Tuberculosis (TB) remains a leading cause of morbidity and mortality in West Africa. An understanding of the barriers to prompt diagnosis and treatment of TB is critical in order to develop strategies to improve TB outcomes. We conducted a qualitative sub-study within the TB-Sentinel Research Network of IeDEA at the CePReF clinic in Abidjan, Côte d’Ivoire. Individuals ≥ 18 years of age who had received treatment for pulmonary TB within the preceding 12 months were interviewed. Qualitative data collection and analysis were guided by the Grounded Theory approach. Interviews were conducted with 40 participants (median age 35 [IQR 25–46] years), including 19 (47.5

Background/objectives: Pseudomonas aeruginosa can cause community-acquired infections affecting various body sites. The present retrospective study investigated the genetic diversity of 173 isolates (166 clinical, 7 environmental) of P. aeruginosa collected from clinical pathology laboratories in Abidjan, Côte d’Ivoire (2001–2011). Methods: Multiple-Locus Variable Number of Tandem Repeats (VNTR) Analysis (MLVA) using 13 loci was applied to all isolates and compared to published MLVA data. The antibiotics status of the isolates was compiled when available and compared to published profiles. Results: Among 95 isolates analyzed for their antibiotics status, 14 displayed concerning resistance profiles: five multidrug-resistant (MDR) and nine extensively drug-resistant (XDR). MLVA typing revealed a high genetic diversity (>130 genotypes), with many genotypes represented by a single strain. Notably, thirteen clusters (≥4 related isolates) were observed. Some clusters displayed close genetic relatedness to isolates from France, Korea, and well-studied strains (ST560, LES and PA14). Comparative analysis suggested the presence of international high-risk MDR clones (CC233, CC111) in Côte d’Ivoire. Importantly, MLVA clustering revealed a close relationship of CC235-MDR strains with a locally identified cluster (group 9). Conclusions: These findings support MLVA as a reliable and cost-effective tool for low-resource settings, allowing the selection of relevant strains for future whole genome sequence analyses. This approach can improve outbreak investigations and public health interventions aimed at curbing MDR P. aeruginosa transmission within hospitals and at the national level.

Aims: Mycoplasmas are bacteria of the urogenital tract often associated with various infections and infertility. In terms of treatment, acquired resistance to antibiotics has been reported. The aim of this study was to investigate changes in the prevalence and antibiotic resistance of Ureaplasma urealyticum strains isolated during sperm culture, in order to help update therapeutic protocols for the treatment of U. urealyticum-associated infections Place and Duration of Study: These were men received at the INHP from January 2018 to December 2021 for sperm culture Methodology: This is a retrospective study in which the culture results of 907 semen samples received in the laboratory between 2018 and 2021 were analysed. Identification, indicative counts and antibiotic susceptibility testing of U. urealyticum were performed using the Biosynex Mycoplasma kit. Results: 283 strains of U. urealyticum were isolated between 2018 and 2021, with an average prevalence of 31.2%. In 2018, only minocycline, josamycin and roxithromycin were active on all the strains tested, while fluoroquinolones and clindamycin showed high levels of resistance, with rates of 75.9% and 86.1% respectively. From 2019 onwards, resistance spread to all antibiotics, with increasing levels of resistance, with the exception of minocycline, which remained active on all strains. The highest resistance rates were observed in 2021 and were 74.6% and 96.6% for pristinamycin and clindamycin respectively. Conclusion: Despite the high level of resistance, minocycline and josamycin have shown relatively stable antibacterial activity and could be proposed as the molecules of choice for the treatment of U. urealyticum infections. Closer monitoring of the development of antibiotic resistance in these bacteria is therefore necessary.

