[HIV-2 infections in heroin addicts].
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Deltaretrovirus Infections↗
Biomedical subjects
D Malvy
Publications and source records attributed to D Malvy.
[Serological study of the virus responsible for hemorrhagic fever in an urban population of Cameroon].
A sero-epidemiological study of Hemorrhagic Fever Viruses in a urban population of Cameroon. The authors report the results of a sero-epidemiological survey undertaken in a urban population of Cameroon and concerning Congo, Rift (RVF), Lassa, Ebola, Marburg and Yellow Fever Viruses. On 375 human sera tested, 1.06% show antibodies against RVF virus and 1.87% are positive for anti-Ebola antibodies thus yielding evidence that these two viruses are present in this area of Cameroon. 33.75% have antibodies against Yellow Fever Virus as determined with an Hemagglutination-inhibition test. This quite high percentage, in spite of the weak specificity of the method for this virus, could raise the problem of the opportunity of a vaccination campaign. No antibody to Marburg, Lassa or Congo viruses is detected.
Adolescent↗
[Vitamin A: an indirect factor in the prevention of cancer].
Although vitamin A intervenes essentially in the mechanism of sight, its possible role in the prevention and treatment of cancer is widely discussed. Epidemiological studies have demonstrated a correlation between vitamin A deficiency and an increase in the frequency of cancers in man. Several hypotheses have been put forward concerning the mechanism of interaction between vitamin A and cancer on the basis of experimental models showing that vitamin A exerts a protective action against spontaneous or induced neoplasias in animals. The toxicological aspects of vitamin A administration and the relevance of these experimental results to human oncology are discussed.
Cell Differentiation↗
Trachoma, flies and environmental factors in Burkina Faso.
The presence of flies is one of the earliest risk factors for trachoma and it has been suggested that flies could act as vectors for transmission of chlamydiae. A national trachoma survey was conducted in 1997 in Burkina Faso to (i) study the relationship between trachoma occurrence, flies, dirty faces and some environmental factors, and (ii) investigate the role of flies in the presence of trachoma. The country was stratified into eight groups of provinces and a random sample of 30 clusters was selected in each group. All children aged < 10 years were examined for the diagnosis of active trachoma (trachomatous inflammation which was follicular and/or intense) and the dirtiness of the face and the presence of flies on the face were recorded. The children's carers were questioned about the number of baths given and daily face-washing. Household heads were asked about ownership of cattle and small ruminants. The presence of latrines, a stable, and garbage collection inside the yard was noted. Among 16,514 children examined, 27.0% had active trachoma and 3.3% intense inflammatory trachoma. Flies were present on 11.2% of children's faces and 82.4% and 19.7% of these children had active and intense inflammatory trachoma, respectively. Among the 30.2% of children with dirty faces, 70.2% had active and 10.2% intense inflammatory trachoma. In multivariate analysis, at least one daily bath showed a protective effect on both active and intense inflammatory trachoma. Face-washing twice daily was found to be significantly protective for active trachoma in some regions. A strong association was demonstrated between the presence of flies and dirty faces (odds ratio = 334, 95% confidence interval 202-546). The presence of flies on children's faces, dirty faces and trachoma appeared to be strongly associated. Although the presence of flies may be a marker of socio-economic status and is probably linked with other trachoma risk factors, our data indicated that interventions targeting fly control should be an important issue in controlling trachoma.
Animals↗
"The SU.VI.MAX Study": a primary prevention trial using nutritional doses of antioxidant vitamins and minerals in cardiovascular diseases and cancers. SUpplementation on VItamines et Minéraux AntioXydants.
The "SUpplementation en VItamines et Minéraux AntioXydants" (SU.VI.MAX) Study is a randomized double-blind, placebo-controlled, primary-prevention trial which started in 1994 in France. This epidemiologic study is designed to test the efficacy of a daily supplementation with antioxidant vitamins (vitamin C, 120 mg, vitamin E, 30 mg, and beta-carotene, 6 mg) and minerals (selenium, 100 microg, and zinc, 20 mg) at nutritional doses, in reducing the main causes of premature death (cancers and cardiovascular diseases); 12,735 eligible subjects (women aged 35 to 60 years, and men aged 45 to 60 years) were included in 1994 and and will be followed up for 8 years. Participants undergo a yearly visit consisting, every other year, of either biological sampling or clinical examination. They also regularly provide information on health events and dietary intake by filling out computerized questionnaires using the Minitel Telematic Network. After 2 years of supplementation, biochemical indicators of vitamin and trace element status reach reasonable level without reaching concentrations as high as those observed in intervention studies, which tested relatively high doses of antioxidants, and ended up with higher risk of pathology.
