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HIV Infection in Women of Childbearing Age at Brazzaville University Hospital: Prevalence and Associated Factors

Ossibi Ibara BR , Bintséné Mpika G, Adoua Doukaga T., Mouanga-Yidika SVS, Potokoue Mpia SN, Ekat M, Bendett P, Voumbo G, Kinga F, Itoua C, Iloki H.L
American Journal of Infectious Diseases and Microbiology. 2022, 10(2), 54-57. DOI: 10.12691/ajidm-10-2-1
Received November 24, 2021; Revised December 29, 2021; Accepted January 07, 2022

Abstract

Objective: This paper aims to determine the prevalence of HIV infection in women of childbearing age in the Infectious Diseases Unit of the Brazzaville University Hospital and to know about the associated factors. Patients and method: This is a cross-sectional descriptive and analytical study of cases of HIV infection in women aged between 15 and 49 years, hospitalized in the infectious diseases unit between January 1, 2018 and June 30, 2021, screened in pre or per-hospitalization, whether or not receiving highly active antiretroviral therapy and having given a free and informed consent to participate in the present study. Results: 361 hospitalized patients (19.1% of admissions) with mean age 38.7 ± 7.2 years [17-49], a primary education level (n = 209; 57.9%), housewives (n = 185; 51.2) and single (n = 295; 81.7%). These women were nulliparous in 27.4% of cases (n = 99) and 202 of them (56%) no longer had the desire to procreate. The mean time to consultation was 39.3 ± 80.5 [1-730] days, mainly for fever and deterioration of general condition respectively in 91.7% (n = 331) and 53.5% (n = 193). The various opportunistic infections found were tuberculosis (n = 143; 39.6%), cerebral toxoplasmosis (n = 50; 13.9%) and cryptococcosis (n = 34; 9.4%). They were infected with HIV1 (n = 303; 83.9%) and WHO stage 4 (n = 260; 72%). Mean CD4 rates were 165.2 ± 56.8 [2-644]. 213 patients (59%) were administered antiretroviral therapy within a duration of 30 ± 6.7 days [10-90]. This was mainly the combination TDF + FTC + EFV (n = 151; 41.8%). The outcome was unfavourable in 46.3% (n = 167). Immune restoration syndrome was found in 17 cases (8%). The overall lethality was 41.3% (n = 149) due mainly to septic shock (n = 76; 21.1%) and anaemia (n = 31; 8.7%). The desire to procreate (p = 0.001), the impairment of general condition (p = 0.01), the stage of WHO (p = 0.001) and the antiretroviral treatment (p = 0.002) have a link with the death of patients. Conclusion: The prevalence of HIV infection in childbearing age women is high at Brazzaville University Hospital, in a context of low socio-economic level and late treatment. This justifies the high lethality. This shows the interest of strengthening awareness of HIV in this category of the population for a better prevention.

1. Introduction

The advent of highly active antiretroviral therapy has considerably changed the natural history of HIV infection by dramatically improving the quality of life and extending the life expectancy of people living with HIV (PvHIV) 1. People no longer die from HIV but with HIV. However, women are still the dominant victim in connection with the feminization of the pandemic and their socioeconomic vulnerability in general and childbearing age women particularly (FAP) 2. According to the WHO, there are nearly 14 million women infected with HIV between the ages of 15 and 49, resulting in the high rate of HIV transmission among children under 15 in sub-Saharan Africa 1. In Senegal, the hospital frequency of childbearing age women infected with HIV in 2008 was 85%, in connection with the socio-cultural and economic factors specific to this category of population 3. In the Congo, few studies have addressed the problem of HIV infection about childbearing age women, reflecting the situation in paediatric settings, hence the interest of this work, whose general objective is to determine the prevalence of HIV infection in young childbearing age women at Brazzaville University Hospital and identify the various associated factors.

