Palokinam Pitché

Bio: Palokinam Pitché is an academic researcher from University of Lomé. The author has contributed to research in topics: Medicine & Population. The author has an hindex of 12, co-authored 42 publications receiving 456 citations.

High rates of virological failure and drug resistance in perinatally HIV-1-infected children and adolescents receiving lifelong antiretroviral therapy in routine clinics in Togo.

Abstract: Introduction : Antiretroviral treatment (ART) has been scaled up over the last decade but compared to adults, children living with HIV are less likely to receive ART. Moreover, children and adolescents are more vulnerable than adults to virological failure (VF) and emergence of drug resistance. In this study we determined virological outcome in perinatally HIV-1-infected children and adolescents receiving ART in Togo. Methods : HIV viral load (VL) testing was consecutively proposed to all children and adolescents who were on ART for at least 12 months when attending HIV healthcare services for their routine follow-up visit (June to September 2014). Plasma HIV-1 VL was measured using the m2000 RealTime HIV-1 assay (Abbott Molecular, Des Plaines, IL, USA). Genotypic drug resistance was done for all samples with VL>1000 copies/ml. Results and discussion : Among 283 perinatally HIV-1-infected children and adolescents included, 167 (59%) were adolescents and 116 (41%) were children. The median duration on ART was 48 months (interquartile range: 28 to 68 months). For 228 (80.6%), the current ART combination consisted of two nucleoside reverse transcriptase inhibitors (NRTIs) (zidovudine and lamivudine) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) (nevirapine or efavirenz). Only 28 (9.9%) were on a protease inhibitor (PI)-based regimen. VL was below the detection limit (i.e. 40 copies/ml) for 102 (36%), between 40 and 1000 copies/ml for 35 (12.4%) and above 1000 copies/ml for 146 (51.6%). Genotypic drug-resistance testing was successful for 125/146 (85.6%); 110/125 (88.0%) were resistant to both NRTIs and NNRTIs, 1/125 (0.8%) to NRTIs only, 4/125 (3.2%) to NNRTIs only and three harboured viruses resistant to reverse transcriptase and PIs. Overall, 86% (108/125) of children and adolescents experiencing VF and successfully genotyped, corresponding thus to at least 38% of the study population, had either no effective ART or had only a single effective drug in their current ART regimen. Conclusions : Our study provided important information on virological outcome on lifelong ART in perinatally HIV-1-infected children and adolescents who were still on ART and continued to attend antiretroviral (ARV) clinics for follow-up visits. Actual conditions for scaling up and monitoring lifelong ART in children in resource-limited countries can have dramatic long-term outcomes and illustrate that paediatric ART receives inadequate attention. Keywords: HIV; virological failure; drug resistance; children; antiretroviral treatment; Togo; Africa. (Published: 27 April 2016) Citation: Salou M et al. Journal of the International AIDS Society 2016, 19 :20683 http://www.jiasociety.org/index.php/jias/article/view/20683 | http://dx.doi.org/10.7448/IAS.19.1.20683

High prevalence of HIV-1 drug resistance among patients on first-line antiretroviral treatment in Lomé, Togo

Abstract: With widespread use of antiretroviral (ARV) drugs in Africa, one of the major potential challenges is the risk of emergence of ARV drug-resistant HIV strains. Our objective is to evaluate the virological failure and genotypic drug-resistance mutations in patients receiving first-line highly active antiretroviral therapy (HAART) in routine clinics that use the World Health Organization public health approach to monitor antiretroviral treatment (ART) in Togo.

Predictors of adherence to antiretroviral therapy among people living with HIV and AIDS at the regional hospital of Sokodé, Togo

