Oral Health and HIV Infection among Female Sex Workers in Abidjan, Côte d’Ivoire

Background

Worldwide, female sex workers (FSW) represent a vulnerable population for oral diseases due to many risk factors including HIV infection and drug abuse. In sub-Saharan Africa, little is known about the burden of oral diseases and their determinants in vulnerable populations. The aim of the study was to estimate the prevalence and associated factors of oral diseases among FSW.

Methods

A cross sectional study was conducted among FSW who attended a dedicated non-profit clinic in Abidjan, Côte d’Ivoire from June to August 2013. Data about the presence of dental caries, periodontitis and oral-mucosal lesions were collected by a dentist during an oral examination. Behavioural information related to oral hygiene habits as well as tobacco and alcohol consumption were collected through a standardized questionnaire. Information related to HIV infection including HIV diagnosis, last known CD4 count and antiretroviral therapy were documented through a medical chart review. Logistic regression models were used to identify factors associated with oral diseases.

Results

A total of 249 FSW with a median age of 29 years, and a median duration of sex work of 24 months [IQR 9–60]) were included. Current tobacco use and hazardous alcohol use were reported in 21.7 % and 19.7 % of FSW, respectively. The estimated prevalence of HIV infection was 33.7 % [95 % confidence interval (CI); 27.8 – 39.6]) and 82.1 % of HIV-infected FSW were on antiretroviral therapy . The prevalence of dental caries, periodontitis and oral-mucosal lesions were 62.3 % [95 % CI 55.5 – 67.5], 14.5 % [95 % CI 10.2 – 18.9] and 8.2 % [95 % CI 4.8 – 11.5], respectively. In multivariate analysis, periodontitis, oral-mucosal lesions and HIV infection were associated with odds ratio of 2.6 [95 % CI, 1.2–5.8]) and 50.0 [95 % CI; 6.4–384.6].

Conclusions

This study showed a high prevalence of oral diseases among FSW in Abidjan. HIV infection was common and significantly associated with periodontal diseases and oral-mucosal lesions. There is a need to integrate regular screening and treatment of oral lesions into the medical follow-up of FSW along with strategies for HIV prevention.

Full article at:   http://goo.gl/jHlUCY

By:   Marcellin N. Nouaman^1*, David G. Meless², Patrick A. Coffie¹³, Elise Arrivé⁴⁵, Boris K. Tchounga¹⁴⁵, Didier K. Ekouévi¹⁴⁵⁶, Camille Anoma⁷, Serge P. Eholié³, François Dabis⁴⁵,Antoine Jaquet⁴⁵ and the IeDEA West Africa collaboration

¹Programme PACCI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d’Ivoire

²UFR Odonto-Stomatologie, Université Félix Houphouët Boigny, Abidjan 18, 18 BP 1954, Côte d’Ivoire

³Département de Dermatologie et Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d’Ivoire

⁴Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, F-33000, France

⁵INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, F-33000, France

⁶Département de santé publique, Faculté des Sciences de la santé, Université de Lomé, Lomé, Togo

⁷Clinique de Confiance, Abidjan, Côte d’Ivoire

 

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Women (15–24 years old) Newly Infected with HIV in Côte d’Ivoire, 2014

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Full slide deck:  http://goo.gl/uS2HNO

Number of People Living with HIV Who Know Their Status and Are Not Receiving Antiretroviral Therapy in Côte d’Ivoire

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Full slide deck:  http://goo.gl/VMVnWm

Disparate Distribution of Hepatitis B Virus Genotypes in Four Sub-Saharan African Countries

Hepatitis B virus (HBV) places a substantial health burden on Africa. Here, we investigated genetic diversity of HBV variants circulating in 4 countries of sub-Saharan Africa using archived samples. In total, 1492 plasma samples were tested from HIV-infected individuals and pregnant women, among which 143 (9.6%) were PCR-positive for HBV DNA (Côte d’Ivoire, 70/608 [11.5%]; Ghana, 13/444 [2.9%]; Cameroon, 33/303 [10.9%]; and Uganda, 27/137 [19.7%]).

Phylogenetic analysis of the S-gene sequences identified HBV genotypes E (HBV/E, n = 96) and A (HBV/A, n = 47) distributed as follows: 87% of HBV/E and 13% of HBV/A in Côte d’Ivoire; 100% of HBV/E in Ghana; 67% of HBV/E and 33% of HBV/A in Cameroon; and 100% of HBV/A in Uganda. The average and maximal nucleotide distances among HBV/E sequences were 1.9% and 6.4%, respectively, suggesting a greater genetic diversity for this genotype than previously reported (p < 0.001). HBV/A strains were classified into subgenotypes HBV/A1, HBV/A2 and HBV/A3. In Uganda, 93% of HBV/A strains belonged to HBV/A1 whereas HBV/A3 was the only subgenotype of HBV/A found in Cameroon. In Côte d’Ivoire, HBV/A strains were classified as HBV/A1 (11.1%), HBV/A2 (33.3%) and HBV/A3 (55.6%). Phylogeographic analysis of the sequences available from Africa supported earlier suggestions on the origin of HBV/A1, HBV/A2 and HBV/A3 in East, South and West/Central Africa, respectively. Using predicted amino acid sequences, hepatitis B surface antigen (HBsAg) was classified into serotype ayw4 in 93% of HBV/E strains and adw2 in 68% of HBV/A strains. Also, 7.7% of the sequences carried substitutions in HBsAg associated with immune escape.

The observations of pan-African and global dissemination of HBV/A1 and HBV/A2, and the circulation of HBV/E and HBV/A3 almost exclusively in West and Central Africa suggest a more recent increase in prevalence in Africa of HBV/E and HBV/A3 compared to HBV/A1 and HBV/A2. The broad genetic heterogeneity of HBsAg detected here may impact the efficacy of prevention and control efforts in sub-Saharan Africa.

Below:  Maximum likelihood tree of the HBV/A S-gene sequences. HBV/A1, HBV/A2 and HBV/A3 are subgenotypes of HBV/A. Sequences from Uganda, Cameroon and Côte d’Ivoire are noted with red, blue or green dots, respectively. Reference sequences are shown as branches without dots.

Below:  Maximum likelihood tree of the HBV/A S-gene sequences determined in this study and those available in GenBank from other African countries: East Africa (red), Central Africa (Blue), West Africa (green), South Africa (yellow) and North Africa (cyan).

Full article at: http://goo.gl/mGh8pj

By: Joseph C. Forbi,a,* Yousr Ben-Ayed,a Guo-liang Xia,a Gilberto Vaughan,a Jan Drobeniuc,a William M. Switzer,b andYury E. Khudyakova

^b

aMolecular Epidemiology and Bioinformatics Laboratory, Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA

bLaboratory Branch, Division of HIV/AIDS, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA

aMolecular Epidemiology and Bioinformatics Laboratory, Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA

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