Adult↗
Fatal cardiac incident after use of halofantrine.
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Adult↗
[Ethical issues and preventive vaccination].
Preventive vaccination is one of the most spectacular examples of success in the fight against disease. However, the implementation of vaccination strategies is not dependent solely on identifying appropriate vaccines. It also requires organization and is affected by complex economic issues, which are subject to ethical considerations. These include the mobilization of resources and skills for the common good and the respect of the individual such that the use and acceptability of vaccines are optimized.
AIDS Vaccines↗
[Nutrition problems experienced by adults infected with the human immunodeficiency virus in Abidjan (Ivory Coast)].
Denutrition is frequent among HIV-infected (HIV+) adults in sub-Saharan Africa. One of the risk factors for denutrition is a reduction in dietary intake. Eating disorders may be partly responsible for such decreases in food intake. We prospectively analyzed the frequency, associated factors and progression of anorexia, dysphagia and food aversion in a cohort of 330 HIV-infected adults included in a trial of early chemoprophylaxis with cotrimoxazole in Abidjan, Ivory Coast. Patients were followed-up by means of scheduled monthly visits. Eating disorders were assessed using a standardized questionnaire after 6, 12 and 18 months of follow-up. After six months of follow-up, 28% of the patients reported anorexia, 9% dysphagia and 28% food aversion. Multivariate analysis showed that anorexia was significantly more frequent in women than in men (odds ratio (OR) = 2.0 [95% confidence interval: 1.2-3.5]) and in patients with a CD4+ lymphocyte count < 200/mm3 (OR = 1.8 [1.0-3.5]). The risk of dysphagia was also higher for women than for men (OR = 1.8 [1.0-3.5]). The risk of dysphagia was also higher for women than for men (OR = 3.3 [1.3-8.4]). Patients with < 200 CD4+ lymphocytes/mm3 were more likely than those with CD4+ lymphocyte counts of over 200 to suffer food aversion (OR = 1.8 [1.1-3.0]). We analyzed the progression of dietary problems during follow-up and found that anorexia and dysphygia tended to disappear from one evaluation to the next whereas the number of patients reporting food aversion tended to increase. For patients reporting anorexia at the 6-month evaluation, significantly more women than men reported the persistence of anorexia at the 12-month evaluation (16% versus 5%; p = 0.03). Among patients with dysphagia at six months, those with a CD4+ lymphocyte count below 200/mm3 were much more likely than those with a CD4+ count above 200 to report persistent dysphagia at the 12-month evaluation (7% versus 0%; p = 0. 02, Fischer's exact test). For patients with no dietary problems after six months, those taking cotrimoxazole were significantly more likely than those of the placebo group to report food aversion at the 12-month evaluation (21% versus 8%; p = 0.01). We found that dietary problems were associated more with the stage of immunodeficiency that with socioeconomic factors, with the exception of sex, which was associated with several outcomes. These data stress the importance of detecting these frequent dietary problems as part of the overall clinical management of HIV+ adults in Africa, and of providing affected individuals with early nutritional counseling.
Adult↗
Guess what! Human West African trypanosomiasis with chancre presentation.
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Animals↗
[Approach to sexuality in an AIDS context in Congo].
