Opportunistic Infections and associated factors among HIV infected patients on anti-retroviral treatment at Bombo Hospital in Tanga Region, Tanzania

Background: A substantive number of People Living with HIV (PLHIV) develop Opportunistic Infections (OIs). The introduction of Anti-Retroviral Therapy (ART) in Tanzania led to a significant decline in opportunistic infections and a slower progression to AIDS, but OIs are still prevalent. This study was set to determine the magnitude of OIs and associated factors among HIV/AIDS patients on Anti-Retroviral Therapy (ART) attending care and treatment clinic at Bombo Regional Referral hospital, Tanga region. Materials And Methods: A cross­sectional descriptive study was conducted on HIV/AIDS patients on ART attending Bombo Hospital in Tanga from July to October 2019. A non-probability, consecutive sampling technique was employed to obtain study participants. Data were collected using available data obtained from the patients' files, hospital record books and interviews of study participants by using semi-structured questionnaires. Data were entered into the computer using Excel 2013, cleaned and analysed using Epi Info version 7.2.2.6. Any p-value of < 0.05, at a 95% confidence interval was regarded as statistically significant. Results : The study showed that out of the 360 participants, 126 cases (35.0%) of OIs were reported. Pulmonary Tuberculosis had the highest prevalence of 18.0% among PLHIV while other opportunistic Infections altogether contributed 17.0%. Late ART initiation (OR=10.9, 95% CI: 6.5 ­ 18.3, p-value <0.001), Poor drug adherence (OR=19, 95% CI: 9.0 ­ 39.7, p-value <0.001), female gender (69% vs. 31%), which was however, not statistically significant (p-value ­ 0.904), Informal and Primary School education (OR = 1.6, 95% CI: 1.1 ­ 1.6, p-value 0.04) being married (OR=2.1, 95% CI: 1.3 ­ 3.4, p ­ value 0.004) and widowed/widower (OR=7.7, 95% CI: 1.7 ­ 33.7, p ­ value 0.007) respectively were found to be associated with OIs to PLHIV.CONCLUSION : The rate of OIs still high among PLHIV, Pulmonary Tuberculosis is the leading disease with 18.0% of all OIs symptomatic patients. Delay in ART initiation after positive test results, poor drug adherence and moderate malnutrition have been identified as major risk factors affecting 66.0%, 70.0%, 71%of PLWHA with OIs. We recommend early initiation of ART, Education on ART adherence and refilling of large quantities of ARV drugs to individuals working far from their homes.

Temporal distribution of baseline characteristics and association with early mortality among HIV-positive patients at University College Hospital, Ibadan, Nigeria

The first six months of HIV care and treatment are very important for long-term outcome. Early mortality (within 6 months of care initiation) undermines care and treatment goals. This study assessed the temporal distribution in baseline characteristics and early mortality among HIV patients at the University College Hospital; Ibadan; Nigeria from 2006-2013. Factors associated with early mortality were also investigated. This was a retrospective analysis of data from 14 857 patients enrolled for care and treatment at the adult antiretroviral clinic of the University College Hospital; Ibadan; Nigeria. Effects of factors associated with early mortality were summarised using a hazard ratio with a 95% confidence interval obtained from Cox proportional hazard regression models. The mean age of the subjects was 36.4 (SD=10.2) years with females being in the majority (68.1%). While patients' demographic characteristics remained virtually the same over time; there was significant decline in the prevalence of baseline opportunistic infections (2006-2007=55.2%; 2011-2013=38.0%). Overall; 460 (3.1%) patients were known to have died within 6 months of enrollment in care/treatment. There was no significant trend in incidence of early mortality. Factors associated with early mortality include: male sex; HIV encephalopathy; low CD4 count ( 50 cells); and anaemia. To reduce early mortality; community education should be promoted; timely access to care and treatment should be facilitated and the health system further strengthened to care for high risk patients

Communication characteristics of young children with HIV in South Africa as reported by some physicians

HIV has been shown to have significant effects on the development of a child. Currently; there is limited South African research regarding HIV and specific characteristics of communication development; and the treatment thereof; in the child infected with HIV. The objective of the research was to describe the communication characteristics of a group of children between the ages of 0 and 5 years infected with HIV at a hospital in Gauteng; South Africa. Clinic records of 203 children infected with HIV between the ages of 0 and 5 years were reviewed using a pre-designed checklist within the outreach clinic of a large regional hospital. A questionnaire was completed by four medical practitioners working with this population within the outreach clinic. A total of 91.62 of the infected children were diagnosed as being either in Stage III or IV of the disease (according to the WHO classification system of 2005); with all infants presenting with a CD4 count of =60. Most (75.37 of the total sample) were receiving Highly Active Antiretroviral Therapy (HAART) at the time the data were collected. According to their medical; social; communication and general development; almost all the children qualified for Early Communication Intervention (ECI) but were not recorded as being referred for such services. A large proportion of the target population presented with opportunistic infections and/or HIV associated conditions. The results highlight the developmental characteristics of children living with HIV; and identify the need for medical doctors and allied health professionals to be provided with relevant literature or training regarding the communication development of children infected with HIV. This will facilitate appropriate referrals for ECI services

Preventing HIV Transmission : a New Argument for Tracing Patients Lost to Follow-Up ?

