Evaluation of 9 rapid diagnostic tests for screening HIV infection, in Lomé, Togo.

PURPOSE: HIV rapid diagnostic tests (RDT) could be greatly contributive for a universal access to HIV diagnosis. However, according to the WHO, these tests need to be assessed before they can be used in routine. METHOD AND RESULTS: We assessed 9 RDT in routine clinical use between 2009 and 2013. The sensitivity and specificity observed for 7 tests were≥99% and≥98%, respectively: FIRST RESPONSE HIV1-2-O PMC Medical, India, GENIE Fast HIV 1-2 and GENIE™ III HIV(1/2) Bio-Rad, France, HIV TRI-DOT+Ag;J. Mitra, INDIA; SD BIOLINE HIV(1/2) 3.0 and SD BIOLINE HIV/SYPHILIS DUO Standard Diagnostic, Korea; and VIKIA HIV(1/2); BioMérieux, France. Two tests had performances inferior to WHO recommendations: INSTI HIV1/2 Biolytical Canada; sensitivity=97.8% and HEXAGON HIV HUMAN GmbH Germany; specificity=94.8%. CONCLUSION: Seven of 9 RDT had excellent performances. Nevertheless, they can be used only after training staff, and taking into account national algorithm for their safe use.

[Accessibility of early infant diagnosis of HIV infection in Lome (Togo)]. / Accessibilité au diagnostic précoce de l'infection à VIH chez les enfants à risque de Lomé (Togo).

BACKGROUND: Early infant diagnosis of HIV is the key step for the early initiation of HAART among HIV-exposed children. The aim of this study was to estimate the proportion of children born to mothers infected with HIV who completed the early infant HIV diagnosis process and the factors associated with this complete process. METHODS: We conducted a retrospective cohort study at Tokoin University Hospital in the pediatrics ward. This study included all HIV-exposed children born between July 2009 and June 2011. The association between the mother's, spouse's, and child's characteristics as well as access to early HIV diagnosis by PCR (blood collection and reporting of results before the 6months of age) was studied using logistic regression analysis. RESULTS: A total of 455 HIV-exposed children were included: for 52.7%, the first test was PCR, 99 of them received their results, 59 of whom received their results before the 6th month of life (undergoing the complete process). In multivariate analysis, the only factor associated with the complete process of early HIV diagnosis was the maternal age≥28years (adjusted odds ratio, 1.75, 95% CI [1.18-2.76]). CONCLUSION: The availability of early infant PCR diagnosis remains a challenge and innovative strategies must be implemented.

[HIV seroprevalence and associated factors among men who have sex with men in Togo]. / Séroprévalence du VIH et facteurs associés chez les hommes ayant des rapports sexuels avec d'autres hommes au Togo.

BACKGROUND: Limited data are available on HIV infection among vulnerable populations in sub-saharan African countries, especially among men who have sex with men (MSM). The aim of this study was to estimate HIV prevalence and the factors associated with HIV infection among MSM in Togo in 2011. METHOD: A cross-sectional survey was carried out among MSM aged at least 18years old, living in Togo for at least 3months. They were recruited through the snowball method in six cities of Togo from November 2011 to January 2012. A survey form was used and an HIV screening test was proposed to the participants. The HIV prevalence was estimated with a 95% confidence interval. Univariate and multivariate analyses were performed to identify factors associated with HIV infection. RESULTS: A total of 758 MSM were enrolled in this study, including 498 (67.5%) from Lomé, the capital of Togo. The median age was 24years with an interquartile range of [21-27years] and 271 MSM (35.7%) were students. The vast majority of MSM were Togolese (90.3%) and 14.6% were married or committed to a woman. HIV testing was accepted by 488 MSM (64.3%) but only 408 (53.8%) finally accepted a blood sample collection. The prevalence of HIV infection was 19.6% [95% confidence interval, 15.9-23.8]. In multivariate analysis, three factors were associated with HIV infection: living in Lomé, with an HIV prevalence of 29.8% against 4.3% in the other cities of Togo [adjusted odds ratio (aOR)=9.68; P<0.001]; having a good knowledge of HIV transmission modes (aOR=0.59; P=0.049); and not having a regular sex partner (aOR=1.69; P=0.049). CONCLUSION: One MSM out of five was HIV-infected. Intervention programs targeting this vulnerable population are urgently needed, to reduce HIV incidence in Togo.

