Prevalence and incidence of pulmonary hypertension among HIV-infected people in Africa: a systematic review and meta-analysis
Identifieur interne : 000685 ( Pmc/Checkpoint ); précédent : 000684; suivant : 000686Prevalence and incidence of pulmonary hypertension among HIV-infected people in Africa: a systematic review and meta-analysis
Auteurs : Jean Joel R. Bigna [Cameroun, France] ; Jobert Richie N. Nansseu [Cameroun] ; Lewis N. Um [Cameroun] ; Steve Raoul N. Noumegni [Cameroun] ; Paule Sandra D. Simé [Cameroun] ; Leopold Ndemngue Aminde [Australie, Cameroun] ; Sinata Koulla-Shiro [Cameroun] ; Jean Jacques N. Noubiap [Afrique du Sud, Cameroun]Source :
- BMJ Open [ 2044-6055 ] ; 2016.
Abstract
Patients infected with HIV have a direly increased risk of developing pulmonary hypertension (PH), and of dying from the condition. While Africa carries the greatest burden of HIV infection worldwide, there is unclear data summarising the epidemiology of PH among HIV-infected people in this region. Our objective was to determine the prevalence and incidence of PH among HIV-infected people living across Africa.
A systematic review and meta-analysis.
HIV-infected African people residing in Africa.
Prevalence and incidence of PH diagnosed through echocardiography or right heart catheterisation.
Articles published in PubMed/MEDLINE, EMBASE, African Journals Online and African Index Medicus between 1 January 1980 and 30 June 2016, without any language restriction.
Overall, 121 studies were screened; 3 were included in this review: 1 from Southern Africa (South Africa), 1 from Eastern Africa (Tanzania) and 1 from Central Africa (Cameroon). These studies included HIV-infected adult patients selected based on presentation with cardiovascular symptoms. No study reported PH incidence or PH incidence/prevalence among children and adolescents. The quality assessment yielded moderate risk of bias. Ages of participants ranged between 18 and 78 years, and the proportion of females varied between 52.3% and 68.8%. The prevalence of PH in the pooled sample of 664 patients was 14% (95% CI 6%–23%).
Only 3 studies were found eligible from 3 regions of the African continent.
The prevalence of PH among HIV-infected people in Africa seems very high. Further studies are urgently warranted to determine the incidence of HIV-induced PH, which must include all subregions of Africa.
Review registration number PROSPERO CRD42016033863.
Url:
DOI: 10.1136/bmjopen-2016-011921
PubMed: 27554104
PubMed Central: 5013504
Affiliations:
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Noubiap</name><affiliation wicri:level="1"><nlm:aff id="af9"><addr-line>Department of Medicine</addr-line>,<institution>Groote Schuur Hospital and University of Cape Town</institution>,<addr-line>Cape Town</addr-line>,<country>South Africa</country></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af10"><institution>Medical Diagnosis Center</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></nlm:aff><country xml:lang="fr">Cameroun</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27554104</idno><idno type="pmc">5013504</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013504</idno><idno type="RBID">PMC:5013504</idno><idno type="doi">10.1136/bmjopen-2016-011921</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002F75</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002F75</idno><idno type="wicri:Area/Pmc/Curation">002E24</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002E24</idno><idno type="wicri:Area/Pmc/Checkpoint">000685</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000685</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prevalence and incidence of pulmonary hypertension among HIV-infected people in Africa: a systematic review and meta-analysis</title><author><name sortKey="Bigna, Jean Joel R" sort="Bigna, Jean Joel R" uniqKey="Bigna J" first="Jean Joel R" last="Bigna">Jean Joel R. Bigna</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Epidemiology and Public Health</addr-line>,<institution>Centre Pasteur of Cameroon</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></nlm:aff><country xml:lang="fr">Cameroun</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af2"><institution>Bordeaux School of Public