[Study of factors associated to therapeutic failure of children infected by HIV1 under antiretroviral treatment in the Sanou Sourô University Hospital of Bobo-Dioulasso (2007-2013)]

OBJECTIVE

To determine the prevalence of therapeutic failure and the associated factors in children aged 6 months to 15 years old with HIV 1 and regularly visiting the Sanou Sourô University Hospital (SSUH) of Bobo-Dioulasso.

METHODS

A retrospective study was conducted concerning the children followed in the SSUH between February, 2007 and February 2013 infected by HIV 1 under ARV for at least six months. The diagnosis of therapeutic failure was defined according to the WHO criteria.

RESULTS

the population of study was 311 infected patients, 53.8 % were male. The average age was of 108 months ± 67, and 62.0 % had a rate CD4 higher than 200 cells/ µ L; 43.5 % of the patients were at class III / IV of the WHO classification. Prevalence of the failure was at 19.6 %. The female genital organ (RR: 0.49 IC95 %: [0.24-0.99] p = 0.03), respect for the treatment ≤ 95 % (RR 0.37 IC95 % [0.15-0.92] p=0.04), the death of the mother (RR: 0.33 IC95 % [0.09-1.21] p=0.04) and the class WHO advanced (III / IV) (RR 0.26 IC95 % [0.09-0.77] p=0.02) was associated to the therapeutic failure.

CONCLUSION

prevalence of therapeutic failure was high for the children being followed at the Sanou-Sourô University Hospital of Bobo-Dioulasso. The female genital organ, respect for the treatment ≤ 95 %, death of the mother, and the advanced WHO classification stages (III / IV) were associated with therapeutic failure.

[Immuno-virologic dissociation in patients infected by HIV-1 under antiretroviral treatment at the Day hospital of Bobo-Dioulasso from 2008 to 2012 (Burkina Faso)]

OBJECTIVE

describe the sociodemographic, clinical, therapeutic, biological profile and the observance of treatment in cases of immuno-virologic dissociation response (IVDR) in HIV-1 patients at te 12 months of antiretroviral treatment (ARVT).

METHODS

This was a historical cohort study with a descriptive and analytical focus from January 2008 to December 2012; covering the IVDR cases at the day hospital of Bobo Dioulasso. We collected the data during medical consultations by means of the ESOPE software and from medical records of the patients.

RESULTS

Of 2078 patients on ARVT, 84 or 4% presented one IVDR, among which 56 women (66.7%) and 28 men (33.3%). The average age was 45 years [range: 45-55 years]. At the initiation of ARVT, most patients were in clinical stage 3 or 4 of the WHO classification (57.1%). The body mass index (BMI) average was 20.5kg/m² [IQR = 18.5 and 23]. The average number of +CD4 T lymphocyte was 42 cells/mm³ [IQR = 12- 63]. During follow-up, the median gain in BMI was 3.2 kg/m² [IQR = 1.2 to 4.3 kg/m²], the median gain was 76 cells/µl [IQR = 60 - 88]. The viral plasmatic load of the HIV-1 was undetectable with a rate of TCD4+ < 100 cells /µl in 12 months. Factors associated with IVDR were the age between 35 and 45 years (p = 0.0009), the number of +CD4 T cells (+CD4T≤50) at initiation of ARVT (p = 0.00045 ) and the WHO classification clinical stage 3.

CONCLUSION

This study demonstrates the problem of IVDR management in Bobo-Dioulasso and reminds of the interest of care follow-up of people living with HIV-1 by viral load and not only by the rate of CD4+ T especially in the decentralized structures of coverage of HIV, where changes of therapeutic mechanisms operate disjointedly.

[Side infection during HIV/AIDS at Trechville university health center (CHU)]

To highlight the main sides infections and their progress with HIV sick people selected in the inner health department of the CHU of Treichville, Abidjan, a retrospective survey was carried out from the files of sick people over 30 months of period; from January 1, 1999 through July 15, 2001. 279 patients (143 males and 136 females) where involved; 382 side infections where found out and the most frequent were: tuberculosis (28.3%), fungous infection (26.7%), gastro-enteritis.7%) and brain toxoplasmosis (15%). The lethal rates were respectively 16.6% for tuberculosis, 51.6 for gastroenteritis, 66.7% for neuro-meningeal Cryptococcus and 68.1% for brain toxoplasmosis. The impact of side infections on the progress of HIV/AIDS requires a preventive type of rallying as therapeutic progress is still unreachable for developing countries, which are the most affected by the HIV epidemics.

[Pulmonary tuberculosis in an endemic area with high HIV prevalence]

The aim of this study was to study clinical and radiological aspects of caseous pneumonia in Burkina Faso where we have higher prevalence of tuberculosis/HIV. 3 years of retrospective study, from 1st January to December 31-1999, had been carried out in the "Centre Hospitalier National Yalgado Ouédraogo de Ouagadougou". Among 106 of patients studied, 26 caseous pneumonia were observed (24.5%) of whom 9 patients were holders of HIV. Often observe on late because of the non specificity of signs, 9 cases of pneumonia upon 26 were excaved (2 holders of HIV and 7 non holders of HIV). The lesion have predominated on upper right lob (19 cases upon 26). The antituberculosis treatment was effective in the major cases but with the sequella (excavations, fibrosis) in patients with excaved lesions or treated in late. Considering the gravity of the disease and its sequella which can be avoid, the presence of fever, slimming even at absence of bacteriologic prouf in debilited patient must evoke caseous pneumonia diagnosis and allowed to begin specific treatment.