HIV seroprevalence among inmates in Togo.

BACKGROUND: There is no data on HIV seroprevalence among prisoners in Togo. METHODS: A cross-sectional study was conducted among prisoners in Togo from November 2011 to January 2012. The study population was included by selecting the most densely populated prison in each of the six Togo regions, and by including prisoners (at least18years of age and having been in prison for more than 30days) on a voluntary basis. HIV prevalence was estimated with a 95% confidence interval (CI). RESULTS: One thousand three hundred and fourty-two prisoners were included in the study. Their median age was 28years, (IQR 25-33years) and 39 (2.9%) were women. The median time spent in the prison was 10months, interquartile range [4-24months]. HIV testing was accepted by 96.0%. HIV seroprevalence in prisons was 4.3%, 95 CI% [3.2-5.5%]. Few prisoners (2.9%) reported having had sex in prisons. The only factor associated with HIV infection was gender with an HIV seroprevalence of 14.3% for women compared to 4.0% for men (P=0.003). CONCLUSION: The prevention and the management of HIV infection should be a priority in Togolese prisons. This requires implementing healthcare facilities in prisons.

[Pediatric salmonellosis at the Tokoin's teaching hospital, Lomé (Togo)]. / Les salmonelloses chez l'enfant au CHU Tokoin de Lomé (Togo).

OBJECTIVE: The authors had for aim to describe the epidemiological, clinical, and bacteriological aspects and outcome of pediatric Salmonella enterica, Salmonella septicemia, over the last 10 years. PATIENTS AND METHODS: We analyzed the case history of 132 patients hospitalized for Salmonellasepticemia (positive blood culture) between 1995 and 2004. RESULTS: Salmonellosis accounted for 0.36% of all hospitalizations. The mean age of patients was 5.86 plus or minus 4.06 years, significantly higher in patients with S. ser. Typhi (7.14+/-4.04 years) than in patients with other serotypes (4.95+/-3.8 years). The clinical presentation was severe in many children (with dehydration (34.8%) and emaciation (55.3%)), so HIV was suspected and investigated in 51 patients (38.6%). Eight patients were HIV positive. Three serotypes of S. enterica were predominant: S. ser. Typhi, 55 cases (41.7%), S. ser. Enteritidis, 32 cases (24.2%), and S. ser. Typhimurium, 19 cases (14.4%). The bacterial susceptibility to antibiotics was good for ceftriaxone and ciprofloxacin (100%). But 78.8% of the serotypes were resistant to amoxicillin, 75.4% to chloramphenicol, and 69.4% to cotrimoxazole. The mean duration of hospitalization was 13.7 plus or minus 7.4 days (range 4-34 days). Complications occurred in 15.9% of cases, dominated by digestive bleeding (10.6%), and 6.1% of patients died.

[Human immunodeficiency virus, hepatitis C virus and hepatitis B viruses in patients with sickle-cell disease in Togo]. / Virus de l'immunodéficience humaine et virus des hépatites virales C et B chez les patients drépanocytaires au CHU Campus de Lomé (Togo).

CONTEXT: The clinical features of sickle cell disease (SCD) are vaso-occlusive and/or hemolytic crises which treatment may require blood transfusions. OBJECTIVE: This study aimed to determine the prevalence of HIV, Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) infections in a population of SCD patients. METHODS: All the samples were analyzed by Elisa technique. We studied 119 sera for HIV using Elisa and a confirmation test in case of positive Elisa. We screened 91 sera for HCV and 119 sera for HBV. RESULTS: The prevalence was 5.04% for HIV, 6.5% for HCV and 20.2% for HBs Ag. Homozygous (SS) patients were more infected than compound heterozygous patients SC, (p < 0.02). 24.6% of the children (0 to 15 years of age) were infected as well as adults (35.5%). The Relative Risk to be contaminated was 7.14 for HIV, 4.29 for HCV and 5.43 for HBV in transfused compared to non transfused SCD patients. CONCLUSIONS: This high infectious risk in SCD patients should lead us to elaborate a better strategy to increase the safety of blood transfusion in Togo.

[Incidence and impact of HIV infection among patients with bacterial pleurisy in Lomé (Togo)]. / Fréquence et impact de l'infection au virus de l'immunodéficience humaine chez les patients souffrant de pleurésies bactériennes à Lomé (Togo).

