NEURO AIDS IN MALI : PRESENT and FUTURE
RESEARCH ACTIVITIES.
TRAORE M *, GUINTO C.O*, TRAORE S*, DAO S**, SANGARE M*,
COULIBALY B***, DIAKITE B***, KOUMARE B*** .
*Department of Neurology
**Department of Infectious Disease
***Department of Psychiatry
The current data of epidemiology AIDS
have demonstrated that African People
are exposed to major peril:
29.4 millions people are infected with Human
Immunodeficiency Virus.
47 Years have been noted as life
expectancy;
68 millions of early death have been
expected from 2000 to 2020.
Loss of Productive capacity will be noted
for the people aged from 15 to 59 years
In Mali the global Prevalence of AIDS
were 1.7 % . The prevalence for young
people aged 15 to 19 years was 1, 1 %
and 0,3%. In this context , the present
Presentation will summarize the
Present and Future Research activities in
Neuro Aids field.
Central nervous system and peripheral nervous
system complications are common in HIV
infected patients and occur either as a result
of concomitant immunosuppression
(Opportunistic Infections , lymphoma and
tumors) as a primary manifestation of HIV
infection, or as an adverse effect of therapy
( immune restoration and toxicity ).These
complications contribute largely to patient
morbidity and mortality.
We review in detail clinical features,
diagnosis and management of these disorders,
and we will describe our future Research
overview.
SPECTRUM OF NEUROLOGICAL DISEASES
ASSOCIATED WITH HIV INFECTION.
From January 1991 to December 2002, 239
patients infected with human
Immunodeficiency virus have been admitted in
our clinical Department. These patients
presented neurological symptoms and HIV
antibody have been identified by appropriate
test. Usually New Lav-Blot I and New Lav-Blot
II were the serologic test which have been
performed
Analysis of CD4 had not been systematic. It has
been achieved if you want to introduce
antiretroviral therapy. Cerebrospinal fluid test
to diagnose neurosyphilis was achieved if the
clinical symptoms suggested neurosyphilis.
Biologic test include: Blood routine test,
creatinine, transaminase, glycemia.
Cerebral Scan has been performed when the
patient presented the central nervous system
disorders. IRM is not available.
Clinical examen had been standardized.IT
allowed to classify neurological disorders in 4
following rubrics :
A)HIV and the central nervous system
focal brain lesions: hemiplegia, headache, focal
crisis of epilepsia, movement disorders.
diffuse cerebral disorders : Enceplalitis ,
memory disorders , confusionnal , Demence .
B )HIV associated with cranial nerves disorders :
Facial paralysis, optic neuropathy,
Ophthalmoplegia .
C )HIV and spinal disorders: Myeloradiculitis,
Spinal cord compression,
D)HIV and the peripheral nervous system
Polyneuropathy, Multineuritis ,Zosterian
Radiculis .
In the same time, 5128 Patients have been
admitted in the Department. So the frequency
of the neurological disorders associated with
HIV was 4,66 %. Among the 239 patients
reported here, there are 117 Men and 122
Women.
Age of the patients varied between 18 months to
65 Years. The middle age was of 34 Years.
15 Patients have less than 20 Years. The under
50 years represented 96, 23 % of the patients.
Neurological disorders associated with HIV
infection represented 4,66%.17 patients
have less than 20 years among them 2
children and 15 adolescents (4 boys and
11 girls). The under 50 years represented
96,23 % of the patients.
HIV 1 was revealed
in 228 cases
HIV 2 was noted
in
4 cases
HIV 1 and HIV2 were noted in
7 cases
In 33 Cases the peripheral nervous system
will be involved:
Sensory Neuropathy
12
Polyradiculoneuritis
9
Multineuritis
Zosterian Radiculitis
4
8
SPINAL Disorders (41)
Paraplegia
LumboradiculoMyelopathy
26
15
Cranial lesions (55)
Bell’s Paralysis
49
Ophthalmoplegia
3
Cochlear
3
BRAIN Disorders
(110 ):
Focals Disorders
Hemiplegia
Toxoplasmosis
Tumors
33
18
16
Diffuse
Meningoencephalitis
Demence
Progressive multifocal leukoencephalopathy
18
24
1
The outcome of this study note the
frequency and the diversity of
neurological disorders associated with
HIV infection, the precocity of adolescent
sexual relationship.
Central nervous system complications were
more frequent than peripheral nervous
system complications .
We might reasonably conclude with
regard to Clinical aspects that youthful
and working population constitute the
privileged target.
The outcome is that population pyramid is
deeply and durably affected. The
productive capacity and economic
growth are altered. The need of the
sexual Education for the adolescent is
relevant .
How about the highly antiretroviral therapy?
What are the future Challenges?
Antiretroviral therapy has been introduced in
Sept 2001 in Mali . It was available in 3
centers only the capital Bamako. A symbolic
contribution was demanded from patients but
since 2004 it is out of charge .
Now 5 another centers have been opened
through the country .
In the future we will face 4 major
problems:
long term financing linked to the number
of patients (in only one center ,the
number passed from 33 in 2001 to 648
in 2005 ).
Viral resistance to treatment (12 drugs are
available in Mali ).
Control of the adverse linked to treatment.
Viral persistence in the brain and the
specific Immune response
Constitute the future challenges.
AGE And SEX
Age
10
10 20
20 30
30 40
40 50
50 60
60 70
> 70
Men
1
4
25
57
25
4
1
117
Women
1
11
44
40
22
3
1
122
TYPE OF VIH
HIV1
228
HIV2
4
HIV1 & HIV2
7
TRANSMISSION
Heterosexual
Homosexual
Mother/
children
Intra
venous
injection
(heroin)
233
2
3
1
Peripheral Disorders
Sensitive
Neuropathy
12
Multineuritis
4
Polyradiculoneuritis
9
Zosterian Radiculis
8
SPINAL DISORDERS
LUMBO RADICULO
MYELOPATHY
15
PARAPLEGIA
26
Cranial Lesions
• Bell’s Paralysis
• Ophthalmolegia
• Cochlear
49
3
3
BRAIN DISORDERS
Focals
67
Diffuses
43