2. Patients and Method

This is a cross-sectional study, with a descriptive and analytical aim, on the medical records of childbearing age women infected with HIV whatever the type, receiving or not antiretroviral treatment, hospitalized in the infectious diseases unit at Brazzaville University Hospital from January 2018 to June 2021. Free and informed consent was obtained from all patients. The study variables were epidemiological (age, socio-economic level, marital status, profession), clinical (reason for hospitalization, time to treatment, history and/or comorbidities, different opportunistic conditions, the clinical stage of WHO), paraclinical (type of HIV, CD4 number. The viral load when available was carried out in the Bacteriology-Virology laboratory of the CHUB using the Qiagen Extraction Kit. The amplification was carried out on MiniOptcon (Biorad) using the Generic HIV Charge Viral Kit from Biocentric), therapeutic (diagnosis time to start the treatment, the type of antiretroviral treatment, the chemoprophylaxis of opportunistic infections (OI)), progressive (duration of hospitalization treatment, complications, death and cause of death).

Data were collected using a pre-designed survey sheet, and analysed using EPI software. Info 3.3.1 with the determination of qualitative and quantitative variables from statistical tests according to their criteria of applicability. For all the tests used, the significance level was set at <0.05.

3. Operational Definition

Childbearing age woman: Any woman between the ages of 15 and 49.

4. Results

1888 women out of 2852 hospitalized during the study period, including 361 patients of reproductive age (19.1% of admissions) with a mean age of 38.7 ± 7.2 years [17-49]. The distribution of patients by age group is shown in Figure 1. The FAP had a primary school level (n = 209; 57.9%), housewives (n = 185; 51.2), shopkeepers. (n = 101; 28%) and single (n = 295; 81.7%). Marital status is shown in Figure 2. These women were nulliparous in 27.4% of cases (n = 99) and others had more than four children (n = 80; 22.2%). Among these women, 202 (56%) had no longer the desire to procreate. The mean time to consultation was 39.3 ± 80.5 [1-730] days. Fever and deterioration of general condition were the main reasons for consultation, respectively in 91.7% (n = 331) and 53.5% (n = 193). The various opportunistic infections found were tuberculosis (n = 143; 39.6%), cerebral toxoplasmosis (n = 50; 13.9%) and cryptococcosis (n = 34; 9.4%). The patients were infected with HIV1 (n = 303; 83.9%), dual HIV (n = 55; 15.3%) and classified as WHO stage 4 (n = 260; 72%). The mean CD4 was 165.2 ± 56.8 [2-644]. Antiretroviral therapy was administered to 213 patients (59%) within a mean of 30 ± 6.7 days [10-90]. There was mainly the combination of TDF + FTC + EFV (n = 151; 41.8%), TDF + 3TC + DTG (n = 27; 7.5%). The outcome was unfavourable in 46.3% (n = 167). Immune restoration syndrome was found in 17 cases (8%). The overall lethality was 41.3% (n = 149) due mainly to septic shock (n = 76; 21.1%) and anaemia (n = 31; 8.7%). The desire to procreate (p = 0.001), deterioration in general condition (p = 0.01), WHO stage (p = 0.001) and antiretroviral treatment (p = 0.002) were associated to the death of patient (Table 2).

