Apport de l’échographie abdominale au cours de l’infection par le virus de l’immunodéficience humaine de l’adulte à Bangui (République centrafricaine)

Purpose

Describe the most frequent abdominal lesions in the ultrasound examination during the infection with HIV.

Patients and method

A transverse prospective study over a period of 12 months included 104 patients infected by the HIV and who presenting abdominal lesions.

Results Profits

The mean age of the patients was 36.2 years with extremes from 15 to 70 years and a sex-ratio of 1.3 in favour of the women. The age bracket from 30 to 39 years was the most affected touched. The abdominal lesions were dominated by: the lesions hepatobiliary in 41.2% of the cases, the deep adenopathies in 24.4%, deep lymph nodes in 24.4%, ascites in 14.4% and homogeneous or multinodulaire enlarged spleen in 11% of the cases. The renal, pancreatic and intestinal hurts were rare. About 30% of the patients had a rate of CD4 lower than 50 elements/mm³ and a little more than half (51%) was under for HIV.

Conclusion

Abdominal injury during the infection by the HIV are multiple. Abdominal echography allows to make an exhaustive work-up of the main lesions; any time, the results of this examination must be confronted with the biology and the anatomopathology for a diagnosis of certainty with the aim of better treatment.     

Prévalence du virus de l’hépatite C au Burundi : enquête nationale

Introduction

The national prevalence of hepatitis C virus (HCV) is not known in Burundi. Studies carried out in specific populations found various rates. There is no nationwide study made in the country.

Aim

To determine the prevalence of anti-HCV antibodies in Burundi based on a nationwide survey.

Methods

During a nationwide survey of HIV prevalence in 2002, conducted by the CEFORMI in CHU Kamenge, two to four ml of serum and plasma had been extracted from each sample and stored under ?20°C for an ulterior use. We recuperated and analyzed them.

Results

A total of 5569 persons have been enrolled. 2660 (47,8%) were males and 2909 (52,2%) females. The mean age was 31±15 years with a median of 28 years. The global prevalence of HVC antibodies was 8,2%. It was 8,3% among males and 8,1% among females. According to strata, the prevalence was 10% in urban area, 9,1% in semi-urban area and 7,4% in rural area. The co-infection with HIV was 1,3% in urban area, 0,8% in semi-urban area and 0,1% in rural area.

Conclusion

The prevalence of anti-HCV antibodies is estimated to 8,2% in Burundi. It is one of the highest rates in Africa.     

Occlusion de l’aorte abdominale chez les patients infectés par le virus de l’immunodéficience humaine : cas clinique et revue de littérature

HIV infection has now become a chronic disease with a good life expectancy thanks to antiretrovirals. The mortality currently is attributed to other pathologies in particular cardiovascular because of the inflammation and the side effects of the drugs. All arteries can be damaged in HIV, especially the aorta, with several types of lesions which can be occlusive, aneurysmal, dissecting, even with the cases of arteriovenous fistula which have been described. HIV occlusive arterial disease is different from atheromatous disease in HIV-free patients and this is confirmed by pathology and ultrasound studies, which makes it more difficult to manage HIV-related occlusions. The open surgical treatment especially in the acute forms is disappointing with complications of rethrombosis and infectious and of sepsis of prosthesis considering the immunosuppression, the endovascular treatment begins to become the treatment of choice in the aneurysmal pathology and probably it would be in the future for occlusive disease.     

Infection par le virus de l’hépatite B : histoire naturelle,manifestations cliniques et principes thérapeutiques

Chronic hepatitis B infection remains a major public-health problem, with approximately 260 million world-wide cases of infection. Recent advances in the understanding of the natural history of chronic hepatitis B infection have led to progress in the care of infected patients. Sustained viral suppression is now possible for a majority of treated patients and is associated with a decrease in the morbidity and mortality attributable to cirrhosis and hepatocellular carcinoma. Complete cure is however not yet possible, due to the long-term persistence of viral DNA in hepatocytes of treated patients. Assessing the risk of viral reactivation in patients receiving immunosuppressive therapy is an increasingly frequent situation in clinical practice and its management is guided by both the patient's serological status and the potency of the immunosuppressive regimen. This review aims to present the clinical and biological presentations of chronic hepatitis B infection, the modalities of antiviral treatment, and how to assess the risk of viral reactivation in patients receiving immunosuppressive therapy.     