Abstract: Adherence to antiretroviral therapy (ART) is beneficial in reducing the risk of emergence of HIV resistant strains. Adherence to ART among Persons Living with HIV/AIDS (PLWHA) is influenced by several factors related to the patient, the medication, and health facilities. In Togo, previous studies on adherence to ART have reported good adherence to ART during the first year of follow-up. However these may hide many disparities dues to cultural specificities which may differ across geographic areas of the country. We sought to determine the level of adherence to ART and document the associated factors among PLWHA at the regional hospital of Sokode, Togo. This was an analytical cross-sectional study conducted from May to July 2013 at the regional hospital of Sokode among 291 PLWHA who had been on ART for at least three months before the study. A total of 291 PLWHA on ART were enrolled in the study. The mean age (±SD) was 37.3 ± 9.3 years and the sex ratio (Male/Female) was 0.4. Among them, 195 (67.0%) were living with their partners and 210 (72.2%) had formal education. Two-thirds (194/291; 66.7%) of the PLWHA interviewed lived in urban areas. The global adherence to ART was 78.4%; the factors associated with ART adherence were: level of education (aOR = 3.54; p = 0.027), alcohol consumption (aOR = 0.43; p = 0.033), ART perception (aOR = 2.90; p = 0.026) and HIV status disclosure to sexual partner (aOR = 7.19; p ≤ 0.001). Although the level of adherence to ART in this study was higher than those reported in some studies in Sub-Saharan Africa, it remains sub-optimal and needs improvement. This may therefore hinder the implementation of efficient interventions related to access to ART services.

Cosmetic use of skin-bleaching products and associated complications

Abstract: This was a cross-sectional study performed on a sample of women over 15 years of age and resident in the city of Lomé. The sample was based on a rational selection from different neighborhoods and departments of the city of Lomé, covering all socio-professional categories of the female population. A pre-set and pre-tested questionnaire was used. In the first part of the study, direct contact was made with the women to collect sociodemographic data (age, socio-professional activity, marital status and educational level) and the names of the cosmetic products used. In the second part, after identifying the users of skin-bleaching cosmetic products, we performed a dermatologic examination on these women to investigate any potential cutaneous complications arising from this practice. The findings were analyzed using the E PI -I NFO program, version 5.01b (1992; Epicentre, Paris). The χ 2 test and Fisher’s exact test were used for the statistical analysis with a 5% significance threshold.

Effectiveness of Co-trimoxazole to Prevent Plasmodium falciparum Malaria in HIV-Positive Pregnant Women in Sub-Saharan Africa: An Open-Label, Randomized Controlled Trial

Abstract: BACKGROUND: Human immunodeficiency virus (HIV) and malaria during pregnancy cause substantial perinatal mortality. As co-trimoxazole (CMX) protects children and HIV-positive adults against malaria we compared the effectiveness of daily CMX with sulfadoxine-pyrimethamine intermittent preventive treatment (IPT-SP) on malaria risk in HIV-positive pregnant women in a Plasmodium falciparum-endemic African area. METHODS: From January 2009 to April 2011 we included in a randomized noninferiority trial all HIV type 1-infected pregnant women ( /=200 cells/microL hemoglobin level >/=7 g/L) in 19 health centers in Togo. Women were randomly assigned to daily 800 mg/160 mg CMX or IPT-SP. The primary outcome was the proportion of malaria-free pregnancies. Other outcomes included malaria incidence parasitemia placental malaria anemia and infants birth weight. RESULTS: Of 264 women randomly assigned to the CMX or IPT-SP group 126 of 132 and 124 of 132 respectively were included in the analysis. There were 33 confirmed cases of clinical malaria among 31 women in the CMX group and 19 among 19 women in the IPT-SP group. Ninety-five of 126 (75.4%) women in the CMX group and 105 of 124 (84.7%) in the IPT-SP group remained malaria-free during their pregnancy (difference 9.3%; 95% confidence interval [CI] -.53 to 19.1 not meeting the predefined noninferiority criterion). The incidence rate in intention-to-treat analysis was 108.8 malaria episodes per 100 person-years in CMX (95% CI 105.4-112.2) and 90.1 in IPT-SP (95% CI 86.8-93.4) (not significant). Prevalence of parasitemia was 16.7% in the CMX group vs 28% in the IPT-SP group (P = .02). Histology revealed 20.3% placental malaria in the CMX group vs. 24.6% in the IPT-SP group (not significant). Grade 3-4 anemia was more frequent in the CMX group (10% vs 4%; P = .008). No pregnant women died. Median birth weight was similar. CONCLUSIONS: Daily CMX was not noninferior to IPT-SP for preventing maternal malaria but safe and at least similar regarding parasitemia or placental malaria and birth outcomes. Clinical Trials Registration ISRCTN98835811.

