TITLE:
Buruli Ulcer and HIV Coinfection: Cases in Togo
AUTHORS:
Menssah Teko, Mounerou Salou, Fifonsi A. Gbeasor-Komlanvi, Abla Ahouefa Konou, Yaovi Ameyapoh
KEYWORDS:
Buruli Ulcer, Coinfection Buruli Ulcer and HIV, HIV Seroprevalence, Mycobacterium ulcerans, TOGO
JOURNAL NAME:
World Journal of AIDS,
Vol.10 No.3,
August
26,
2020
ABSTRACT: Background: In Togo, as in all sub-Saharan countries, the burden of HIV infection
remains high. The registration of new cases of Buruli ulcer every year also
remains a major public health problem. Buruli ulcer (BU) is a disabling disease
and the presentation of lesions is frequently severe. A feature of BU and HIV
coinfection is the rarity of cases, which makes its study difficult, but, nevertheless, important to study
its seroprevalence, biological data, risk factors and genetic diversity. The
purpose of this study is to explore the comorbidity of Buruli ulcer and HIV by
evaluating HIV seroprevalence in BU patients, assessing demographic data,
reviewing biological data including CD4+ T cell count, hemoglobin levels, and
viral loads, and evaluating clinical and therapeutic data. Methods: This
is a cross-sectional study including only BU patients confirmed by Ziehl Neelsen staining and IS 2404 PCR.
The patients were hospitalized in the National Reference Center for Tsevie.
They were recovered patients and patients undergoing outpatient treatment in
the Gati and Tchekpo Deve treatment centers, respectively, within the Sanitary
Districts of Zio and Yoto of the Maritime Region during the period from August
2015 to March 2017. Results: The number of HIV-positive BU patients is 4
out of a total of 83 BU patients. All patients are HIV-1 positive. HIV
prevalence among BU patients is 4.8% compared to 2.5% nationally and 3% at
regional level. Three BU patients are seropositive out of a total of 46 female
patients while one patient under 15 years is seropositive out of a total of 37
male BU patients. There are a greater proportion of female patients with BU/HIV coinfections. Half
of the BU/HIV positive patients (BU/HIV+) have a CD4+ TL of fewer than 500 cells/μl and the
difference is significant between those of the BU HIV- and those of the BU/HIV+
patients. Two patients have undetectable
viral loads while the other two have more than 1000 copies/ml (33,000 and
1,100,000 copies/ml). Anemia is significantly present in BU/HIV+ patients with a p-value = 0.003. Half of BU patients have primary education,
while three-quarters of BU/HIV+ patients have no education. All patients are
either in stage I or stage II of the AIDS WHO classification. All patients are
on first line ARV therapy and only ARV nucleoside reverse transcriptase
inhibitors (NRTIs) are used. Conclusion: In Togo, the prevalence of HIV
in BU patients, although higher, is not significantly different from that of
national and regional. The relatively high CD4+ LT levels of relatively high BU
HIV + patients, undetectable viral loads, and AIDS WHO stages I and II indicate
good quality management. Author Summary: Buruli ulcer disease (BUD) is a
mycobacterial skin disease that leads to extensive ulcerations and causes
disabilities in approximately 25% of the patients. Co-infection with HIV is
described by the authors through the prism of risk factors and the severity of
ulcerations. Healing time is described as longer than in BU/HIV- patients. The
scarcity of cases seems to be an obstacle for further study. Noteworthy are the study of cases in
Benin and the study of cohort cases in Cameroon. However, no study appears to
be based on the seroprevalence of this morbid association, the biological data
and the antiretroviral regimens. These regimens, if poorly instituted, conflict
with antimycobacterial drugs against Buruli ulcer. This study, although
confronted with the particular configuration of Togo, a country with a low HIV
prevalence of 2.8% national prevalence and an average of 55 cases of Buruli
ulcer per year, is studying the biological aspects of co-infection HIV/BU,
including seroprevalence of HIV, CD4+ LT levels, patient viral load and
hemoglobin levels and ARV regimens. This study shows the need for future
studies, including the study of the genetic diversity of circulating Mycobacterium ulcerans strains in Togo
and the study of Buruli ulcer co-infection/HIV and tuberculosis.