Manifestations cardiovasculaires au cours de l'infection à VIH à Libreville: étude comparative de patients séropositifs et séronégatifs / Cardiovascular Manifestations during HIV infection in Libreville: Comparative study of seropositive and seronegative patients

Introduction. Le spectre des atteintes cardiovasculaires au cours de l'infection à VIH a été modifi é par la trithérapie antirétrovirale. L'objectif de ce travail était de décrire le profi l des manifestations cardiovasculaires chez les patients vivants avec le VIH en le comparant à celui de patients séronégatifs. Méthodes. Il s'est agi d'une étude cas-témoins des dossiers de patients respectivement séropositifs et séronégatifs hospitalisés pour une pathologie cardiovasculaire au service de cardiologie du Centre Hospitalier Universitaire de Libreville de janvier 2015 à décembre 2018. L'analyse statistique a été réalisée à l'aide du logiciel Statview 5.0. Lestests de Chi-2 de Pearson ou Exact de Ficher ont été utilisés pour la comparaison des proportions. Résultats. L'étude a porté sur sur l'analyse de 82 et 150 dossiers de patients respectivement séropositifs et séronégatifs. Un âge inférieur à 50 ans était retrouvé chez 70,7% des séropositifs et 43,3% des séronégatifs (p<0,01). Le taux de CD4 moyen des séropositifs était de 189±170/mm3 et 45,1% d'entre eux étaient sous trithérapie antiretrovirale.La cardiomyopathie dilatée était l'atteinte cardiaque la plus fréquente chez les séropositifs (42,7%) et chez les séronégatifs (52,7%) (p=0,14). La maladie thromboembolique veineuse était relevée chez 7(8,5%) séropositifs et 14 (8,8%) séronégatifs (p=0,93). Une péricardite était diagnostiquée chez 25,6% des séropositifs avec une étiologie tuberculeuse dans 85,7% des cas. Les pathologies vasculaires athéromateuses étaient plus fréquentes chez les séronégatifs (23,1%) comparés aux séropositifs (6,1%) (p<0,01). La mortalité des séropositifs était principalement due aux péricardites (71,4%). Conclusion. les manifestations cardiovasculaires liées à l'immunodépression persistent chez les personnes vivant avec le VIH à Libreville. Un dépistage précoce de ces atteintes permettrait de réduire la mortalité.

Introduction. The spectrum of cardiovascular damage during HIV infection has been modified by triple antiretroviral therapy. The objective of this study was to describe the profile of cardiovascular manifestations in patients living with HIV by comparing it to the one of seronegative patients. Methods. This was a case-control study which focused on the files of patients hospitalized for a cardiovascular pathology in the cardiology department of the Center Hospitalier Universitaire de Libreville from january 2015 to december. 2018. Results. In total, there was on the analysis of the files of 82 seropositive patients and 150 seronegative patients. The age found was less than 50 years old in 70.7% of seropositives and 43.3% of seronegatives (p <0.01). The mean CD4 count in seropositives was 189 ± 170 /mm3 and 45.1% of them were on triple antiretroviral therapy. Dilated cardiomyopathy was the most common cardiac disease in HIVpositive (42.7%) and HIV-negative (52.7%) (p = 0.14). Venous thromboembolic disease was noted in 7 (8.5%) seropositives and 14 (8.8%) seronegatives (p=0.93).Pericarditis was diagnosed in 25.6% of seropositives patients with a tuberculous etiology in 85.7% of cases. Atheromatous vascular pathologies were more frequent in seronegative (23.1%) compared to seropositive (6.1%) (p <0.01). Mortality among seropositive was mainly due to pericarditis (71.4%)

Maternal mental health and caregiver competence of HIV-positive and negative women caring for their singleton newborns in KwaZulu-Natal Province, South Africa

