Prévalence et incidence du VIH et de l’hépatite B chez les donneurs de sang et estimation du risque résiduel de transmission du virus VIH et du virus VHB par la transfusion sanguine. Une étude à l’hôpital provincial général de référence de Bukavu,République démocratique du Congo

BackgroundTo estimate the residual risk of transmission of HIV and HBV virus by blood transfusion in Bukavu.MethodsRetrospective cohort study designed for exploratory purposes, which took place in Bukavu (DR Congo) between January 2001 and December 2005, among 3292 blood donors. The incidences were estimated by survival curves and Cox models. The adjusted relative risks with their confidence interval at 95% were derived from Cox models. The residual risk of viral transmission associated with the serological window is equal to the incidence rate multiplied by the duration of the serological window divided by 365.ResultsThe prevalence among blood donors in Bukavu was 1% for HIV and 3.7% for HbsAg. The number of incident cases observed was seven for HIV and 40 for hepatitis B between 2001 and 2005. The incidence rates obtained were 3.57 for 1000 person-years (0.93/1000–6.23/1000) and 25.4 per 1000 person-years (17.6/1000–33.36/1000), respectively for HIV and hepatitis B. The residual risk was 1/4608 donations for HIV or 0.22 (0.02–0.65) and 1/257 donations for HBV or 3.90 (1.20–9.96). Also there were more seroconversions among family blood donors than in volunteer donors. The risk of seroconversion in family donors compared to volunteer donors adjusted for age, sex and residence was 7.09 (3.75–13.39) for HIV and 4.03 (2.63–6.20) for HBsAg. The same result was observed with the survival curves.ConclusionThe prevalences of HIV and HBsAg in Bukavu are lower than in most major cities in sub-Saharan Africa. Residual risks are especially important for hepatitis B.     

Séroprévalence des marqueurs de l’infection chez les donneurs de sang à Niamey (Niger)

BackgroundThe study aimed to determine the seroprevalence of transfusion-transmitted infectious (TTI) markers for human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV, HCV) and syphilis among blood donors in Niamey (Niger). The association between seroprevalence of ITT markers and sociodemographic characteristics of blood donors was investigated.MethodsA cross-sectional study was conducted in 2010 among 3213 blood donors. Data were collected from a pre-donation questionnaire and from laboratory tests results.ResultsThe male/female ratio was 4/1. Up to 18.1% of donations had at least one positive marker, in which 2.7% presented a positive test for two or more agents. A seroprevalence of 1.62% (95%CI: 1.21–2.12) was associated with HIV, 15.4% (13.9–16.7) with HBV, 1.18% (0.84–1.62) with HCV, and 0.47% (0.26–0.77) for blood samples reacted with RPR test for syphilis. The HIV seroprevalence was two-fold higher in family than in volunteer donors (OR = 2.15, 95%CI: 1.24–3.73). It was also higher in Rhesus D negative donors (OR = 2.40, 95%CI: 1.11–5.17). The hepatitis B surface antigen seroprevalence was significantly higher in males than females (OR = 1.85, 95%CI: 1.39–2.45) and in first time than in regular donors (P < 0.0001). The HCV seroprevalence was significantly higher in male donors (OR = 4.41, 95%CI: 1.06–18.4) and in donors from rural areas (OR = 4.09, 95%CI: 1.42–11.8). Syphilis marker was significantly associated with the marital status (higher seroprevalence in divorced donors, P = 0.0085).ConclusionPrevalence of TTI markers is high and national strategies for safe blood transfusion have to be strengthened. It is essential to recruit and maintain more volunteer donors, while females should be encouraged to donate blood.     

Séroprévalence du VIH et facteurs associés chez les hommes ayant des rapports sexuels avec d’autres hommes au Togo

BackgroundLimited 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.MethodA cross-sectional survey was carried out among MSM aged at least 18 years old, living in Togo for at least 3 months. 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.ResultsA total of 758 MSM were enrolled in this study, including 498 (67.5%) from Lomé, the capital of Togo. The median age was 24 years with an interquartile range of [21–27 years] 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).ConclusionOne MSM out of five was HIV-infected. Intervention programs targeting this vulnerable population are urgently needed, to reduce HIV incidence in Togo.     

