Liver Fibrosis and Hepatitis B Coinfection among ART Naive HIV-Infected Patients at a Tertiary Level Hospital in Northwestern Tanzania: A Cross-Sectional Study.
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ABSTRACT:
SUBMITTER: Kilonzo SB
PROVIDER: S-EPMC5554579 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:Background:Schistosoma mansoni is highly endemic in the Lake Zone part of Tanzania and most people are chronically infected. Periportal fibrosis (PPF) is the commonest complication of chronic S. mansoni infection documented in up to 42% of studied participants in the community-based studies. These patients are at high risk of mortality since most of them are diagnosed late with bleeding varices. At Bugando, Schistosoma-related varices contributed to 70% of patients admitted due to vomiting blood with a two months' mortality of over 10%. Earlier studies had reported higher mortality of up to 29% among patients with PPF even with the best in-hospital care. Understanding factors that increased the risk of mortality is important clinically in devising ways that can improve the outcome of this subgroup of patients. Methods:A retrospective analysis of patients with PPF from 2015 through 2018 was done. Their sociodemographic, clinical, laboratory, ultrasonographic, endoscopic, and survival status data were collected for analysis. STATA 13 was used for analysis, the prevalence of varices, active schistosomiasis, and hepatitis B coinfection was determined. Cumulative mortality as a major outcome was also determined, and factors associated with increased risk of mortality were assessed by a logistic regression model. Results:In total, 250 participants were included in this analysis. Majority, 222 (88.8%; 95% CI: 84.2-92.4) had active S. mansoni infection, and 40 (16.0%; 95% CI: 11.6-21.1) had S. mansoni-HBV coinfection. Cumulatively, 39 (15.6%; 95% CI: 11.3-20.7) patients died, with most deaths, 31 (79.5%; 95% CI: 63.5-90.7) occurring within two years following the diagnosis of PPF (chi2 = 6.3; p = 0.012). The odds of mortality were independently associated with fishing (OR: 10.8; 95% CI: 2.2-52; p = 0.003), upper gastro intestinal bleeding (OR: 2.4; 95% CI: 1.1-5.4; p = 0.037), HBV coinfection (OR: 3.3; 95% CI: 1.2-91; p = 0.019), and ascites (OR: 3.3; 95% CI: 1.3-8.2; p = 0.010). Conclusions:In this, S. mansoni endemic area, varices, actives schistosomiasis, hepatitis B coinfection, and mortality are highly common. Screening for varices and initiation of prophylaxis, administration of praziquantel, and screening for hepatitis B should be part and parcel of care of these patients. The first two years of diagnosis, patients are at high risk of mortality; risk factors in this study should assist planning a closer follow-up of patients at risk of mortality to improve their long-term outcome.
| S-EPMC7094192 | biostudies-literature
Project description:BackgroundThe need to study the outcome of Antiretroviral Therapy (ART) among Human Immunodeficiency Virus (HIV) infected individuals in Ghana, a sub-Saharan African country crucial in the era of the "Treat All" policy. The aim of this study was to analyze selected determinants of immunological and virological response to ART among HIV infected individuals in a tertiary facility in Cape Coast, Ghana.MethodsAn analytical cross sectional study with a retrospective component was conducted in the Cape Coast Teaching Hospital (CCTH), Central Region. Clients aged 18 years and above attending the HIV Clinics for ART and who were on ART for 6 months or more were recruited. The viral loads, CD4 count and other socio-demographic data were analyzed using STATA version 13 (STATA Corp, Texas USA). Descriptive analysis was done and presented with appropriate measures of central tendencies. In addition, bivariate and multivariate analysis was carried out with p value of 0.05 interpreted as evidence of association between variables.ResultsA total of 440 participants were included in this study with a mean age of 45.5 (±11.6) years. The mean CD4 count at baseline, 6 months on ART and currently at study recruitment were 215.1 cells/mm3 (±152.6), 386.6 cells/mm3 (±178.5), and 579.6 cells/mm3 (±203.0) respectively. After 6 months and 12 months on ART, the number who had achieved viral copies < 1000/ml were 149 (47.0%) and 368 (89.6%) respectively. There was strong evidence of an association between having CD4 count < 350 cells/mm3 after 6 months on ART and having a diagnosis of tuberculosis since HIV diagnosis (aOR 8.5, 95% CI 1.1-73.0, p = 0.05) and clients having plasma viral load > 1000 copies/ml after 6 months on ART (aOR 2.0, 95% CI 1.2-3.2, p = 0.01).ConclusionThere was good response to ART among clients, high virological suppression and immunological recovery hence low rates of change to second line ART regimen in this cohort studied. With strict adherence to the national policy on HIV testing, management of positive clients and full implementation of the "Treat All" policy, Ghana could achieve, if nothing at all, the third "90, 90, 90" target by 2020.
