RESUMEN
In the developed word, monitoring HIV-infected patients is routinely determined by CD4+ T lymphocyte absolute counts. The reference procedure, flow cytometry, is expensive, requires sophisticated instrumentation and operators with specific training. Due to these limitations, CD4 counting is often unavailable in developing countries. The Capcellia assay is an enzyme-linked immunoassay for quantitative determination of CD4 and CD8 molecules. We evaluated this method in West Africa on blood samples collected from 39 HIV-uninfected and 44 HIV-infected adult subjects. CD4 concentration ranges were determined according to the clinical stages of the disease. We then studied the relationship between the two methods in the HIV-infected patients. The Spearman's rank correlation was 0.61 (95% confidence interval: 0.38-0.76, P < 0.0001). Nevertheless, determination of limits of agreement revealed discrepancies between the two methods, especially for CD4 counts > 0.4 x 10(9)/l, which are discussed. We conclude that the Capcellia assay is a convenient means to determine the immunodepression level where flow cytometric instrumentation is unavailable, and can be complementary to CD4 T lymphocyte enumeration.
Asunto(s)
Antígenos CD4/sangre , Antígenos CD8/sangre , Ensayo de Inmunoadsorción Enzimática/métodos , Infecciones por VIH/inmunología , Recuento de Linfocitos , Adulto , África Occidental , Anticuerpos Monoclonales , Recuento de Linfocito CD4 , Linfocitos T CD8-positivos , Estudios de Evaluación como Asunto , Citometría de Flujo , Infecciones por VIH/sangre , VIH-1 , Humanos , Juego de Reactivos para DiagnósticoRESUMEN
The medical inequalities between countries of the North and South (infrastructure, drug availability, medical techniques) are particularly marked in terms of the challenge posed by HIV infection. We propose a strategy for monitoring adult patients in West Africa that is appropriate to the situation in the field and to economic constraints. The aim of this strategy is to increase the quality of life and the life expectancy of HIV-infected adults and to prevent the overcrowding of hospital departments with patients in the terminal phase of AIDS. We analyzed the biological and clinical spectrum of HIV infection before the onset of the diseases that define AIDS (excluding pulmonary tuberculosis). We found that it was particularly important to diagnose B-stage diseases early, especially atypical chronic cutaneous and mucous diseases. Careful analysis of data from a routine hemogram (total lymphocyte count 2500/ml; paradoxical eosinopenia), even in the absence of a CD4 lymphocyte count, should also enable clinicians from a wide variety of health structures to identify the HIV-infected patients most likely to benefit from more detailed clinical follow up, prophylaxis of opportunistic infections using cotrimoxazole, nutritional checkups and prevention of wasting. Cachexia is the most common AIDS-associated disease in West African patients. It involves an overall decrease in calorific intake, diarrhea, immune system activation, an increase in TNFalpha production and greater energy expenditure when resting. Recent nutritional studies have shown that it is vital to optimize the calorific intake of HIV-infected patients presenting with chronic diarrhea, before the onset of severe immune deficiency, to prevent wasting. So, spontaneous calorific intake should de routinely determined in HIV-infected patients and an optimal diet provided. Specific training in nutrition is required for doctors and nurses, as is consideration of the logistic organization required to provide nutritional support to HIV-infected adults. Despite the large number of individuals infected and the lack of sophisticated paraclinical facilities, we feel that it is possible to establish rational management "a minima" of HIV infection in West Africa, whilst waiting for antiretroviral drugs to become more widely available. This strategy could be of direct benefit to patients without swallowing up the financial resources of the health system in expensive biological follow up. Such basic management is also required before the new antiretroviral drugs become widely available. Research should be carried out in parallel in several reference centers in West Africa to determine the most effective associations of antiretroviral drugs and the optimal timing of treatment during the course of infection and to assess the potential side effects of these drugs in HIV patients exposed to recurrent antigenic stimulation by a wide diversity of pathogens.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/prevención & control , Síndrome de Emaciación por VIH/prevención & control , Síndrome de Inmunodeficiencia Adquirida/terapia , Adulto , Burkina Faso , Caquexia/fisiopatología , Caquexia/prevención & control , Atención a la Salud/economía , Quimioterapia Combinada , Ingestión de Energía , Eosinófilos/patología , Estudios de Seguimiento , Infecciones por VIH/clasificación , Infecciones por VIH/fisiopatología , Recursos en Salud , Humanos , Tolerancia Inmunológica , Leucopenia/clasificación , Esperanza de Vida , Recuento de Linfocitos , Evaluación Nutricional , Apoyo Nutricional , Admisión del Paciente , Calidad de Vida , Enfermedades Cutáneas Infecciosas/prevención & control , Cuidado TerminalRESUMEN
Our objective was to propose a strategy to screen HIV-infected African people for biological immunodeficiency easily. In a cross-sectional study, we analysed the patterns of diseases and of CD4 counts among 266 HIV-infected adults. Peripheral facial paralysis and chronic cutaneo-mucous diseases were the earlier B-stage diseases. Pulmonary tuberculosis was close to B-stage diseases, and chronic diarrhoea was borderline between B and C stages. Cachexia was the most frequent C-stage symptom (47.8%). Ninety per cent of CDC-C stage people had CD4 counts below 350/microliter, whereas only 75% had CD4 counts below 200/microliter. Regression analysis identified the lymphocyte count, clinical stage and platelet count as predictors of CD4 count below 350/microliter. A simple score (lymphocyte count < or = 2500/microliter and clinical stage > or = B) is proposed to determine this CD4 threshold (positive predictive value: 83%) and to determine those patients needing treatment to prevent wasting and opportunistic infections.