An Update on the Global Epidemiology of Syphilis

Abstract: Syphilis continues to cause morbidity and mortality worldwide. While syphilis infection is easily identifiable and treatable, rates of syphilis infection continue to increase among select populations in high-income countries and remain at endemic levels in low- and middle-income countries. World Health Organization recommended strategies have led to the dual elimination of mother-to-child transmission of syphilis and HIV in several countries; however, outbreaks among select populations need to be adequately addressed. Continued vigilance and investment are needed to address syphilis worldwide. The epidemiology of syphilis differs in high-, and low- and middle-income countries.

HIV-hepatitis B virus coinfection: epidemiology, pathogenesis, and treatment.

Abstract: HIV infection has a significant impact on the natural history of chronic hepatitis B virus (HBV) infection, with increased levels of HBV DNA, accelerated progression of liver disease and increased liver-associated mortality compared with HBV monoinfection. Widespread uptake and early initiation of HBV-active antiretroviral therapy has substantially improved the natural history of HIV-HBV coinfection but the prevalence of liver disease remains elevated in this population. In this paper, we review recent studies examining the natural history and pathogenesis of liver disease and seroconversion in HIV-HBV coinfection in the era of HBV-active antiretroviral therapy and the effects of HIV directly on liver disease. We also review novel therapeutics for the management of HBV with a particular emphasis on clinical strategies being developed for an HBV cure and an HIV cure and their impact on HIV-HBV coinfected individuals.

Food allergies in developing and emerging economies: need for comprehensive data on prevalence rates

Abstract: Although much is known today about the prevalence of food allergy in the developed world, there are serious knowledge gaps about the prevalence rates of food allergy in developing countries. Food allergy affects up to 6% of children and 4% of adults. Symptoms include urticaria, gastrointestinal distress, failure to thrive, anaphylaxis and even death. There are over 170 foods known to provoke allergic reactions. Of these, the most common foods responsible for inducing 90% of reported allergic reactions are peanuts, milk, eggs, wheat, nuts (e.g., hazelnuts, walnuts, almonds, cashews, pecans, etc.), soybeans, fish, crustaceans and shellfish. Current assumptions are that prevalence rates are lower in developing countries and emerging economies such as China, Brazil and India which raises questions about potential health impacts should the assumptions not be supported by evidence. As the health and social burden of food allergy can be significant, national and international efforts focusing on food security, food safety, food quality and dietary diversity need to pay special attention to the role of food allergy in order to avoid marginalization of sub-populations in the community. More importantly, as the major food sources used in international food aid programs are frequently priority allergens (e.g., peanut, milk, eggs, soybean, fish, wheat), and due to the similarities between food allergy and some malnutrition symptoms, it will be increasingly important to understand and assess the interplay between food allergy and nutrition in order to protect and identify appropriate sources of foods for sensitized sub-populations especially in economically disadvantaged countries and communities.

Rates of emergence of HIV drug resistance in resource-limited settings: a systematic review.

Abstract: BackgroundThe increasing availability of antiretroviral therapy (ART) has improved survival and quality of life for many infected with HIV, but can also engender drug resistance. This review summar...

The widespread use of skin lightening creams in Senegal: a persistent public health problem in West Africa

Abstract: Background The use of skin lightening creams is common in the female population of some African countries. The long-term use of certain products for several months to years may cause cutaneous adverse effects. Methods From 1992 to 1993, we conducted an epidemiologic and clinical study in Dakar, Senegal. Women were questioned about the use of skin lightening creams and examined for potential adverse skin reactions. Six hundred and eighty-five Senegalese women participated in the study. Results Twenty-six per cent of women were using skin lightening creams at the time and 36% had used them at some time. The most common products used were hydroquinone and corticosteroids, but 25% of women had used products of unknown composition. Seventy-five per cent of women using such creams showed cutaneous adverse effects. Facial acne was the most common adverse effect. Conclusions A major part of the female adult population of Senegal used skin lightening creams. The long-term use of these creams is responsible for a high rate of cutaneous adverse effects. This practice has also been reported in other countries from sub-Saharan Africa and suggests a widespread use in the African population.