5. Discussion

The prevalence of HIV infection in childbearing age women in the infectious diseases unit at Brazzaville University Hospital is relatively high, in line with the feminization of the pandemic. It is also lower than that found in Dakar in Senegal and in Abidjan in Ivory Coast 2, 3. Early marriages in a context of multi-partnership specific to the target populations partly justify the observed differences. There are women whose age group is most represented between 30 and 49 years old. This category of population is sexually active in the quest for a situation of union with a view to procreation 4, 5. The low level of education of housewives testifies the ignorance and vulnerability of this category of population in terms of knowledge about preventive measures against HIV infection. In a KAP study carried out in Brazzaville, in the same population category, authors report that 27.5% of FAP had insufficient, if not mediocre, knowledge about the HIV-AIDS pandemic 6. In Africa, HIV infection is seen as an obstacle to procreation and therefore an obstacle to marriage. In 27% of the cases, FAP infected with HIV did not yet have children and in most of them, the desire to give birth had been affected. The religious and cultural considerations of the African populations vis-à-vis HIV infection in young women suggest the impossibility of granting a marriage and remaining fertile, as long as this situation is experienced as a bad fate [4.6]. The weaknesses of the programs in the area of communication for development partly justify these bad and stigmatizing considerations. The long consultation times found in the present study are classic in an African environment 7. Indeed, the cultural considerations of the HIV-AIDS disease modify the therapeutic route of infected patients who traditionally consult above all pastors before resorting to a health structure. The low socio-economic level is also a barrier to accessing health services. It is important that the national AIDS control programs (PNLS) intensify communication and facilitate access to health care structures for women at the age of giving birth already impoverished by stigma. The late use of care structures justifies the critical stage of deterioration in the general condition of patients on admission. This table has as a corollary, the appearance of opportunistic infections of which tuberculosis remains today the main pathology in PvHIV, alongside with others such as cerebral toxoplasmosis and neuromeningeal cryptococcosis 8. Most FAP were classified as WHO stage 4 with the mean CD4 number 165.2 ± 56.8. Patients did not know their HIV status on admission in almost all cases and only 59% of them were on antiretroviral therapy. These data disagree with new estimates from the WHO in its 90-90-90 strategy that by 2030, 90% of people infected with HIV know their HIV status and that 90% of these people start on ART and finally 90% of those treated have an undetectable viral load 1. Achieving these goals in childbearing age women requires the development of innovative strategies in Congo in the area of diagnosis and care of PLHIV. The average time to start antiretroviral therapy after diagnosis of HIV infection in childbearing age women appears to be long. This long delay is similar to that observed in most African series 7. Several factors justify this therapeutic delay. In fact, the majority of patients are diagnosed at the advanced immunosuppression stage with its corollary, the appearance of opportunistic infections, most of which are pathologies of immune restoration such as tuberculosis and cryptococcosis 7. It is recommended in the current UN-AIDS strategy, on the comprehensive care of people living with HIV, to detect and treat these patients quickly while giving priority to opportunistic infection. The general poor and nutritional condition of some patients also hinders the initiation of antiretroviral treatment. Also, when consent to adhere to treatment is not freely obtained from the patient, it seems difficult to start such a treatment for a chronic disease whose compliance is the only guarantee of success. All these difficulties are reported in the literature 1, 7, 8, 9. When treated, most patients received tenofovir, Emtricitabine and Efavirenz in combination followed by zidovudine, Lamuvidine and Nevirapine. The new guidelines from the World Health Organization, adapted in every country by the national AIDS programs, position integrase inhibitors (in combination with other molecules) as first-line drugs, in particular dolutegravir at the dose of 50 mg in the absence of tuberculosis and in double dose if necessary. This new molecule has just been inserted into the guidelines of the Congo National AIDS Control Program as recommended by the WHO 10. On this antiretroviral treatment, the outcome was unfavourable in the majority of cases. Immune restoration inflammatory syndrome was observed in five patients with tuberculosis who started early on highly active antiretroviral therapy before that for the opportunistic infection. In the reported series of HIV-infected patients starting ARV treatment, the incidence of IRIS varies between 10 and 40%, with a mortality rate between 1 and 15%. 11

In the cohort reported by Shelburne which included 57 patients with IRIS and 123 patients without IRIS, the underlying opportunistic infection was predominantly mycobacteriosis and predominantly tuberculosis or cryptococcosis 12. Among the factors associated with the occurrence of an IRIS, were found: the median time to introduction of ARVs after initiation of treatment for opportunistic infection: 50 days in the group without IRIS, versus 27 days in the group with IRIS; the decrease in plasma HIV-RNA in the first 3 months, which is more predictive of the occurrence of IRIS than the increase in TCD4 lymphocytes; factors that were not taken into account in our study [13 = 4R]. In 3% of cases, a notion of lost to follow-up (PDV) was found in the patients followed during the study period. This result seems difficult to exploit since the nature of our study did not allow us to know the reasons for being PDV. Some patients during treatment could change their care site in terms of dispensing drugs for reasons of distance or even being dead.

Our study found a mortality rate of 41.3% of cases. These were cases of tuberculosis and central nervous system disorders as reported in the literature 14, 15. The low standard of living of our populations for whom the cost of treatment is out of reach, the diagnostic delay in childbearing age women with the corollary of the appearance of opportunistic infections, the limitation of diagnostic and therapeutic means for certain opportunistic pathologies largely justify this high mortality rate. In Senegal, Ivory Coast and South Africa, Manga, Ouedraogo and Khan found similar rates 16, 17, 18. More than half of the patients who died in our study developed septic shock and anaemic shock in 51% and 32.2%, respectively. Anaemia is still the formidable complication of tuberculosis-HIV coinfection and is multifactorial when it occurs in women as reported in the literature 19. Regarding the pathogens found at the origin of septic shock, when cultures were available, Echerichia-coli and Klebsielle pneumonia had been identified in significant proportions. The desire to procreate (p = 0.001), the weight loss (p = 0.01) and the stage of WHO (p = 0.001) as well as antiretroviral treatment (p = 0.002) were statistically significant for death in childbearing age women.