Health, University of Bordeaux</institution>,<addr-line>Bordeaux</addr-line>,<country>France</country></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Nansseu, Jobert Richie N" sort="Nansseu, Jobert Richie N" uniqKey="Nansseu J" first="Jobert Richie N" last="Nansseu">Jobert Richie N. Nansseu</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Faculty of Medicine and Biomedical Sciences, Department of Public Health</addr-line>,<institution>University of Yaoundé 1</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></nlm:aff><country xml:lang="fr">Cameroun</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af4"><addr-line>Sickle Cell Disease Unit</addr-line>,<institution>Mother and Child Centre of the Chantal Biya Foundation</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></nlm:aff><country xml:lang="fr">Cameroun</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Um, Lewis N" sort="Um, Lewis N" uniqKey="Um L" first="Lewis N" last="Um">Lewis N. Um</name><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Faculty of Medicine and Biomedical Sciences</addr-line>,<institution>University of Yaoundé 1</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></nlm:aff><country xml:lang="fr">Cameroun</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Noumegni, Steve Raoul N" sort="Noumegni, Steve Raoul N" uniqKey="Noumegni S" first="Steve Raoul N" last="Noumegni">Steve Raoul N. Noumegni</name><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Faculty of Medicine and Biomedical Sciences</addr-line>,<institution>University of Yaoundé 1</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></nlm:aff><country xml:lang="fr">Cameroun</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Sime, Paule Sandra D" sort="Sime, Paule Sandra D" uniqKey="Sime P" first="Paule Sandra D" last="Simé">Paule Sandra D. Simé</name><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Faculty of Medicine and Biomedical Sciences</addr-line>,<institution>University of Yaoundé 1</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></nlm:aff><country xml:lang="fr">Cameroun</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Aminde, Leopold Ndemngue" sort="Aminde, Leopold Ndemngue" uniqKey="Aminde L" first="Leopold Ndemngue" last="Aminde">Leopold Ndemngue Aminde</name><affiliation wicri:level="1"><nlm:aff id="af6"><addr-line>Faculty of Medicine and Biomedical Sciences</addr-line>,<institution>School of Public Health, University of Queensland</institution>,<addr-line>Brisbane, Queensland</addr-line>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af7"><institution>Clinical Research Education, Networking and Consultancy (CRENC)</institution>,<addr-line>Douala</addr-line>,<country>Cameroon</country></nlm:aff><country xml:lang="fr">Cameroun</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Koulla Shiro, Sinata" sort="Koulla Shiro, Sinata" uniqKey="Koulla Shiro S" first="Sinata" last="Koulla-Shiro">Sinata Koulla-Shiro</name><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Faculty of Medicine and Biomedical Sciences</addr-line>,<institution>University of Yaoundé 1</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></nlm:aff><country xml:lang="fr">Cameroun</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af8"><addr-line>Infectious Diseases Unit</addr-line>,<institution>Yaoundé Central Hospital</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></nlm:aff><country xml:lang="fr">Cameroun</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Noubiap, Jean Jacques N" sort="Noubiap, Jean Jacques N" uniqKey="Noubiap J" first="Jean Jacques N" last="Noubiap">Jean Jacques N. Noubiap</name><affiliation wicri:level="1"><nlm:aff id="af9"><addr-line>Department of Medicine</addr-line>,<institution>Groote Schuur Hospital and University of Cape Town</institution>,<addr-line>Cape Town</addr-line>,<country>South Africa</country></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af10"><institution>Medical Diagnosis Center</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></nlm:aff><country xml:lang="fr">Cameroun</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMJ Open</title><idno type="eISSN">2044-6055</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>Patients infected with HIV have a direly increased risk of developing pulmonary hypertension (PH), and of dying from the condition. While Africa carries the greatest burden of HIV infection worldwide, there is unclear data summarising the epidemiology of PH among HIV-infected people in this region. Our objective was to determine the prevalence and incidence of PH among HIV-infected people living across Africa.