RESUMO
To strengthen HIV screening in the French West Indies (FWI), we evaluated the feasibility of rapid tests in sexually transmitted infection (STI) testing centres. Rapid testing was offered to each user ahead of the standard screening tests. Between October 2007 and December 2008, 847 users had HIV rapid testing, and 1724 users did not have rapid testing. The results of rapid testing were returned to 99.1% of testers. However, clients who underwent rapid testing were significantly more likely than others to have not returned to get the results of their standard screening tests (for HIV and other STIs): 27.4% versus 14.0% with a relative risk of 1.96 (95% confidence interval [CI] 1.67-2.30, P < 0.0001). Rapid HIV testing has the capacity to reduce the return rates for confirmatory results of HIV testing and other STIs.
Assuntos
Infecções por HIV/diagnóstico , Adulto , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores de Tempo , Índias Ocidentais/epidemiologiaRESUMO
OBJECTIVE: Late screening for HIV is frequent in people living in the French West Indies. Rapid tests (RT) create new opportunities to improve screening for HIV. We evaluated the feasibility and acceptability of RT among users of free and anonymous screening consultations in Fort-de-France and Saint-Martin. METHODS: After confirming its reliability on more than 20,000 samples, a RT (Determine HIV-1+2 was offered on site to all testers in addition to the classic tests. RESULTS: From October 2007 to May 2008, 373 RT were performed, four were confirmed positive. Results of RT were returned to 99.4% of testers versus 89.4% of persons who underwent additional classic tests. The rate for unclaimed classic tests results was higher for the latter than for persons who had only RT: 22.2% versus 10.6%. CONCLUSIONS: Results show that RT improves the proportion of people who are informed of their results. Nevertheless, efforts must be made to persuade patients to come back for results of the standard tests to be informed of a potential sexually transmitted infection or an acute HIV infection.
Assuntos
Testes Anônimos/métodos , Infecções por HIV/diagnóstico , Reações Falso-Negativas , Reações Falso-Positivas , Infecções por HIV/prevenção & controle , HIV-1/isolamento & purificação , HIV-2/isolamento & purificação , Hospitais Universitários , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Martinica , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Abuso de Substâncias por Via Intravenosa , Fatores de TempoRESUMO
BACKGROUND: Few data are available on cutaneous leishmaniasis caused by dermotropic species in human immunodeficiency virus (HIV)-infected patients. OBJECTIVES: To describe nine cases of cutaneous leishmaniasis in HIV+ patients and to compare their clinical features and their response to treatment with those of HIV- patients with the forms of leishmaniasis commonly found in French Guiana. METHODS: A case-control study was carried out between July 1994 and December 2000 in French Guiana. We compared the following variables in nine HIV-infected patients with leishmaniasis and 27 matched controls: clinical type of leishmaniasis, number of lesions, presence of lymphangitis and adenopathy, the rate of recovery after treatment, and recurrence or reinfection. RESULTS: Eight of the HIV-infected patients had localized cutaneous leishmaniasis and one had mucocutaneous leishmaniasis. All of the controls had localized cutaneous leishmaniasis. Leishmania guyanensis was the only species isolated from HIV-infected subjects. HIV-Leishmania coinfected patients had a higher rate of recurrence or reinfection (P < 0.02) and a lower rate of recovery after one treatment cycle with pentamidine (P < 0.02) than did HIV- subjects. The CD4+ lymphocyte counts exceeded 200 mm(-3) in all HIV+ patients at the time of the diagnosis with leishmaniasis. CONCLUSIONS: In French Guiana, cutaneous leishmaniasis in moderately immunosuppressed HIV-infected subjects (> 200 CD4+ T cells mm(-3)) is characterized by a higher rate of recurrence or reinfection and is more difficult to treat than that in HIV- subjects.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/patologia , Leishmaniose Cutânea/patologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Idoso , Antiprotozoários/uso terapêutico , Contagem de Linfócito CD4 , Estudos de Casos e Controles , Feminino , Humanos , Hospedeiro Imunocomprometido , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/imunologia , Masculino , Pessoa de Meia-Idade , Pentamidina , Recidiva , Resultado do TratamentoRESUMO
OBJECTIVE: The survey "Mortality 2000" had for aim to describe the distribution of causes of death in HIV-infected adults in France. METHOD: Hospital wards involved in the management of HIV infection prospectively reported deaths occurring in 2000. The causes of death were documented using a standardized questionnaire. RESULTS: In French Guyana and the French West Indies the five referent wards reported 81 deaths. The main underlying causes of death were AIDS-related (67%), non-AIDS and non-hepatitis related cancer (9%), cardiovascular disease (7%), bacterial infections (5%), and end stage liver disease (4%). Among AIDS-related deaths, the more frequent diseases were histoplasmosis and toxoplasmosis in Guyana and atypical mycobacterial infection, tuberculosis, and cytomegalovirus disease in the West Indies. Median age was 43 years, transmission of HIV infection was heterosexual in 79%; 56% lived in poor socio-economic conditions, and 30% were born abroad. One out of five had been recently diagnosed with HIV infection and one out of three had never received antiretroviral treatment. CONCLUSION: In 2000, two in three death cases in HIV-infected adults were AIDS-related in French Guyana and the French West Indies. Improved strategies for screening HIV infection before the occurrence of AIDS are still needed taking into consideration poor socio-economic and migrant conditions.