[Bronchopulmonary Kaposi's disease in 2 AIDS patients living in a zone of high tuberculosis/HIV prevalence]

The epidemic form of Kaposi's disease, called Kaposi-AIDS, was first described in 1981 by Hymmes in two young AIDS patients. Lung lesions are observed in 10 to 45% of patients with cutaneous Kaposi and are the second leading localization of visceral involvement after the digestive tract. Diagnosis and management of these visceral forms remains difficult. We report two cases of broncho-pulmonary Kaposi-AIDS in two patients treated for cutaneous Kaposi's disease. The diagnosis was made on the basis of epidemiological, clinical, biological, radiological, endoscopic, and histological evidence. The diagnosis was achieved by elimination after ruling out all other opportunistic diseases with pulmonary tropism. The fear of miliary tuberculosis remains strong in zones with a high prevalence of tuberculosis. Despite considerable improvement with antiretroviral drugs, especially antiproteases, outcome remains unpredictable with or without specific treatment.

[Primary pulmonary myxoid liposarcoma discovered fortuitously]

We report a fortuitous discovery of primary pulmonary myxoid liposarcoma in an HIV-positive patient. Primary pulmonary localizations are uncommon. Generally, pulmonary localizations are metastatic. There is a male predominance and diagnosis is generally made around 40 years of age. The two main features of liposarcoma are the large tumor size and the complex histology that evolves over time. Pathology findings are rarely reproducible and vary from one pathologist to another. Macroscopically, liposarcomas can mimic benign tumors. The risk of recurrence is high after simple enucleation due to microscopic extracapsular extensions. Surgery remains the predominant treatment. Wide complete excision, if possible, provides long-term survival.

[Contribution of bronchial fibroscopy in pneumonology services in developing countries]

Bronchial fibroscopy is a recent investigation method that requires equipment and facilities difficult to implement in respiratory diseases units in developing countries. In Burkina Faso, this technique was introduced for the first time in February 1997. The purpose of this study was to determine the contribution of bronchial fibroscopy for the diagnosis of respiratory disease in countries with limited resources. This study was conducted between February 1997 and October 1998 at the respiratory diseases unit of the Yalgado Ouedraogo National Hospital Center in Ouagadougou, Burkina Faso. Thirty-five cases of tuberculosis were diagnosed, including 29 cases with bronchial node involvement, where bronchial fibroscopy is an essential diagnostic examination, and 6 cases of bacteriologically proven pulmonary tuberculosis. Ten cases of lung cancer were diagnosed (40% squamous cell carcinoma). Malignant disease is a reality in developing countries despite low rates of diagnosis due to insufficient diagnostic facilities. For tuberculosis, the importance of specific treatment is certainly well established and should always be initiated, even if fibroscopy cannot be performed. This contrasts with the situation for malignant disease, where the high prevalence of lung cancer (9.9% of the bronchial fibroscopies performed) is associated with total lack of treatment due to the absence of a thoracic surgery unit or a radiotherapy unit, and the impossibility of providing satisfactory surveillance of anti-cancer chemotherapy.

[Simultaneous resistance to rifampicin and isoniazid in patients with pulmonary tuberculosis]

Percentages of primary and acquired resistance to anti-tuberculosis drugs provide an epidemiological indicator useful for assessing national anti-tuberculosis programs. Rifampicin and isoniazide are widely used in countries with a high prevalence of tuberculosis. In tropical Africa, these drugs are the mainstay treatment for tuberculosis, used both in the initial and long-term regimens. Simultaneous resistance to these two antibiotics would seriously jeopardize therapeutic efficacy. We studied simultaneous rifampicin and isoniazide resistance in patients hospitalized for tuberculosis in the respiratory disease unit of the Treichville University hospital in Abidjan, Ivory Coast. Mycobacterium tuberculosis was isolated in 8 patients. All the strains isolated were resistant to streptomycin. History taking revealed that resistance was observed at the initial prescription in 6 cases. A notion of contagion was present in 4 cases. Six patients were HIV-positive. Surveillance of resistance to anti-tuberculosis drugs is helpful in detecting early changes which could compromise the efficacy of the therapeutic scheme.

[Active tuberculosis in a patient with Hodgkin's disease. A case report]

We report a case of active tuberculosis in a patient with Hodgkin's disease. The two diagnoses were established simultaneously at the Respiratory Disease Unit of the Yalgado National Hospital, Burkina Faso. The clinical presentation was misleading as the signs and symptoms of the two disease are similar. Certain diagnosis was established after isolation of tuberculosis bacilli and histocytology findings for Hodgkin's disease. Both diseases are potentially curable. The clinical course depends on early diagnosis and treatment.