</p></sec><sec><title>Design</title><p>A systematic review and meta-analysis.</p></sec><sec><title>Participants</title><p>HIV-infected African people residing in Africa.</p></sec><sec><title>Outcome</title><p>Prevalence and incidence of PH diagnosed through echocardiography or right heart catheterisation.</p></sec><sec><title>Data sources</title><p>Articles published in PubMed/MEDLINE, EMBASE, African Journals Online and African Index Medicus between 1 January 1980 and 30 June 2016, without any language restriction.</p></sec><sec><title>Results</title><p>Overall, 121 studies were screened; 3 were included in this review: 1 from Southern Africa (South Africa), 1 from Eastern Africa (Tanzania) and 1 from Central Africa (Cameroon). These studies included HIV-infected adult patients selected based on presentation with cardiovascular symptoms. No study reported PH incidence or PH incidence/prevalence among children and adolescents. The quality assessment yielded moderate risk of bias. Ages of participants ranged between 18 and 78 years, and the proportion of females varied between 52.3% and 68.8%. The prevalence of PH in the pooled sample of 664 patients was 14% (95% CI 6%–23%).</p></sec><sec><title>Limitations</title><p>Only 3 studies were found eligible from 3 regions of the African continent.</p></sec><sec><title>Conclusions</title><p>The prevalence of PH among HIV-infected people in Africa seems very high. Further studies are urgently warranted to determine the incidence of HIV-induced PH, which must include all subregions of Africa.</p></sec><sec><title>Trial registration number</title><p>Review registration number PROSPERO CRD42016033863.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Simonneau, G" uniqKey="Simonneau G">G Simonneau</name></author><author><name sortKey="Gatzoulis, Ma" uniqKey="Gatzoulis M">MA Gatzoulis</name></author><author><name sortKey="Adatia, I" uniqKey="Adatia I">I Adatia</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hoeper, Mm" uniqKey="Hoeper M">MM Hoeper</name></author><author><name sortKey="Bogaard, Hj" uniqKey="Bogaard H">HJ Bogaard</name></author><author><name sortKey="Condliffe, R" uniqKey="Condliffe R">R Condliffe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bigna, Jj" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMJ Open</journal-id><journal-id journal-id-type="iso-abbrev">BMJ Open</journal-id><journal-id journal-id-type="hwp">bmjopen</journal-id><journal-id journal-id-type="publisher-id">bmjopen</journal-id><journal-title-group><journal-title>BMJ Open</journal-title></journal-title-group><issn pub-type="epub">2044-6055</issn><publisher><publisher-name>BMJ Publishing Group</publisher-name><publisher-loc>BMA House, Tavistock Square, London, WC1H 9JR</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27554104</article-id><article-id pub-id-type="pmc">5013504</article-id><article-id pub-id-type="publisher-id">bmjopen-2016-011921</article-id><article-id pub-id-type="doi">10.1136/bmjopen-2016-011921</article-id><article-categories><subj-group subj-group-type="heading"><subject>Respiratory Medicine</subject><subj-group><subject>Research</subject></subj-group></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>1506</subject><subject>1731</subject><subject>1692</subject><subject>1842</subject><subject>1724</subject></subj-group></article-categories><title-group><article-title>Prevalence and incidence of pulmonary hypertension among HIV-infected people in Africa: a systematic review and meta-analysis</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bigna</surname><given-names>Jean Joel R</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Nansseu</surname><given-names>Jobert Richie N</given-names></name><xref ref-type="aff" rid="af3">3</xref><xref ref-type="aff" rid="af4">4</xref></contrib><contrib contrib-type="author"><name><surname>Um</surname><given-names>Lewis