;0) de femmes avec un sex-ratio (H/F) de 0;62. L'age moyen de nos patients etait de 36;83 [18 70]. Le poids moyen initial de nos patients etait de 59;88 kg [30 -107] avec la majorite (66;91) au stade III de la classification clinique de l'OMS

[Causes and characteristics of patient death under ARV at the Dermatology-Venereology Department of the Donka National Hospital, GUINEA]. / Causes et caracteristiques des deces des patients sous ARV au service Dermatologie-Venereologie de L'Hopital National Donka, Guinee.

INTRODUCTION: The antiretroviral treatments led to a spectacular reduction of morbidity and mortality of HIV-infected patients, transforming it into a chronic infection. HIV infection remains potentially lethal and requires a long term treatment to obtain an immunological and virological control. The goal of this work was to describe the characteristics of the deaths during the ARV treatment. MATERIALS AND METHOD: We led a descriptive retrospective study of a 4 year period, from July 2004 to August 2007 which looked at 429 patient under ARV followed in the dermatology - venereology department of the Donka national hospital and whose death during hospitalization occurred for the study period. We excluded the patients who suffered loss of sight or who died during the ARV treatment period. RESULTS: On 429 included patients, recorded death rate was of 27,7%. The mean age of included patients was 42 ± 6.5 years old. Patients at the stage 3 and 4 of the WHO classification recorded the greatest number of death. There was no patient at stage I. More half of the patients were immunosuppressed with a count of CD4 < 200/mm3. In our study 66 patients died with a rate of CD4 < 200/mm3 21 patients with a rate of CD4 ranging between 200 and 499 or 17,6%. Only one patient had a rate of CD4 > 500/mm3 while 31 other patients did not have a CD4 at the time of the death. We recorded 57 deaths in the first 6 months of HAART (among which 32 occurred within the first 3 months) and 24 after. The leading causes of death were tuberculosis (47,05%) including 64,28% of pulmonary localization and 35,71% of extrapulmonary localization, followed by cerebral toxoplasmosis (19,62%) and Kaposi disease (15,12%). The other causes of death found were hepatitis B (4,20%) and neuro-meningeal cryptococcosis (2,52%). A socio-economic unstable situation was found at half of the patients For 14 case the cause of death remained unknown. There no was death due to side effects of the ARV therapy. 89,1% of the patients deceased were under protocol 2 INTI + 1 INNTI which represents the layout of first line in our country. CONCLUSION: The mortality of the infection by HIV remains high in spite of the introduction of ARV treatment into our service. The patients who passed away were mainly characterized by a low level of CD4 and a very advanced stage of the evolution of the infection to the initiation of the ARV. The leading causes of death were opportunist infections. An early tracking of the infection by HIV and an early and optimal assumption of responsibility of the opportunist infections could contribute to reverse the tendencies in Guinea.

