Background: HIV advance disease and tuberculosis (TB) are still frequent in Gabon. Objectives: This study described the clinical and radiological features of bacteriologically confirmed TB among hospitalised persons living with HIV (PLHIV) and in-hospital death-associated factors. Methods: Patients older than 18 years old, with a diagnosis of TB between 2021 and 2022, were prospectively included. Sociodemographic, clinical, radiological data, CD4 cell count, ART, lenght of hospital stay and mortality were recorded and analyzed. Factors associated with patient death were investigated. Results: Overall, 94 (54.7%) of 172 hospitalised PLHIV had TB. Their median age was 37 (32–42) years, 67.0% were females, 47.9% were on ART and 85.0% were in the advanced disease stage. Overall, 52 (55.3%) PLHIV had isolated pulmonary TB, 13 (13.8%) had extra-pulmonary forms, mainly neuromeningeal and lymph node forms, 25(26.6%) had a disseminated TB that involved pulmonary lesions and 4 (4.3%) had an extra-pulmonary disseminated TB. The median CD4 count was 83 (54–128) cells/µL. It was lower in the group of deceased participants (p = 0.04). The case fatality rate was 26.0% (n = 24). Mortality associated factors were length of hospital stay below 10 days (odds ratio [OR] = 3.9 [1.06–14.3], p = 0.04) and CD4 < 200 cells/mm³ (p = 0.01). A trend was also observed for males (OR = 2.11 [0.81–5.5], p = 0.062) and age above 45 years (OR = 2.68 [0.92–7.78], p = 0.07). Conclusion: HIV–TB coinfection and extra-pulmonary forms are still frequent in immunocompromised PLHIV. The in-hospital mortality is high, probably because of late diagnosis. Contribution: This study highlights the need of integrated early HIV and TB diagnosis and management in highly endemic settings to improve coinfected patient outcome.

Le retard de délai d'entrée aux soins est un obstacle à la mise en route immédiate du traitement antirétroviral (TARV) dès le diagnostic, tel que recommandé par l’Organisation mondiale de la santé. Cette étude a pour but de déterminer et de comparer les délais d'entrée aux soins et les facteurs associés chez des personnes vivant avec le VIH (PvVIH) vues dans deux centres de traitement ambulatoires de Libreville entre 2012 et 2020. Étude rétrospective réalisée à partir des dossiers colligés de PvVIH, de janvier 2012 à mars 2020, au sein des deux plus grands Centres de traitement ambulatoire (CTA) de Libreville, celui du Centre hospitalier universitaire de Libreville (CHUL) et celui de l'hôpital de Nkembo. L'entrée aux soins était définie comme précoce lorsque le délai entre le diagnostic de l'infection à VIH et la première consultation au CTA était de moins de 28 jours. Elle était tardive lorsque ce délai était de plus de trois mois. Pour l'analyse, les patients ont été répartis entre deux périodes : 2012-2015 quand le démarrage du traitement était lié au taux de CD4, et 2016-2020, période au cours de laquelle le Test and Treat a été adopté au Gabon. Au total, 979 patients ont été nouvellement pris en charge dans les deux CTA et les dossiers de 672 personnes ont pu être exploités. Dans 48,3 % des cas, le diagnostic d'infection à VIH était réalisé à un stade tardif (OMS 3 ou 4). Le délai médian d'entrée aux soins était de 1,2 [IQ : 0-3] mois après le diagnostic de l'infection à VIH. Entre 2016 et 2020, 47 % entraient aux soins dans un délai de moins de 28 jours alors que cette proportion était de 35,7 % en 2012-2015 (p < 0,01). Le pourcentage de PvVIH ayant eu une entrée aux soins tardive était comparable entre les deux périodes (14,4 % vs 15,9 % en 2012-2015; p = 0,62). Les facteurs associés à un délai tardif étaient le stade OMS 3, la non-réalisation du dosage des CD4, la profession et la grossesse (p<0,05). Le délai d'entrée aux soins est encore long à l'ère du Test and Treat à Libreville. Une meilleure connaissance des facteurs associés et une approche décentralisée et intégrée de la prise en charge de l'infection à VIH permettraient d'atteindre le 2^e pilier des « 95-95-95 » à Libreville.