A prospective study was made in the Tokoin university hospital in Lomé (Togo) to determine the incidence and the impact of HIV among patients with bacterial pleurisy. Two hundred cases of bacterial pleurisy were consecutively included over 17 months. The HIV diagnostic was performed using ELISA (Vironostika HIV Uni-Form II plus O and HIV1 and 2 Bispot Immunocomb II). The 200 cases of pleurisy included 152 (76%) tuberculous pleural effusion and 48 (24%) pleural empyema. Staphylococcus aureus (32%), Streptococcus pneumoniae (14.9%), and Pseudomonas (14.9%) were the main causes of pleural empyema. The HIV incidence was 61% (122/200). The mortality rate ranged from 26.2% in the HIV positive group to 5.1% in HIV negative group (P = 0.0001). The bacterial aspect of pleural empyema was heterogeneous in both groups but Salmonella Enteritidis and Salmonella Typhimurium were identified only among patients with HIV.

[Evaluation of eight diagnostic tests for HIV infection in Lome (Togo)]. / Evaluation de la performance de huit tests de diagnostic de l'infection à VIH à Lome (Togo).

This study to evaluate the performance of eight diagnostic tests for HIV/AIDS infection was conducted at the National Reference Center for HIV/AIDS/STD in Lomé, Togo. The tests were as follows: Enzymum test anti HIV Combi, Enzymum tests anti-HIV1 + 2 + subtype O, Genscreen HIV 1/2, Ice 1.0.2, Vironostika HIV Uni-Form II Plus O, Genie II HIV 1/2, SFD HIV 1/2 PA and DETERMINE HIV 1/2. A total of 238 serum specimens collected consecutively between January and April 1999 were studied. They were from 161 occasional blood donors and 77 patients. New Lav-Blot I and Ii (western blot) were used as reference tests. Test sensitivity ranged from 90 to 100%. Specificity ranged from 96 to 100%. The Enzymum test anti HIV Combi used only on serum samples from blood donors demonstrated a sensitivity and specificity of 100%. Tests based on Elisa (Emzymum Combi, Enzymum HIV 1 + 2 + subtype O, Genscreen, Ice 1.0.2 and Vironostika) allowed acceptable diagnosis of HIV/AIDS as alternatives to western blot. Two of the three rapid assays tested provided acceptable results, i.e., Genie II HIV 1/2 and SFD HIV 1/2. They are suitable for screening to prevent HIV transmission by blood transfusion in areas where Elisa is unfeasible.

[Antimicrobial activity of ciprofloxacin and netilmicin compared to various antibiotics in Lome, Togo]. / Activité antimicrobienne de la ciprofloxacine et de la nétilmicine comparée à celle de divers antibiotiques à Lomé, Togo.

We report the antimicrobial activity of ciprofloxacin and netilmicin on 577 strains such as S. aureus, Pseudomonas, E. coli, Salmonella, Proteus, Klebsiella and Enterobacter. Isolation and identification were performed by standard methods. Disk diffusion tests were performed to evalute the susceptibility. The percentage resistance to ciprofloxacin for bacteria was: E. coli = 15%, Enterobacter = 13%, Proteus = 10%, Pseudomonas = 9%, S. aureus and Klebsiella = 4%. The percentage resistance to netilmicin for bacteria was: Pseudomonas = 29%, Proteus = 26%, S. aureus = 21%, Enterobacter = 16%, Klebsiella = 14% and E. coli = 5%. The antimicrobial activity of ciprofloxacin and netilmicin was higher than that of others antibiotics.

[Is endoscopic diagnosis of Candida albicans esophagitis reliable? Correlations with pathology and mycology]. / Le diagnostic endoscopique d'oesophagite à Candida albicans est-il fiable?

