Impact of HIV on the Severity of Buruli Ulcer Disease: Results of a Retrospective Study in Cameroon

Medicine students in front of new dressing used by MSF to treat wounds caused by Buruli Ulcer. The MSF medical team is explaining how to use them. Christelle Ntsama/MSFMedicine students in front of new dressing used by MSF to treat wounds caused by Buruli Ulcer. The MSF medical team is explaining how to use them. Buruli Ulcer is a neglected disease related to leprosy that attacks and destroys the flesh and is extremely painful, disabling and stigmatising.

Background. Buruli ulcer (BU) is the third most common mycobacterial disease after tuberculosis and leprosy and is particularly frequent in rural West and Central Africa. However, the impact of HIV infection on BU severity and prevalence remains unclear.

Methods. This was a retrospective study of data collected at the Akonolinga district hospital, Cameroon, from 1 January 2002 to 27 March 2013. HIV prevalence among BU patients was compared to regional HIV prevalence. Baseline characteristics of BU patients were compared between HIV-negative and HIV-positive patients, and according to CD4 cell count strata in the latter group. BU time-to-healing was assessed in different CD4 count strata and factors associated with BU main lesion size at baseline were identified.

Results. HIV prevalence among BU patients was significantly higher than the regional estimated prevalence in each group (children, 4.00% vs 0.68% [P<.001]; men, 17.0% vs 4.7% [P<.001]; women, 36.0% vs 8.0% [P<.001]). HIV-positive individuals had a more severe form of BU with an increased severity in those with a higher level of immunosuppression. Low CD4 cell count was significantly associated with a larger main lesion size (beta-coefficient, -0.50; P=.015; 95% confidence interval [CI], -0.91 – 0.10). BU time-to-healing was more than double in patients with a CD4 cell count below 500 cell/mm3 (hazard ratio, 2.39; P=.001, 95% CI, 1.44 - 3.98).

Conclusion. HIV-positive patients are at higher risk for BU. HIV-induced immunosuppression appears to have an impact on BU clinical presentation and disease evolution.

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Authors: Vanessa Christinet1, Ludovic Rossel, Micaela Serafini, Cecile Delhumeau1, Peter Odermatt, Laura Ciaffi, Alain-Bertrand Nomo, Patrick Nkemenang, Annick Antierens, Eric Comte, Akoa Tsoungui and Alexandra Calmy

Journal: Open Forum Infectious Diseases

Keyword(s): HIV / AIDS; Buruli ulcer