Background. Maternal mental health during the perinatal period has been of interest to many researchers, with antenatal depression and postnatal depression (PND) being a leading cause of morbidity. The adverse effects of maternal depression on the offspring throughout infancy, childhood and adolescence are well documented. Studies on the mental health of persons living with HIV have also reported a high prevalence of depression. Objectives. To describe the prevalence of PND in a sample of HIV-positive and HIV-negative mothers delivering healthy singleton infants at one obstetric unit in KwaZulu-Natal (KZN) Province, South Africa, and the subsequent factors influencing neonatal behaviour and perceptions of caregiver competence. Correlations between the presence of PND and perceptions of caregiver competence (with the mother as caregiver), and between infant behaviour, the mother's confidence in her competence as caregiver, and demographic and medical variables, were also examined. Methods. Demographic and clinical data were collected from 132 mothers at initial contact and from 32 mothers at the 6-week follow-up appointment. Mothers independently completed the Edinburgh Postnatal Depression Scale at each time point, and the Mother and Baby Scales (MABS) at the 6-week follow-up appointment. Results. The prevalence of depression among all mothers at initial contact was 72.0%, remaining high (68.8%) among the mothers who returned for follow-up. There was a statistically significant correlation between depression and employment at follow-up (p=0.013), and between depression and delivery method (p=0.030). The majority of mothers reported being 'able to laugh and see the funny side of things' and 'looking forward with enjoyment to things' at initial contact and follow-up. Thoughts of self-harm were reported by 44.7% of mothers at baseline, and by 53.1% at follow-up. Although most infants scored in the average clinical band for neonatal behavioural factors in the MABS, mothers reported lack of confidence, globally and in caring for their infant. Conclusion. This study of maternal mental health of a sample of HIV-positive and HIV-negative mothers of infants in KZN revealed a higher prevalence of PND than reported in other studies. This population of mothers and infants is at risk of adverse outcomes of maternal depression, in addition to other possible risk factors.

Quantifying the relationship of HIV infection with clinicopathological spectrum and outcome among patients with colorectal cancer in a South African population

Introduction: Literature is limited on HIV and colorectal cancer (CRC) in sub-Saharan Africa despite it being the epicentre of the HIV epidemic, Purpose: To compare clinicopathological features and outcome of CRC in HIV-negative and HIV-positive patients. Methods: Retrospective analysis of a prospective CRC database. Demographic details, HIV status, anatomical site, disease stage, treatment and follow-up were documented. Results: Of 715 patients with CRC, 145 and 570 tested positive and negative respectively for HIV. Median age was 45 (IQR 36-53 and 57 (IQR 45-66) years among HIV-positive and HIV-negative patients respectively (p<0.0001). Tumour differentiation differed between the two groups (p=0.003) but staging was not different (p=0.6). Surgical resection rate was 52% for HIV-positive patients versus 59% for HIV-negative patients (p=0.07). Median follow-up was 9 (IQR 2-20.5) months for HIV-positive patients and 12 (IQR 6-29) months for HIV-negative patients (p=0.154). Recurrence rate was 14.7% among HIV positive patients and 6.8% in HIV negative patients (p=0.089). Conclusion: When compared with HIV-negative patients, HIV-positive patients with CRC presented at a younger age and tended to have lower surgical resection rates. There was no difference between the two groups with CRC in terms of anatomical sub-site distribution, disease staging and recurrence rates

Increased utilisation of PEPFAR-supported laboratory services by non-HIV patients in Tanzania

Background: It is unknown to what extent the non-HIV population utilises laboratories supported by the President's Emergency Plan for AIDS Relief (PEPFAR).Objectives: We aimed to describe the number and proportion of laboratory tests performed in 2009 and 2011 for patients referred from HIV and non-HIV services (NHSs )in a convenience sample collected from 127 laboratories supported by PEPFAR in Tanzania. We then compared changes in the proportions of tests performed for patients referred from NHSs in 2009 vs 2011.Methods: Haematology; chemistry; tuberculosis and syphilis test data were collected from available laboratory registers. Referral sources; including HIV services; NHSs; or lack of a documented referral source; were recorded. A generalised linear mixed model reported the odds that a test was from a NHS.Results: A total of 94 132 tests from 94 laboratories in 2009 and 157 343 tests from 101 laboratories in 2011 were recorded. Half of all tests lacked a documented referral source. Tests from NHSs constituted 42% (66 084) of all tests in 2011; compared with 31% (29 181) in 2009. A test in 2011 was twice as likely to have been referred from a NHS as in 2009 (adjusted odds ratio: 2.0 [95% confidence interval: 2.0-2.1]).Conclusion: Between 2009 and 2011; the number and proportion of tests from NHSs increased across all types of test. This finding may reflect increased documentation of NHS referrals or that the laboratory scale-up originally intended to service the HIV-positive population in Tanzania may be associated with a 'spillover effect' amongst the general population

Adverse Effects Profile of Multidrug-Resistant Tuberculosis Treatment in a South African Outpatient Clinic