Mutant selection is due to the high rate of viral replication and lack of proofreading activity in the hepatitis B virus (HBV) polymerase thus leading to the generation of mutations in HBV. However naturally occurring HBV strains carrying primary drug resistance mutations are very rare in the absence of prior treatment. Monitoring changes in primary and secondary resistance mutations in patients who haven't been treated is crucial in order to optimize and promote the best treatment, to obtain a sustained virological response (SVR) and therefore, reduce the progression to cirrhosis and later to hepatocellular carcinoma (HCC). The main purpose of this research was to evaluate the resistance of HBV to antivirals and show the genetic variability of HBV in a population of blood donors, carrying HBs antigen, naïve to anti-HBV treatment in Abidjan. A descriptive and analytical cross-sectional method was used to establish the molecular profile and to identify the polymorphism of HBV in treatment-naïve infected study participants. Adults blood donors, of any sex, with a positive result for HBsAg, naïve to any antiviral treatment but with an HBV viral load superior to 1000 IU/ml were included. The ABI 3130 Avant sequencer (Applied Biosystems, Courtaboeuf, France) was used to sequence the polymerase (pol) gene to determine HBV resistance genotypes. Fifty-three (N=53) blood donors infected with HBV (HBs Ag positive) were screened. All patients were naïve to any antiviral treatment. Of all these patients, 30 (56.6%) blood donors, carrying HBsAg with a viral load superior to 1000 IU/mL were included in the study. The median age was 34 years old (21-52). The median viral load was 6561 IU/mL (103 – 1.65 x 109). Two mutations of a single base, notably A181T and A181S were highlighted in this study. The A181T mutation was associated with resistance to adefovir, lamivudine and telbivudine. As for the A181S mutation, it was associated with resistance to adefovir only. Analysis of phylogenetic trees obtained by sequencing confirmed the circulation of 2 genotypes: E (22; 92%) and A (2; 8%). The circulation of genotypes A and E of HBV in Côte d'Ivoire has been confirmed by this study, with an estimated genotypic mutation prevalence of 8%. The resistance of HBV to some antiretroviral drugs in the class of HBV polymerase inhibitors, such as lamivudine (3TC), telbivudine (LdT) adefovir (ADV) may be attributed to these mutations.

Waters used for recreational activities in order to ensure the health of populations who practice their recreational activity. Disease or infection risk associated with recreational water areas is mainly related either to faecal contamination or to domestic or hospital effluents. The present study aimed assessment of microbiological contamination of surface waters (rivers and lake) of three cities in southern Côte d’Ivoire used for recreational activities, by bacteria generally found in humans and animal’s digestive tract, and then assesses their resistance to commonly antimicrobial drugs used in human therapy. Water samples have been taken from different identified sites over a 13-months period. A microbiological analysis based on numbering of germs was performed then isolated strains were assayed for antibiotic sensitivity tests. Data analysis was performed using SPSS 22.0 software. Results have shown the presence of Escherichia coli, Pseudomonas aeruginosa and Enterococcus faecalis in waters analysed. E. coli, a faecal contamination marker, was present in all the analysed waters with levels higher than standards defined by the 2006/7 /EC European Directive for bathing water, making them unsuitable for swimming. E. coli strains showed high levels of resistance to amoxicillin, ticarcillin, nalidixic acid and cotrimoxazole. Moreover, a beta-lactamase producing strain was isolated, suggesting probability of contamination by hospital or domestic effluents. The results of this study show the importance of microbiological monitoring of surface.