PIP: Findings are presented from a cross-sectional study conducted in 1995 in Bobo-Dioulasso, Burkina Faso, in which the patterns of diseases and CD4 counts among 266 HIV-infected adults of mean age 33 years were analyzed. The bioclinical spectrum of subjects' HIV disease is described and a simple alternative proposed to CD4 enumeration for screening and monitoring HIV-infected Africans. Dermatological symptoms and diarrhea were the most frequent signs associated with B-stage disease, while cachexia and digestive candidosis were the most frequent AIDS-defining diseases (ADD). Peripheral facial paralysis and cutaneo-mucous diseases were associated with weak immune deficiency. Pulmonary tuberculosis (TB) was close to B-stage diseases, and chronic diarrhea was borderline between B and C stages. Cachexia was the most frequent C-stage symptom (47.8%). 90% of CDC C-stage subjects had CD4 counts of less than 350 per mcl, while only 75% had CD4 counts under 200/mcl. Regression analysis identified the lymphocyte count, clinical stage, and platelet count as predictors of CD4 count below 350/mcl. A lymphocyte count of less than or equal to 2500/mcl and clinical stage of B or higher is proposed to determine the CD4 threshold and to determine those patients in need of treatment to prevent wasting and opportunistic infections.
Asunto(s)
Infecciones por VIH/terapia , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adulto , Burkina Faso , Recuento de Linfocito CD4 , Estudios Transversales , Eosinófilos , Infecciones por VIH/sangre , Hemoglobinas/análisis , Humanos , Recuento de Linfocitos , Recuento de Plaquetas , Tuberculosis Pulmonar/etiologíaRESUMEN
Little information is available regarding human immunodeficiency virus (HIV) infection among female sex workers (FSW) in Burkina Faso, West Africa. A cross-sectional study was conducted in Ouagadougou and Bobo-Dioulasso, the 2 largest cities of the country, to determine the prevalence of HIV infection and other sexually transmitted diseases (STDs) among FSWs, and to investigate the factors which were associated with HIV infection in this population. From October to November 1994, 426 FSWs were recruited. The method of anonymous and unlinked HIV screening recommended by the World Health Organization (WHO) was used. The overall HIV seroprevalence was 58.2% (95% confidence interval: 53.4-62.9) and 52.6% of FSWs had at least one STD agent. The most common STDs were trichomoniasis (23%), syphilis (15%) and gonorrhoea (13%). In a logistic regression analysis, risk factors for HIV infection were high gravidity (> or = 2 pregnancies), low perception of personal risk of HIV infection, syphilis and the presence of genital warts. These results suggest that FSWs in Burkina Faso need better information about HIV transmission and prevention and then need better access to STD detection and management services.