The pandemic due to the human immunodeficiency virus (HIV) is extensive in Sub-Saharan Africa and especially in Congo. Congo is a small country on the Atlantic coast and characterized by plentiful equatorial forests and low population density (essentially urban). In Congo, there is a high prevalence of HIV. The social and economic consequences of AIDS add to those of a recent civil war in 1997. There were fratricidal confrontations before and after this period. These confrontations have led to a massive exodus of the inhabitants of the capital, Brazzaville, to the forests and neighbouring cities, essentially towards Pointe-Noire. Pointe-Noire, chief place of the region of Kouilou, in the South of the country, is the second city of Congo and the economic Capital. It is undoubtedly for this reason that it has been globally saved. In this context, a sanitary policy of prevention of sexual risky behavior can appear as a challenge. While it supposes a better knowledge of the sexual activity of the young people, it cannot be dissociated from the analysis of the other factors. These factors can be of socio-economic political or cultural order. Thus the influence of cultural variables in the field of sexuality is certainly preponderant in African countries, where sexuality is taboo. Sexuality is a private matter (personal intimacy and the couple), but concerns also the family (in the sense of membership in an extended domestic group or in a system of relationship) in its aspects related to procreation and to the social field (power, alliances). Such individual behaviour can be lived as a questioning of the social order. In this article, the authors question the place of sexuality in Congo, particularly based on the work of anthropologists [2, 6, 7, 9]. Research in the field of sexuality at adolescence is rather recent in France and investigations that have been done in Congo these last ten years do not exist. Meetings and exchanges in 1998 with high-school pupils and schoolboys and girls of Pointe-Noire, have shown that they had a high level of knowledge (about contamination by HIV). On the other hand, this has also been associated with a number of beliefs, which are higher than in France: relating to the possibilities of interpersonal contagion by saliva (by kissing), food. but also a contagion by mosquito bites. Some of these pupils (essentially boys) have asked us about the greater risk of contagion when the male sexual partner presents an irritation or a wound in the penis. This recurring question seemingly concerns a point of knowledge. However a more attentive analysis lets us think that there could be various interpretations. First of all, if the penis is healthy, the risk is low, nearly absent. The concern about a friction or about a wound in the penis could be associated with the concept of forbidden sexual positions (similar to animal positions). Proscriptions are explained by their traumatic character for the feminine device and because they are able to induce an infertility or dystocia (difficult) childbirth. Other beliefs have connected the origin of AIDS with prohibited sexual practices, committed by foreigners, who passed on them secondarily to the natives of the country. They are clearly blamed in their contributions to the decline of customs and the corruption of tradition. However this unfavourable evolution is not longer only their privilege. Sexual superactivity and "sexual wandering" are also concerned. It is dialectic of the pure and the impure. The rejection or the stigmatisation of foreign values can allow the group to find its led astray identity. Condoms are well known by Congolese pupils, but there is mistrust of their use, notably for the "elders", guarantor for the moral order. This mistrust is probably connected with the beliefs of risks of infertility, infection or weakening of the virile force. Condoms are mechanical barriers, made by foreigners, to protect native people from foreign troubles, which foreigners generate. The investigation of chains of significant from the primary couple "nature/artificial (synthetic)" can establish a bait of understanding. The contraceptive action of condoms is a problem. Reproduction remains family business. Moreover, the place of the "morality", the official speech of condemnation from the Roman Catholic Church and the ambivalent positioning of certain Congolese religious congregations does not encourage condom use. Finally, one should not neglect their cost compared to the standard of living. The religious faith is a source of comfort for many Congolese. AIDS can be lived as a spiritual probation that certain traditional healers would have foreseen. Certain ideologies can be a source of intolerance for people who transgress "ways of life" (alcohol, tobacco, anal sexual intercourse.). The religious congregations have invaded the public space. The medical world and the political institutions cannot ignore them any more. (ABSTRACT TRUNCATED)
Acquired Immunodeficiency Syndrome↗
[Survey on sexual behavior by Congolese and French high-school students in an AIDS context].