| S-EPMC5963173 | biostudies-literature
Project description:ObjectiveThe study was designed to assess the hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection scenario among the human immunodeficiency virus (HIV) infected patients attending a tertiary healthcare unit in eastern India. Additionally, clinical and virological characterization of these viruses, prior to antiretroviral therapy (ART) initiation was also done for better understanding of the disease profile.MethodsPool of ART-naive HIV/HBV co-infected and HIV mono-infected patients, participating in two different studies, were included in this study. HBV DNA was detected by nested-PCR amplification followed by HBV genotype determination and HBV reverse transcriptase (RT) region amplification and direct sequencing for detecting drug resistance.ResultsThe prevalence of HBsAg (11.3%) was higher compared to anti-HCV (1.9%) among the HIV infected ART-naive patients. Moreover, majority of the HBeAg positive HIV/HBV co-infected patients (87.7%) had HBV DNA ?20,000 IU/ml with median HBV DNA significantly higher than that of HBeAg negative subjects (5.7 log10 IU/ml vs. 4.2 log10 IU/ml; p<0.0001). Multivariate analysis also showed that HBeAg-positive status was independently associated with higher HBV DNA level (p?=?<0.001). Notably, 60.9% of the HBeAg negative co-infected subjects had HBV DNA ?2,000 IU/ml of which 37.0% had HBV DNA ?20,000 IU/ml. Genotype HBV/D (68.2%) was the predominant genotype followed by HBV/A (24.3%) and HBV/C (7.5%). Anti-HBV drug resistant mutations were detected in two (3.8%) of the ART-naive patients.ConclusionThe prevalence of HIV/HBV co-infection was relatively higher in our study subjects. HBeAg testing might provide clue for early treatment initiation. Furthermore, HBeAg negative patients are also associated with high HBV DNA levels and therefore require appropriate medical attention. Pre-treatment screening for anti-HBV drug resistant mutations is not necessary before ART initiation.
| S-EPMC3758335 | biostudies-literature
Project description:This study aimed to determine the spectrum and antibiogram of the isolated bacteria from patients presenting with infected wounds at Kilimanjaro Christian Medical Centre in northern Tanzania.Bacterial growth was observed in the vast majority of wound swabs (91.4%). Most of the bacteria isolated (62.3%) were Gram-negative rods. Staphylococcus aureus was the most common isolated organism (16%) followed by other Coliforms and Enterococcus spp. (12.5% each). Enterococcus spp. (36.4%) was the most common isolated bacteria in diabetic wounds whereas S. aureus was the most common isolated bacteria from the wounds caused by trauma (40.0%) and surgical site infection (20.6%). Resistance was high to most common antibiotics used in the hospital.
| S-EPMC5738783 | biostudies-literature
Project description:This study aimed to determine the prevalence of hepatitis B virus (HBV) coinfection and HBV seropositivity in perinatally HIV-infected adolescents. A secondary objective was to describe the clinical characteristics of adolescents with chronic HBV/HIV coinfection.Multicenter cross-sectional study of perinatally HIV-infected adolescents aged 12-25 years. HBV surface antigen, surface antibody (anti-HBs) and core antibody (anti-HBc) were measured. Coinfection was defined as having persistently positive HBV surface antigen. Seroprotective antibody from immunization was defined as having anti-HBs ?10 mIU/mL with negative anti-HBc. HBV DNA quantitation and rtM204V/I mutation analysis (lamivudine resistance-associated mutation) were performed in adolescents with chronic HBV infection.From November 2010 to March 2011, 521 patients were enrolled. Mean (SD) of CD4 lymphocyte count was 685 (324) cells/?L. The prevalence of HBV/HIV coinfection was 3.3% (95% confidence interval: 1.9-5.2%). Protective antibody against HBV was found in 18% of population, and this was significantly higher among adolescents who received than those who did not receive HBV revaccination after receiving antiretroviral therapy (93% versus 6%, P < 0.01). Among adolescents with chronic HBV infection, 88% have received lamivudine; however, 69% have HBV DNA >10 copies/mL and 75% had the rtM204V/I mutation.The prevalence of HBV coinfection in HIV-infected Thai adolescents was 3.3%. Most HIV-infected adolescents had no HBV protective antibody; therefore, revaccination with HBV vaccine is encouraged. The high prevalence of HBV-lamivudine resistance underscores the importance of HBV screening prior to antiretroviral therapy initiation to guide the selection of optimal regimen for coinfected children.