Prévalence du virus de l’hépatite B au Burundi sur la base d’une enquête nationale

Introduction

The prevalence of hepatitis B virus (HVB) is not well known in Burundi. Some fragmentary studies found various rates. No nationwide study had been made in our country.

Aim

To determine the prevalence of HBsAg in Burundi based on a nationwide survey.

Methods

During a national investigation of HIV prevalence in 2002, conducted by the CEFORMI in CHU Kamenge, between 2 and 4 ml of serum and plasma had been decanted from each sample and stored under ?20°C for ulterior use. We recuperated and analyzed these samples.

Results

A total of 5.569 persons have been enrolled, 2.660 (47.8%) males and 2.909 (52.2%) females. 1.051 (18.9%) were in urban areas; 1.062 (19.1%) in semi-urban areas and 3.456 (62%) in rural areas. The middle age was 31±15 years with a median of 28 years. The national HBsAg prevalence was 4.6% (259/5569). It was 5.4% (144/2660) among male populations and 3.9% (114/2909) among female populations (p<0,01). In urban areas, that prevalence was 5.9% (62/1051). It was 6.3% (32/505) among males and 5.5% (30/546) among females. In semi-urban areas, the prevalence was 4.6% (49/1062), 5.4% (26/484) among males and 4% (23/578) among females. In rural areas, it was 4.3% (148/3456), 5.2% (87/1672) among males 3.4% (61/1784) among females. The co-infection with the HIV was rare: 0,9% (9/1051) in urban areas, 0,3% (3/1062) in semi-urban areas and 0.3% (9/3456) in rural areas.

Conclusion

The prevalence of HBsAg is estimated to 4.6%in Burundi. It is more elevate among males (5.4%) than among females (3.9%); and in urban areas (5.9%) than in rural areas (4.3%). It is in the lowest rates found in black Africa countries.     

Cryoglobulinémie mixte symptomatique au cours de l’hépatite virale C

Cryoglobulins are immunoglobulins that reversibly precipitate in the cold. They may lead to an immune complex-mediated vasculitis, which may sometimes be severe. A wide range of conditions may be related to cryoglobulinaemia, and the most frequent of them is chronic hepatitis C. The purpose of this work was to emphasize the diagnostic and therapeutic characteristics of cryoglobulinaemia associated with hepatitis C. A 55-year-old woman, with a history of arterial hypertension, was admitted with transudative ascites. Clinical investigation revealed purpuric lesions and oedema of the lower limbs with Raynaud phenomenon. Proteinuria and haematuria were detected in the urine test strip. The patient had a positive serology for hepatitis C, but no signs of portal hypertension. Further investigations showed renal failure with nephrotic syndrome. Renal biopsy showed membranous proliferative glomerulonephritis with parietal and mesangial deposits of IgM and IgG antibodies. Skin biopsy showed leucocytoclastic vasculitis. Immunological investigations found type IIb mixed cryoglobulinaemia associated with hepatitis C. The patient was treated by pegylated interferon and ribavirin. She showed a satisfactory clinical and a sustained virological response for 1 year after the withdrawal of therapy. Mixed cryoglobulinaemia is the main extrahepatic manifestation of hepatitis C, but it is rarely symptomatic. The combination of peginterferon-α and ribavirin leads to virological and clinical responses of vasculitis in most patients.     

Les hépatites virales B et C chez les porteurs du virus de l’immunodéficience humaine à Bukavu (Sud-Kivu), République démocratique du Congo

Objective

To determine the prevalence of the co-infection of hepatitis B (HBV) and C (HCV) viruses with the human immunodeficiency virus (HIV) in individuals living with HIV in comparison with a control group HIV(?).

Methods

During a transversal study from March until August 2008 in Bukavu, we collected 209 sera from individuals living with HIV, mean age 36.7 ± 11.7 years with 67.4% females and 51% under antiretroviral (ARV) drugs. The control group consisted of 211 subjects: 143 voluntary blood donors and 68 patients, all HIV (?), with a mean age of 37.3 ± 11.3 years.

