Early Diagnosis of HIV-1 in Infants: The Prevention of Mother-To-Child Transmission Program in Equatorial Guinea

BACKGROUND:

Great efforts have been made in the last few years in order to implement the prevention of mother-to-child transmission (PMTCT) program in Equatorial Guinea (GQ). The aim of this study was to evaluate the rates of mother-to-child HIV transmission based on an HIV early infant diagnosis (EID) program.

METHODS:

A prospective observational study was performed in the Regional Hospital of Bata and Primary Health Care Centre Maria Rafols, Bata, GQ. Epidemiological, clinical, and microbiological characteristics of HIV-1-infected mothers and their exposed infants were recorded. Dried blood spots (DBS) for HIV-1 EID were collected from November 2012 to December 2013. HIV-1 genome was detected using Siemens VERSANT HIV-1 RNA 1.0 kPCR assay.

RESULTS:

Sixty nine pairs of women and infants were included. Sixty women (88.2%) had WHO clinical stage 1. Forty seven women (69.2%) were on antiretroviral treatment during pregnancy. Forty five infants (66.1%) received postnatal antiretroviral prophylaxis. Age at first DBS analysis was 2.4 months (IQR 1.2-4.9). One infant died before a HIV-1 diagnosis could be ruled out. Two infants were HIV-1 infected and started HAART before any symptoms were observed. The rate of HIV-1 transmission observed was 2.9% (95%CI 0.2-10.5).

CONCLUSIONS:

The PMTCT rate was evaluated for the first time in GQ based on EID. EID is the key for early initiation of antiretroviral therapy and to reduce the mortality associated with HIV infection.

Purchase full article [In Spanish] at:  http://goo.gl/cP1e56

By:  Prieto-Tato LM1, Vargas A2, Álvarez P3, Avedillo P4, Nzi E5, Abad C4, Guillén S6, Fernández-McPhee C3, Ramos JT7, Holguín Á3, Rojo P4, Obiang J8.

• 1Servicio de Pediatría, Hospital Universitario de Getafe, Getafe, Madrid, España. Electronic address: lmprieto.hugf@salud.madrid.org.
• 2Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, RICET, Madrid, España.
• 3Laboratorio de Epidemiología Molecular VIH-1, Departamento de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, IRYCIS y CIBERESP, Madrid, España.
• 4Departamento de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, España.
• 5Servicio de Análisis Clínicos, Hospital Regional de Bata Dr. Damian Roku, Bata, Guinea Ecuatorial.
• 6Servicio de Pediatría, Hospital Universitario de Getafe, Getafe, Madrid, España.
• 7Servicio de Pediatría, Hospital Universitario Clínico San Carlos, Madrid, España.
• 8Servicio de Pediatría, Hospital Regional de Bata Dr. Damian Roku, Bata, Guinea Ecuatorial. 

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Self-Reported Adherence to Antiretroviral Therapy in HIV+ Population from Bata, Equatorial Guinea

The human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS) represent a serious public health problem in Equatorial Guinea, with a prevalence of 6.2% among adults. the high-activity antiretroviral treatment (HAART) coverage data is 10 points below the overall estimate for Sub-Saharan Africa, and only 61% patients continue with HAART 12 months after it started. 

This study aims to assess HAART adherence and related factors in Litoral Province of Equatorial Guinea. In this cross-sectional study, socio-demographic and clinical data were collected at Regional Hospital of Bata, during June-July 2014. 

Adherence to treatment was assessed by using the Spanish version of CEAT-VIH. Bivariate and linear regression analyses were employed to assess HAART adherence-related factors. We interviewed 50 men (35.5%) and 91 women (64.5%), with a mean age of 47.7 ± 8.9 and 36.2 ± 11.2, respectively (p < .001). 

Overall, 55% patients had low or insufficient adherence. CEAT-VIH score varied by ethnic group (p = .005). There was a positive correlation between CEAT-VIH score and current CD4 T-cells count (p = .013). The Cronbach's α value was 0.52. 

To our knowledge, this is the first study to assess HAART adherence in Equatorial Guinea. Internal reliability for CEAT-VIH was low, nonetheless the positive correlation between the CEAT-VIH score and the immunological status of patients add value to our findings. 

Our results serve as baseline for future research and will also assist stakeholders in planning and undertaking contextual and evidence-based policy initiatives.

