Management of BU-HIV Co-infection

Excerpt

In many Buruli ulcer (BU) endemic countries worldwide there is also a high HIV prevalence. This is especially the case in Africa with adult HIV prevalence rates between 1 and 5% in BU endemic countries. Evidence from Benin, Cameroon, Ghana and Gabon suggest that HIV may increase the risk of BU [1–5]. For example, in the Médecins Sans Frontières programme in Akonolinga, Cameroon, the prevalence of HIV was approximately 3–6 times higher in BU treated patients compared to the regional estimated HIV prevalence (37% vs 8% in women; 20% vs 5% in men; and 4% vs 0.7% in children) [2]. Likewise in Benin, in one region patients with BU were eight times more likely to have HIV infection than those without BU (2.6% vs 0.3%) [3], and in another region adults with BU were five times more likely to have HIV compared to the regional estimated HIV prevalence (5.0% vs 1.1%) [4]. In Ghana HIV prevalence was 4–5 times higher in BU patients than those without BU (5% vs 0.9% in one study and 8.2% vs 2.5% in another study) [1, 6]. Therefore, there is a significant potential for the two infections to overlap in the same individual and HIV needs to be considered in all BU patients in settings with high background HIV prevalence.