N</given-names></name><xref ref-type="aff" rid="af5">5</xref></contrib><contrib contrib-type="author"><name><surname>Noumegni</surname><given-names>Steve Raoul N</given-names></name><xref ref-type="aff" rid="af5">5</xref></contrib><contrib contrib-type="author"><name><surname>Simé</surname><given-names>Paule Sandra D</given-names></name><xref ref-type="aff" rid="af5">5</xref></contrib><contrib contrib-type="author"><name><surname>Aminde</surname><given-names>Leopold Ndemngue</given-names></name><xref ref-type="aff" rid="af6">6</xref><xref ref-type="aff" rid="af7">7</xref></contrib><contrib contrib-type="author"><name><surname>Koulla-Shiro</surname><given-names>Sinata</given-names></name><xref ref-type="aff" rid="af5">5</xref><xref ref-type="aff" rid="af8">8</xref></contrib><contrib contrib-type="author"><name><surname>Noubiap</surname><given-names>Jean Jacques N</given-names></name><xref ref-type="aff" rid="af9">9</xref><xref ref-type="aff" rid="af10">10</xref></contrib></contrib-group><aff id="af1"><label>1</label><addr-line>Department of Epidemiology and Public Health</addr-line>,<institution>Centre Pasteur of Cameroon</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></aff><aff id="af2"><label>2</label><institution>Bordeaux School of Public Health, University of Bordeaux</institution>,<addr-line>Bordeaux</addr-line>,<country>France</country></aff><aff id="af3"><label>3</label><addr-line>Faculty of Medicine and Biomedical Sciences, Department of Public Health</addr-line>,<institution>University of Yaoundé 1</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></aff><aff id="af4"><label>4</label><addr-line>Sickle Cell Disease Unit</addr-line>,<institution>Mother and Child Centre of the Chantal Biya Foundation</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></aff><aff id="af5"><label>5</label><addr-line>Faculty of Medicine and Biomedical Sciences</addr-line>,<institution>University of Yaoundé 1</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></aff><aff id="af6"><label>6</label><addr-line>Faculty of Medicine and Biomedical Sciences</addr-line>,<institution>School of Public Health, University of Queensland</institution>,<addr-line>Brisbane, Queensland</addr-line>,<country>Australia</country></aff><aff id="af7"><label>7</label><institution>Clinical Research Education, Networking and Consultancy (CRENC)</institution>,<addr-line>Douala</addr-line>,<country>Cameroon</country></aff><aff id="af8"><label>8</label><addr-line>Infectious Diseases Unit</addr-line>,<institution>Yaoundé Central Hospital</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></aff><aff id="af9"><label>9</label><addr-line>Department of Medicine</addr-line>,<institution>Groote Schuur Hospital and University of Cape Town</institution>,<addr-line>Cape Town</addr-line>,<country>South Africa</country></aff><aff id="af10"><label>10</label><institution>Medical Diagnosis Center</institution>,<addr-line>Yaoundé</addr-line>,<country>Cameroon</country></aff><author-notes><corresp><label>Correspondence to</label> Dr Jean Joel R Bigna; <email>bignarimjj@yahoo.fr</email></corresp></author-notes><pub-date pub-type="collection"><year>2016</year></pub-date><pub-date pub-type="epub"><day>23</day><month>8</month><year>2016</year></pub-date><volume>6</volume><issue>8</issue><elocation-id>e011921</elocation-id><history><date date-type="received"><day>15</day><month>3</month><year>2016</year></date><date date-type="rev-recd"><day>30</day><month>7</month><year>2016</year></date><date date-type="accepted"><day>3</day><month>8</month><year>2016</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access"><license-p>This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</ext-link></license-p></license></permissions><self-uri xlink:title="pdf" xlink:href="bmjopen-2016-011921.pdf"></self-uri><abstract><sec><title>Objective</title><p>Patients infected with HIV have a direly increased risk of developing pulmonary hypertension (PH), and of dying from the condition. While Africa carries the greatest burden of HIV infection worldwide, there is unclear data summarising the epidemiology of PH among HIV-infected people in this region. Our objective was to determine the prevalence and incidence of PH among HIV-infected people living across Africa.