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Farnarier G.,Marseille University Hospital Center | Gueye L.,Fann University Hospital Center
Epilepsies | Year: 2010

EEG remains the first-line diagnostic tool in epileptology. Each reference hospital should include a dedicated room with at least one video-EEG apparatus and the possibility of performing sleep studies. Polygraphy shows the correlation between EEG and EMG; EMG and evoked potentials are useful in myoclonic epilepsies. Tropical climate may pose problems for the material, protection being adequate in institutions, but not in rural areas. Prejudice and beliefs may delay diagnosis, EEG and treatment of epilepsy. Information, education and communication programs have led the progress in the knowledge of traditional healers and of the community. When economic possibilities are limited, and needs are high, neurophysiological material is not a priority, but the cost of investment and use must be compared to the cost of neglected disease. Procedures must be financially accessible to patients. The reliability of neurophysiological procedures depends on the quality of recordings and interpretation, which implies an adequate training in technology and in EEG symptomatology in correlation with clinical data. Complements of training are necessary for medical and paramedical actors. The scarcity of neurologists implies that general practioners be implicated in the care of patients with epilepsy. Specific training for EEG technicians is also advisable. Two factors may influence brain electrogenesis in tropical countries and lead to particular responses: the organization of sleep and the lesser response to ILS stimulation in the dark skinned population. In large African hospitals, epilepsy accounts for at least 50% of EEG indications. Tropical diseases, in particular parasitic, may translate into EEG changes that may be specific. Nonepileptic, psychogenic seizures are sometimes mistaken for epilepsy. Various strategies have been adopted for the management of epilepsy in rural areas: specialized clinics moving to the countryside, networks of specially trained general practioners, organization of access to drugs, all these measures have shown their efficacy. The level of equipment depends on political choices and priorities, but the main challenge is to obtain the best possible adequation between what should be done and what is possible, a function of local possibilities. Source


De Beaudrap P.,Montpellier University | Thiam M.,Laboratoire Of Bacteriologie Virologie | Diouf A.,Multisectorial AIDS Program | Toure-Kane C.,Laboratoire Of Bacteriologie Virologie | And 7 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2013

Background: In 1998, Senegal launched one of Africa's first antiretroviral therapy (ART) programs. Since then, the number of treated patients in Africa has substantially increased thanks to simplification in treatment management. Although good outcomes over the first years of ART have been observed in sub-Saharan Africa, little is known about the long-term (.5 years) risks of virological failure and drug resistance and about second-line treatment response. Methods: Patients from the ANRS-1215 cohort in Senegal, started with either one nonnucleoside reverse transcriptase inhibitor or indinavir, a first-generation nonboosted protease inhibitor, followed for .6 months and having .1 viral load (VL) measurement were included. Virological failure was defined as 2 consecutive VL measurements .1000 copies/mL. Results: Of the 366 patients included, 89% achieved a VL ,500 copies/mL. The risk of virological failure at 12, 24, and 60 months was 5%, 16%, and 25%, being higher in younger patients (P = 0.05), those receiving a protease inhibitor-containing regimen (P = 0.05), and those with lower adherence (P = 0.03). The risk of resistance to any drug at 12, 24, and 60 months was 3%, 11%, and 18%. After virological failure, 60% of the patients were switched to second-line treatments. Although 81% of the patients achieved virological success, the risk of virological failure was 27% at 24 months, mostly in patients with multiple resistances. Conclusions: In this cohort, virological outcomes for first-line treatments were good compared with those from high-resource settings. However, the rate of virological failure for second-line treatment was high, probably because of accumulation of resistances. Copyright © 2012 by Lippincott Williams & Wilkins. Source


Drylewicz J.,French Institute of Health and Medical Research | Drylewicz J.,Center Hospitalier University Chu Of Treichville | Eholie S.,Service dHepato gastro enterologie | Maiga M.,University of Benin | And 9 more authors.
AIDS | Year: 2010

OBJECTIVE: To compare the lymphocyte T CD4+ (CD4) response to combinations of antiretroviral therapy (ART) in HIV-1, HIV-2 and dually positive patients in West Africa. DESIGN AND SETTING: Collaboration of 12 prospective cohorts of HIV-infected adults followed in Senegal (2), Gambia (1), Mali (2), Benin (1) and Côte d'Ivoire (6). SUBJECTS: Nine thousand, four hundred and eighty-two patients infected by HIV-1 only, 270 by HIV-2 only and 321 dually positive, who initiated an ART. OUTCOME MEASURES: CD4 change over a 12-month period. RESULTS: Observed CD4 cell counts at treatment initiation were similar in the three groups [overall median 155, interquartile range (IQR) 68; 249 cells/μl). In HIV-1 patients, the most common ART regimen was two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI; N = 7714) as well as for dually positive patients (N = 135). HIV-2 patients were most often treated with a protease inhibitor-based regimen (N = 193) but 45 of them were treated with an NNRTI-containing ART. In those treated with a NNRTI-containing regimen, the estimated mean CD4 change between 3 and 12 months was significantly lower in HIV-2 (-41 cells/μl per year) and dually positive patients (+12 cells/μl per year) compared to HIV-1 patients (+69 cells/μl per year, overall P value 0.01). The response in HIV-2 and dually positive patients treated by another regimen (triple NRTIs or protease inhibitor-containing ART) was not significantly different than the response obtained in HIV-1-only patients (all P values >0.30). CONCLUSION: An optimal CD4 response to ART in West Africa requires determining HIV type prior to initiation of antiretroviral drugs. NNRTIs are the mainstay of first-line ART in West Africa but are not adapted to the treatment of HIV-2 and dually positive patients. Copyright © 2010 Lippincott Williams & Wilkins. Source


Diouf A.,Fann University Hospital Center | Cournil A.,IRD Montpellier
Bulletin de la Societe de Pathologie Exotique | Year: 2014

Among the patients of the cohort still followed after a median of 9 years of antiretroviral treatment (ART), 37% had lipodystrophy, 28% had hypertension and 14% presented with diabetes. This study confirms the association between stavudine and lipodystrophy particulary lipoatrophy and shows that a longer duration of ART was associated with the presence of diabetes. These results highlight the need to implement programs for prevention of cardiovascular risk factors in HIV patients from resource-constrained settings. © 2014, Springer-Verlag France. Source


Diop-Ndiaye H.,Laboratoire Of Bacteriologie Et Virologie | Toure-Kane C.,Laboratoire Of Bacteriologie Et Virologie | Leye N.,Laboratoire Of Bacteriologie Et Virologie | Ngom-Gueye N.F.,Fann University Hospital Center | And 3 more authors.
AIDS Research and Human Retroviruses | Year: 2010

To evaluate the presence of drug resistance mutations in antiretroviral-naive patients in Dakar (Senegal), cross-sectional studies were conducted since the circulation of ARVs in the country. Protease and RT genes were sequenced in 96 baseline samples from patients included in the Senegalese Initiative for Antitretroviral Access treatment between 1998 and 2001 and for 104 samples from naive, recently diagnosed patients in 2003, 2005, and 2007. Phylogenetic analysis showed a predominance of CRF02-AG [128/200 (64%)] and a high genetic diversity with 10 other variants and 25 URFs. Analysis for the presence of drug resistance mutations according to the WHO SDRM 2009 list showed a prevalence of 4.16% for nucleoside inhibitors and 1.04% for protease inhibitors at the start of the structured Senegalese ART initiative and 1.9% for protease inhibitors at the time of scaling up. The prevalence in untreated patients remains low and stable, below 5% after 10 years of ARV circulation. Copyright 2010, Mary Ann Liebert, Inc. Source

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