6. Conclusion

HIV infection in childbearing age women is relatively frequent in the infectious diseases unit at Brazzaville University Hospital in a context of late diagnosis and treatment justifying the advanced stage with the onset of opportunistic infections as a corollary. The classic low socio-economic level in this category of population contributes to increasing the cases of contamination. The lethality remains high due to the late use of care structures. Improving conditions for early screening and treatment coupled with compliance with preventive measures would improve the situation of these women vis-à-vis HIV in Congo.

References

[1]  WHO-UNAIDS. Rapport global sur la situation de l’infection à VIH-Sida; 2019.
In article      
 
[2]  Soro BN, Koffi K, Brengues C, Coulibaly A, Houdier R, Kassi K, et al. L’infection par le VIH chez les femmes en âge de procréer à Sassandra (Côte-d’Ivoire). Cahiers santé 1993; 3: 31-6.
In article      
 
[3]  Mohamed El Amine R. L’infection à VIH chez la femme en âge de procréer : aspects épidémiologiques, cliniques, paracliniques et évolutifs.A propos de 234 cas colligés à la clinique des maladies infectieuses du CHNU de Fann. Thèse de médecine 2011; n°12.
In article      
 
[4]  Centre Régional d’Information et de prévention du Sida (Sénégal). Les femmes et l’infection à VIH/Sida. Dossier de synthèse documentaire et bibliographique, Septembre 2008. http//paca.lecrips.net/img/pdf/femmes 2008.
In article      
 
[5]  WHO-UNAIDS. Lutter contre les inégalités entre les sexes: Renforcer la programmation relative au VIH/Sida pour les femmes et les filles. www.Who.int/hiv/pub/toolkits/Gender/french.pdf.
In article      
 
[6]  Ossibi Ibara BR, Antaon J SS, Kibimi Goubili CE, Bintséné Mpika G, Adoua Doukaga T, Angonga Pabota E et al. Knowledge, attitudes and practices of women of childbearing age with regard to HIV in Brazzaville-Congo. Annals of Reviews and Research 2019, 5(4): 42-48.
In article      
 
[7]  Manga NM, Diop SD, Ndour CT, Dia NM, Mendy A, Coudec M et al. Dépistage tardif de l’infection à VIH à la clinique des maladies infectieuses de Fann, Dakar: circonstances de diagnostic, itinéraire thérapeutique des patients et facteurs déterminants. Med Mal Infect 2009; 39: 95-100.
In article      View Article  PubMed
 
[8]  Ossibi Ibara BR, Bemba ELP, Okemba Okombi FH, Mouloungui M, Adoua Doukaga T, Angonga Pabota E et al.Opportunistic infections in patients living with HIV at Brazzaville University Hospital : prevalence and associated factors. American journal of Infectious diseases and Microbiology, 2020, Vol 8, No 1, 20-23.
In article      
 
[9]  Eholie SP, Girard PM, Bissagnene E, Dariosecq J, Drabo J, Inwolet A et al. Mémento thérapeutique du VIH/Sida en Afrique. Ed Doin Paris 2009; 22-67.
In article      
 
[10]  PNLS. Lignes dierctrices pour le traitement et la prevention de l’infection à VIH au Congo. Fevrier 2018.
In article      
 
[11]  Muller M, Wandel S, Colebunders R. Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. Lancet Infect Dis 2010; 10(4): 251-61.
In article      View Article
 
[12]  Shelburne SA, Visnegarwala F, Darcourt J. Incidence and risk fectors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. AIDS 2005:19 (4):399-406.
In article      View Article  PubMed
 
[13]  Blanc FX, Sok T, Laureillard D. Significant enhancement in survival with early (2 weeks) vs.late (8 weeks) initiation of highly active antiretroviral treatment (HAART) in severely immunosuppressed HIV-infected adults with newly diagnosed tuberculosis. XVIII International AIDS Conference, 18-23 July 2010, Vienna [Abstract n°17091].
In article      View Article
 
