Guénaël R. Rodier

Comparative field evaluation of HIV rapid diagnostic assays using serum, urine, and oral mucosal transudate specimens☆

BACKGROUND Comparative field utility of selected HIV-1 assays using homologous collections of serum, urine and oral mucosal transudate (OMT) was determined in adult populations from a tuberculosis hospital and STD clinic in Djibouti, East Africa. STUDY DESIGN Enzyme immunoassay with confirmatory Western blot was performed on all serum specimens for comparison with rapid, instrument-free assays (SUDS HIV-1, Murex: TestPack HIV-1/2. Abbott; and COMBAIDS HIV 1 + 2, SPAN Diagnostics) using various specimen sources. Delayed (48 h post-collection) testing was also performed on urine. Sensitivity and specificity for the rapid assays, in descending order, were as follows: serum SUDS HIV-1 assay (100%, 98.3%), serum COMBAIDS HIV-1/2 assay (98.4%, 99.6%), and OMT SUDS HIV-1 assay (98.4%, 94.5%). RESULTS The OMT EIA optical density cutoff value was modified resulting in an improved specificity from 89.1 to 99.6%, however, sensitivity decreased from 100 to 98.5%. Urine EIA and rapid assays demonstrated unacceptable test performance for use as a screening test.

Presence of antibodies to Hantavirus in rat and human populations of Djibouti.

Abstract : The4 diagnosis of human haemorrhagic fever with renal syndrome (HFRS) has not been recorded in the Horn of Africa. Since the identification of a virus as agent of HFRS (LEE et al., 1978), several serotypes of this virus have been described as members of a new genus of viruses, Hantavirus, within the family Bunyaviridae (LEDUC et al., 1986). Severak hynab cases if HFRS have been reported in Central Africa (COULAUD et al., 1987).

HHV-6 in Djibouti—an epidemiological survey in young adults

Human herpesvirus type six (HHV-6), previously called human B-cell lymphotropic virus (HBLV), was first isolated in 1986 from patients with various lymphoproliferative disorders, some related to the acquired immunodeficiency syndrome. In order to investigate the epidemiology of HHV-6 in the Horn of Africa, we studied 281 young adults living in the city of Djibouti during June 1988. Of these, 181 belonged to various groups at risk for human immunodeficiency virus (HIV), while 100 represented the normal young adult population. Sera were screened and titrated for antibodies against HHV-6 by an indirect fluorescent antibody assay. The percentage seropositivity for HHV-6 was 71 in the normal population, 75 in the population at risk for HIV, and 93 in the population of subjects with a confirmed positive HIV Western blot. Mean titres of positive sera were similar in all population groups. No correlation existed between HHV-6 seropositivity and age, sex, tribe, habitat, and risk factors for HIV. A positive correlation was noted between HHV-6 and patients complaining of fatigue.

Clinical features associated with HIV-1 infection in adult patients diagnosed with tuberculosis in Djibouti, Horn of Africa

The US Naval Medical Research Unit headed up a retrospective study of all adult patients diagnosed in 1991 with tuberculosis (TB) at the Paul Faure Hospital Center in Djibouti city. 92% (1844) of the medical records had complete information on demographics, clinical, and radiological characteristics associated with TB and HIV serological status. 106 (5.7%) patients had HIV-1 infection. Two patients had both HIV-1 and HIV-2 infection. Clinical predictors for HIV seropositivity included peritonitis (odds ratio [OR] = 5.08; p = 0.0164) and pleural effusion (OR = 2.15; p = 0.0037). Ethiopian nationality also predicted HIV infection among TB patients (OR = 2.13; p = 0.0002). The high percentage of glandular TB in this area of Africa, even before the HIV epidemic, may account for the lack of statistical association between HIV positivity and peripheral lymphadenopathy. These findings indicate that newly diagnosed TB adult patients with peritonitis or pleural effusion are rather likely to also have HIV infection. Physicians should suspect HIV infection in such patients, since they may be at high risk of exposure to body fluids during surgery for peritonitis and drainage of pleural effusion. The high variance makes peritonitis and pleural effusion relatively poor predictors of HIV infection, however.

Remote village survey for agents causing hepatosplenic disease in the Republic of Yemen

The objective of this study was to epidemiologically describe potential infectious agents among rural people in the Republic of Yemen. This would aid clinicians in designing empirical therapy and public health officials in planning disease prevention. We sought to examine evidence for the geographical distribution of pathogens causing human hepatic and splenic disease among villagers and domestic animals living in three remote areas with differing altitudes. In June 1992, a cross-sectional survey was conducted at three survey sites of differing altitudes: 3080, 1440 and 250 m above sea level. Questionnaires, parasitic and serological tests were administered to 627 human volunteers. Additionally 317 domestic animals were studied. Malaria, schistosomiasis, and hepatitis B and C infections were found to be likely causes of human hepatic or splenic disease. Additionally, evidence of human and animal infections with the agents of brucellosis and Q fever was found: IgG antibodies against hepatitis E virus were discovered in two (2.0%) of the 100 volunteers. The prevalence of markers for human and animal disease was often lowest at the village of highest elevation, suggesting that increasing altitude, as a surrogate or a true independent risk factor, was protective against infection with the agents studied.