| S-EPMC3511890 | biostudies-literature
Project description:Paediatric rheumatic disorders are common in children and result in significant impairment in quality of life, morbidity and mortality. There is limited information on the burden of these disorders in lower income countries especially in sub-Saharan Africa. Few case reports have documented presence of paediatric rheumatic disorders in Tanzania. This study was conducted to determine the spectrum of rheumatic disorders among children at Muhimbili National Hospital (MNH). This was a retrospective study conducted among children who were attended at MNH between January 2012 and August 2019. Paediatric patients seen in the out-patient clinics and those admitted in the wards were eligible. All patients with diagnosis of rheumatic disorders were identified from admission books and outpatient clinic logbooks, and later data were collected from their case notes and were recorded in clinical research forms. Collected information included age, sex, clinical features and laboratory tests results. A total of 52 children with mean age of 9.5?±?4.3?years, 12 (40.4%) participants were aged above 10?years and 32 (61.5%) were females. Frequently reported clinical presentations were joint pain 44 (84.6%), joint swelling 34 (65.4%), fever 24 (46.2%) and skin rashes 21(40.4%). Juvenile idiopathic arthritis (JIA) was the predominant diagnosis reported in 28 (53.8%) participants followed by juvenile systemic lupus erythematosus 8 (15.4%), mixed connective tissue diseases 4 (7.7%) and juvenile dermatomyositis 4 (7.7%). Antinuclear antibody test was performed in 16 participants it was positive in 9 (56.2%). Nine participants were tested for anti-double stranded DNA test and 5 (55.6%) were positive for this test. C-reactive protein was tested in 46 participants out of which 32 (69.6%) had elevated levels. HIV was tested in 24 (46.2%) participants and results were negative. Thirty-five out of 52 (67.3%) participants had anaemia. Predominant drugs used for treatment of JIA include prednisolone and methotrexate. Paediatric rheumatic disorders are not uncommon in Tanzania-and were noted to affect more female children in this study. Predominant conditions included juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM).
| S-EPMC7126129 | biostudies-literature
Project description:BACKGROUND:The term "collodion baby" is used to describe a newborn covered with a translucent, parchment-like skin sheet. It is an extremely rare condition with an estimated incidence of 1 in 300,000 live births. Clinically, the baby will present with a collodion membrane with fissures, ectropium, eclabium, and hypoplastic digits. Shedding of the membrane increases risk of dehydration and infection. CASE PRESENTATION:We present the case of an African baby girl, who died when she was 7-months old, who presented with features of collodion membrane at birth. She later developed hypernatremic dehydration and a constricted band on her lower limb that required urgent surgical release. She stayed in our hospital for 35 days; she was then discharged home after improvement for 6 months of follow-up clinics at Muhimbili National Hospital: neonatal; dermatology; ear, nose, and throat; and physiotherapy units. She died at 7 months of age. CONCLUSION:Despite limited resources, the early survival of these babies can be improved by providing basic care.