Results

The co-infection HIV-HBV affected 8% of the individuals living with HIV. The latter had no increased risk of HBV seropositivity in comparison with the control group: odds ratio (OR) of 1.0 [95% confidence interval (CI): 0.5–2.2]. HCV infection affected 4% of the control group versus 10% in the group of individuals living with HIV, which had a three times increased risk of positive serology for HCV in comparison with the control group: OR = 2.7; P = 0.02 (95% CI: 1.1–6.8). Co-infection either with HBV or HCV affected 18% of the group HIV (+). Two patients (1%) of the latter group had the markers for both hepatitis viruses. In the HIV (?) group, co-infection with HBV and HCV reached 12%.

Conclusion

Owing to the relative high prevalence of HBV and HCV co-infection, we recommend the systematic screening for hepatitis markers in the patients infected by HIV.     

Connaissance et couverture vaccinale contre le virus de l’hépatite B,des étudiants de l’université de Ouagadougou

Abstract

The aim of this study was to assess the level of knowledge of hepatitis B and it’s immunization coverage among students of the university of Ouagadougou.

Materials and methods

A cross-sectional study was conducted from 1^st to 15^th, April 2015. It involved students coming from the university of Ouagadougou selected by proportional stratified random sampling. Data were collected through an anonymous self-administered questionnaire.

Results

Five hundred students among 507 respondents agreed to take part to the study. The average age was 24 years ± 2 years. Four hundred fifty seven (91,4% of sample students) had heard about hepatitis B before. One hundred twenty four students (24,8%) had a good knowledge of this disease. Enrollment in Faculty of Health Sciences (Odds ratio (OR)=22,4 and p=0,000), being a scholarship beneficiary (OR=8 and p=0,000), living on campus (OR=2,6 and p=0,001) and the high level of education (OR=1,4 and p=0,02) were associated with good knowledge of the disease. The overall immunization coverage was 1,4% and that of students in the faculty of Health Sciences is 6%. Enrollment in this faculty (OR= 8,8 and p=0,001), being a scholarship beneficiary (OR=5,5 and p=0,000) and having good knowledge of hepatitis B (OR=3,6 and p=0,003) were associated with immunization.

     

L’infection par le virus de l’hépatite C altère-t-elle la qualité de vie des patients hémodialysés à Cotonou ?

Abstract

The aim of this study was to determine a relation between hepatitis C virus (HCV) infection and changes in the quality of life of patients with chronic renal failure undergoing haemodialysis in Cotonou.

Patients and methods

This prospective study was carried out in the Nephrology and Haemodialysis Unit of the National Teaching Hospital of Cotonou. It included 64 patients (43 men and 21 women) with a mean age of 50 ± 8.5 years. Four parameters were used to evaluate quality of life: fatigue and repercussions of current state of health on the patient’s social, professional and sexual lives. The diagnosis of hepatitis C infection was established by detecting the presence of anti-hepatitis C virus antibody using PCR.

Results

Seventeen patients (26.5%) were HVC infected. Impaired quality of life was noted in 54 (84.3%) of these patients. There were 45 cases of fatigue, 31 cases of changes in social life, and 31 cases of changes in professional life. Erectile dysfunction was noted in 29 cases. There was no difference between hepatitis C-infected and uninfected patients.

Conclusion

Hepatitis C viral infection does not impair the quality of life in this population. The lack of chronic liver disease symptoms, ignorance of HVC infection status and the lack of antiviral treatment may explain these results. The administration of a specific questionnaire may help expand these explanations.     

Séroprévalence de l’infection par le virus de l’hépatite D dans une population de donneurs de sang porteurs de l’Antigène HBs au Centre régional de transfusion sanguine de Bobo-Dioulasso

Delta superinfection can transform asymptomatic or mild chronic hepatitis B infection to severe progressive chronic active hepatitis and cirrhosis and accelerate the course of chronic active hepatitis B. The aim of this study was to determine the seroprevalence of HDVamong HBsAg positive blood donnors in Bobo Dioulasso using ELISA method (Diasorin, Antony, French). From 177 individuals included, Anti-HDV antibodies were detected in 6 (3,38%). Due to pejorative role of HDV concerning HBV natural history, we recommend systematic research of VHD antibodies on every 0.HBsAg positive patient.