Background: Highly active antiretroviral therapy (HAART) and drugs that are used to treat multidrug-resistant tuberculosis have potentially overlapping adverse effects. Few South African studies have documented adverse effects in the multidrugresistant tuberculosis population. This study examined the adverse effects profile in a sample of the outpatient population at the King George V Hospital Multidrug-Resistant Tuberculosis Clinic in Durban; KwaZulu-Natal.Method: The method was an anonymous; retrospective record review of 350 patients with multidrug-resistant tuberculosis; who were attending the King George V Hospital Multidrug-Resistant Tuberculosis Clinic (2010-2011). Adverse effect profiles in patients with multidrug-resistant tuberculosis only; and those who were co-infected with the human immunodeficiency virus (HIV) who were on and not on HAART; were documented and analysed.Results: Adverse events were recorded for 80.6 of patients. These included hearing loss (28.7); peripheral neuropathy (23.2); diarrhoea; nausea and vomiting (20.5); arthralgia (15.9); rashes and dermatological effects (excluding Stevens-Johnson syndrome) (14); abdominal pain and dyspepsia (10.3); and psychoses and confusion (8.3). In this study population; 72.6 of patients were HIV positive; and 85 were concomitantly on HAART and multidrug-resistant tuberculosis treatment. Adverse events were significantly more common in patients who were HIV positive than in patients who were HIV negative with regard to peripheral neuropathy (p-value 0.001); psychosis and confusion (p-value

A comparison of the clinical features of depression in hiv-positive and hiv-negative patients in Uganda

Objective: Depressive illness is the most common psychiatric disorder in HIV/AIDS with prevalence 2 to 3 times higher than the general population. It's still questionable whether HIV related depression is clinically different from depression in HIV-negative populations; a fact that could have treatment implications.This study compared the clinical features of major depression between HIV-Positive and HIV-negative patients with a view to intervention strategies. Method: A comparative; descriptive; cross-sectional study was carried out on 64 HIV-Positive depressed patients and 66 HIV-negative depressed patients in Butabika and Mulago hospitals. They were compared along the parameters of clinical features of depression; physical examination and laboratory findings. Pair wise comparisons; logistic regression and Multivariate analysis were done for the two groups on a number of variables. Results: Compared to HIV-Negative patients; HIV-Positive patients were more likely to be widowed ; older (? 30years); less likely to have a family member with a mental illness; a later onset of depressive illness (?30years); more likely to have a medical illness and taking medication before onset of depressive; symptomatically compared to HIV-Negative patients; HIV-Positive patients were more critical of themselves ; had significantly more problems making decisions ; had poorer sleep; felt more easily tired; more appetite changes; more cognitive impairment. Low CD4 counts were not significantly associated with depression; but HIV related depression was more likely to occur in stages II and III illness. Conclusion: These findings show that the clinical and associated features of depression differ between HIV-Positive and HIV-Negative patients; thus requiring different management approaches and further studies related to HIV-related depression

The Dilemma of Safe Sex and Having Children: Challenges Facing HIV Sero-Discordant Couples in Uganda

Background: Sixty percent of new HIV infections in Uganda occur in stable relationships between HIV discordant couples. Given the importance of fertility in Uganda; we hypothesized that unsafe sexual practices may be used to found a family/replace a dead child. Thus; we explored sexual practices to understand to what extent these are influenced by the desire to have children and the implications for HIV transmission among discordant couples. Methods: A cross-sectional survey of 114 HIV discordant couples in Kampala; and in-depth interviews with 15 purposively selected couples. Quantitative data were analysed using STATA. Multivariate logistic regression analysis done to identify factors associated with consistent condom use. Thematic content analysis of qualitative data was done using NVIVO 2. Results: Participants wanting children and those with multiple sexual partners were less likely to use condoms (Adj OR 0.51; and 0.36 respectively). Three of the five types of sexual practices used by couples do not allow pregnancy to occur. Main reasons for wanting a child included: ensuring lineage continuity and posterity; securing relationships and pressure from relatives to reproduce. Challenges included: risk of HIV transmission to partner and child; lack of negotiating power for safer sex; failure of health systems to offer safe methods of reproduction. Conclusions: HIV sero-discordant couples with strong desire for childbearing have a dilemma of risking HIV infection or infecting their spouse. Some risk transmission of HIV infection to reproduce. We need to address gender issues; risky behaviour and reproductive health services for HIV sero-discordant couples

Radiological features of pulmonary tuberculosis in HIV-positive and HIV-negative adult patients in south-eastern Nigeria

