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Master Thesis

L’infection par le VIH dans l’ouest guyanais : étude comparative du statut immunitaire au diagnostic entre les patients dépistés au centre hospitalier André Rosemon à Cayenne (CHAR) et ceux dépistés au centre hospitalier de l’ouest guyanais à Saint Laurent du Maroni (CHOG) entre 2007 et 2017

Abstract : Introduction. French Guiana is the territory which is the most deeply affected by HIV in France (1.3% of the population in 2009). The distribution of new cases across the territory is scattered. For the last ten years, the virus has spread around the West coast and diagnosis are made at late stages. This study aims at comparing the immune status at diagnosis of HIV infected patients between the CHAR hospital center and the CHOG hospital between 2007 and 2017. The secondary goals are to understand predictive factors of delayed diagnosis for both centers. Methods. We lead an observational retrospective study, based on multicentered cohorts. The primary study endpoint is the immune status, defined by the WHO CDC Classification, and the number of CD4(/mm3) at diagnosis. The diagnosis was defined as delayed if the patients were detected with a stage C or with less than 200/mm3 CD4. Results. The patients of the CHOG’s group were diagnosed later than those from the CHAR’s one (p<0,05 OR 2.06 IC [1.52, 2.80]). The predictive factors of late diagnosis in CHOG’s group were : being a male (OR 3,27 IC [2,01-5,31]), aged 30 to 49 (OR 2,54 IC [1,58-4,08]), and coinfected with HBV and/or HCV (OR 3,40 IC [1,07-10,80]). Pregnancy was a protective factor (OR 0,14 IC [0,06-0,33]). Being born in Suriname was a predictive factor of late diagnosis in the CHAR’s group (OR 2,88 IC[1,11-7,46]). Discussion. Patients from the West of Guiana were diagnosed with a more advanced disease than in Cayenne. Women are detected early thanks to a systematic screening during their pregnancy. Suriname’s permeable border formed by the Maroni river is one of the explanations. Before 2015 in Suriname, the antiretroviral therapy was only indicated for patients with fewer than 200 CD4 leading to an active spreading. Conclusion. French west Guiana must reinforce its systematic screening approach and information campaigns by targeting young men born in Suriname as well as women detected during their first pregnancy.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03085280
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Submitted on : Monday, December 28, 2020 - 6:33:06 PM
Last modification on : Wednesday, December 30, 2020 - 3:23:02 AM
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Enora Louaisil. L’infection par le VIH dans l’ouest guyanais : étude comparative du statut immunitaire au diagnostic entre les patients dépistés au centre hospitalier André Rosemon à Cayenne (CHAR) et ceux dépistés au centre hospitalier de l’ouest guyanais à Saint Laurent du Maroni (CHOG) entre 2007 et 2017. Médecine humaine et pathologie. 2020. ⟨dumas-03085280⟩

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