Assuntos
Infecções por HIV/mortalidade , Adulto , Terapia Antirretroviral de Alta Atividade , Causas de Morte , Feminino , Guiana Francesa , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Estudos Prospectivos , Estatísticas VitaisRESUMO
OBJECTIVE: The aim of this study is to analyse the characteristics of HIV pregnant women in French Guiana then to evaluate the HIV mother to child transmission rate (MTCT) and determine the pronostic factors associated with MTCT. PATIENTS AND METHOD: An epidemiological study has been led including all deliveries in French Guiana from January 1998 to December 2000. For each case a standardized questionnaire has been gathered including epidemiological, clinical and biological data and an univariate analysis has been realized. A hundred and forty-eight women have been included in the study among 135 women came for delivery. RESULTS: The factors associated with increased MTCT in our study were no antiretroviral therapy before delivery, the lack of follow-up during pregnancy and no antiretroviral therapy in children. The HIV mother to child transmission rate was 6,5% despite the availability of antiretroviral therapies. DISCUSSION AND CONCLUSION: This rate may be explained by the difficulties of follow-up in HIV infected women. Much more needs to be done to improve access to care for women coming from foreign countries. This may be indispensable to reduce the HIV mother to child transmission rate in French Guiana.
Assuntos
Infecções por HIV/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Fármacos Anti-HIV/uso terapêutico , Feminino , Guiana Francesa/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , PrognósticoRESUMO
The most common presentation of symptomatic postnatally acquired toxoplasmosis in immunocompetent patients is painless cervical adenopathy. Acute visceral manifestations are associated in rare cases. We report 16 cases of severe primary toxoplasmosis diagnosed in French Guiana during a 6.5-year period. All of the subjects were immunocompetent adults hospitalized with clinical presentations consisting of a marked, nonspecific infectious syndrome accompanied by an altered general status with at least one visceral localization, mainly pulmonary involvement (14 cases). Acute toxoplasmosis was diagnosed according to the results of serological tests suggestive of recent primary infection and the absence of an alternative etiology. Recovery was rapid following specific antitoxoplasmosis treatment. Thirteen of the 16 patients had consumed game in the 2 weeks before the onset of the symptoms, and in eight cases the game was considered to have been undercooked. Toxoplasma strains, which were virulent in mice, were isolated from three patients. Microsatellite analysis showed that all of these isolates exhibited an atypical multilocus genotype, with one allele found only for isolates of this region.
Assuntos
Imunocompetência , Toxoplasma/isolamento & purificação , Toxoplasmose/epidemiologia , Toxoplasmose/fisiopatologia , Doença Aguda , Adolescente , Adulto , Animais , Anticorpos Antiprotozoários/sangue , DNA de Protozoário/análise , Guiana Francesa/epidemiologia , Genótipo , Humanos , Incidência , Masculino , Camundongos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Índice de Gravidade de Doença , Toxoplasma/classificação , Toxoplasma/genética , Toxoplasmose/parasitologiaRESUMO
We investigated the characterization of different HIV-1 subtypes present in French Guiana by use of three different methods. Serological methods were used for the initial screening, which were then confirmed by the heteroduplex mobility assay (HMA). The V3 env region was subsequently sequenced for phylogenetic analysis, to confirm the subtype of the samples, and to assign a subtype to samples that gave results that were difficult to interpret or discordant by serology or HMA. A total of 221 HIV-1 seropositive samples were typed; 110 of them were confirmed by HMA and 16 were sequenced. Of the 221 samples tested 210 patients (95%) were found to be infected with subtype B, 10 (4.5%) were infected with subtype A, and one patient was infected with subtype F. Phylogenetic analysis demonstrated that the strains from French Guiana were closely related to the subtype A and B subtypes, and that one strain was closely related to an F subtype (100% bootstrap value). Four strains from French Guiana clustered in the subtype A (99% bootstrap value) and the other strains were associated with subtype B (100% bootstrap value). The geographic position of French Guiana suggested that HIV-1 was probably introduced into the country via several routes, and thus the pattern of the HIV-1 epidemic might evolve in the near future.