[14]  Lewden C, Sobesky M, Cabie A, Coupie P, Boulard F, Bissuel F et al. Causes de décès des adultes infectées par le VIH dans les départements français d’Amérique à l’ère des traitements antirétroviraux hautement actifs. Med Mal Infect 2004; 34: 286-292.
In article      View Article
 
[15]  Ossibi Ibara BR, Bemba ELP, Okemba Okombi FH, Adoua Doukaga T, Sekangué Obili G, Angonga , Ellenga Mbolla BF and Ikama MS. Causes of death of patients living with HIV in the section of Infectious Diseases at the University Hospital of Brazzaville. Annals of Reviews and Research 2018, 4(1): 1-5.
In article      
 
[16]  Manga NM. Infection à VIH chez la femme en âge de procréer dans le service des maladies infectieuses du CHNU de Fann à Dakar. Medecine et maladies infectieuses 2011, 10(1): 42-47
In article      
 
[17]  Ouedraogo SM, Ouedraogo M, Dagnan NS, Adom AH. Infections opportunistes au cours du sida au CHU de Treichville. Mali Médical 2007 tome XXII (1): 26-28.
In article      
 
[18]  Khan M, Pillay T, Moodley JM, Conolly CA. Maternal mortality associated with tuberculosis HIV-1 co-infection in Durban, South Africa. AIDS 2001, 15: 1857-1863.
In article      View Article  PubMed
 
[19]  Diallo A. Fréquence, facteurs de risque et valeur pronostique de l’anémie associée au VIH/Sida chez l’adulte au Mali. Bull Soc Pathol Exot 2003; 96: 123-7.
In article      
 

Published with license by Science and Education Publishing, Copyright © 2022 Ossibi Ibara BR, Bintséné Mpika G, Adoua Doukaga T., Mouanga-Yidika SVS, Potokoue Mpia SN, Ekat M, Bendett P, Voumbo G, Kinga F, Itoua C and Iloki H.L

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Cite this article:

Normal Style
Ossibi Ibara BR, Bintséné Mpika G, Adoua Doukaga T., Mouanga-Yidika SVS, Potokoue Mpia SN, Ekat M, Bendett P, Voumbo G, Kinga F, Itoua C, Iloki H.L. HIV Infection in Women of Childbearing Age at Brazzaville University Hospital: Prevalence and Associated Factors. American Journal of Infectious Diseases and Microbiology. Vol. 10, No. 2, 2022, pp 54-57. http://pubs.sciepub.com/ajidm/10/2/1
MLA Style
BR, Ossibi Ibara, et al. "HIV Infection in Women of Childbearing Age at Brazzaville University Hospital: Prevalence and Associated Factors." American Journal of Infectious Diseases and Microbiology 10.2 (2022): 54-57.
APA Style
BR, O. I. , G, B. M. , T., A. D. , SVS, M. , SN, P. M. , M, E. , P, B. , G, V. , F, K. , C, I. , & H.L, I. (2022). HIV Infection in Women of Childbearing Age at Brazzaville University Hospital: Prevalence and Associated Factors. American Journal of Infectious Diseases and Microbiology, 10(2), 54-57.
Chicago Style
BR, Ossibi Ibara, Bintséné Mpika G, Adoua Doukaga T., Mouanga-Yidika SVS, Potokoue Mpia SN, Ekat M, Bendett P, Voumbo G, Kinga F, Itoua C, and Iloki H.L. "HIV Infection in Women of Childbearing Age at Brazzaville University Hospital: Prevalence and Associated Factors." American Journal of Infectious Diseases and Microbiology 10, no. 2 (2022): 54-57.
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[1]  WHO-UNAIDS. Rapport global sur la situation de l’infection à VIH-Sida; 2019.
In article      
 
[2]  Soro BN, Koffi K, Brengues C, Coulibaly A, Houdier R, Kassi K, et al. L’infection par le VIH chez les femmes en âge de procréer à Sassandra (Côte-d’Ivoire). Cahiers santé 1993; 3: 31-6.
In article      
 
[3]  Mohamed El Amine R. L’infection à VIH chez la femme en âge de procréer : aspects épidémiologiques, cliniques, paracliniques et évolutifs.A propos de 234 cas colligés à la clinique des maladies infectieuses du CHNU de Fann. Thèse de médecine 2011; n°12.
In article      
 