The social and economic impact of AIDS add to those of a recent civil war in 1997. There were fratricidal confrontations before and after this period. Pointe-Noire, the second city of Congo and the economic Capital, was on the whole spared. We carried out a survey of 292 high-school students: 39% of girls and 61% of boys, from 14 old to 25 years old (average age of 19 years). They were from 5 general and technical schools, which are representative of the school recruitment of the city of Pointe-Noire. This study made in 1998 was the second part of a work achieved in France in 1997 with 1,859 high-school students: 70% of girls and 30% of boys, mean age 17.7 years, range 15-25 years. They came from 3 general, technical and professional schools of two departments of the region "Centre" ("Indre-et-Loire" and "Loir-et-Cher"). The material, corresponding to this study, is an anonymous self-questionnaire of 55 closed items presented in the form of assertions to which the student respond either yes or no. Items investigated: 1) pubertal maturation and subjective maturation; 2) different aspects of sexual experience in adolescence (components of sexual experience) [9] and 3) sexual behaviour (including sexual risk taking). All items have been formulated in the most accessible possible way for the youngsters. Previously, in 1996, we had made a pre-test with this material near sample of French people from 16 to 68 years old. The results of the study highlight that the Congolese youngsters present more risk than their French homologues. Although the pubertal status (the menarche and the spermarche) occurs slightly later, Congolese boys present a greater number of sexual partners and greater sexual precocity. Among 54% of Congolese pupils from the sample which had already had a sexual intercourse (68% of boys and 42% of girls) versus 52% of French pupils (58% of boys and 49% of girls), 88% of the Congolese boys have sexual intercourse at the age of 15, versus 72% of the girls at 16.5 versus 65% of the French boys in their 15.5 and 52% of the girls at 16. These differences are significant (p < 0.001) like all the following ones. Congolese students declare more sexual partners (4 during the last 12 months and 5 for all their life versus 3.2 and 4.4 for the French students); the boys more than the girls (6.5 sexual partners on the whole versus 3.7 for the girls in Congo and 5.7 versus 3.8 in France). Congolese girls generally have fewer sexual relations (over 12 months or during their entire life) than French high-school girls (respectively 5.9, 6.9 versus 8.7 and 9.3). We can see with French and Congolese students, a "traditional" dichotomy between boys and girls: that is to say girls tend to engage later in sexual relations and to favour the long and regular relations, while the boys have more short, and spaced sentimental relations. The relations of these last ones tend to evolve on a more preparatory mode, genital and intermittent, contrary to those girls who seem more sentimental and continuous. The use of the condom concerns 72% of the French pupils for the first sexual intercourse (74% of boys versus 72% of girls) - which is close to results of French reference surveys [1, 3]. On the other hand, they are only 39% to make use of it in Congo in this circumstance (36% of the boys and 34% of the girls). All Congolese young people present more STD (6% versus 4% for the French pupils) and more pregnancy (11% versus 3%). The other risky situations appear also more important in Congo: as the fact of having sexual intercourse after having drunk too much (6% of case where it arrives systematically versus 2% in France); to have sexual intercourse with a injecting drug user (4% versus 1%); paying or to have been paid (in a systematic way 7% versus 1%). The Congolese answers concerning the recourse to prostitution are more dissimilar and alarming concerning Congolese young people, especially if one takes into account all the situations where it occurred at least once (29% of the boys and 13% of the Congolese girls who declare to have had a sexual intercourse by paying (with money). Homosexual relations are more frequent in Congo (4 and 6% versus 2 and 3% for France). Homosexual experience concerned 13% of the Congolese pupils versus less than 5% of the French ones. The answers concerning a sexual partner who is "not sure" (20% in Congo versus 2% in France) can get clearer in the Congolese context with an elevated prevalence rate of infection by HIV. However, other cultural factors should not be neglected. The same applies for the answers relative to the sexual intercourse under duress (29% for Congo versus less than 7% in France). The answers relative to the fact of having a sexual intercourse with a much older partner (21% versus 13%) do not seem surprising for Congo. But it does not free risks. All these elements are not associated with a better estimate of the personal risk. (ABSTRACT TRUNCATED)
Acquired Immunodeficiency Syndrome↗
[Severe skin disease induced by a chloroquine-proguanil combination].
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Adult↗
[Efficacy of cidofovir in an HIV infected patient with an acyclovir and foscarnet resistant herpes simplex virus infection].
