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Ndiaye B.P.,Center hospitalier University Le Dantec | Thienemann F.,University of Cape Town | Ota M.,Medical Research Council Unit | Landry B.S.,Aeras | And 22 more authors.
The Lancet Respiratory Medicine | Year: 2015

Background: HIV-1 infection is associated with increased risk of tuberculosis and a safe and effective vaccine would assist control measures. We assessed the safety, immunogenicity, and efficacy of a candidate tuberculosis vaccine, modified vaccinia virus Ankara expressing antigen 85A (MVA85A), in adults infected with HIV-1. Methods: We did a randomised, double-blind, placebo-controlled, phase 2 trial of MVA85A in adults infected with HIV-1, at two clinical sites, in Cape Town, South Africa and Dakar, Senegal. Eligible participants were aged 18-50 years, had no evidence of active tuberculosis, and had baseline CD4 counts greater than 350 cells per μL if they had never received antiretroviral therapy or greater than 300 cells per μL (and with undetectable viral load before randomisation) if they were receiving antiretroviral therapy; participants with latent tuberculosis infection were eligible if they had completed at least 5 months of isoniazid preventive therapy, unless they had completed treatment for tuberculosis disease within 3 years before randomisation. Participants were randomly assigned (1:1) in blocks of four by randomly generated sequence to receive two intradermal injections of either MVA85A or placebo. Randomisation was stratified by antiretroviral therapy status and study site. Participants, nurses, investigators, and laboratory staff were masked to group allocation. The second (booster) injection of MVA85A or placebo was given 6-12 months after the first vaccination. The primary study outcome was safety in all vaccinated participants (the safety analysis population). Safety was assessed throughout the trial as defined in the protocol. Secondary outcomes were immunogenicity and vaccine efficacy against Mycobacterium tuberculosis infection and disease, assessed in the per-protocol population. Immunogenicity was assessed in a subset of participants at day 7 and day 28 after the first and second vaccination, and M tuberculosis infection and disease were assessed at the end of the study. The trial is registered with ClinicalTrials.gov, number NCT01151189. Findings: Between Aug 4, 2011, and April 24, 2013, 650 participants were enrolled and randomly assigned; 649 were included in the safety analysis (324 in the MVA85A group and 325 in the placebo group) and 645 in the per-protocol analysis (320 and 325). 513 (71%) participants had CD4 counts greater than 300 cells per μL and were receiving antiretroviral therapy; 136 (21%) had CD4 counts above 350 cells per μL and had never received antiretroviral therapy. 277 (43%) had received isoniazid prophylaxis before enrolment. Solicited adverse events were more frequent in participants who received MVA85A (288 [89%]) than in those given placebo (235 [72%]). 34 serious adverse events were reported, 17 (5%) in each group. MVA85A induced a significant increase in antigen 85A-specific T-cell response, which peaked 7 days after both vaccinations and was primarily monofunctional. The number of participants with negative QuantiFERON-TB Gold In-Tube findings at baseline who converted to positive by the end of the study was 38 (20%) of 186 in the MVA85A group and 40 (23%) of 173 in the placebo group, for a vaccine efficacy of 11·7% (95% CI -41·3 to 44·9). In the per-protocol population, six (2%) cases of tuberculosis disease occurred in the MVA85A group and nine (3%) occurred in the placebo group, for a vaccine efficacy of 32·8% (95% CI -111·5 to 80·3). Interpretation: MVA85A was well tolerated and immunogenic in adults infected with HIV-1. However, we detected no efficacy against M tuberculosis infection or disease, although the study was underpowered to detect an effect against disease. Potential reasons for the absence of detectable efficacy in this trial include insufficient induction of a vaccine-induced immune response or the wrong type of vaccine-induced immune response, or both. Funding: European & Developing Countries Clinical Trials Partnership (IP.2007.32080.002), Aeras, Bill & Melinda Gates Foundation, Wellcome Trust, and Oxford-Emergent Tuberculosis Consortium. © 2015 Ndiaye et al. Open Access article distributed under the terms of CC BY. Source

Coume M.,Center Hospitalo University | Toure K.,Cheikh Anta Diop University | Toure K.,Center Hospitalier National University Of Fann | Thiam H.M.,Center Hospitalier University Of Fann | And 3 more authors.
Cahiers de l'Annee Gerontologique | Year: 2012

Objective: The objective of this study was to identify the risk factors of cognitive impairment in Senegalese elderly patients of the Social and Health Center of Senegalese National Retirement Institution, Dakar-Senegal. Methods: A cross-sectional study was conducted in 872 Senegalese elderly patients aged 55 years and over at the Social and Health Center of Senegalese National Retirement Institution, Dakar-Senegal. Data on sociodemographic characteristics, lifestyles, social network, past medical and familial history were collected with a structured questionnaire completed with a clinical exam and neuropsychological testing. Cognitive impairment was defined as a score of 28/39 or less with the test of Senegal. Results: The patients had a mean age of 67.2 years (± 7.5), 63% were men, 79% were married and 49,3% were educated. The social network was important. Smoking and alcohol consumption were rare. Hypertension, arthritis, gastrointestinal diseases, respiratory diseases, and genito-urinary diseases were the main health conditions reported. Ninetyfour subjects (10.8%; CI 95%: [8.7-12.9]) had cognitive impairment. Age, low social network, heart disease, stroke, epilepsy, head trauma, and family history of dementia were associated with cognitive impairment, while medical history of arthritis was protective. Risk factors associated with cognitive impairment in the Social and Health Center of Senegalese National Retirement Institution, Dakar-Senegal, are similar to what is reported in Western countries. It is important to take them into consideration for primary prevention of cognitive impairment. © 2012 Springer-Verlag France. Source