Les traitements antirétroviraux (ARV) ont permis d'obtenir une réduction spectaculaire mais non complète de la morbidité et de la mortalité à VIH. Cependant malgré ces résultats positifs, plusieurs études rapportent des taux de mortalité élevée chez des patients soumis aux traitements ARV. Le but de ce travail était de décrire les caractéristiques des décès au cours du traitement ARV. MATÉRIEL ET MÉTHODE: Il s'agissait d'une étude rétrospective descriptive d'une période de 4 ans, allant de juillet 2004 à août 2007 portant sur 429 patients sous traitement ARV suivis dans le service de dermatologie-vénéréologie de l'hôpital national guinéen de Donka et dont le décès est survenu dans le service pendant la période d'étude. RESULTATS: Sur 429 patients sous ARV inclus dans l'étude, 119 étaient décédés soit une fréquence de 27,7%. L'âge moyen de nos patients était de 42 ± 6,5 ans. Il y avait une légère prédominance féminine (52,1%) avec un sex ratio F/H égal à 1,08. Les patients au stade 3 et 4 de la classification de l'OMS ont enregistré le plus grand nombre de décès. Aucun patient n'était au stade I. Plus de moitié des patients étaient dans un état de déficit immunitaire très profond (CD4 < 200 / mm3). Au cours de notre étude, 66 patients étaient décédés avec un taux de CD4 < 200 / mm3 soit 55%. Nous avons enregistré 57 décès (47,9%) dans les 6 mois suivants l'introduction du traitement anti VIH dont 32 (soit 26,9% de l'ensemble des décès enregistrés) dans les 3 premiers mois alors que 24 patients (20,2%) étaient décédés après 6 mois de traitement. Les principales causes de décès étaient la tuberculose (47,05%), dont 64,28% de localisation pulmonaire, suivie de la toxoplasmose cérébrale (19,62%) et la maladie de Kaposi (15,12%). Les autres causes de décès retrouvées étaient l'hépatite B (4,20%) et la cryptococcose neuro-méningée (2,52%). Pour 14 cas soit 11,76% la cause de décès était inconnue. Aucun décès dû aux effets secondaires des ARV n'était noté. La majorité (89,1%) des patients décédés étaient sous le protocole 2 INTI + 1 INNTI qui représente le schéma de première ligne dans notre pays. CONCLUSION: La mortalité de l'infection par le VIH reste élevée malgré l'introduction du traitement ARV dans notre service. Les patients décédés étaient principalement caractérisés par un faible taux de CD4 et un stade très avancé de l'évolution de l'infection à l'initiation des ARV. Les principales causes de décès étaient les infections opportunistes. Un dépistage précoce de l'infection par le VIH et une prise en charge précoce et optimale des infections opportunistes pourraient contribuer à inverser les tendances en Guinée.

Connaissances, attitudes et pratiques des tradipraticiens de la sante de la ville d'Abidjan sur le paludisme.

INTRODUCTION : An estimated 300 to 500 million clinical cases of malaria occur each year worldwide, 90% in Africa, mostly among young children. In Cote d'Ivoire, malaria is 46.03% of disease states and 62.44% of hospital admissions. In children under 5 years, it is 42.67% of the reasons for consultation and 59.68% of hospital admissions. In pregnant women, it represents 22.91% of disease states and 36.07% of hospital admissions. In Africa, traditional medicine is the first resort for the vast majority of people, because of its accessibility both geographically, economically and culturally. However, some modern practitioners show an attitude of distrust of traditional medicine and its players, calling them irrational. This work had set out to assess knowledge, attitudes and practices of traditional healers in the uncomplicated and complicated in the context of collaboration between traditional and modern medicine for the optimal management of critical cases. MATERIALS AND METHOD : The study focused on traditional healers practicing in the city of Abidjan. The study was conducted using individual interviews over a period of 30 days. The interviews were conducted in local languages, with the assistance, if necessary, translators. For data collection, we used a questionnaire containing four items: the socio-demographic characteristics of traditional healers, their knowledge on malaria, diagnostic practices and traditional therapies. RESULTS : Of the 60 healers and included in the study, only six were women (10%), a sex-ratio of a woman to 9 men. 66.7% of respondents traditional healers are herbalists and 25% of naturopaths.Only 8.3% were spiritualists. The etiology of malaria most commonly cited by the traditional healers were mosquito bites (16.7%), food (1.7%), solar (1.7%) and fatigue (1.7%) . 25% of traditional healers are associated with mosquitoes, sun and fatigue. Symptomatology most cited were fever (100%), dark urine (86%), the yellow or pale conjunctiva (80%), vomiting (71.7%), nausea (58.3%) and abdominal pain (48.3%). Traditional healers recognized three types of malaria: the white shape, form yellow / red and the black form. Traditional healers malarious patients surveyed were receiving both first (58.3%) than second-line (41.7%). 78.3% of them practiced an interview and physical examination of theirpatients before the diagnosis. In 13.3% of cases they were divinatory consultation. Medications used to treat malaria were herbal in 95% of cases. The main sign of healing was the lack of fever (58.3%). 90%of traditional healers interviewed referring cases of malaria black (severe malaria). This reference is made to modern health facilities (90.2%). 68.3% of respondents practiced traditional healers of malaria prophylaxis among pregnant women and children under 5 years.CONCLUSION : A description of clinical malaria by traditional practitioners in health is not very far from that of modern medicine. Nevertheless, the logics of our respondents are etiological more complex and linked to their cultural context. The management of cases is made from medicinal plants in treatment failure patients are usually referred to modern health facilities. The involvement of traditional healers in the detection and quick reference risk cases can contribute to reducing child mortality due to severe malaria.