Asunto(s)
Infecciones por VIH/epidemiología , Trabajo Sexual , Adulto , Burkina Faso/epidemiología , Estudios Transversales , Femenino , Humanos , Prevalencia , Factores de RiesgoRESUMEN
BACKGROUND: It is important for HIV/AIDS control programmes to determine population knowledge on AIDS in order to develop appropriate Information, Education and Communication (IEC) messages. The objectives of our study were to determine the seroprevalence of HIV and syphilis among pregnant women, female prostitutes and long-distance truck drivers and to evaluate knowledge, attitudes, beliefs, and practice (KABP) with respect to the HIV/AIDS epidemic in these three groups in Burkina Faso. METHODS: We performed three cross-sectional serosurveys including face-to-face interviews on KABP between October 1994 and February 1995 in three population groups. RESULTS: Overall, 1,294 pregnant women, 236 long-distance truck drivers and 426 female prostitutes were recruited. HIV seroprevalence was 8% (95% Confidence Interval (CI): 6.6-9.6) among pregnant women, 18.6% (95% CI: 13.9-24.2) among long-distance truck drivers and 58.2% (95% CI: 53.4-62.9) in female prostitutes. The prevalence of syphilis was 2.5%, 9.3% and 15%, respectively. Most pregnant women (98%), long-distance truck drivers (96%) and female prostitutes (98%) had already heard of AIDS. However, the level of knowledge of HIV transmission routes, of risk factors for HIV transmission and of available preventive measures was very low. Consequently, 41% of pregnant women, 40% of long-distance truck drivers and an alarming 61% of female prostitutes reported that they did not feel themselves at risk for HIV. In each group, high levels of knowledge on AIDS were associated with increased awareness of AIDS risk and the adoption of preventive behaviours. Level of education was associated with knowledge of AIDS and condom use. However, in the 12 months preceding the surveys, condom use was very low among pregnant women (0.1%), long-distance truck drivers (18%) and among female prostitutes (42%). CONCLUSIONS: These results indicate that HIV is widespread in Burkina Faso and that there is an urgent need to develop and evaluate HIV prevention strategies in the general population and among core groups such as female prostitutes and long-distance truck drivers. Interventions must include information campaigns, condom promotion and distribution, and sexually transmitted diseases control.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Brotes de Enfermedades , Infecciones por VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adulto , Burkina Faso/epidemiología , Condones , Intervalos de Confianza , Estudios Transversales , Escolaridad , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Seroprevalencia de VIH , Conductas Relacionadas con la Salud , Educación en Salud , Promoción de la Salud , Humanos , Entrevistas como Asunto , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Factores de Riesgo , Trabajo Sexual , Enfermedades de Transmisión Sexual/prevención & control , Sífilis/epidemiología , TransportesRESUMEN
SETTING: The study was conducted in Bobo-Dioulasso, Burkina Faso, where Mycobacterium tuberculosis infection and human immunodeficiency virus type 1 (HIV-1) infection are prevalent. OBJECTIVE: To identify proportions of representative (test) populations who are reactive to the tuberculin skin test, and to study the relationship between CD4 T-lymphocyte counts and the induration size of the tuberculin skin test in these groups. DESIGN: A group of 435 healthy students was tuberculin skin tested in order to evaluate the intensity of skin testing in a 'normal' population. The study group consisted of 195 subjects with or without tuberculosis, and with or without HIV-1 infection, who received a tuberculin skin test and a CD4 T lymphocyte count on the same day. RESULTS: In total, 90% of the control (nontuberculous, HIV negative) subjects, 32% of the HIV-1 seropositive subjects, 76.5% of the tuberculous patients and 57% of the tuberculous HIV-1 seropositive patients were tuberculin positive. There was no direct correlation between the induration size of reactions to the tuberculin skin test and CD4 T-lymphocyte count in these study groups using linear regression analysis. CONCLUSION: In vivo skin testing using tuberculin yields clinically significant information on the degree of immunodeficiency which is different from that of CD4 T-lymphocyte counts. The tuberculin skin test should therefore be used as an independent marker of the weakened immunological status of HIV-1 seropositive subjects.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Recuento de Linfocito CD4 , Seropositividad para VIH , Prueba de Tuberculina , Tuberculosis/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Adulto , Burkina Faso/epidemiología , Femenino , VIH-1 , Humanos , Modelos Lineales , Masculino , Prevalencia , Tuberculosis/diagnósticoRESUMEN
To determine the prevalence of HIV infection among pregnant women in Burkina Faso and to identify factors associated with HIV infection in this population, we performed in 4 antenatal clinics in 4 urban centres located in the centre, the north, the east and the south-west of the country cross-sectional serological surveys between 7 October 1994 and 7 February 1995 using unlinked anonymous HIV screening method. In the towns included in the study more than 94% of pregnant women attend at least 2 antenatal consultations. In each centre all pregnant women attending an antenatal consultation during a 2-week period were invited to take part in a study to measure the prevalence of syphilis. Women with positive syphilis serology were offered treatment free of charge. A total of 1294 pregnant women were recruited into the study. There were no refusals. Thirty-two women (2.5%) had positive syphilis serology. The overall seroprevalence of HIV infection was 8% (95% confidence interval [CI]: 6.6-9.6). There was no evidence that the prevalence of syphilis or HIV infection varied between the 4 towns (P=0.12 and 0.52 respectively). In logistic regression analyses only the presence of syphilis infection was associated with risk of HIV (odds ratio=3.4; 95% CI: 1.4-7.9). The prevalence of syphilis among pregnant women in Burkina Faso is relatively low compared with that of HIV infection. These results suggest that HIV epidemic in Burkina Faso is important and that there is an urgent need to intensify HIV-prevention activities. The need for HIV surveillance in this sentinel population is urgent to follow the course of the epidemic and to measure the impact of interventions. One of the consequences of the high prevalence of HIV infection among pregnant women which requires greater attention in Burkina Faso is the increasing number of children who will be infected with HIV by vertical transmission.