Pulmonary tuberculosis (PTB) is the most common clinical presentation of tuberculosis. This study was carried out to appraise the radiological features of PTB in adult HIV-positive and HIV-negative pa-tients. The chest radiographs of the patients were evaluated in the tuberculosis, leprosy, and endemic disease (TBL) clinic, Ebonyi State University Teach-ing Hospital (EBSUTH), Abakaliki, south-eastern Nigeria, from April 2004 to June 2006. Of the total of 117 individuals studied, 68 (58.1) were males and 49 (41.8%) females, indicating a male preponderance of 1.4:1. Up to 49.6% of the subjects had PTB/HIV co-infection. The highest prevalence of PTB/HIV co-infection was recorded among males aged 31­40 (12.8%), and females aged 21­30 (11.1%). The com-monest radiological features observed were cavitory lesions (64.1%), patchy opacities (44.4%), and hilar opacities (38.5%). Bilateral cavitory lesions, patchy opacities and hilar opacities were more prominent than the right-sided or left-sided ones and appeared more frequently among individuals with PTB/HIV co-infection. Perihilar patchy opacities, consolidation and pleural effusion were seen in 19.6%, 6.0%, and 4.3% of all cases, respectively. There was no statisti-cally significant difference in the association between the radiological features and patient category (χ2 = 17.74, df = 18, p = 0.47). The chest radiography re-mains an important tool in the diagnosis of PTB and will continue to provide essential information for the management and follow-up of patients

Opportunistic and other Intestinal Parasitic Infections in Aids Patients; HIV Seropositive healthy carriers and HIV seronegative Individuals in SouthWest Ethiopia

Background: Human Immunodeficiency Virus (HIV) infection leads to acquired immunodeficiency syndrome (AIDS) and major causes of morbidity and mortality of such patients are opportunistic infections caused by viral; bacterial; fungal and parasitic pathogens. Objectives: To determine the magnitude of opportunistic and non-opportunistic intestinal parasitic infections among AIDS patients and HIV positive carrier individuals Method: Cross-sectional study was conducted among AIDS patients; HIV positive healthy carriers and HIV negative individuals in Jimma University Hospital; Mother Theresa Missionary Charity Centre; Medan Acts Projects and Mekdim HIV positive persons and AIDS orphans' national association from January to May; 2004. Convenient sampling technique was employed to identify the study subjects and hence a total of 160 subjects were included. A pre-tested structured questionnaire was used to collect socio-demographic data of the patients. Stool samples were examined by direct saline; iodine wet mount; formol-ether sedimentation concentration; oocyst concentration and modified Ziehl-Neelsen staining technique. Results: Out of 160 persons enrolled in this study 100(62.5) (i.e. 65 male and 35 female) were infected with one or more intestinal parasites. The highest rate 36(69.2) of intestinal parasites were observed among HIV/AIDS patients; followed by HIV positive healthy carriers 35 (61.4) of and HIV negative individuals (29(56.9). Isospora belli 2(3.9); Cryptosporidum parvum 8(15.4); Strongyloides stercoralis 6(11.5) and Blastocystis 2(3.9) were found only in HIV/AIDS groups Conclusion: I. belli; C. parvum; S. stercoralis and Blastocystis are the major opportunistic intestinal parasites observed in HIV/AIDS patients. Therefore; early detection and treatment of these parasites are important to improve the quality of life of HIV/AIDS patients with diarrhoea

HIV-positive and HIV-negative consumers accept an instant soy maize porridge

The objective of this study was to assess consumer acceptability; preference and consumption intent of an instant soy maize porridge; compared to an instant plain maize porri- dge; in order to determine the successful inclusion of the soy maize porridge as a food supplement for HIV subjects in a subsequent nutrition intervention trial; to improve their nutritional status. A 5-point hedonic and food action rating scale was used for this purpose. HIV-positive (n=57) and HIV-negative (n=47) subjects were recruited on a basis of availability and willingness to participate. Long-term acceptability and compliance of HIV-positive consumers (n=9) was assessed after three and five months. Analysis of variance (ANOVA); Tukey's multiple comparison test and T-tests (p=0.05) were performed. Overall; consumers found the soy maize porridge significantly more acceptable; preferred it to; and also intended to consume it more often than the plain maize porridge. There were no significant differences between the HIV-positive and HIV-negative group regarding acceptability; preference and consumption intent. After three and five months; the HIV-positive consumers (n=9) did not find acceptability of the soy maize porridge significantly different from the first evaluation. It therefore had the potential to be included successfully in the nutrition intervention trial. The current study emphasises the need for sensory evaluation of food products prior to including them in intervention studies; to assess consumers' acceptance of them