[Knowledge, attitude, and practice of traditional healers on the topic of malaria in the city of Abidjan]. / Connaissances, attitudes et pratiques des tradipraticiens de la sante de la ville d'Abidjan sur le paludisme.

INTRODUCTION: An estimated 300 to 500 million clinical cases of malaria occur each year worldwide, 90% in Africa, mostly among young children. In Cote d'Ivoire, malaria is 46.03% of disease states and 62.44% of hospital admissions. In children under 5 years, it is 42.67% of the reasons for consultation and 59.68% of hospital admissions. In pregnant women, it represents 22.91% of disease states and 36.07% of hospital admissions. In Africa, traditional medicine is the first resort for the vast majority of people, because of its accessibility both geographically, economically and culturally. However, some modern practitioners show an attitude of distrust of traditional medicine and its players, calling them irrational. This work had set out to assess knowledge, attitudes and practices of traditional healers in the uncomplicated and complicated in the context of collaboration between traditional and modern medicine for the optimal management of critical cases. MATERIALS AND METHOD: The study focused on traditional healers practicing in the city of Abidjan. The study was conducted using individual interviews over a period of 30 days. The interviews were conducted in local languages, with the assistance, if necessary, translators. For data collection, we used a questionnaire containing four items: the socio-demographic characteristics of traditional healers, their knowledge on malaria, diagnostic practices and traditional therapies. RESULTS: Of the 60 healers and included in the study, only six were women (10%), a sex-ratio of a woman to 9 men. 66.7% of respondents traditional healers are herbalists and 25% of naturopaths.Only 8.3% were spiritualists. The etiology of malaria most commonly cited by the traditional healers were mosquito bites (16.7%), food (1.7%), solar (1.7%) and fatigue (1.7%) . 25% of traditional healers are associated with mosquitoes, sun and fatigue. Symptomatology most cited were fever (100%), dark urine (86%), the yellow or pale conjunctiva (80%), vomiting (71.7%), nausea (58.3%) and abdominal pain (48.3%). Traditional healers recognized three types of malaria: the white shape, form yellow / red and the black form. Traditional healers malarious patients surveyed were receiving both first (58.3%) than second-line (41.7%). 78.3% of them practiced an interview and physical examination of theirpatients before the diagnosis. In 13.3% of cases they were divinatory consultation. Medications used to treat malaria were herbal in 95% of cases. The main sign of healing was the lack of fever (58.3%). 90%of traditional healers interviewed referring cases of malaria black (severe malaria). This reference is made to modern health facilities (90.2%). 68.3% of respondents practiced traditional healers of malaria prophylaxis among pregnant women and children under 5 years. CONCLUSION: A description of clinical malaria by traditional practitioners in health is not very far from that of modern medicine. Nevertheless, the logics of our respondents are etiological more complex and linked to their cultural context. The management of cases is made from medicinal plants in treatment failure patients are usually referred to modern health facilities. The involvement of traditional healers in the detection and quick reference risk cases can contribute to reducing child mortality due to severe malaria.

HLA-B allele frequencies in Côte d'Ivoire defined by direct DNA sequencing: identification of HLA-B*1405, B*4410, and B*5302.

Direct automated DNA sequencing was used to analyze exons 2 and 3 of HLA-B alleles present in forty-four unrelated individuals residing in the village of Adiopodoume, Côte d'Ivoire (Ivory Coast). Of the 23 HLA-B alleles observed, the most frequently detected allele was HLA-B*5301 (22.7%), which is believed to confer resistance to severe Plasmodium falciparum malaria. B*4501 (9.1%), B*1503 (8.0%), B*0705 (5.7%), B*1510 (5.7%) and B*3501 (5.7%) occurred frequently in the population. A second allele of B53 was identified; B*5302 contains a single amino acid variation at residue 171 (Y-->H). Two additional novel alleles, B* 1405 (a single amino acid variant of B*1402) and B*4410 (a five amino acid variant of B*4403) were characterized.