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By:   Salmanton-García J1, Herrador Z2,3, Ruiz-Seco P4, Nzang-Esono J2,5, Bendomo V6, Bashmakovic E6, Nseng-Nchama G7, Benito A2,3, Aparicio P2,3.

• 1a Intern of the Spanish Society of Tropical Medicine and International Health , Madrid , Spain.
• 2b National Centre for Tropical Medicine, Instituto de Salud Carlos III (ISCIII) , Madrid , Spain.
• 3c Tropical Diseases Research Network (RICET in Spanish) , Madrid , Spain.
• 4d National Institute of Social Security of Equatorial Guinea (INSESO in Spanish) , Bata , Equatorial Guinea.
• 5e Reference Centre for Epidemics Control of Equatorial Guinea (CRCE in Spanish) , Malabo , Equatorial Guinea.
• 6f Reference Unit for Infectious Diseases (UREI in Spanish) , Regional Hospital of Bata , Bata , Equatorial Guinea.
• 7g National Plan Against AIDS (PNLS in Spanish) , Ministry of Healthcare and Social Welfare , Malabo , Equatorial Guinea (MINSABS in Spanish). 

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Seroprevalence of Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus, and Treponema pallidum Infections among Blood Donors on Bioko Island, Equatorial Guinea

Regular screening of transfusion-transmissible infections (TTIs), such as human immunodeficiency virus (HIV), hepatitis B and hepatitis C virus (HBV and HCV, respectively), and Treponema pallidum, in blood donors is essential to guaranteeing clinical transfusion safety. This study aimed to determine the seroprevalence of four TTIs among blood donors on Bioko Island, Equatorial Guinea (EG).

A retrospective survey of blood donors from January 2011 to April 2013 was conducted to assess the presence of HIV, HBV, HCV and T. pallidum. The medical records were analyzed to verify the seroprevalence of these TTIs among blood donations stratified by gender, age and geographical region.

Of the total 2937 consecutive blood donors, 1098 (37.39%) had a minimum of one TTI and 185 (6.29%) harbored co-infections. The general seroprevalence of HIV, HBV, HCV and T. pallidum were 7.83%, 10.01%, 3.71% and 21.51%, respectively. The most frequent TTI co-infections were HBV-T. pallidum 60 (2.04%) and HIV-T. pallidum 46 (1.57%). The seroprevalence of HIV, HBV, HCV and T. pallidum were highest among blood donors 38 to 47 years, 18 to 27 years and ≥ 48 years age, respectively (P<0.05). The seroprevalence of TTIs varied according to the population from which the blood was collected on Bioko Island.

Our results firstly provide a comprehensive overview of TTIs among blood donors on Bioko Island. Strict screening of blood donors and improved hematological examinations using standard operating procedures are recommended.

Below:  The geographic location of research population.

Malabo city was divided into eight regions including the old city center (A), the presidential office and residential area (B), the public residential area from previous planning (C), the modern residential area with a low population density (D), the modern residential area with a high population density (E), the un-planned residential area with a different population density (F) and the un-planned residential area with a high population density (G). The rural area included Luba, Moka, Riaba and Baney on Bioko Island.

Below:  The distribution of the TTI seroprevalence rates among the blood donors

Purchase full article at: http://goo.gl/HiesEB

By: Xie DD1, Li J2, Chen JT3, Eyi UM4, Matesa RA4, Obono MM4, Ehapo CS4, Yang LY5, Yang H5, Yang HT5, Lin M5.

• 1Laboratory Medical Center, The People's Hospital of Jiangmen, Jiangmen; The Chinese Medical Aid Team to the Republic of Equatorial Guinea, Guangzhou, Guangdong Province, People's Republic of China.
• 2Department of Infectious Diseases, Renmin Hospital; Department of Parasitology, College of Basic Medicine, Hubei University of Medicine, Shiyan, Hubei, People's Republic of China.
• 3Laboratory Medical Center, The People's Hospital of Jiangmen, Jiangmen; The Chinese Medical Aid Team to the Republic of Equatorial Guinea, Guangzhou, Guangdong Province, People's Republic of China; Laboratory Medical Center, Huizhou Municipal Central Hospital, Guangdong, Huizhou, Guangdong, People's Republic of China.
• 4Central Blood Transfusion Service; Medical Laboratory, Malabo Regional Hospital, Malabo, the Republic of Equatorial Guinea.
• 5Central Laboratory, Chaozhou Central Hospital, Southern Medical University, Chaozhou, Guangdong, People's Republic of China.  

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