A Highly Heterogeneous HIV-1 Epidemic in the Central African Republic

Massanga, M; Ndoyo, J; Hu, Dale J.; Pau, Chou‐Pong; S, Lee-Thomas; Hawkins, R; Senekian, Dominique; Rayfield, Mark; George, J. Richard; Zengais, A; Yatere, N N; Yossangang, V; Samori, Arduino; Schochetman, Gerald; Dondero, Timothy J.

doi:10.3201/eid0203.960310

Cited by 12 publications

(7 citation statements)

References 11 publications

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“…The HIV test results from our study population give further evidence for the high prevalence of HIV infection in the sexually active population of Bangui 23 . Assuming that all HIV infections were caused by sexual contact (2 HIV-positive study women who reported receipt of a blood transfusion were excluded) and calculating the time of sexual exposure by subtracting the age of ® rst sexual contact by the current age, we calculated an approximate incidence rate of 3.7% per year in our study population, which is comparable to the high incidence rates observed in adolescent populations from other African regions 4,24,25 .…”

Section: Discussionmentioning

confidence: 72%

Sexually transmitted infections in young pregnant women in Bangui, Central African Republic

Blankhart¹,

Müller²,

Grésenguet³

et al. 1999

Int J STD AIDS

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In early 1996, 481 women visiting the antenatal services of the 3 major governmental health centres in the capital city of the Central African Republic (CAR) were included in the study. All study participants underwent the health centre's routine gynaecological examination, including laboratory diagnosis of trichomoniasis, candidiasis, gonorrhoea, syphilis and bacterial vaginosis. Cervical secretions and blood samples from study participants were sent to the National STD Reference Centre for diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, Candida albicans, Treponema pallidum, and HIV. Overall, 34% of the study women were diagnosed with at least one sexually transmitted infection (STI) (3.1% N. gonorrhoeae, 6.2% C. trachomatis, 9.9% T. vaginalis, 6.7% T. pallidum, 12.2% HIV-1). In addition, 29.1% of women were diagnosed with bacterial vaginosis and 46.6% with candidiasis. Only a small proportion of these women had sought treatment during the weeks before, despite the recognition of genital symptoms. Self-reported and health worker-recognized symptoms, signs and laboratory results exhibited only low sensitivities, specificities, and positive predictive values in the diagnosis of STIs. These findings confirm the high vulnerability of young African women to STIs and emphasize the need for specific control interventions which should include affordable and user-friendly services. Moreover, these results call for more effective quality control in case of laboratory-based STI control strategies and question the validity of syndromic STI management strategies in women attending antenatal care services in Africa.

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Section: Discussionmentioning

confidence: 72%

Sexually transmitted infections in young pregnant women in Bangui, Central African Republic

Blankhart¹,

Müller²,

Grésenguet³

et al. 1999

Int J STD AIDS

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“…Subtyping using PEIA in countries such as Thailand where only two subtypes of HIV-1 circulate has been shown to be very effective [6,9]. However, this technique has not been successful in population-based studies in areas where several antigenically related subtypes of HIV-1 cocirculate, due to a high level of cross-reactivity [10,11]. PEIA methodologies for HIV-1 subtyping vary from one laboratory to another; both in the concentration of peptides used for coating, choice and length of peptides, and dilution factors of both specimens and reagents.…”

Section: Introductionmentioning

confidence: 99%

Lack of correlation between V3-loop peptide enzyme immunoassay serologic subtyping and genetic sequencing

Nkengasong

Willems²,

Janssens³

et al. 1998

AIDS

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Our results indicate that V3-loop PEIA methodologies used in different laboratories correlate poorly with genetic subtyping, and that their accuracy to predict HIV-1 subtypes in sera of Belgian individuals infected with different HIV-1 subtypes (A, B, C, D, F, G and H) vary considerably. The poor correlation between serotyping and genetic subtyping was partly due to the simultaneous occurrence of subtype-specific octameric sequences at the tip of the V3 loop of viruses belonging to different genetic subtypes.

