Management of HIV Infected Patients with Active Buruli Ulcer in Tropical Regions in Africa, a New Therapeutic Challenge: A Review

Abstract

BU is endemic in tropical and sub-tropical regions mainly with high prevalence in sub-Saharan Africa, in particular in West Africa. SubSaharan Africa is also burdened with high HIV prevalence. Therefore, there is a significant potential for BU and HIV to occur in the same individual, and it represented a treatment challenge related to paradoxical reactions or IRIS onset. A study conducted in Cameroon reported that the mortality rate was higher among HIV-positive/BU patients compared to HIV-negative /BU patients (11% dying compared to 1%). We conducted this work based on review articles on HIV/BU co-infection to summarize information and guidance data to help health care practitioners for proper patients' management. It is becoming obvious that HIV infection have an effect on BU incidence mainly in Sub-Saharan Africa and its clinical presentation and treatment similar to tuberculosis. Based on TB/HIV and HIV/others microorganism s management experience and WHO expert in HIV and BU management guidance protocol, it is recommended to health practitioner. To actively screen all HIV/MU co-infected patients for tuberculosis, before commencing BU treatment and before starting ART. To start BU treatment before commencing ART and it should be provided for 8 weeks duration. The outcomes of HIV/BU coinfection management should be monitored and evaluated, taking account the drugs interactions between ART and antimicrobial agents. And the program for HIV, BU and TB control should work in a collaborative framework. As, HIV/BU co-infection becomes frequent in Sub-Saharan Africa where both disease incidence is high. This represents a treatment challenge related to IRIS occurrence, optimal ART regimens, and when to start ART and antimicrobial treatment. Base on TB/HIV co-infection, the preliminary guidance protocol issue by WHO should be recommended, and further study should be initiated to show its efficacy and to give answers to unknown mechanism of IRIS in HIV/BU co-infection.