AIM OF STUDY: To assess the reliability of endoscopic diagnosis of Candida albicans esophagitis. PATIENTS AND METHODS: A case - control prospective study was carried out from November 1997 to July 1998 at the Campus Teaching Hospital of Lome, in patients with esophagitis macroscopically suggestive of Candida albicans origin at upper digestive endoscopy. Fifteen subjects with normal endoscopy served as controls. Esophageal biopsies for mycologic and pathological examination were performed, as well as HIV serology. RESULTS: During the study period, 26 of the 850 endoscopies performed in our Unit revealed an esophagitis suggestive of Candida albicans origin. Mycology confirmed the presence of filamentous form of Candida albicans in 23 patients and pathology showed non-specific lesions of esophagitis, 20 with intramucous hyphae. HIV serology was positive in 19/23 patients (82.6%) and in 1/15 controls (6.6%). Sensitivity and specificity of upper GI endoscopy for the diagnosis of Candida albicans were 100 and 83.3% respectively; positive and negative predictive values were 88.5 and 100%, respectively. CONCLUSION: Upper digestive endoscopy is a reliable method for the diagnosis of Candida albicans esophagitis. However, mycological confirmation is warranted.

[Pediatric AIDS at the University Hospital Center-Tokoin (Lomé): the role of protein-calorie malnutrition and a formulation trial of a clinical diagnostic score]. / Sida pédiatrique au CHU-Tokoin (Lomé): place de la malnutrition protéino-énergétique et essai d'élaboration d'un score de diagnostic clinique.

Two cross-sectional studies were carried out in the pediatric ward of the Tokoin Teaching Hospital, Lome. One study determined the prevalence of HIV infection in the 49 malnourished patients treated in the ward in February to March and between August and December 1994. The other was carried out between July 1994 and January 1995 and included 57 other hospitalized children fulfilling at least one of the WHO's pediatric AIDS criteria. The aim was to draw up a screening system for pediatric AIDS based on clinical scores that would be more sensitive than and as specific as the WHO criteria. We tested these criteria and the other signs used in the suggested scoring system using the reference test, HIVchek. The seroprevalence of HIV was 28.6% in malnourished children and transmission was probably exclusively from mother to child. It was difficult to distinguish pediatric AIDS from protein energy malnutrition on clinical grounds, although some of the associated morbidities, including anemia, adenopathy and splenomegaly, were highly suggestive of pediatric AIDS. The second study showed that: 1) the sensitivity of the WHO criteria was low; 2) the best positive predictive values were obtained in cases of polyadenopathy and confirmed HIV infection of the mother. Both these criteria were relatively infrequent; 3) there were 6 criteria significantly associated with HIV infection, each being given a point score according to its Yule coefficient: chronic cough (4 points), chronic diarrhea (3 points), chronic fever (2 points), oropharyngeal candidiasis (2 points) and marasmus (1 point). A score of 4 points was the threshold for suspicion of pediatric AIDS. Our scoring system was more sensitive than the WHO criteria and had similar specificity and positive predictive value. We stress the importance of preventive measures against HIV infection, particularly for women of child-bearing age and suggest a new score test and appropriate clinical definitions for infants and older children.

[Serologic and genomic research by PCR of hepatitis C virus in different populations in Lomé (Togo)]. / Recherche sérologique et génomique par PCR du virus de l'hépatite C dans différentes populations à Lomé (Togo).

An epidemiological survey carried out on several groups at University Hospital of Lome showed that the prevalence of anti-HCV antibodies is 3.3 % among blood donors, 1.3 % in STD positive subjects and 6.1 % in hospitalized patients. The disparity of the HCV seropositivity rate was not statistically significant among HIV-infected and non-infected subjects (6.9 % vs 3.3 % respectively). The HCV RNA was most frequently recovered from patients, whose serological pattern was confirmed but also from 30 % of subjects, for whom the HCV serology was proved. This shows the limits of serological tests in Africa.

[Cerebral toxoplasmosis in a hospital environment in Lomé (Togo)]. / Toxoplasmose cérébrale en milieu hospitalier a Lomé (Togo).

The authors report the clinical, serological and neuroradiological results of a study about 23 cases of cerebral toxoplasmosis in the Teaching Hospital of Lome. Response to antitoxoplasmic treatment was rapidly favourable with all patients. Cerebral toxoplasmosis was the inaugural manifestation of AIDS in 20 of the 23 patients.

[Prevalence of Delta hepatitis in health workers in Dakar (Senegal)]. / Prévalence de l'hépatite Delta chez les travailleurs de la Santé à Dakar (Sénégal).