Coume M.,Service de Medecine Interne | Toure K.,Center Hospitalier University Of Fann | Toure K.,Cheikh Anta Diop University | Thiam M.H.,Center Hospitalier University Of Fann | And 4 more authors.
Geriatrie et Psychologie Neuropsychiatrie du Vieillissement | Year: 2012

Objective: To assess the prevalence of cognitive impairment in a Senegalese elderly population, of the Sociohealth and university center of Senegalese national retirement institution, Dakar, Senegal. Methodology: A cross sectional study was conducted in 872 Senegalese elderly population aged 55 years and over utilizing the Sociohealth and university center of IPRES, Dakar, Senegal for health care. Sociodemographic, lifestyles, physical activity, medical history, familial history of dementia data were collected with a structured questionnaire completed with a clinical exam and neuropsychological testing. Cognitive impairment was defined as a score of 28 or less with the test of Senegal. Results: Ninety four subjects (10.8%; 95% CI 8,7-12,9) had cognitive impairment. Mean age was 67.2 years (±7.5 years), 63% were men, 79% were married, and half of them knew how to read and write. Hypertension, arthritis and gastro-intestinal diseases were the main health conditions reported. Prevalence of cognitive impairment varied with age and education. Conclusion: Prevalence of cognitive decline in the Sociohealth and university center of IPRES, Dakar, Senegal, is higher and varied with age and education. Source

Maouly F.,Service de Medecine Interne | Kamadore T.,Cheikh Anta Diop University | Bouna S.L.,Center Hospitalier University Of Fann | Moustapha N.,Center Hospitalier University Of Fann | And 2 more authors.
Tunisie Medicale | Year: 2015

Background: Epilepsy remains a major public health problem especially in developing countries where access to new therapies remains limited. Objective: The aim of this work was to study the socio-demographic profile of patients living with epilepsy in Dakar and supported. Methods: We conducted a cross-sectional study over a period of eight months from November 2009 to June 2010 at Fann University Hospital and Health Center Pikine through research on adherence. Results: The study involved patients living with epilepsy aged over 15 years, diagnosed clinically with epilepsy and/or confirmed by an electroencephalogram and put under antiepileptic drug for more than 3 months. We recruited 411 patients aged 15-74 years with a mean age of 28.93 years. The age range was 15-24 years with 44.6% majority. The male sex predominated with 52.3% and the sex ratio was 1.09. Singles outnumbered with 64.7%. The level of education was the most representative secondary with 29.4% and patients without profession were 35.5%. Most of the patients was from semi-urban areas with 47.7%. Generalized seizures were more frequent with about 70%. Most of the patients was supported either by their family or by themselves. Conclusion: The management should be multisectoral for epilepsy out of darkness. © 2015 Maison du Medicine. All Rights Reserved. Source

Lepretre A.,Institut Universitaire de France | Ba I.,Hopital Psychiatrique de Thiaroye | Lacombe K.,University of Paris Pantheon Sorbonne | Lacombe K.,Hopitaux Universitaires Of Lest Parisien | And 13 more authors.
Journal of the International AIDS Society | Year: 2015

Objectives: Data on the extent of drug use and associated HIV, hepatitis C and hepatitis B infection in West Africa are lacking. The objectives of ANRS12244 UDSEN study were to estimate the size of the heroin and/or cocaine drug user (DU) population living in the Dakar area (Senegal), and assess the prevalence and risk factors of HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV), including behavioural determinants in this population, in order to set up an integrated prevention and treatment programme for DUs. Design and methods: A capture-recapture method was applied for population size estimation, whereas the respondentdriven sampling (RDS) method was used to recruit a sample of DUs living in the Dakar area and determine HIV, HBV and HCV prevalence. Behavioural data were gathered during face-to-face interviews, and blood samples were collected on dried blood spots for analysis in a central laboratory. Data analysis was performed using the RDS analysis tool, and risk factors were determined by logistic regression. Access to laboratory results was organized for the participants. Results: The size of the DU population in the Dakar area was estimated to reach 1324 (95% confidence interval (95% CI: 1281-1367)). Based on the 506 DUs included in the study, the HIV, HCV and HBV prevalence were 5.2% (95% CI: 3.8-6.3), 23.3% (95% CI: 21.2-25.2) and 7.9% (95% CI: 5.2-11.1), respectively. In people who inject drugs (PWID), prevalence levels increased to 9.4% for HIV and 38.9% for HCV (p=0.001 when compared to those who never injected). Women were more at risk of being HIV infected (prevalence: 13.04% versus 2.97% in males, p=0.001). Being PWID was a risk factor for HCV and HIV infection (odds ratio, OR: 2.7, 95% CI: 1.7-4.3, and OR: 4.3, 95% CI: 1.7-10.7, respectively), whereas older age and female sex were additional risk factors for HIV infection (10% increase per year of age, p=0.03 and OR: 4.9, 95% CI: 1.6-156, respectively). No specific determinant was associated with the risk of HBV infection. Conclusions: High HIV and HCV prevalence were estimated in this population of DUs (including non-injectors) living in the Dakar area, Senegal, whereas HBV prevalence was close to that of the global Senegalese population, reflecting a risk of infection independent of drug use. Women seem to be highly vulnerable and deserve targeted interventions for decreasing exposure to HIV, while behavioural risk factors for HIV and HCV include the use of unsafe injections, reflecting the urgent need for developing harm reduction interventions and access to opioid substitution therapy services. © 2015 Leprêtre A et al. Source

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