Pour le suivi biologique du traitement antirétroviral, les recommandations nationales ivoiriennes préconisent la mesure de charge virale plasmatique ARN (CV) du VIH qui dans la pratique demeurait inaccessible jusqu’en 2013. A partir de 2014, la réalisation de ce paramètre a été offerte en routine grâce à l’appui financier d’UNITAID. L’objectif de l’étude était d’analyser la CV ARN VIH-1 et le taux de lymphocytes TCD4 (CD4) dans ce suivi. Ainsi, les patients infectés par le VIH sous antirétroviraux depuis au moins 6 mois ont bénéficié des mesures de CV et de CD4. Ont été inclus 8410 patients d’un âge médian de 41 ans (1- 91 ans), avec un sex-ratio de 0,46 et 91% sous première ligne d’antirétroviraux. Le taux médian de CD4 était de 399 cellules/µL (1-17185 /µL) et 80,3% des cas présentaient un taux de CD4>200 cellules/µL. La CV médiane était de 4,61 log10/mL (2,5-7,60 log10/mL) et la réplication virale était sous contrôle de l’organisme (< 3 log10/mL) dans 73,8% des cas. Il a été observé 50,1% de discordance immuno-virologique dont 44,5% de succès virologique malgré un échec immunologique (I-/V+) évitant un changement inutile de ligne thérapeutique et 5,6% de dépistage précoce d’échec virologique malgré un succès immunologique (I+/V-). Finalement, l’ARN VIH-1 permettait un meilleur suivi biologique du traitement antirétroviral et la dynamique de son évolution devrait être étudiée.Mots clés: ARN VIH, numération des CD4, ARV, OPP-ERA, routine. English Title: HIV-1 plasma RNA mesearment and lymphocytes TCD4 count in the monitoring of antiretroviral treatment of HIV infected patients in Côte d’Ivoire Côte d'Ivoire national recommendations for biological monitoring of antiretroviral therapy (ART) include measurement of HIV RNA viral load (VL), but this assay remained inaccessible until 2013. Since 2014, VL was made routinely available with the financial support of UNITAID. The objective of the current study was to analyze the relevance of HIV1 RNA VL versus CD4 count (CD4 ) in this follow-up. Thus, people living with HIV (PLWH) receiving ART for at least 6 months had VL and CD4 measurements. A total number of 8410 patients were included with a median age of 41 years (1-91). Sex ratio was 0.46 and 91% of PLWH were on first-line treatment. Median CD4 count was 399 cells/μL (1-17185 /μL) and 80.3% of the patients had CD4 count higher than 200 cells/μL. The Median of VL was 4.61 log10/mL (2.5-7.60 log10/mL) and 73.8% of the cases had viral replication under control (<3 log10/mL). There were 50.1% cases of immuno-virological discordance of which 44.5% were virological success with immunological failure (I-/V+) avoiding an unnecessary change of therapeutic line and 5.6% of early screening of virological failure despite an immunological success (I+/V-). Finally, HIV-1 RNA allowed a better biological monitoring of antiretroviral therapy and its evolution must be monitored.Keywords: HIV RNA, CD4 count, ART, OPP-ERA, routine.

This study aims at the Microbiological and Physicochemical Characterization of the Bathing Waters of Atlantic Ocean Beaches of Grand Bassam in Côte d’Ivoire. Waters Sampling campaigns were carried out from December 2017 to December 2018 with a monthly sample per water point (Azuretti-village and “France” neighborhood). The analysis focused on assessment of eight (8) bacteria and parasites and the determination of twenty-eight (28) organoleptic and physicochemical parameters. The results of the physicochemical assays showed that these waters were strongly mineralized with a mean of 47.3mS/cm at Azuretti-village and “France” neighborhood. Microbiological analyses revealed presence of total coliforms (TC), thermo-tolerant coliforms (THC), Escherichia coli, Enterococcus faecalis, Pseudomonas aeruginosa, yeasts and molds. The bathing water of on the Azuretti-village beach are conform according to the Ivorian reference system (CT and CTH are respectively less than 10,000CFU/100ml and 2,000CFU/100ml) throughout the campaign, only one non-compliance is noted in August on the beach of “France” neighborhood. Regarding the Algerian standard taken in addition to Ivorian criteria, the number of E. faecalis bacteria must be less than 100CFU/100ml. Based on this standard, both ranges exhibited total coliform and heat-tolerant conformities throughout the study period and did not comply with E. faecalis during the months of January to February 2018 and from June to September 2018. The Canadian and American standard stipulates only the geometric mean of E. faecalis which must be lower than 35. In view of this standard, these waters present 54% of non-compliance in the “France” neighborhood and 62% of non-conformities in Azuretti-villages during the months of January to February 18 and from June to October 18. According to Algerian and Canadian standards, the bathing waters of both beaches are unsatisfactory microbiological qualities during dry and rainy periods.