Asunto(s)
Infecciones por VIH/epidemiología , Seroprevalencia de VIH , Tamizaje Masivo , Complicaciones Infecciosas del Embarazo/epidemiología , Adolescente , Adulto , Burkina Faso/epidemiología , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Persona de Mediana Edad , Oportunidad Relativa , Vigilancia de la Población , Embarazo , Factores de Riesgo , Estudios Seroepidemiológicos , Sífilis/epidemiología , Salud UrbanaRESUMEN
OBJECTIVES: (1) To determine the prevalence of sexually transmitted diseases (STDs) in pregnant women in Burkina Faso. (2) To evaluate the potential of clinical management of STDs based on screening with clinical data and urine leucocyte esterase test (LET). METHODS: Cross sectional study among antenatal clinic attendees was conducted in 1994 in Ouagadougou and Bobo-Dioulasso, the two largest urban centres in Burkina Faso, where more than 94% of the pregnant women benefit from antenatal care at least twice during their pregnancy. Each woman selected underwent an interview, general and gynaecological examination. Genital samples were collected to confirm the presence of STD pathogens. Logistic regression analysis was done to identify models that predict (a) gonorrhoea and/or chlamydia, (b) trichomoniasis and/or bacterial vaginosis, (c) candidiasis. Sensitivity, specificity and positive and negative predictive values of these models were assessed using standard methods. RESULTS: All 645 consecutive pregnant women were enrolled in the two sites. Among these women 32.4% presented at least one STD. The major STDs were: trichomoniasis (14%), bacterial vaginosis (13%), recent syphilis (3.6%), chlamydial infection (3.1%), genital warts (3%), gonococcal infection (1.6%) and genital ulcer (0.8%). Prevalence of vaginal candidiasis was 14%. The use of a risk marker (length of relationship with regular sexual partner < 3 years), and the positivity +3 of the urine LET provided a sensitivity of 80% and a positive predictive value of 7% for the screening of gonococcal and/or chlamydial infection. If clinical signs and positivity of the urine LET were taken into account sensitivity and positive predictive value of trichomoniasis and/or bacterial vaginosis screening were 77% and 37%, respectively. Clinical signs and positivity of the urine LET showed a low sensitivity (23%) for screening vaginal candidiasis. CONCLUSIONS: The prevalence of STDs in pregnant women is high in urban Burkina Faso. Systematic screening combined with effective treatment should be included in antenatal care in the future. Urine LET, if associated with interview and clinical examination offers a simple, rapid and affordable tool for systematic screening of STDs in pregnant women. However, the proportion of overtreatments with proposed strategies will be high. Further studies are needed to develop and validate better algorithms with probably cheap laboratory tests.
Asunto(s)
Enfermedades de los Genitales Femeninos/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Burkina Faso/epidemiología , Estudios Transversales , Esterasas/orina , Femenino , Humanos , Leucocitos/enzimología , Modelos Logísticos , Modelos Biológicos , Análisis Multivariante , Valor Predictivo de las Pruebas , Embarazo , Prevalencia , Sensibilidad y Especificidad , Salud Urbana/estadística & datos numéricosRESUMEN
We evaluated the immunoglobulin G (IgG) antibody response to the 45/47-kDa secreted protein of Mycobacterium tuberculosis by immunoblot assay, to assess its potential value for serological diagnosis. Control subjects consisted of healthy volunteers with negative or positive tuberculin skin tests. Most (>98%) scored negative in an immunoblot test when the sera were analyzed at a 1:400 dilution. Approximately 40% of sera (diluted 1 in 400) from tuberculous patients (positive smears) recognized the antigen complex. The sensitivity of the test for patients suffering from extrapulmonary tuberculosis was similar to that for patients suffering from pulmonary tuberculosis but who had negative smears. The frequency of positive reactions among the patients suffering from other pulmonary diseases was similar to that among the control subjects. In tuberculous patients infected with human immunodeficiency virus, the sensitivity of the immunoblot test was significantly lower. Thus, this test based on an antigen complex used in an immunoblot assay to detect the presence of IgG antibody has a specificity of 98% and a sensitivity of 40%. The simultaneous use of different purified antigens, selected at the same high specificity level, may improve the sensitivity of such an assay.