[4]  Centre Régional d’Information et de prévention du Sida (Sénégal). Les femmes et l’infection à VIH/Sida. Dossier de synthèse documentaire et bibliographique, Septembre 2008. http//paca.lecrips.net/img/pdf/femmes 2008.
In article      
 
[5]  WHO-UNAIDS. Lutter contre les inégalités entre les sexes: Renforcer la programmation relative au VIH/Sida pour les femmes et les filles. www.Who.int/hiv/pub/toolkits/Gender/french.pdf.
In article      
 
[6]  Ossibi Ibara BR, Antaon J SS, Kibimi Goubili CE, Bintséné Mpika G, Adoua Doukaga T, Angonga Pabota E et al. Knowledge, attitudes and practices of women of childbearing age with regard to HIV in Brazzaville-Congo. Annals of Reviews and Research 2019, 5(4): 42-48.
In article      
 
[7]  Manga NM, Diop SD, Ndour CT, Dia NM, Mendy A, Coudec M et al. Dépistage tardif de l’infection à VIH à la clinique des maladies infectieuses de Fann, Dakar: circonstances de diagnostic, itinéraire thérapeutique des patients et facteurs déterminants. Med Mal Infect 2009; 39: 95-100.
In article      View Article  PubMed
 
[8]  Ossibi Ibara BR, Bemba ELP, Okemba Okombi FH, Mouloungui M, Adoua Doukaga T, Angonga Pabota E et al.Opportunistic infections in patients living with HIV at Brazzaville University Hospital : prevalence and associated factors. American journal of Infectious diseases and Microbiology, 2020, Vol 8, No 1, 20-23.
In article      
 
[9]  Eholie SP, Girard PM, Bissagnene E, Dariosecq J, Drabo J, Inwolet A et al. Mémento thérapeutique du VIH/Sida en Afrique. Ed Doin Paris 2009; 22-67.
In article      
 
[10]  PNLS. Lignes dierctrices pour le traitement et la prevention de l’infection à VIH au Congo. Fevrier 2018.
In article      
 
[11]  Muller M, Wandel S, Colebunders R. Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. Lancet Infect Dis 2010; 10(4): 251-61.
In article      View Article
 
[12]  Shelburne SA, Visnegarwala F, Darcourt J. Incidence and risk fectors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. AIDS 2005:19 (4):399-406.
In article      View Article  PubMed
 
[13]  Blanc FX, Sok T, Laureillard D. Significant enhancement in survival with early (2 weeks) vs.late (8 weeks) initiation of highly active antiretroviral treatment (HAART) in severely immunosuppressed HIV-infected adults with newly diagnosed tuberculosis. XVIII International AIDS Conference, 18-23 July 2010, Vienna [Abstract n°17091].
In article      View Article
 
[14]  Lewden C, Sobesky M, Cabie A, Coupie P, Boulard F, Bissuel F et al. Causes de décès des adultes infectées par le VIH dans les départements français d’Amérique à l’ère des traitements antirétroviraux hautement actifs. Med Mal Infect 2004; 34: 286-292.
In article      View Article
 
[15]  Ossibi Ibara BR, Bemba ELP, Okemba Okombi FH, Adoua Doukaga T, Sekangué Obili G, Angonga , Ellenga Mbolla BF and Ikama MS. Causes of death of patients living with HIV in the section of Infectious Diseases at the University Hospital of Brazzaville. Annals of Reviews and Research 2018, 4(1): 1-5.
In article      
 
[16]  Manga NM. Infection à VIH chez la femme en âge de procréer dans le service des maladies infectieuses du CHNU de Fann à Dakar. Medecine et maladies infectieuses 2011, 10(1): 42-47
In article      
 
[17]  Ouedraogo SM, Ouedraogo M, Dagnan NS, Adom AH. Infections opportunistes au cours du sida au CHU de Treichville. Mali Médical 2007 tome XXII (1): 26-28.
In article      
 
[18]  Khan M, Pillay T, Moodley JM, Conolly CA. Maternal mortality associated with tuberculosis HIV-1 co-infection in Durban, South Africa. AIDS 2001, 15: 1857-1863.
In article      View Article  PubMed
 
[19]  Diallo A. Fréquence, facteurs de risque et valeur pronostique de l’anémie associée au VIH/Sida chez l’adulte au Mali. Bull Soc Pathol Exot 2003; 96: 123-7.
In article