Treatment of Hepatitis C with Pegylated Interferon Alpha-2a and Ribavirin:Experience from Benin

Background: Viral hepatitis C (HCV) is common in Benin. Untreated, it can be complicated by cirrhosis and hepatocarcinoma, which are sources of death. The objectives of this work were twofold: 1) to evaluate the effectiveness and safety of treatment with classic dual interferon pegylated alpha-2a (IFN) and ribavirin therapy in Benin, and 2) to present problems related to financial accessibility to this treatment. Methods: This was a cross-sectional, descriptive and analytical study, with a retrospective collection of data from November 1, 2010 to December 31, 2015 and prospective collection from January 1, 2016 to July 31, 2016 (7 months). We included all patients treated with IFN + ribavirin for hepatitis C at CNHU/HKM. Sustained virological response (SVR) was defined as undetectable viral load C 6 months after stopping treatment. Safety was appreciated by the search for clinical and hematological adverse effects. Results: One hundred and six patients were followed for HCV, of whom 58 (54.7%) undergoing treatment (26 under standard dual therapy and 32 under direct-acting antivirals). Of the 26 patients under-conventional dual therapy, 12 (46.1%) were genotype 1, 13 (50%) genotype 2 and one (3.9%) genotype 4. In conventional dual therapy, SVR was achieved in 15 (57.7%) patients, including the genotype 4 patient, 4 out of 12 (33.3%) genotype 1 patients, and 10 out of 13 (76.9%) for genotype 2 patients. The most common side effects with this treatment were severe asthenia (23 cases), flu-like symptoms (22 cases), weight loss (21 cases) and neutropenia (22 cases), anemia and thrombocytopenia (20 of 26 cases). The overall cost of treatment per patient was 11,800,624 FCFA for genotypes 1 and 4;and 7,835,048 FCFA for genotype 2. Conclusion: The treatment of HCV with IFN + ribavirin in Benin is effective for genotype 2. But its adverse effects are manifold and its cost is high. The switch to direct-acting antivirals (more effective, better tolerated and less expensive) was therefore necessary.

Kaposi’s Sarcoma Associated with Gastrointestinal Bleeding: A Rare Complication of Long-Term Corticosteroid Therapy

Corticosteroid therapy has revolutionized the treatment of many diseases in medicine. The most concerned diseases are chronic inflammatory diseases. Its use may be either short-term or long-term, thus generating several side effects, some of which are conventional and known, but others are rare, such as Kaposi’s sarcoma. We report here a particular clinical observation. Observation: This is a patient of 37 years, who consults in Internal Medicine for the treatment of mucocutaneous lesions, papular nodular, hyper pigmented, budding and disseminated appeared after six months of corticosteroid therapy. This treatment was introduced for the treatment of acoustic neurinoma. The patient is not diabetic or alcoholic and has a negative HIV status. The diagnosis of Kaposi’s sarcoma was made by histology of biopsied skin lesions which concluded for a regular proliferation without atypia spindle cell or mitosis. The lesions persisted over a month despite discontinuation of corticosteroid therapy. Treatment with Bleomycin was necessary. The outcome was favorable under treatment with progressive and complete disappearance of lesions after 15 treatments. Conclusion: The classical side effects of long-term corticosteroid are known, but Kaposi sarcoma complicating long-term corticosteroid is rare in the literature. It is vital that any long-term corticosteroid should be the subject of careful and regular monitoring.

Frequency of Modifiable Cardiovascular Risk Factors Such as Obesity, Diabetes Mellitus and Hypertension in a Benin Rural Area

The fight against cardiovascular diseases requires the knowledge of their modifiable risk factors. This study aimed to assess the level of modifiable cardiovascular risk factors in a rural area in order to develop a prevention program. Methods: This is an analytical and cross-sectional study on data collected during a fairground medical consultation of adults from 20 to 25 May 2013, in both border districts of the municipality of Djidja (Agouna and Houto). The studied parameters were the capillary blood glucose profile, blood pressure profile, waist circumference (WC) and Body Mass Index (BMI). Diabetes is defined by a fasting blood glucose ≥ 1.26 g/L two times. Hypertension is defined according to the criteria of JNC VII and obesity by BMI ≥ 30 kg/m2;abdominal obesity is defined by a WC above 102 cm in men and 88 cm in women. Data were analyzed using SPSS software version 18.0. Results: A total of 926 people were included among whom 57.8% were women. The average age was 38.43 ± 15.84 years. The prevalence of diabetes mellitus was 2.9%. The prevalence of obesity (BMI ≥ 30 kg/m2) was 8.4%;10.8% of studied population had abdominal obesity and 19.2% had hypertension. Age above 35 years and obesity were significantly associated with hypertension. Risk factors of obesity (IMC ≥ 30 kg/m2) were the place of residence (Agouna), the female gender, age between 35 and 64 and abdominal obesity. Conclusion: The frequency of cardiovascular risk factors, although small compared to the national level, remains a concern in the investigated rural communities. This must lead to undertake a survey on the lifestyle and dietary habits of the inhabitants of these areas.