Health care professionals working in laboratories located in Africa are supposed to deal with many potentially infectious fluids in a context of high prevalence for infectious diseases and particularly hepatitis B virus (HBV). The goal of this study was to evaluate the seroprotection against HBV and possible contact with the virus before vaccination in the staff of a laboratory specialized in the diagnosis of infectious diseases.

Sexually transmitted infections (STIs) are considered to be responsible for a major health and economic burden worldwide with many cases due to Neisseria gonorrhoeae and Chlamydia trachomatis. In Ivory Coast, a few information about the burden of bacterial STIs are available. The aim of this study was to determine the prevalence C. trachomatis and N. gonorrhoeae in the genital tract of asymptomatic adults with a non-invasive sampling and by using a nucleic acid amplification test. Thus, asymptomatic adults was consecutively recruited during a cross-sectional study conducted from July 2018 to October 2018 in Abidjan, Ivory Coast. Then, first void urine was collected and tested with the Xpert CT/NG. During the period of study, 439 subjects were tested including 203 (46.2%) male and 236 (53.8%) female. The age of patients ranged from 15 to 84 years with a median of 30 years. Prevalence of N. gonorrhoeae and C. trachomatis were 21/439 (4.8 %) and 3/439 (0.7 %) respectively and in two cases (0.5 %), subjects were infected by both bacterial species. N. gonorrhoeae was only detected in subjects under age 30 with a higher prevalence below the age of 20. Also, neither N. gonorrhoeae, nor C. trachomatis were detected in subjects more than 40 years. The prevalence of N. gonorrhoeae and C. trachomatis were not statistically different between male and female. According to occupation, N. gonorrhoeae was only detected in students and no infection was found in retired, people without any occupation and housewives. The results of this study which was the first one consisting in an active screening of N. gonorrhoeae and C. trachomatis in adults in Ivory Coast showed that these pathogens are present even in asymptomatic people and that young people are at greater risk of being infected.

Setting Tuberculosis (TB) drug resistance survey was conducted in 2016–2017 to estimate the burden of drug-resistant TB in Côte d'Ivoire. Design A cross-sectional cluster-based survey was conducted. All eligible smear positive patients were interviewed using a structured questionnaire to collect clinical and sociodemographic information and tested by the Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay. If resistant to rifampicin, solid and liquid cultures were performed. Phenotypic drug susceptibility testing (DST) was conducted in liquid medium for rifampicin, isoniazid, ethambutol, streptomycin, ofloxacin, and amikacin. Results Of the 1105 sputum smear positive patients enrolled, 995 new and 100 previously treated patients were positive for Mycobacterium tuberculosis complex by Xpert. Proportion of patients with rifampicin resistance was 4.6% (95% CI: 2.4–6.7) and 22% (95% CI: 13.7–30.3), respectively, for new and previously treated patients. Second-line DST results were available for most rifampicin-resistant patients. None were resistant to amikacin, only two were ofloxacin-resistant. Apart from the antecedent of previously treatment for TB, no other risk factors for rifampicin resistance were detected. Conclusion Prevalence of rifampicin resistance among TB patients in Côte d'Ivoire is higher than that in other countries in the region. Surveillance of drug resistance, through an expanded GeneXpert network, and programmatic management of drug-resistant TB (PMDT) must be strengthened in Côte d'Ivoire.

