The Spectrum of Liver Diseases in HIV Infected Individuals at an HIV Treatment Clinic in Kampala; Uganda

Background: Liver diseases are common in patients with HIV due to viral hepatitis B and C co-infections; opportunistic infections or malignancies; antiretroviral drugs and drugs for opportunistic infections. Objective: To describe the spectrum of liver diseases in HIV-infected patients attending an HIV clinic in Kampala; Uganda. Method: Consecutive patients presenting with jaundice; right upper quadrant pain with fever or malaise; ascites and/or tender hepatomegaly were recruited and underwent investigations to evaluate the cause of their liver disease. Results: Seventy-seven consecutive patients were recruited over an eleven month period. Of these; 23 (30) had increased transaminases because of nevirapine (NVP) and/or isoniazid (INH) hepatotoxicity. Although 14 (61) patients with drug-induced liver disease presented with jaundice; all recovered with drug discontinuation. Hepatitis B surface antigen was positive in 11 (15) patients while anti-hepatitis C antibody was reactive in only 2 (3). Probable granulomatous hepatitis due to tuberculosis was diagnosed in 7 (9) patients and all responded to anti-TB therapy. Other diagnoses included alcoholic liver disease; AIDS cholangiopathy; hepatocellular carcinoma; schistosomiasis; haemangioma and hepatic adenoma. Twelve (16) patients died during follow-up of which 7 (9) died because of liver disease. Conclusion: Drug history; liver enzyme studies; ultrasound; and hepatitis B and C investigations identified the probable etiology in 60 (78) of 77 patients with HIV infection presenting with symptoms and/or signs of liver disease

Eligibility for HIV/AIDS Treatment among Adults in a Medical Emergency Setting at an Urban Hospital in Uganda

Background: Despite global effort to scale up access to antiretroviral therapy (ART); many people in need of HIV/AIDS care in Uganda have not been reached. HIV testing and ART are not widely offered as routine medical services and data on HIV/AIDS in emergency settings in Sub-Saharan Africa is limited.We determined the HIV prevalence and eligibility for ART in a medical emergency unit at Mulago hospital. Methods: In a cross-sectional study; we interviewed 223 patients who were systematically selected from the patients'register from October through December 2004. HIV testing was offered routinely and results were delivered within 30 minutes.We evaluated HIV infected patients for WHO clinical stage of disease and referred them for HIV/AIDS care. Results: Out of 223 patients; 111 (50) had HIV infection of whom 78 (70) had WHO clinical stage 3 and 4 of disease thereby requiring ART. Overall; 84 out of 111 (76) HIV positive patients had not received any specific HIV/AIDS care. Conclusion: The burden of HIV infection in the medical emergency unit is high and majority of the patients who required ART had no prior HIV/AIDS care.We recommend scale up of HIV/AIDS care in acute care settings in order to increase access to ART

Low-Dose Oral Interferon Alpha in the Management of Symptomatic HIV-1 Infection

Objectives: To determine whether symptomatic HIV-1 infected persons will benefit from treatment with low doese oral interferon alpha (IFN). Study Design: This was a randomised ; double-blind; placebo controlled trial. Results: a total of 560 patients (45male; 55females) were enrolled between May 1991 and July 1992. At entry the baseline characteristic of age; WHO clinical stage; body weight; Karnofsky score and CD4+ cell count between the 2 groups were similar. Patients were followed up to between 30 and 60 weeks. Survival rates and disease progression was analysed using Kaplan-Meier estimation long-rank test and proportional hazards regression. Symptoms on follow up were analysed using logic regression and adjusted relative risk estimates. The details will be presented. Conclusion: The study did not reveal any significant differences between the group which took IFN and the one on placebo

Development and Evaluation of Guidelines for the Clinical Management of HIV Infection in Adults and Children in Uganda

Objective: To assist health workers in diagnosis and treatment and rational use of drugs in symptomatic HIV infection. Methods: The different stages of the development and evaluation: 1. Development of draft guidelines through national consensus of policy makers; programme managers and AIDS Care workers. 2. Training of personnel in selected health units in the use of the guidelines. 3. Field testing of the guidelines for a period of 5 months. 4. Evaluation workshop. 5. Second National Consensus Seminar. Results and Conclusions: 1. The guidelines were applicable in the field and were mostly used by nurses and medical assistants. 2. Restriction of the number of drugs was difficult because of the multiple complaints of the patients: 24; of the patients received more than 3 different drugs. 3. Most conditions were easily managed but for chronic diarrhoea only 40of the health workers adhered to the treatment guidelines. 4. Further training with regular evaluation is required in the use of the guidelines

A comparison of different treatment regiments for oral thrush

The objective was to compare the effectiveness of 4 different antifungal regimens in the treatment and maintenance of HIV-associated oral thrush (OT). HIV infected patients with OT were randomised to receive ketoconazole 400 mg/day + glutamic acid 340mg/day to (gp 1); ketoconazole 400mg/day PO (gp 2); Miconazole 2oral gel 2.5ml g