The objective of this study was to analyze the effect of hydroxychloroquine or chloroquine associated with azithromycin on the QTc interval in Gabonese patients treated for COVID-19. Methods: This was an observational study conducted from April to June 2020, at the Libreville University Hospital Center in Gabon. Patients admitted for COVID-19 and treated with hydroxychloroquine or chloroquine, each combined with azithromycin were included. The QTc interval was measured upon admission and 48 h after starting treatment. The primary endpoint was QTc prolongation exceeding 60 ms and/or a QTc value exceeding 500 ms at 48 h. Results: Data from 224 patients, 102 (45.5%) who received hydroxychloroquine and 122 treated with chloroquine, were analyzed. The median baseline QTc was 396 (369–419) ms. After 48 h of treatment, 50 (22.3%) patients had a significant prolongation of QTc. This tended to be more frequent in patients treated with chloroquine (n = 33; 27.0%) than in those treated with hydroxychloroquine (n = 17; 16.7%) (p = 0.06). QTc prolongation exceeding 60 ms was found in 48 (21.3%) patients, while 11 patients had a (4.9%) QTc exceeding 60 ms at admission and exceeding 500 ms after 48 h. Conclusion: Early QTc prolongation is frequent in COVID-19 patients treated with hydroxychloroquine or chloroquine in association with azithromycin.

Central nervous system (CNS) infections are an important cause of morbidity and mortality among people living with HIV (PLWHIV), particularly in resource-l

Introduction: Cryptococcal meningitis is a major cause of death in HIV/AIDS patients due to the existence of Cryptococcus neoformans in the central nervous system. Our objective was to evaluate the prevalence of Cryptococcus antigenuria in a population of HIV-infected patients in Libreville, Gabon. Patients and Methods: This study was conducted from April to October 2021 at the Infectious Diseases ward of the Centre Hospitalier Universitaire de Libreville. Hospitalized patients with HIV were included. The detection of cryptococcal antigen (CrAg) in urine was performed using the Pastorex Crypto Plus Kit. Results: Out of the 255 PLHIV, 142 benefited from the CrAg detection. The prevalence of urine CrAg was 24.6% (n = 35). The majority of CrAg+ patients (82.8%; n = 29) were under 55 years old. Almost three-quarters of them (n = 25; 71.4%) had CD4 counts < 200, and 80.0% (n = 28) were at WHO clinical stages III and IV. All patients with neck stiffness at admission had a CrAg positive test. Conclusion: This study showed a non-negligible prevalence of Cryptococcal urinary antigen in HIV-infected patients with neurological symptoms. These data underline the importance of CrAg screening in routine care for better management of PLHIV.

Digestive candidiasis is a major opportunistic infection among people living with HIV (PLHIV). In Gabon, data on antifungal resistance remain limited. This study aimed to characterise Candida colonisation and antifungal resistance according to anatomical site and species in Libreville. In this cross-sectional study, 108 PLHIV provided paired oral and stool samples. Candida spp. was identified using conventional phenotypic methods. Antifungal susceptibility to azoles and polyenes was assessed by disc diffusion following CLSI guidelines. Resistance burden was classified by drug class and by cumulative number of antifungal agents involved. Digestive colonisation was detected in 97 (89.8%) participants. Oral and intestinal colonisation rates were 78.7% and 66.7%, respectively, with dual-site involvement in 55.6%. Among resistant isolates, Candida albicans accounted for 55.2% (oral) and 48.9% (intestinal), while non-albicans Candida represented 29.8% and 44.4%, respectively. Multidrug resistance was significantly higher in intestinal than oral isolates (36.2% vs. 11.8%; OR = 4.99; 95% CI: 2.04–12.16; p < 0.01). Resistance was predominantly azole-driven, with complex cumulative resistance profiles in intestinal isolates. The intestinal tract showed resistance profiles consistent with a preferential accumulation of MDR Candida populations in PLHIV. Site-specific resistance patterns underscore the importance of targeted sampling and antifungal stewardship strategies in resource-limited settings.