Background In Côte d’Ivoire, a TB prison program has been developed since 1999. This program includes offering TB screening to prisoners who show up with TB symptoms at the infirmary. Our objective was to estimate the prevalence of pulmonary TB among inmates at the Correctional and Detention Facility of Abidjan, the largest prison of Côte d’Ivoire, 16 years after this TB program was implemented. Methods Between March and September 2015, inmates, were screened for pulmonary TB using systematic direct smear microscopy, culture and chest X-ray. All participants were also proposed HIV testing. TB was defined as either confirmed (positive culture), probable (positive microscopy and/or chest X-ray findings suggestive of TB) or possible (signs or symptoms suggestive of TB, no X-Ray or microbiological evidence). Factors associated with confirmed tuberculosis were analysed using multivariable logistic regression. Results Among the 943 inmates screened, 88 (9.3%) met the TB case definition, including 19 (2.0%) with confirmed TB, 40 (4.2%) with probable TB and 29 (3.1%) with possible TB. Of the 19 isolated TB strains, 10 (53%) were TB drug resistant, including 7 (37%) with multi-resistance. Of the 10 patients with TB resistant strain, only one had a past history of TB treatment. HIV prevalence was 3.1% overall, and 9.6%among TB cases. Factors associated with confirmed TB were age ≥30 years (Odds Ratio 3.8; 95% CI 1.1–13.3), prolonged cough (Odds Ratio 3.6; 95% CI 1.3–9.5) and fever (Odds Ratio 2.7; 95% CI 1.0–7.5). Conclusion In the country largest prison, pulmonary TB is still 10 (confirmed) to 44 times (confirmed, probable or possible) as frequent as in the Côte d’Ivoire general population, despite a long-time running symptom-based program of TB detection. Decreasing TB prevalence and limiting the risk of MDR may require the implementation of annual in-cell TB screening campaigns that systematically target all prison inmates.

BackgroundTemprano ANRS 12136 was a factorial 2 × 2 trial that assessed the benefits of early antiretroviral therapy (ART; ie, in patients who had not reached the CD4 cell count threshold used to recommend starting ART, as per the WHO guidelines that were the standard during the study period) and 6-month isoniazid preventive therapy (IPT) in HIV-infected adults in Côte d'Ivoire. Early ART and IPT were shown to independently reduce the risk of severe morbidity at 30 months. Here, we present the efficacy of IPT in reducing mortality from the long-term follow-up of Temprano.MethodsFor Temprano, participants were randomly assigned to four groups (deferred ART, deferred ART plus IPT, early ART, or early ART plus IPT). Participants who completed the trial follow-up were invited to participate in a post-trial phase. The primary post-trial phase endpoint was death, as analysed by the intention-to-treat principle. We used Cox proportional models to compare all-cause mortality between the IPT and no IPT strategies from inclusion in Temprano to the end of the follow-up period.FindingsBetween March 18, 2008, and Jan 5, 2015, 2056 patients (mean baseline CD4 count 477 cells per μL) were followed up for 9404 patient-years (Temprano 4757; post-trial phase 4647). The median follow-up time was 4·9 years (IQR 3·3–5·8). 86 deaths were recorded (Temprano 47 deaths; post-trial phase 39 deaths), of which 34 were in patients randomly assigned IPT (6-year probability 4·1%, 95% CI 2·9–5·7) and 52 were in those randomly assigned no IPT (6·9%, 5·1–9·2). The hazard ratio of death in patients who had IPT compared with those who did not have IPT was 0·63 (95% CI, 0·41 to 0·97) after adjusting for the ART strategy (early vs deferred), and 0·61 (0·39–0·94) after adjustment for the ART strategy, baseline CD4 cell count, and other key characteristics. There was no evidence for statistical interaction between IPT and ART (pinteraction=0·77) or between IPT and time (pinteraction=0·94) on mortality.InterpretationIn Côte d'Ivoire, where the incidence of tuberculosis was last reported as 159 per 100 000 people, 6 months of IPT has a durable protective effect in reducing mortality in HIV-infected people, even in people with high CD4 cell counts and who have started ART.FundingNational Research Agency on AIDS and Viral Hepatitis (ANRS).

