[Relapse of pulmonary tuberculosis in the context of tuberculosis-HIV co-infection in Abidjan (Côte d'Ivoire). Short note]. / Rechute de la tuberculose pulmonaire bacillifère dans le contexte de la co-infection tuberculose-VIH à Abidjan (Côte d'Ivoire).

A cohort study was carried out from October 2001 to March 2002, in order to analyze the main characteristics of 53 adults patients (38 HIV-positive and 15 HIV-negative), who had a relapse of pulmonary tuberculosis. The observance in the first period of the treatment of tuberculosis was regular in 79% of tuberculous patients infected by the HIV (30/38) and in 87% of tuberculous patients who where HIV-negative (13/15) (p = 0.7). The relapse occurred before one year after recovery in 74% among the HIV-positive (28/38) and in 33% among the HIV-negative patients (5/15) (p = 0.00). Most of the HIV-positive patients (74%) had CD4 counts under 200/mm3 and 80% of the HIV-negative patients had more than 500 CD4 counts/mm3 (p = 0.00). After two months of retreatment following the relapse diagnosis, the rate of improvement in patients was about 16% in HIV infected (6/38) and about 67% in HIV-negative patients (10/15) (p = 0.00).

[Efficacy of a short 6 month therapeutic coursefor HIV infected tuberculosis patients in Abidjan, Côte d'Ivoire]. / Efficacité du régime thérapeutique court de six mois chez les tuberculeux infectés par le VIH à Abidjan, Côte d'Ivoire.

From December 1992 to February 1993, 104 newly diagnosed pulmonary tuberculosis patients were enrolled in a prospective cohort study to assess the response to the 6 month-short-course regimen implemented in Cote d'Ivoire. This treatment encompassed the daily intake of Rifampicin and Pyrazinamide for 2 months followed by Rifampicin and Isoniazid for the remaining 4 months. All the patients were enrolled at the Treichville Tuberculosis Treatment Centre in Abidjan, and a follow-up of 6 months was observed for each patient. All in all, 41 patients were HIV-positive whereas 63 where HIV-negative. No statistical difference was noted between HIV-positive and HIV-negative patients with regard to the completion of therapy (85% versus 87%). The cure rate after an effective 6 month-therapy was similar among HIV-positive and HIV-negative patients (83% versus 84%) as well as the treatment failure rate which was 2.4% and 3% respectively. The results clearly indicate that the 6 month-short-course regimen policy implemented in Côte d'Ivoire is as effective for the treatment of HIV-associated tuberculosis as for the treatment of tuberculosis.

[Pulmonary complications of human immunodeficiency virus infection in sub-Saharan Africa]. / Complications pulmonaires de l'infection par le virus de l'immunodéficience humaine en Afrique sub-saharienne.

Based on a selection of articles published in the literature and reports from international AIDS conferences, we present the main pulmonary complications of HIV-infection observed in sub-Saharan Africa. The different clinical studies demonstrate the predominance of infectious complications, mainly tuberculosis (29 to 44%) and bacterial pneumonia (21 to 35%). The frequency of Pneumocystis carinii pneumonia remains low (5 to 19%). Other complications (mycobacterial infection, cytomegalovirus, toxoplasmosis, cryptococcus, aspergillosis, interstitial lymphoid pneumonia, Kaposi sarcoma) are less frequent. The autopsy studies report similar results and mention the predominance of tuberculosis and pneumonia due to common germs as well as the low frequency of pneumocystosis. This analysis of work conducted in sub-Saharan Africa clearly indicate that tuberculosis remains the leading cause of morbidity and mortality in HIV-infected patients.

[The new face of tuberculosis in the context of the tuberculosis-HIV association in Abidjan, Ivory Coast]. / Le nouveau visage de la tuberculose dans le contexte de l'association tuberculose-VIH à Abidjan, Côte d'Ivoire.

This article reviews the main clinical aspects and progression of HIV-related tuberculosis in Abidjan. HIV prevalence in tuberculosis patients is high, estimated at 46.2% in 1992, with a clear predominance of HIV-1 over HIV-2. More than 61% of co-infected tuberculous patients meet the WHO's clinical definition of AIDS (the Bangui definition) at the time of diagnosis of tuberculosis. This rates falls to 46-51% when cough is excluded from the definition. On X-rays, the signs of pulmonary tuberculosis in co-infected tuberculous patients are atypical in the advanced stages of HIV infection, when extra-pulmonary localization, mainly mediastinal adenopathy, is frequent. Short-course chemotherapy consisting of 2 months' unsupervised daily treatment with rifampicin/isoniazid/pyrazinamide, followed by 4 months of a daily combination of rifampicin/isoniazid, applied in the Ivory Coast since 15 July 1985, has proved successful in HIV-associated tuberculosis, with treatment effectiveness rates of more than 90%.

[Aspects of thoracic radiography of patients with tuberculosis and HIV infection in Ivory Coast]. / Les aspects de la radiographie thoracique chez les tuberculeux infectés par le VIH en Côte d'Ivoire.

The aim of this prospective study was to investigate the main features of standard chest X-ray in patients with concomitant tuberculosis and HIV infection. From 21 December 1992 to 21 February 1993, we compared 45 chest X-rays of HIV+patients with pulmonary tuberculosis with those of 73 HIV negative patients with pulmonary tuberculosis. Our results revealed that extrapulmonary thoracic localizations were remarkably frequent in HIV+tuberculosis patients (57.8% versus 22% in HIV-patients; P < 0.05). Extrapulmonary localizations were frequently mediastinal lymph nodes (82.7%). Parenchymal involvement was often extensive including frequent miliary images (20% versus 38.3% in HIV-patients). Thus despite the lack of CD4 counts in our study, we were able to observe that about one half the co-infected tuberculosis patients had reached the stage of AIDS as defined by the CDC in 1987. These findings are in agreement with those reported in the literature and would suggest that thoracic manifestations of tuberculosis is a good marker of the state of immunodepression.

PIP: In the Ivory Coast, pneumologists examined 188 chest X-rays of patients with pulmonary tuberculosis (TB) treated at the Treichville Antituberculosis Center to compare the principal X-ray characteristics of patients with only TB with those of patients infected with TB and HIV. They did not conduct CD4 counts. 45 TB patients were also infected with HIV for an HIV prevalence rate of 38%. 73.3% of HIV infected TB patients were infected with HIV-1. 4.4% were infected with HIV-2. 22.3% were infected with both HIV-1 and HIV-2. Men predominated in both the TB only group and the TB-HIV group (67.1% and 77.7%, respectively). HIV infected patients were more likely to have thoracic extrapulmonary TB lesions than HIV seronegative patients (57.8% vs. 22%; P 0.05). Thus, 57.8% of co-infected patients had AIDS as defined by the CDC in 1987. Among co-infected patients, lesions on the mediastinal lymph nodes predominated (80.7%). Involvement of the parenchyma, demonstrated by miliary X-rays, was rather common (22.3% vs. 38.3% for HIV negative patients). The X-ray of 84.6% of patients with caseous pneumonia were infected with HIV and TB. These findings parallel those in the literature. They suggest that thoracic manifestations of TB indicate the state of immunodepression.