708 hospital workers in University Teaching Hospital of Dakar were tested to HBs antigen; among them 128 were positive and tested to Delta antibody, by ELISA Abbott kit. Seven (7) men and one woman were positive. However, the positivity of Delta antibody is neither linked to sex, nor to age of subjects. 87% of the Delta antibody carriers were found among the trainees, and 50% of them studied in the Odonto-Stomatology Institute.

Seroepidemiology of human herpesvirus-6 in pregnant women from different parts of the world.

The prevalence of HHV-6 IgG was studied in 11 different countries across several continents: Morocco, Burkina-Faso, Congo, Ivory Coast, Mali, Niger, Senegal, Togo, Ecuador, Martinique, and France. The study group consisted of 550 pregnant women, representative of the general adult population in each country. Antibodies were detected by immunofluorescence assay on HSB-2 cells infected with HHV-6. Each serum was tested at nine dilutions (1:20 to 1:5,120), sera greater than or equal to 20 being considered positive. For the negative antigen control, we used mock-infected HSB-2 cells. Great differences were seen between separate areas: Morocco showed both low prevalence (20%) and a low geometric mean titer (12), whereas sub-Saharan Africa displayed high prevalences (60% to 90%) and variable geometric mean titers (34 to 229). This study revealed a prevalence of 92% for Ecuador, significantly higher than the prevalence for Martinique (50%), yet both countries had very low antibody titers compared with those found in Africa. The prevalence in France (76%) was similar to previous results from other European countries.

[Maternal-infant transmission of the HTLV-1 virus]. / Transmission mère-enfant du virus HTLV-1.

The virus is transmitted horizontally via the bloodstream or sexual intercourse but vertical transmission is also believed to be a major mode of contamination. Between 20 and 25% of children born to seropositive mothers are believed to be infected and more than 90% of mothers whose children are found to be seropositive are themselves infected. If transplacental route appears to be exceptional or poorly documented, transmission by breast-feeding has been proved by virological, experimental and epidemiological arguments and is a major mode of contamination.

Confirmatory tests for human T-cell leukemia virus type 1 (HTLV-1): western blot compared with RIPA on African sera.

Confirmation of human T-Cell leukemia virus type 1 (HTLV-1) seropositivity calls for reactivity against at least 2 proteins encoded by 2 different genes, revealed by Western blot (WB) and/or radioimmuno-precipitation assay (RIPA). To evaluate the use of WB as a basis for applying these criteria, we conducted a study of two types of WB and compared them with RIPA patterns. The first part of the work, performed with 40 African sera, used Dupont de Nemours commercialized WB and an 'in-house' WB. Both WB detected antibody to proteins encoded by 2 different genes: antibody to gag products were revealed equally by both WB, but commercialized WB detected antibody to tax protein whereas the 'in-house' WB detected antibody to env protein (gp46) more efficiently. The second part of the work, conducted with 158 African sera, compared results of an 'in-house' virus lysate WB and RIPA. Our data show a perfect concordance between the two procedures when sera were clearly positive by WB (gag + env reaction). Sera reacting to p19 and p24 (both gag) by WB were confirmed positive by RIPA in 75% of the cases. The majority of the indeterminate WB profiles not confirmed by RIPA presented isolated gag reactivity (p15 or p19 or p24).

Comparison of immunofluorescence, particle agglutination, and enzyme immunoassays for detection of human T-cell leukemia virus type I antibody in African sera.

The effectiveness of four screening tests for detecting antibody to human T-cell leukemia virus type I (HTLV-I) was determined by using 2,700 African serum specimens. The tests studied were indirect immunofluorescence, particle agglutination from Fujirebio, and two enzyme immunoassays, one from Abbott Laboratories that used virus lysate from HUT 102 cells and the other from Cambridge BioScience Corp. that used an env recombinant protein. Positive and doubtful sera were confirmed by Western immunoblot and radioimmunoprecipitation assay with Food and Drug Administration seropositivity criteria. The best results were obtained with the two enzyme immunoassays, which were more sensitive (100 and 98.6% [Abbott and Cambridge, respectively]) and more specific (98.7 and 96.5%). Indirect immunofluorescence exhibited difficulties for reading and interpretation. With particle agglutination, prozone was observed for 9 of 78 HTLV-I-positive serum specimens. False-positives in any of the tests were not linked to cross-reactions with human immunodeficiency viruses. However, confirmation tests remain necessary for HTLV-I screening.