Hepatitis B Infection in HIV-1-Infected Patients Receiving Highly Active Antiretroviral Therapy in Lome; Togo: Prevalence and Molecular Consequences

BACKGROUND:No data are available on HIV/hepatitis B virus (HBV) or hepatitis C virus coinfection in Togo; and patients are not routinely tested for HBV infection.OBJECTIVE:To determine the prevalence of HBV and the risk of HBV drug resistance during antiretroviral treatment in HIV-coinfected patients in Togo.METHOD:This cross-sectional study was carried out in Lome; Togo; from January 2010 to December 2011 among HIV-infected patients who had been on antiretroviral therapy (ART) for at least 6 months.RESULTS:In total; 1 212 patients (74.9% female) living with HIV/AIDS and treated with ART were included in the study. The seroprevalence of hepatitis B surface antigen (HBsAg) was 9.7% (117/1 212; 95% confidence interval (CI) 8.04 - 11.45). Of these 117 HBsAg-positive patients; 16 (13.7%) were hepatitis B e-antigen (HBeAg)-positive; and 115 (98.3%) were on lamivudine. The HBV DNA load was etgt;10 IU/mL in 33/117 patients overall (38%); and in 87.5% of 16 HBeAg-positive patients (petlt;0.0001). In multivariate analysis; factors associated with HBV DNA load etgt;10 IU/mLwere HBeAg positivity (adjusted odds ratio (aOR) 6.4; p=0.001) and a higher level of education (aOR 6.5; p=0.026). The prevalence of HBV resistance to lamivudine was 13.0% (15/115; 95% CI 7.0 - 19.0). The detected resistance mutations were rtL180M (14/15 patients) and rtM204V/I (15/15).CONCLUSION:The seroprevalence of HBV among ART-treated HIV-infected patients in Togo was 9.7%. The prevalence of HBV lamivudine resistance mutations after 2 years of ART was 13.0%. These results suggest that HBV screening before ART initiation can be based on HBsAg testing

[Profile of Buruli ulcer treated at the National Reference Centre of Togo: a study of 119 cases]. / Profil de l'ulcère de Buruli pris en charge au Centre national de référence du Togo: étude de 119 cas.

The purpose of this study was to describe the epidemiological, clinical, therapeutic profile and the outcome of Buruli ulcer (BU) in the National Reference Center for Buruli ulcer treatment (NRCBUT) in Togo. It was a retrospective and descriptive study of records of patients treated for BU in the NRCBUT between June 2007 and December 2010. During the study period, 119 patients (56.3% males) were treated in the NRCBUT for BU. The median age of patients was 14 years. The proportion of children (< 15 years) was 56.3%. On admission, 85 patients were at ulcer stage and 34 patients at the pre-ulcer stage. BU wounds were mainly located on lower limbs (50.4%), followed by upper limbs (32.6%) and trunk (13.3%). The location of the wounds on the lower limbs were more frequent in patients older than 15 years (P < 0.001), while those on the upper limbs (P = 0.002) and trunk (P = 0.03) were more frequent in patients aged less than 15 years. All patients had received medical treatment which was based on rifampicin-streptomycin combination for eight weeks. This treatment was coupled to surgery in 30 cases. The outcome was punctuated by complications in 7 patients, limb amputation in 3 patients, and sequels in 10 patients. This study confirmed that the BU is the prerogative of young subjects and the exposed areas in the skin facilitates transmission. Apart from these classic features, some unique aspects including the age-dependent distribution are related to the pathogenesis of this disease.

[Syndromic management of sexually transmitted infections in health care facilities in Togo: cases reported, 2005-2009]. / Prise en charge syndromique des infections sexuellement transmissibles dans les structures de soins au Togo : étude des cas notifiés de 2005 à 2009.

OBJECTIVE: The aim of this study was to evaluate trends in sexually transmitted infections (STI) in Togo. METHOD: This retrospective descriptive study included all STI cases reported from 2005 through 2009. RESULTS: During the study period, 241,561 STI cases were recorded in the six health regions of Togo, for an annual frequency of 48,312 cases. The mean age of patients was 27.4 ± 12.6 years, and those aged from 20 to 30 years accounted for 55.4% of all cases. The sex ratio (male/female) was 0.3. The most common STI syndrome was vaginal discharge (57.2%), followed by pelvic inflammatory disease (24%), urethral discharge (12.1%), and genital ulcer disease (5%). During the study period, the proportion of cases involving urethral discharge increased significantly, rising from 4.2‰ in 2005 to 4.5‰ in 2009 (p = 0.02), while the proportion involving genital ulcer disease remained stable (1.6‰ in 2005 and 2009). The proportion of cases involving vaginal discharge and pelvic inflammatory disease decreased significantly. CONCLUSION: Overall, this study shows that the number of STI cases reported by health facilities in Togo was stable from 2005 to 2009. Continued epidemiological surveillance is important to document STI trends as part of the HIV control program.

[Evaluation of antiretroviral treatment in a cohort of 1,620 HIV-infected patients in Togo]. / Évaluation du traitement antirétroviral de 1 620 personnes infectées par le VIH au Togo.

PURPOSE: The purpose of this study was to evaluate the efficacy of antiretroviral treatment for HIV-infected patients in Togo. PATIENTS AND METHOD: This retrospective study covered the period from January 2001 to January 2009 and included all HIV-infected patients who received antiretroviral therapy for at least 12 months. RESULTS: The study included 1,620 of the 8,901 patients (18.2%) treated with antiretroviral therapy. Mean patient age was 34.8 ± 11.4 years and the male/female sex-ratio was 0.4. When treatment began, the mean CD4+ T lymphocyte count was 143/mm(3) and mean patient weight was 53.3 kg. Overall, 263 of the 1,620 subjects (16.2%) had opportunistic infections before starting antiretroviral treatment. The most frequently used antiretroviral combination was stavudine/lamivudine/nevirapine (91.7%). The compliance rate for the first 12 months was 89.6%, and the antiretroviral regimen was changed in 5.9% of cases. After 36 months, mean weight gain was 8.8 kg and the mean increase in the CD4(+) T lymphocyte count was 265 cells/mm(3). The number of opportunistic infections decreased from 263 cases at the beginning of antiretroviral treatment to 9 after three years of treatment. During follow-up, 258 deaths were recorded, for a cumulative case fatality rate of 15.9%. The most common side effects were cutaneous toxicity and anemia in the short term and neurological toxicity, lipodystrophy and hepatotoxicity over the long term. DISCUSSION: This study confirms the efficacy of antiretroviral treatment of HIV-infected patients in Togo. These findings should encourage policy-makers to work toward universal access to antiretroviral treatment for people living with HIV.