Prévalence des facteurs de risque cardiovasculaires conventionnels dans la population du Grand Tunis

BackgroundThis study was designed to determine the prevalence of main cardiovascular risk factors in the population of Great Tunis.Subjects and methodsThis cross-sectional study included 2483 individuals aged 35 to 70 years dwelling in the Great Tunis region, recruited between March 2004 and June 2005. The sample was weighted using the inverse of response rate according to governorate, district and sex.ResultsObesity and abdominal obesity were observed respectively in 34 and 48% of subjects. The prevalence of these two factors was particularly elevated in females (46 and 69% respectively). Hypertension was common (31%), especially in women (36%). Diabetes mellitus and dyslipemia were found in 15 and 21% of subjects, respectively, without difference according to sex. More than half of men and 8% of women were current smokers.ConclusionThe prevalence of conventional cardiovascular risk factors is dramatically high in the population of Great Tunis. These findings predict a future expansion of cardiovascular diseases in this population. Profound changes of lifestyle and dietary habits of Tunisians are needed to reduce the risk of cardiovascular morbidity and mortality.     

Épidémiologie hospitalière des patients co-infectés par le VIH et le VHC

Hospital epidemiology of patients co-infected by HIV and HCV.ObjectiveTo describe the epidemiology and the hospital management of patients co-infected by HIV and HCV.MethodA “one-day” survey in 46 French hospitals.ResultsAmong the 990 HIV positive patients, 95% were investigatyed for HCV and 33% of them were positive, 40% with a normal ALT level. The HCV-RNA serum level, obtained in 68%, was positive in 90%. Drinkers were 29%. 46% of the patients with RNA-HCV positive, had had a liver biopsy: 17% had moderate hepatitis, 68% severe hepatitis, 15% cirrhosis, 49% had been treated. The proportion treated was not different, according the ALT level; but more treated patients were found (p > 1%) among non-drinkers (58%) than among drinkers (20%). Furthermore, only 56% with severe hepatitis and 67% with cirrhosis had been treated.CommentsThis survey showed that a large proportion of HIV positive patients were also infected by HCV and are insufficiently investigated and treated.     

Prévalence de l’obésité et du surpoids chez les écoliers de primaire à Marrakech,Maroc

BackgroundChildhood obesity is a phenomenon of growing concern today because of its rapid growth worldwide. The aim of our study was to estimate the prevalence of overweight and obesity among school age children in Marrakech.MethodsWe conducted a cross-sectional study of a random sample of 1418 schoolchildren aged 8–15 years in the public sector in Marrakech in May 2011. Trained physicians measured the weight and size of respondents. The body mass index (BMI) was calculated for each child. Overweight was assessed by comparing BMI with World Health Organization (WHO) and International Obesity Task Force (IOTF) references. Statistical analysis was performed using SPSS version 16.0 and using a macro of WHO Anthro for SPSS.ResultsThe mean age was 10.8 ± 1.6 years. The sex ratio (girl/boy) was 1. The prevalence of overweight and obesity were 8 % (95 % CI [6.7, 9.6]) and 3 % (95 % CI [2.2, 4.1] based on WHO reference. This prevalence were respectively 12.2 % (95 % IC [10.5; 14.0]) and 5.4 % (95 % IC [4.3; 6.7]) using the IOTF reference.ConclusionIn the absence of national data, our results reflect the importance of the phenomenon in our context, hence the importance of monitoring the nutritional status on both individual and collective levels and the need to develop strategies for prevention, diagnosis and early treatment before the problem becomes more widespread.     

Profils métabolique et clinique avant,pendant et après la période du ramadan chez des Maliens atteints de diabète de type 2

ObjectivesTo document the effects of fasting on metabolic and clinical parameters among Malians with type 2 diabetes during Ramadan in Mali.MethodsThis study was conducted with 25 subjects attending the Centre national de lutte contre le diabète in Bamako. Only those that intended to observe the Ramadan fasting in 2010 were selected. Biological and clinical parameters were measured in 25 participants at three different periods: before Ramadan (T0), during the fourth week of Ramadan (T1) and one month after Ramadan (T2).ResultsCompared to T0, an increase was noted at T1 in fasting blood glucose (P < 0.05) and systolic blood pressure (P < 0.01), although not maintained at T2. Glycosylated haemoglobin was also higher at T2 compared to T0 (P < 0.02). Degradation of glycemic control was more marked among patients who had stopped or reduced their doses of medication at T1 (P < 0.01). Also, a decrease in LDL-cholesterol (P < 0.03), total cholesterol (P < 0.05) and total cholesterol/HDL-cholesterol ratio (P < 0.01) were observed at T1, along with a slight weight loss (P < 0.01). Reductions in weight, levels of LDL-cholesterol and total cholesterol/HDL-cholesterol ratio were maintained at T2.ConclusionsThis study showed an adverse effect of fasting on glycemic control among the participants, likely related to the non-observance of oral medication during Ramadan. However, blood lipids sharply improved during Ramadan, and even after.