| S-EPMC6311898 | biostudies-other
Project description:BACKGROUND:HIV infection affects multiple organs and the kidney is a common target making renal disease, one of the recognized complications. Microalbuminuria represents an early, important marker of kidney damage in several populations including HIV-infected antiretroviral therapy (ART) naïve patients. Early detection of microalbuminuria is critical to slowing down progression to chronic kidney disease (CKD) in HIV-infected patients, however, the burden of microalbuminuria in HIV-infected antiretroviral therapy (ART) naïve patients in Uganda is unclear. METHODS:A cross-sectional study was conducted in the Mulago Immune suppression syndrome (ISS) clinic among adult HIV?-?infected ART naïve outpatients. Data on patient demographics, medical history was collected. Physical examination was performed to assess body mass index (BMI) and hypertension. A single spot morning urine sample from each participant was analysed for microalbuminuria using spectrophotometry and colorimetry. Microalbuminuria was defined by a urine albumin creatinine ratio (UACR) 30-299?mg/g and macroalbuminuria by a UACR >?300?mg/g. To assess the factors associated with microalbuminuria, chi-square, Fisher's exact test, quantile regression and logistic regression were used. RESULTS:A total of 185 adult participants were consecutively enrolled with median age and CD4+ counts of 33(IQR?=?28-40) years and 428 (IQR?=?145-689) cells/?L respectively. The prevalence of microalbuminuria was 18.9% (95% CI, 14-25%). None of the participants had macroalbuminuria. CD4+ count <350cells/?L was associated with increased risk of microalbuminuria (OR: 0.27, 95% CI: 0.12-0.59), P value?=?0.001). Diabetes mellitus, hypertension, smoking, alcohol intake were not found to be significantly associated with microalbuminuria. CONCLUSION:Microalbuminuria was highly prevalent in adult HIV?-?infected ART naive patients especially those with low CD4+ count. There is need to study the effect of ART on microalbuminuria in adult HIV?-?infected patients.
| S-EPMC7574295 | biostudies-literature
Project description:BackgroundLittle is known on how the interaction between Sickle Cell Disease (SCD) and renal insults caused by other coexisting conditions in Sub Saharan Africa such as urinary schistosomiasis, malnutrition and HIV affect the prevalence of renal dysfunction in children with SCD.ObjectivesTo determine the prevalence and factors associated with renal dysfunction among children with SCD aged 6 months to 12 years attended at a tertiary hospital in Northwestern Tanzania.MethodsA cross sectional hospital-based study with a short follow up component of 3 months for 153 children with SCD was done to document demographics, clinical characteristics and features of renal dysfunction including urine dipstick albuminuria (>20mg/l) and eGFR (<60ml/ml/min/1.73m2). Other potential renal insults such as HIV infection and Schistosomiasis were also evaluated.ResultsAt enrollment, 48/153(31.37%) children had renal dysfunction declining to 31(20.3%) at 3 months follow up. Acute chest syndrome (OR 3.04, 95% CI [1.08-8.96], p = 0.044), severe anemia (OR 0.44, 95% CI [0.26-0.76],p = 0.003), urinary schistosomiasis (OR 7.43, 95% CI [2.10-26.32] p<0.002) and acute malnutrition (OR 4.92, 95% CI [1.29-18.84], p = 0.020). were associated with renal dysfunction.ConclusionWhere prevalent, urinary schistosomiasis and acute malnutrition increase the risk for renal dysfunction in children with SCD. We recommend albuminuria routine screening in children with SCD especially those presenting with acute chest syndrome, severe anemia and features of acute malnutrition for early detection of renal dysfunction among children with SCD.
| S-EPMC6581240 | biostudies-literature
Project description:Toll-like receptors (TLRs) play an important role in the innate immune response to HIV infection. Single nucleotide polymorphism (SNP) in TLR7 (Gln11Leu) gene has been associated with a rapid decline of CD4T cell count. Hence, we assessed the TLR7 (rs179008, Gln11Leu (A/T) and rs179009, IVS2-151 (A/G)) polymorphism in 150 HIV-infected individuals naïve to ART and 158 healthy controls. The genotyping of TLR7 Gln11Leu (A/T) and IVS2-151 (A/G) polymorphisms was done using the PCR-RFLP method. In univariate analysis, none of the genotype and haplotype of TLR7 Gln11Leu (A/T) and IVS2-151 (A/G) polymorphism differed significantly between HIV-infected individuals and healthy controls. The occurrence of TLR7 rs179009AG genotype in the codominant model and rs179009 AG-GG genotype in the dominant model was significantly reduced in HIV-infected individuals as compared to healthy controls (18.0% vs. 29.1%, OR = 0.42, P = 0.016; 26.7% vs. 36.7%, OR = 0.52, P = 0.016). TLR7 rs179009AG genotype was significantly underrepresented in the intermediate HIV disease stage compared with healthy controls (OR = 0.03, P = 0.04). TLR7 rs179009AG genotype expressed higher in tobacco-consuming HIV-infected individuals compared with nonusers (OR = 1.71, P = 0.47). In conclusion, rs179009 AG-GG and AG genotypes were found reduced in HIV-infected individuals as compared to healthy controls; their higher prevalence in health individuals clearly support that they are associated with reduced risk of acquisition of HIV-1 infection.
| S-EPMC7256714 | biostudies-literature