HIV Insight: Ivory Coast

Sunday, February 28, 2016

Prevalence and Factors Associated with HIV and Tuberculosis in People Who Use Drugs in Abidjan, Ivory Coast

Highlights

Smoking is the main way of cocaine and heroin consumption in Abidjan, Ivory Coast.
People who use drugs in Abidjan can be considered at high risk of HIV, due to sexual transmission in women, sex workers, and men having sex with men using drugs.
Social vulnerability is a major factor of illness in people who use drugs in Abidjan, with particularly high rates of active pulmonary TB associated with living conditions.

Abstract

Background

The number of people who use drugs (PWUD) has dramatically increased in West Africa over the last 15 years, but targeted interventions are falling behind, notably because of the lack of awareness of the health needs of PWUD. We aimed to assess prevalence and factors associated with HIV and other infections in PWUD in Abidjan, Ivory Coast, one of the countries most affected by HIV in Western Africa.

Methods

We used respondent-driven-sampling to obtain a representative sample of heroin or cocaine/crack users aged 18 years or more. Socio-behavioral data were obtained by face-to-face questionnaires. Blood samples were collected and tested for HIV. Two sputa were obtained in tuberculosis (TB) symptomatic participants for acid-fast-bacilli (AFB) smear testing. After a descriptive analysis, crude prevalence were calculated, then weighted to take account of the sampling method. Factors associated with HIV and TB were studied using adjusted log-binomial regression. Population size was estimated by capture-recapture.

Results

450 PWUD were recruited in May 2014. The mean age was 33.5 years; 10.9% were women. Smoking was the main mode of consumption, ever injecting was reported by 12.7% of the participants (3.6% in the past month). Sex work was reported by 15.8% of the PWUD (13.7% of the men), and 10.2% of the men reported sexual relationships with other men (MSM). We found a weighted prevalence of 9.5% for HIV. Women were 3.4 times more likely to be infected than men. Among men, being a sex worker (SW) (adjusted OR 2.9 [95CI 1.06-7.98]) or MSM (adjusted OR 11.5 [95CI 4.22-31.42]) were the main factors associated with HIV infection in adjusted analysis. Injection was not associated with HIV. TB weighted prevalence was 1.8%, associated with poor living arrangements in adjusted analysis. We estimated that 3521; 95CI 3049–3993 PWUD live in Abidjan.

Conclusion

PWUD in Abidjan are at high risk of HIV due to sexual transmission, especially in women, SW and MSM who also use drugs. Interventions should be developed to improve HIV prevention and linkage to care in these specific populations. More generally, improving the health of PWUD involves a broader reflection on the living environment and access to health care of slum residents in large African cities.

Purchase full article at: http://goo.gl/vQo1be

By: Julie Bouscaillou, Jérome Evanno, Myrtille Prouté, André Inwolé, Mathieu Kabran, Thierry N’Guessan, Samedi Djé-Bi, Souleymane Sidibé, Marguerite Thiam-Niangoin, Roger Nguessan Badou, Pascale Blanchetière, Niklas Luhmann

julie.bouscaillou@medecinsdumonde.net

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Monday, November 16, 2015

Cancer of the Penis Associated with HIV: A Report of Three Cases Presenting at the CHU Cocody, Ivory Coast

We describe three cases of advanced penile cancer associated with HIV infection.

Advanced penile cancer associated with VIH infection were discovered in three patients aged respectively 47, 56 and 40. The prognosis was extremely poor. Two patients died without receiving any treatment and one patient was lost to follow-up after refusing all treatment proposed.

There appears to be a link between HIV infection and penile cancer with concomitant HIV infection worsening the prognosis of the disease.

Cancer of the penis is extremely rare. In Europe and the USA, the incidence of this form of cancer is estimated as 1.0 per 100,000 men [1]. The incidence varies between different countries worldwide with a higher incidence in Hispanic individuals, in Brazil and in Uganda [2]. Circumcision in the perinatal period or before puberty has a preventative role, but not circumcision carried out in adulthood. Early circumcision decreases the risk 3–5-fold [3], probably by improving local hygiene. Cancer of the penis is usually a disease of older men and its incidence increases with age. The peak in frequency occurs between 60 and 70 years of age [1], [2], [4]. In 95 % of cases penile tumours are squamous cell carcinomas [5]. Penile cancer may present as a flat or ulcerated exophytic papillary lesion, with the latter having a worse prognosis. The most common locations are the glans (48 % of cases) and the foreskin (25 % of cases). Penile cancer patients with advanced disease have a poor prognosis. Grades 2 and 3 disease, T3 stage and positive lymph nodes are adverse prognostic factors for cancer-specific survival in penile squamous cell carcinoma [6], [7]. In a study of eight patients with metastatic penile cancer, the longest and shortest survival times (from diagnosis of the primary cancer to death) were 16 years and 9 months, respectively [8]. Other, rarer histological forms of penile cancer such as melanoma and sarcoma may also occur [9].

There is a higher risk of penile cancer in patients with AIDS although it is not possible to conclude formally about a causal link with immunosuppression [10]. An increasing number of cases of penile cancer associated with HIV are being reported in the literature [1], [10], [11]. The aim of this report is to describe three cases of penile cancer associated with HIV that presented at the Urology Department of the CHU Cocody and to review the literature...

Below: Cancer of the penis (patient 1), view 3