</p></sec><sec><title>Design</title><p>A systematic review and meta-analysis.</p></sec><sec><title>Participants</title><p>HIV-infected African people residing in Africa.</p></sec><sec><title>Outcome</title><p>Prevalence and incidence of PH diagnosed through echocardiography or right heart catheterisation.</p></sec><sec><title>Data sources</title><p>Articles published in PubMed/MEDLINE, EMBASE, African Journals Online and African Index Medicus between 1 January 1980 and 30 June 2016, without any language restriction.</p></sec><sec><title>Results</title><p>Overall, 121 studies were screened; 3 were included in this review: 1 from Southern Africa (South Africa), 1 from Eastern Africa (Tanzania) and 1 from Central Africa (Cameroon). These studies included HIV-infected adult patients selected based on presentation with cardiovascular symptoms. No study reported PH incidence or PH incidence/prevalence among children and adolescents. The quality assessment yielded moderate risk of bias. Ages of participants ranged between 18 and 78 years, and the proportion of females varied between 52.3% and 68.8%. The prevalence of PH in the pooled sample of 664 patients was 14% (95% CI 6%–23%).</p></sec><sec><title>Limitations</title><p>Only 3 studies were found eligible from 3 regions of the African continent.</p></sec><sec><title>Conclusions</title><p>The prevalence of PH among HIV-infected people in Africa seems very high. Further studies are urgently warranted to determine the incidence of HIV-induced PH, which must include all subregions of Africa.</p></sec><sec><title>Trial registration number</title><p>Review registration number PROSPERO CRD42016033863.</p></sec></abstract><kwd-group><kwd>Pulmonary arterial hypertension</kwd><kwd>Pulmonary hypertension</kwd><kwd>HIV</kwd><kwd>AIDS</kwd><kwd>Africa</kwd></kwd-group></article-meta></front></pmc><affiliations><list><country><li>Afrique du Sud</li><li>Australie</li><li>Cameroun</li><li>France</li></country></list><tree><country name="Cameroun"><noRegion><name sortKey="Bigna, Jean Joel R" sort="Bigna, Jean Joel R" uniqKey="Bigna J" first="Jean Joel R" last="Bigna">Jean Joel R. Bigna</name></noRegion><name sortKey="Aminde, Leopold Ndemngue" sort="Aminde, Leopold Ndemngue" uniqKey="Aminde L" first="Leopold Ndemngue" last="Aminde">Leopold Ndemngue Aminde</name><name sortKey="Koulla Shiro, Sinata" sort="Koulla Shiro, Sinata" uniqKey="Koulla Shiro S" first="Sinata" last="Koulla-Shiro">Sinata Koulla-Shiro</name><name sortKey="Koulla Shiro, Sinata" sort="Koulla Shiro, Sinata" uniqKey="Koulla Shiro S" first="Sinata" last="Koulla-Shiro">Sinata Koulla-Shiro</name><name sortKey="Nansseu, Jobert Richie N" sort="Nansseu, Jobert Richie N" uniqKey="Nansseu J" first="Jobert Richie N" last="Nansseu">Jobert Richie N. Nansseu</name><name sortKey="Nansseu, Jobert Richie N" sort="Nansseu, Jobert Richie N" uniqKey="Nansseu J" first="Jobert Richie N" last="Nansseu">Jobert Richie N. Nansseu</name><name sortKey="Noubiap, Jean Jacques N" sort="Noubiap, Jean Jacques N" uniqKey="Noubiap J" first="Jean Jacques N" last="Noubiap">Jean Jacques N. Noubiap</name><name sortKey="Noumegni, Steve Raoul N" sort="Noumegni, Steve Raoul N" uniqKey="Noumegni S" first="Steve Raoul N" last="Noumegni">Steve Raoul N. Noumegni</name><name sortKey="Sime, Paule Sandra D" sort="Sime, Paule Sandra D" uniqKey="Sime P" first="Paule Sandra D" last="Simé">Paule Sandra D. Simé</name><name sortKey="Um, Lewis N" sort="Um, Lewis N" uniqKey="Um L" first="Lewis N" last="Um">Lewis N. Um</name></country><country name="France"><noRegion><name sortKey="Bigna, Jean Joel R" sort="Bigna, Jean Joel R" uniqKey="Bigna J" first="Jean Joel R" last="Bigna">Jean Joel R. Bigna</name></noRegion></country><country name="Australie"><noRegion><name sortKey="Aminde, Leopold Ndemngue" sort="Aminde, Leopold Ndemngue" uniqKey="Aminde L" first="Leopold Ndemngue" last="Aminde">Leopold Ndemngue Aminde</name></noRegion></country><country name="Afrique du Sud"><noRegion><name sortKey="Noubiap, Jean Jacques N" sort="Noubiap, Jean Jacques N" uniqKey="Noubiap J" first="Jean Jacques N" last="Noubiap">Jean Jacques N. Noubiap</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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