BACKGROUND:In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high. We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy (ART), 6-month isoniazid preventive therapy (IPT), or both among HIV-infected adults with high CD4+ cell counts in Ivory Coast.METHODS:We included participants who had HIV type 1 infection and a CD4+ count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization (WHO) guidelines. Participants were randomly assigned to one of four treatment groups: deferred ART (ART initiation according to WHO criteria), deferred ART plus IPT, early ART (immediate ART initiation), or early ART plus IPT. The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome (AIDS), non-AIDS-defining cancer, non-AIDS-defining invasive bacterial disease, or death from any cause at 30 months. We used Cox proportional models to compare outcomes between the deferred-ART and early-ART strategies and between the IPT and no-IPT strategies.RESULTS:A total of 2056 patients (41% with a baseline CD4+ count of ≥500 cells per cubic millimeter) were followed for 4757 patient-years. A total of 204 primary end-point events were observed (3.8 events per 100 person-years; 95% confidence interval [CI], 3.3 to 4.4), including 68 in patients with a baseline CD4+ count of at least 500 cells per cubic millimeter (3.2 events per 100 person-years; 95% CI, 2.4 to 4.0). Tuberculosis and invasive bacterial diseases accounted for 42% and 27% of primary end-point events, respectively. The risk of death or severe HIV-related illness was lower with early ART than with deferred ART (adjusted hazard ratio, 0.56; 95% CI, 0.41 to 0.76; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.56; 95% CI, 0.33 to 0.94) and lower with IPT than with no IPT (adjusted hazard ratio, 0.65; 95% CI, 0.48 to 0.88; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.61; 95% CI, 0.36 to 1.01). The 30-month probability of grade 3 or 4 adverse events did not differ significantly among the strategies.CONCLUSIONS:In this African country, immediate ART and 6 months of IPT independently led to lower rates of severe illness than did deferred ART and no IPT, both overall and among patients with CD4+ counts of at least 500 cells per cubic millimeter. (Funded by the French National Agency for Research on AIDS and Viral Hepatitis; TEMPRANO ANRS 12136 ClinicalTrials.gov number, NCT00495651.).

The aim of this study was to investigate the usefulness of combining profiles obtained by using a line probe assay (LPA) originally intended to characterize the resistance of two major anti-tuberculosis drugs to the association of spoligotyping and MIRU-VNTR, in order to improve its discriminatory power. For this purpose, 74 strains of Mycobacterium tuberculosis belonging to the same cluster after spoligotyping were further typed by using the 24 loci MIRU/VNTR. These strains were then tested by the GenoType MTBDRplus, and profiles obtained were analyzed within previously obtained clusters. The combination of spoligotying and MIRU-VNTR led to the consolidation of 56 of them (75.7%) in 9 clusters. Most of the strains (54, 96.4%) were multidrug resistant (MDR). From the 9 initial clusters, the addition of GenoType MTBDRplus helped to define 26 profiles including 11 unique profiles, and 3 original clusters remained undifferentiated. Results obtained express the relevance of combining this method which improved quite significantly the discriminatory power in typing Mycobacterium tuberculosis.

In resource-limited settings, scaling-up antiretroviral treatment (ART) has required the involvement of decentralized health facilities with limited equipment. We estimated the incidence of serious morbidity among HIV-infected adults receiving ART in one of these HIV routine care center in sub-Saharan Africa.

Drug-resistant tuberculosis is an important health problem in Côte d'Ivoire.Patients of category I treatment are based on 2RHZE/4RH regimen.For the patients of category II, the 2RHZES/1RHZE/5HRE regimen is systematically initiated.Study objective was to describe the susceptibility profile to Rifampin and Isoniazid among previously treated patients who are eligible for retreatment and who had received the 2RHZES/1RHZE/5HRE regimen in Côte d'Ivoire with a molecular method in 2012.Two sputum samples were collected to each patient recruited in the reference regional centres for tuberculosis.Sputum samples were decontaminated by NALC method.The DNA extraction was realized with 500 µl of decontaminated sputum sample with smear-positive.MTBDRplus assay version 1.0 was performed according to the manufacturer's instruction.An internal quality control program with positive and negative controls was implemented for interpretation of results.A total of 278 patients were enrolled, 148 (53.2%) were recurrent TB cases, 118 (42.5%) failure cases, and 12 (4.3%)defaulters.From sputum of previously treated patients, mutli-drug resistant tuberculosis was diagnosed for 60 (69.8%, 95% IC, 60% -80%) treated with the 2RHZE/4RH regimen, 24 (75%, 95% IC, 60% -90%) with the 2RHZES/1RHZE/5HRE regimen, 60 (41%, 95% IC, 33% -49%) recurrent TB cases, and 4 (33.3%)defaulters.The comparison of resistance rates to Rifampin estimated from sputum samples in the categories of treatment failures and the recurrence TB cases showed a statistically significant difference.In Côte d'Ivoire, genotype ® MTBDRplus assay has permitted to estimate the prevalence of MDR-TB in categories of previously treated patients for tuberculosis.