Asunto(s)
Antígenos Bacterianos , Immunoblotting/métodos , Mycobacterium tuberculosis/inmunología , Pruebas Serológicas/métodos , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/inmunología , Tuberculosis/diagnóstico , Tuberculosis/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Anticuerpos Antibacterianos/sangre , Antígenos Bacterianos/química , Estudios de Casos y Controles , Estudios de Evaluación como Asunto , Seropositividad para VIH/complicaciones , Seropositividad para VIH/inmunología , VIH-1 , Humanos , Immunoblotting/estadística & datos numéricos , Inmunoglobulina G/sangre , Sensibilidad y Especificidad , Pruebas Serológicas/estadística & datos numéricos , Tuberculosis/complicaciones , Tuberculosis Pulmonar/complicacionesRESUMEN
In tropical areas where Plasmodium falciparum malaria is endemic, co-infection with HIV-1 does not lead to a worsening of malaria, raising questions about the immunological interactions between both infections. Alterations of immune response to malaria during HIV-1 infection was investigated in the town of Bobo Dioulasso, Burkina Faso. Sixty-six adults were enrolled, including 37 HIV-1 positive subjects with < 250 CD4+ cells/microliter and clinical AIDS, and 29 HIV-1, negative healthy subjects. In vitro lymphocyte proliferation and cytokine (IFN-gamma, IL-2 and IL-4) production were assessed in isolated mononuclear cells (PBMC) in presence of PHA, PPD or three malarial antigens: the baculovirus-expressed protein from P. falciparum Merozoite Surface Protein-I, a P. falciparum in vitro culture and a crude schizont extract. Compared with healthy subjects. AIDS patients presented with decreased levels of cell proliferation and of IFN-gamma and IL-2 production, in response to all antigens except the schizont extract. Similar levels of IL-4 production were obtained in both groups. Mitogenic stimulation of whole blood cultures was also performed, and revealed similar trends in cytokine production as in PBMC cultures. These results show that some components of the specific human immune responses to falciparum parasites may not be modified during AIDS, in spite of the strong cellular alterations induced by HIV, namely the decrease of the CD4+ lymphocyte subset.
PIP: In tropical areas where Plasmodium falciparum malaria is endemic, concurrent HIV infection does not appear to increase malaria prevalence. To investigate the immunologic interactions between these two infections, 66 adults from Bobo Dioulasso, Burkina Faso, were enrolled in a study in May 1994. The group included 29 HIV-negative adults and 37 hospitalized HIV-positive adults with clinical AIDS and under 250 CD4+ cells per mcgl of blood. All subjects belonged to a population exposed to numerous falciparum malaria infections since birth and were thus presumed to have developed specific antimalarial protective immune mechanisms prior to HIV infection. AIDS patients had a reduced hemoglobin content and a lower number of CD3+ and CD4+ lymphocytes than healthy controls. All thick blood smears were negative for malaria parasites, but the mean level of antibodies to P. falciparum was lower and the total immunoglobulin G content of plasma was higher in AIDS patients than controls. In vitro lymphocyte proliferation and cytokine (IFN-psi, IL-2, and IL-4) production were assessed in isolated mononuclear cells (PBMC) in the presence of PHA, PPD, or 3 antimalarial agents: the baculovirus-expressed protein from P. falciparum Merozoite Surface Protein-1, a P. falciparum in vitro culture, and a crude schizont extract. AIDS patients presented with decreased levels of cell proliferation and of IFN-psi and IL-2 production compared to healthy controls in response to all antigens except the schizont extract. IL-4 production levels were similar in both groups. Mitogenic stimulation of whole blood cultures revealed similar trends in cytokine production as in PBMC cultures. These findings confirm that not all effector cells involved in the immune responses directed against malaria are affected by concurrent HIV infection and/or that important CD4+ independent mechanisms of protection against malaria are conserved. It has been proposed that HIV infection causes a selective depletion of T cell subsets that are not implicated in the antimalarial immune response.