BackgroundFacing the dual burden of invasive cervical cancer and HIV in sub-Saharan Africa, the identification of preventable determinants of Cervical Intraepithelial Neoplasia (CIN) in HIV-infected women is of paramount importance.MethodsA cervical cancer screening based on visual inspection methods was proposed to HIV-infected women in care in Abidjan, Côte d'Ivoire. Positively screened women were referred for a colposcopy to a gynaecologist who performed directed biopsies.ResultsOf the 2,998 HIV-infected women enrolled, 132 (4.4%) CIN of any grade (CIN+) were identified. Women had been followed-up for a median duration of three years [IQR: 1–5] and 76% were on antiretroviral treatment (ART). Their median most recent CD4 count was 452 [IQR: 301–621] cells/mm3. In multivariate analysis, CIN+ was associated with a most recent CD4 count >350 cells/mm3 (OR: 0.3; 95% CI: 0.2–0.6) or ≥200–350 cells/mm3 (OR 0.6; 95% CI 0.4–1.0) (Ref: <200 cells/mm3 CD4) (p<10−4).ConclusionsThe presence of CIN+ is less common among HIV-infected women with limited or no immune deficiency. Despite the potential impact of immunological recovery on the reduction of premalignant cervical lesions through the use of ART, cervical cancer prevention, including screening and vaccination remains a priority in West Africa while ART is rolled-out.
Setting
Drug resistance threatens tuberculosis (TB) control, particularly among HIV-infected persons.
Objective
We surveyed antiretroviral therapy (ART) programs from lower-income countries on prevention and management of drug-resistant TB.
Design
We used online questionnaires to collect program-level data in 47 ART programs in Southern Africa (14), East Africa (8), West Africa (7), Central Africa (5), Latin America (7) and Asia-Pacific (6 programs) in 2012. Patient-level data were collected on 1,002 adult TB patients seen at 40 of the participating ART programs.
Results
Phenotypic drug susceptibility testing was available at 36 (77%) ART programs, but only used for 22% of all TB patients. Molecular drug resistance testing was available at 33 (70%) programs and used for 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the whole treatment, 16 (34%) during intensive phase only and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line TB regimens; 18 (38%) reported TB drug shortages.
Conclusions
Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower income countries. DOT was not always implemented and drug supply was regularly interrupted, which may contribute to the global emergence of drug resistance.
Objective: The aim of the study was to estimate the prevalence of locomotor disorders among people living with HIV in Abidjan.
Methods:A cross-sectional study was conducted in April-July 2014 at the Department of Infectious and Tropical Diseases in Abidjan. Data were collected with a questionnaire and four tests of locomotor function: 4-m walking speed, five timings from sit-to-stand, the timed "up and go" test and standing on one leg with the eyes closed. Logistic regression models were used to find factors associated with locomotors disorders.
Results:Of the 308 patients included in our study, 67.5% were women, and the median age was 45 years. The median duration of HIV infection was 91 months, and 97.4% were receiving antiretroviral therapy. The locomotor test that showed the most frequent alteration (87% of patients) was standing on one leg with the eyes closed. The prevalence of locomotors disorders was estimated to be 34% (95% confidence interval (CI), 28.8-39.4). In the multivariate analysis, age (odds ratio (OR), 1.9; 95% CI, 1.1-3.2; p=0.014) and body mass index (OR, 2.5; 95% CI, 1.5-4.3; p=0.001) were significantly associated with the presence of locomotors disorders. No association was found with time since diagnosis of HIV infection or antiretroviral therapy.
Conclusion:The prevalence of locomotors disorders among people living with HIV is high. Strategies should be developed to screen and treat these disorders in order to limit functional impairment in this population.
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