Background Genotyping methods are useful tools to provide information on tuberculosis epidemic. They can allow a better response from health authorities and the implementation of measures for tuberculosis control. This study aimed to identify the main lineages and clades of Mycobacterium tuberculosis complex strains circulating in Côte d’Ivoire. Methods/Main Findings Strains isolated from sputum samples of patients ongoing retreatment from all the country were characterized by spoligotyping and by MIRU-VNTR. Profiles obtained by spoligotyping were first compared to the SITVIT/SpolDB4 database for family assignment. Of 194 strains analysed, 146 (75.3%) belonged to the T lineage. The most predominant spoligotype was the shared international type 53 with 135 strains (69.6%). In contrast with neighbouring countries, LAM (11 strains, 5.7%) and H (9 strains 4.6%) lineages were slightly represented. Only 3 Beijing strains (1.5%) and 4 strains of Mycobacterium africanum (2%) were found. Analysis of the results obtained with MIRU-VNTR revealed also a high level of clustering. Conclusion/Significance The population of Mycobacterium tuberculosis complex strains among retreatment cases in Côte d’Ivoire exhibits a low diversity, allowing to assume recent transmission and locally based infection.

BACKGROUND:In Western Europe, North America, and Australia, large cohort collaborations have been able to estimate the short-term CD4 cell count-specific risk of AIDS or death in untreated human immunodeficiency virus (HIV)-infected adults with high CD4 cell counts. In sub-Saharan Africa, these CD4 cell count-specific estimates are scarce.METHODS:From 1996 through 2006, we followed up 2 research cohorts of HIV-infected adults in Côte d'Ivoire. This included follow-up off antiretroviral therapy (ART) across the entire spectrum of CD4 cell counts before the ART era, and only in patients with CD4 cell counts >200  cells/μL once ART became available. Data were censored at ART initiation. We modeled the CD4 cell count decrease using an adjusted linear mixed model. CD4 cell count-specific rates of events were obtained by dividing the number of first events occurring in a given CD4 cell count stratum by the time spent in that stratum.RESULTS:Eight hundred sixty patients were followed off ART over 2789 person-years (PY). In the ≥650, 500-649, 350-499, 200-349, 100-199, 50-99, and 0-49  cells/μL CD4 cell count strata, the rates of AIDS or death were 0.9, 1.7, 3.7, 10.4, 30.9, 60.8, and 99.9 events per 100 PY, respectively. In patients with CD4 cell counts ≥200 CD4  cells/μL, the most frequent AIDS-defining disease was tuberculosis (decreasing from 4.0 to 0.6 events per 100 PY for 200-349 and ≥650 cells/μL, respectively), and the most frequent HIV non-AIDS severe diseases were visceral bacterial diseases (decreasing from 9.1 to 3.6 events per 100 PY).CONCLUSIONS:Rates of AIDS or death, tuberculosis, and invasive bacterial diseases are substantial in patients with CD4 cell counts ≥200 cells/μL. Tuberculosis and bacterial diseases should be the most important outcomes in future trials of early ART in sub-Saharan Africa.

Contexte : Selon les nouvelles recommandations françaises, l'objectif d'un traitement antiviral doit être le maintien d'une charge virale (CV) < 50 copies/ml.Objectif : Décrire la population de patients (pts) qui, sous traitement (trt), gardent une charge virale >1000 copies/ml, afin de sensibiliser les médecins à cette situation dangereuse et d'évaluer la part de ceux qui nécessitent la mise à disposition rapide de nouvelles molécules.