BACKGROUND: We report the case of an AIDS patient, whose persistant HSV2 ulceration was clinically and phenotypically resistant to acyclovir and foscarnet. Only five clinical isolates of simultaneous acyclovir and foscarnet resistance have been previously described. CASE REPORT: This patient, without history of opportunistic infection, was hospitalized for a recurrent scrotal ulceration resistant to several antiviral treatment such as acyclovir, valacyclovir or foscarnet. The CD4 count was stable at 150/mm(3) and the HIV viral load was below detection level. The last recurrence appeared rapidly under valacyclovir therapy which had been introduced after 65 days of foscarnet therapy. Thus, the patient received a new dose of foscarnet. After initial efficacy, the ulceration increased once again. HSV2 phenotypic determination was done and detected, at that time, a double resistance to acyclovir and foscarnet. Healing was obtained with intravenous cidofovir. DISCUSSION: Foscarnet and acyclovir resistance in an HSV2 isolate is rare. This report presents several particularities. First, whereas the earlier published patients with an acyclovir and foscarnet resistant strain were widely immunocompromised, this was not the case for our patient. Secondly, in contrast with most precedent observations in which acyclovir-resistant strain disappeared after foscarnet therapy, in our case the acyclovir resistant strain remained after foscarnet therapy. Finally, few reports concerned the clinical efficacy of cidofovir in HSV infection. In this case, we proved that intravenously cidofovir was highly and rapidly effective on acyclovir and foscarnet resistant strains.
AIDS-Related Opportunistic Infections↗
[Dried blood spot Vitamin A determination by high pressure liquid chromatography with electrochemical detection].
In tropical countries. vitamin A deficiency is one of the most important dietary deficiencies. Its monitoring usually involves analysis of retinol after venipuncture with some difficulties (disease transmission, religious belief). Sample collection on Dried Blood Spot (DBS) is less invasive and safer. Sample storage is easier. We developed a liquid chromatography method with electrochemical detection to measure DBS retinol. Retinol acetate was used as an internal standard. The method is linear up to 2.5 microM with a detection limit of 0.04 microM. Precision is below 10% and DBS retinol recovery overage is 90%. DBS retinol concentration decreased during 7 days after sampling, it is necessary to wait this delay before to determine vitamin A concentrations. In Congolese children DBS retinol measurement showed a severe vitamin A deficiency in 8% of them. This percentage is closely correlated with clinical parameters.
Chromatography, High Pressure Liquid↗
[An approach to food consumption in an urban environment. The case of west Africa].
West Africa has undergone rapid economic and political changes during the last 20 years. After the failure of economic policies implemented since independence, programs for structural adjustment have strongly influenced the economy. Food problems affect each country differently. The Sahel has experienced food shortages and starvation whereas in forested countries the food supply has remained stable. Nevertheless, food policies have not succeeded in contributing to urban and rural development. The rate of urbanization in west Africa is generally low but the rate of urban population growth is particularly high, much more than the growth rates of industry and infrastructure. Although metropolitan areas are affected by poverty, they offer more hope and opportunities than rural areas. Urban markets have expanded and diversified as social differences have also increased and contributed to changes in consumption structure. Urban growth has contributed to the increase of imported food: this is indicated by both the strong dependency and the change of food habits towards western food patterns. Recently however, west African urban dwellers are still preferring local items if they are affordable. When imported products are used, they are integrated within a stable meal plan consisting of a single dish with a base and a sauce, which is typical of African food preparation. Surveys of consumption-budgets are still only available on a national scale. These can provide accurate information about food consumption patterns of families, particularly for significant trends. However, they do not provide information about the dynamics of food consumption, neither for urban areas or the individual. Now a significant proportion of individual food consumption occurs outside of the home, mainly with food provided by street vendors. This new consumption habit is a response to the urban food crisis. Consumption of street-vendor-food comprises one component but this cannot be dissociated from in-home food consumption. Despite the growing importance of street-vendor food consumption, it has still not been adequately documented. Theoretically, food consumption is an evolving concept. Single disciplines, such as economics or nutrition, first studied food consumption. More recently, social sciences developed new approaches with various interpretations, which were sometimes contradictory. The evolution of urban food consumption and the numerous related problems support the approach proposed by some authors suggesting a mixed analysis integrating both economics and cultural factors. Operationally, a global and dynamic approach to food styles must consider urban heterogeneity and diversity of situations. For example, food consumption by people maintaining their in-home food habits shows the pertinence of studies focusing on individuals. Therefore, the food course concept may be a useful method for the study of food consumption.