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“…The Central African Republic is strongly affected by the human immunodeficiency virus (HIV) epidemic (24). Nearly 72% of the adults hospitalized with AIDS present initially with chronic diarrhea (CD) (14).…”

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confidence: 99%

Chronic Diarrhea, Hemorrhagic Colitis, and Hemolytic-Uremic Syndrome Associated with HEp-2 Adherent Escherichia coli in Adults Infected with Human Immunodeficiency Virus in Bangui, Central African Republic

et al. 2002

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In human immunodeficiency virus (HIV)-infected adults from the Central AfricanRepublic, the occurrence of chronic diarrhea due to HEp-2 adherent Escherichia coli (EAEC) harboring virulence markers (eaeA, BFP, EAF, astA determinant of EAST/1, positive FAS test, enteropathogenic E. coli O serogroup) was shown to be associated with AIDS. We also show that EAEC that produce verotoxin (Stx2) but do not harbor the genetic markers for classical enterohemorrhagic E. coli are involved in hemorrhagic colitis and hemolytic-uremic syndrome in patients with HIV.The Central African Republic is strongly affected by the human immunodeficiency virus (HIV) epidemic (24). Nearly 72% of the adults hospitalized with AIDS present initially with chronic diarrhea (CD) (14). Between 1996 and 1999 we used phenotypic (14) and genotypic assays to study 88 HIV-infected adults hospitalized in Bangui and their matched controls to determine the clinical significance of diarrheagenic Escherichia coli (7,8,9,10,12,16,22,25,27,29,31,32,34,35). The methods were as previously described (14). To be included in the study, the patients had to be HIV positive and aged 18 or over, have CD (3 or more loose watery stools per day for at least 14 days [3]), have E. coli in a stool sample, and give informed consent. Each patient was matched with a control recruited from among the neighbors and family members of the patient. The matching criteria dictated that the control be aged within 5 years of the patient's age and of the same sex. The recruitment criteria for the matched controls were as follows: testing positive for HIV antibodies, having had no diarrhea on the day of recruitment or during the previous month, and having E. coli in their stools on the day of recruitment. All controls gave informed consent to participate.HEp-2 adherent E. coli (EAEC) (5, 28) with localized adherent (LA), aggregative adherent (AA), or diffuse adherent (DA) patterns were more common in the patients (P Ͻ 10 Ϫ5 ) than in the controls (Table 1). Some EAEC exhibited a strong LA pattern (16 patients versus no control) in which Ͼ20% of the randomly selected cells had attached bacteria (11,19).These LA strains with a strong LA pattern were associated with CD, especially when the assays used to identify enteropathogenic E. coli (EPEC) virulence factors yielded positive results (eaeA, EPEC adherence factor [EAF] plasmid, bundleforming pili [BFP] PCR, and fluorescent actin staining [FAS] test) (P Ͻ 10 Ϫ5 ), and all belonged to known EPEC O serogroups (P ϭ 0.0001). The isolation of enteroaggregative E. coli (EAggEC) was strongly correlated with the presentation of CD (P Ͻ 10 Ϫ5 ). The difference in the isolation rates of EAEC strains exhibiting DA between patients and controls was only significant when the presence of the astA gene encoding EAST/1 was considered (P ϭ 0.016); astA was located on 7-to 40-kb plasmids.Interestingly, all of the enteric bacteria isolated from 42 patients (86% of the 49 patients with severe immunodepression) harboring EAEC with virulence factors were E. co...

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A Highly Heterogeneous HIV-1 Epidemic in the Central African Republic

Cited by 12 publications

References 11 publications

Sexually transmitted infections in young pregnant women in Bangui, Central African Republic

Sexually transmitted infections in young pregnant women in Bangui, Central African Republic

Lack of correlation between V3-loop peptide enzyme immunoassay serologic subtyping and genetic sequencing

Chronic Diarrhea, Hemorrhagic Colitis, and Hemolytic-Uremic Syndrome Associated with HEp-2 Adherent Escherichia coli in Adults Infected with Human Immunodeficiency Virus in Bangui, Central African Republic

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