Stevens-Johnson syndrome and toxic epidermal necrolysis in sub-Saharan Africa: a multicentric study in four countries.

OBJECTIVE: The purpose of this study was to document the clinical profile, etiologies, and outcomes of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in hospitals in four sub-Saharan African countries. PATIENTS AND METHODS: A retrospective study on cases of SJS/TEN treated in dermatology departments and/or intensive care units in four sub-Saharan African countries (Benin, Burkina Faso, Central African Republic, and Togo) from 2000 to 2010. The study focuses on variables such as age, sex, type of SJS/TEN, epidermal detachment of the skin surface, HIV status, drug(s) involved, and outcomes (death and sequelae). RESULTS: This study identified 177 cases of SJS/TEN from 2000 to 2010: 129 with SJS; 37 TEN; and 11 overlapping SJS/TEN. The average age of patients was 32.3 ± 15.4 years, and the sex ratio (M/F) was 0.6. HIV serology was positive in 69 (54.8%) of the 126 patients tested. Antibacterial sulfonamides (38.4%) were the most commonly used drugs followed by nevirapine (19.8%) and tuberculosis drugs (5.6%). We recorded 22 deaths (i.e. six cases of SJS, 15 of TEN, and one of overlapping SJS/TEN). Of the 22 patients who died, 16 were infected with HIV; among them, seven had an opportunistic infection (four cases of cerebral toxoplasmosis and three of pulmonary tuberculosis). Twenty-seven cases of sequelae were noted with a large part of eye complications. CONCLUSION: This study has highlighted: (i) the high proportion of patients infected with HIV among patients who had SJS/TEN in sub-Saharan Africa; (ii) the high frequency of antiretroviral drugs as new SJS/TEN causes in sub-Saharan Africa; and (iii) the impact of HIV infection on morbidity and mortality of these affections.

[HIV seroprevalence among drug users in Togo]. / Séroprévalence du VIH chez les usagers de drogues au Togo.

CONTEXT: In the context of implementing a serological and behavioural surveillance system among drugs users, this study estimated the prevalence of HIV infection and related risk behaviours among drug users (DUs) in Togo. METHOD: A cross-sectional study was conducted among DUs in Togo from November 2011 to January 2012. This study involved all DUs regardless of the type of drug and the mode of consumption, over the age of 18 years, who had lived in Togo for at least 3 months. Behavioural data were collected by face-to-face interviews and serum was obtained for HIV antibody testing. HIV prevalence was estimated together with its 95% confidence interval (CI). Univariate and then multivariate analyses were performed to study the factors associated with HIV prevalence. RESULTS: A total of 387 DUs participated in the survey and 235 (60.7%) of them were enrolled in Lomé, the country's capital. The median age of DUs was 32 years with an interquartile range of [25-39 years] and 10 (2.6%) were women. The mode of drug consumption was: smoking or inhaling drugs in 92.8% of cases and 2.8% of DUs used drugs by injection. HIV testing was accepted in 98.4% of cases. The estimated HIV prevalence among drugs users was 5.5%, (95% CI, 3.2-7.8%). CONCLUSION: This study, the first to be conducted among DUs in Togo, found an HIV prevalence of 5.5%, which is higher than the HIV prevalence in the general population (3.2% in 2010). Specific care of DUs is essential in order to reduce HIV prevalence in Togo.

Feasibility and acceptability of rapid HIV screening in a labour ward in Togo.

BACKGROUND: HIV screening in a labour ward is the last opportunity to initiate an antiretroviral prophylaxis among pregnant women living with HIV to prevent mother-to-child HIV transmission. Little is known about the feasibility and acceptability of HIV screening during labour in West Africa. FINDINGS: A cross-sectional survey was conducted in the labour ward at the Tokoin Teaching Hospital in Lomé (Togo) between May and August 2010. Pregnant women admitted for labour were randomly selected to enter the study and were interviewed on the knowledge of their HIV status. Clinical and biological data were collected from the individual maternal health chart. HIV testing or re-testing was systematically proposed to all pregnant women. Among 1530 pregnant women admitted for labour, 508 (32.2%)were included in the study. Information on HIV screening was available in the charts of 359 women (71%). Overall, 467 women accepted HIV testing in the labour ward (92%). The HIV prevalence was 8.8% (95% confidence interval: 6.4 to 11.7%). Among the 41 women diagnosed as living with HIV during labour, 34% had not been tested for HIV during pregnancy and were missed opportunities. Antiretroviral prophylaxis had been initiated antenatally for 24 women living with HIV and 17 in the labour room. CONCLUSIONS: This study is the first to show in West Africa that HIV testing in a labour room is feasible and well accepted by pregnant women. HIV screening in labour rooms needs to be routinely implemented to reduce missed opportunities for intervention aimed at HIV care and prevention, especially PMTCT.

Knowledge and adherence to antiretroviral therapy among adult people living with HIV/AIDS treated in the health care centers of the association "Espoir Vie Togo" in Togo, West Africa.

BACKGROUND: The efficiency of antiretroviral therapy (ART) depends on a near perfect level of patients' adherence. The level of adherence of adults HIV-infected patients treated in the HIV/AIDS health care centres of the association "Espoir Vie Togo" in Togo, West Africa is not properly documented. The aim of the present study was to examine by means of self-reports the knowledge, the adherence level and associated factors to antiretroviral therapy (ART) among these patients. METHODS: We conducted a cross-sectional survey among adult people living with HIV/AIDS (PLWHA) through a structured questionnaire. RESULTS: A total of 99 patients were enrolled. Among them, 55.6% knew the name of antiretroviral agents of regimens prescribed. All patients had a good knowledge of treatment schedule. The treatment regimens based on 2 NRTIs + 1 NNRTI were used in 90% of patients. The average adherence rate was 89.8% of the total doses prescribed while 62.62% of patients showed an adherence rate of 95% or above. The treated groups were similar in term of median % of medication doses taken according to PLWHA epidemiological characteristics. However, patients reported forgetting (34.9%), travel (25.6%), cost of treatment (13.9%) and side effects (11.6%) as the main factors of missing at least once a dose intake. CONCLUSION: These results should encourage the association and all the involved actors in the HIV/AIDS's program to strengthen counseling, education and information interventions for HIV-infected patients in order to overcome the potential barriers of poor adherence.