'Look and Lletz/' ­ a Chris Hani Baragwanath Hospital experience

Objectives. An audit was undertaken of a 'colposcopy and treatment' clinic between April 2003 and December 2006; to determine: (i) the frequency of overtreatment with Papanicolaou smear on its own; colposcopy on its own or a combination of the two methods; (ii) differences in overtreatment between patients who are HIV positive and those who are HIV negative; and (iii) the short term complications of Lletz (large loop excision of the transformation zone) at this clinic. Design. A retrospective analysis of data from the colposcopy clinic database of patients; who were referred according to national guidelines. Setting. Patients who are referred to Chris Hani Baragwanath hospital. Results. Normal histology was found in 1.3 of patients; and cervical intraepithelial neoplasia (CIN) 1 or human papillomavirus (HPV) in 8.4. The overall complication rate was 3. Conclusion. The high loss to follow-up and the low early complication rate together with an acceptable overtreatment rate make this a justifiable approach in our situation. HIVnegative women were more likely to be overtreated than HIVpositive patients (p=0.03)

Radiographic appearances of pulmonary tuberculosis in HIV-1 seropositive and seronegative adult patientsKawooya; M.Okwera; A

Objective: To describe the radiographic pattern of PTB in HIV - 1 seropositive and seronegative patients and to study the relationship between radiographic pattern and degree of immunosuppression based on CD4 counts.Design:Cross_sectional;descriptive study. Subjects: One hundred and fifty consecutive adult patients; suspected on clinical grounds to have PTB. Setting: TB treatment centre and Department of Radiology; Mulago Referral Hospital and Makerere University Medical Teaching Hospital; Uganda. Interventions: Three early morning sputum specimens and 10 mls of venous blood taken from each qualifying subject. Main out come measures: Chest X-ray changes and CD4 counts. Results:More than sixty eight per cent of the patients were HIV-1 seropositive. Slightly over seventy two per cent of the seropositives were moderately immunosuppressed; 27.2were mildly immunosuppressed or had normal immune status. Approximately ninety three per cent of the seronegative individuals had normal immune status or were mildly immunosuppressed; while 6.4were moderately immunosuppressed. Lung parenchymal opacities were demonstrated in 98.7 of all patients. Intrathoracic lymphadenopathy and cavitation were noted in 43.3respectively. Fibrosis and pleural effusion were observed in 25.3 and 41.3 respectively. Miliary disease occured in 2.0. Seropositives accounted for 81.5and 76.3 of patients with lymphadenopathy and pleural effusion; 18.5 and 23.7 respectively were seronegative. Seronegatives accounted for 64.9 and 64.5of those with fibrosis and cavitation respectively; whereas 35.1 and 35.5 of fibrosis and cavitation respectively were seropositive. Patients who were moderate to severely immunosuppressed accounted for 64;6and 63.2 of patients with lymphadenopathy and pleural effusion; 35.4 and 36.8 respectively had normal immune status or were mildly immunosuppressed (78.4and 72.6) than in moderately to severely immunosuppressed patients (21.6 and 27.4)(p0.001). Conclusion: HIV-seropositivity with moderate to severe immunesuppression are associated with atypical radiographic appearences in adult post primary PTB

Etude de la prevalence des anticorps anti-CMV seriques parmi la population congolaise seronegative et seropositive pour le VIH 1

L'objet de cette etude est d'apprecier la seroprevalence des anticorps de classe IgG et IgM dirigee contre le CMV parmi la population generale congolaise et de la comparer a celle observee chez les patients febriles seropositifs pour le VIH 1. Les bilans bacteriologiques; mycologiques et parasitaires sont negatifs. Les serums proviennent de 100 patients seropositifs pour le VIH 1 en ELISA; confirmes en WESTERN-BLOT et d'un groupe temoin de 100 sujets seronegatifs pour le VIH 1 en ELISA. [abstract terminated]

Survivorship and nutritional response among HIV-1 seropositive and seronegative paediatric patients admitted as cases of Protein-Energy Malnutrition (PEM)

This paper presents results of study that was carried on 110 malnourished children aged 3-84 months who were admitted in the Child Nutrition Ward in Old Mulago Hospital-Kampala; Uganda. The children were admitted for intensive nutritional therapy and came from a radius of about 15 kilometres from the treatment center. Permission from relevant review boards was sought and given; as was permission from the parents or guardians sought before any child was recruited in the study; other inclusion criteria having also been fulfilled. The survival curves derived from life tables for oedema loss did not show any significant difference between the two serostatuses; although HIV-1 seronegative tended to loose oedema faster than their counterparts. However; there was a significant difference when considering cumulative probabilities of survival in the two groups. This suggested that some of the HIV-1 seropositive could actually have had active paediatric AIDS. Therefore; seropositivity affected the outcome of treatment in that there was a much higher case fatality rate among HIV seropositive cases than the other group; other factors remaining constant