Africa, Western↗
[Variability of home dietary habits of families living in Bamako (Mali) according to their socioeconomic status].
We investigated the influence of standard of living on the dietary and eating habits of families in Bamako (Mali). Family meals eaten at home at any time of day were studied. Families were selected for the study according to two criteria: the place of residence and the domestic commodities and urban investments. Thus, 24 families were included from affluent and 24 from moderately affluent neighborhoods, and 26 families from poor neighborhoods. All families ate three meals a day, each including staples and sauce. However, the dishes selected for the different meals and their ingredients varied considerably with the family's status. Cereals were the main component of breakfast, but the type varied from one category of family to another. All poor families and 79% of the intermediate group and only 54% of the affluent group ate millet/sorghum. Seventy-five % of the affluent, 13% of the intermediate and none of the poor families drank coffee at breakfast. Fifty % of the affluent, 29% of the intermediate and 19% of the poor families ate rice with nadji sauce at lunch. The quality of the nadji sauce varied with economic status. Tigadeguena sauce was eaten with rice in 17% of the affluent families, 50% of the intermediate group and 12% of the poor families. Very little millet/sorghum was eaten by the affluent at lunch, whereas it was included in lunch by over half the poor and one fifth of the intermediate families. The diversity of dishes was larger at supper, but only in the affluent families which had 2 to 4 different dishes or produce. They included garden vegetable salads and stews, with or without bread. Dinner for the intermediate and poor families was similar to lunch, that is a cereal base and a sauce. Home eating habits also differed according to status. In the affluent families breakfast was eaten alone, whereas in the poor families it was a communal meal. The intermediate group displayed both patterns. Affluent families tried to alternate and diversify their food intake from one meal to another, whereas the diet of the poor was monotonous. Most intermediate families tried to alternate a small range of staples (rice and traditional cereals) although this necessitated reducing the quality of the sauce. Our study shows that eating habits are affected by both cultural factors and standard of living.
Adolescent↗
[Strategies to control vitamin A deficiency].
Vitamin A deficiency is a major public health problem in the countries of the Sahel. It causes xerophthalmia and high rates of child mortality and it occurs mostly in underdeveloped regions. People of all ages may suffer from vitamin A deficiency but it is a particular problem in pre-school-age children. Each year, about 250,000 children throughout the world become blind due to vitamin A deficiency. Measles, pneumonia and diarrhea reduce the child's reserves of retinol and increase the dietary requirement for vitamin A. Improvement of social conditions is a radical approach to preventing vitamin A deficiency. Three strategies are currently in use: horticultural activities and health education; fortification of food products; distribution of high-dose vitamin A capsules.
Africa↗
[Prevalence of urogenital mycoplasma infection in women infected with HIV in Bangui (Central African Republic)].
Urogenital mycoplasma (UGM) infections have often been reported in HIV patients. Little is known about UGM colonization and infection. We assessed the level of UGM colonization and infection in a cohort of HIV-positive women living in Bangui, Central African Republic. We studied 146 women of child-bearing age, some of whom were pregnant. All were HIV-positive but asymptomatic and attended one of the urban health centers and the National Center for Sexually Transmitted Diseases in Bangui in April or May 1995. Colonization was defined as an endocervical mycoplasma concentration of less than 10(4) color change units per milliliter (CCU/ml) and infection was defined as an endocervical mycoplasma concentration of at least 10(4) CCU/ml. 58 of the 146 HIV-positive women were pregnant (group A). Group B comprised the other 88 women who were not pregnant. The mean age of the women in group A was 22.7 years (range: 15 to 41) and that for the women in group B was 25.8 years (range: 17 to 40). 134 of the 146 women were carrying one or both of the two types of UGM. There were 53 (91.4%) cases in group A and 81 (92%) in group B. Overall, 40% of the women were colonized and 51.4% were infected. UGM infections frequently affect HIV-positive pregnant women in Bangui. Our results suggest that women should be screened for UGM as well as for other sexually transmitted diseases, to improve the care of HIV-infected women attending antenatal clinics in developing countries.
AIDS-Related Opportunistic Infections↗