Loss to follow-up (LTFU) is a serious problem in most sub-Saharan African ART programmes. If ART is interrupted or reduced; HIV again progresses; and this increases the risk of opportunistic infections and; ultimately; AIDS and death. In addition; the viral load of a patient who interrupts ART will rebound; and the probability of onward transmission increases. If tracing programmes can accelerate the return of lost patients; these patients may be less likely to transmit the virus; since the period of lapsed treatment is shortened. In this study; we created a mathematical model to determine whether tracing patients LTFU from ART programs would lower the rate of HIV transmission

Ambiguous Diagnosis; Futile Treatments and Temporary Recovery: Meanings of Medical Treatment Among HIV/AIDS Family Caregivers Providing Care without ARVs

The capacity of countries with high HIV and AIDS prevalence to provide antiretroviral treatment and care for all people who need support remains a public health challenge. In Lesotho; there are improvements in this area but the high proportion of people who need ART yet they do not receive treatment suggests that many HIV-infected people continue to depend on medicines that treat opportunistic infections. The objective of the article is to explore caregivers' experiences with diagnostic procedures and outcomes; prescriptions and treatment outcomes when ARVs were unavailable. A phenomenological design using in-depth face-to-face interviews was used to obtain the experiences of 21 family caregivers about caregiving; including access to and use of medical treatments. Caregivers' experiences indicate that most of the consulted health professionals provided vague and inconsistent diagnoses while the medication they prescribed failed to treat most of the symptoms. Unavailability of medicines that control pain and symptoms effectively continues to be a prominent feature of HIV and AIDS home-based caregiving in Lesotho. It is recommended that health professionals should facilitate disclosure of HIV diagnosis to family caregivers to assist them to understand unstable treatment outcomes; and policy makers should strengthen home-based care by developing policies that integrate palliative care into HIV and AIDS care

Les infections au cours des maladies inflammatoires chroniques de l'instestin

Pre-requis:les infections sont frequentes au cours des maladies inflammatoires chroniques de l'intestin.Elles sont associees a un risque eleve de mortalite.But:preciser les differentes infections survenants chez les malades atteints des maladies Crohn et de rectocolite hemorragique et leurs moyens de preventions .Materiel et methodes: revue de la litterature .Resultats: les infections survenant au cours des poussees peuvent expliquer la resistance aux traitements de la maladie. Il s'agit le plus souvent des infections a clostridium difficile et a cytomegalovirus.Les infections a Epstein -Barr virus majorent le risque de lymphomes chez les malades sous azathioprine. Les infections opportunistes sont relativement frequentes au cours des maladies inflammatoires chroniques de l'intestin; en particulier en cas de prise d'un ou de plusieurs immunosuppresseurs. prevention de ces infections opportunistes se base sur un bilan pre-therapeutique complet; les vaccinations chez les patients immunodeprimes et la chimioprophylaxie dans certaines situations .Conclusion: la connaissance des differentes infections pouvant survenir chez les malades attientes de maladies inflammatoires chroniques de l'intestin est primordiale.Le traitement de ces infections est associees a une meilleures reponse aux traitements de la maladie et a une reduction de la mortalite en cas d'infection opportuniste

Common Opportunistic Infections in HIV Infected Infants and Children : Part 2 Non-Respiratory Infections

Increased susceptibility to infections is the major cause of disease; end organ damage and death in human immunodeficiency virus (HIV)-infected children. This article will focus on prevention; diagnosis and management of the most common and less common severe infections that are specifically associated with HIV-related immune compromise; as well as some aspects relating to immune reconstitution inflammatory syndrome (IRIS)

Management of Human Immunodeficiency Virus (HIV) Infection in Adults in Resource-Limited Countries: Challenges and Prospects in Nigeria

Nigeria has an HIV seroprevalence of 5.0with an estimated 3.5 million infected persons. By June 2005; an estimated 28 - 48;000 or 4 - 8of those requiring Anti-Retroviral Treatment (ART) receive it through various means and support. It is targeted that 350;000 and 1 million persons will be on ART by 2006 and 2009 respectively. Clinical studies on ART have demonstrated virological; immunological and survival benefits comparable to those reported in the developed world. Situation analyses and audits in the country have shown promising and comparable findings to results elsewhere. They have also identified areas of potential concern - rational use of ART; adherence and monitoring. As ART scale up is ongoing there is need for continued technical support; laboratory standardization; commodities management / supply and training of health care workers. Simple guidelines and algorithms for ART; care and monitoring to facilitate rapid scaleup should be developed for use in tertiary and non-tertiary facilities in the country. Preventive and ART services should be fully linked. With considerable funding from many sources there is need for good governance; accountability; coordination and continuous provision of resources with cogent targets and objectives in the scale up as we seek to improve survival; quality of life and productivity of patients in Nigeria

Toxoplasma serology in Zambian and Ugandan patients infected with the human immunodeficiency virus

In the USA and Europe; toxoplasmosis is well recognized as an important cause of morbidity and mortality among immunocompromised individuals. Toxoplasma gondii has been shown to be a common opportunistic infection in patients infected with the human immunodeficiency virus (HIV) in the USA and Europe with published estimates ranging from 20pc to 80pc. The importance of Toxoplasma infection in East Africa has not yet been defined. The seroprevalence rates of toxoplasmosis in Zambian and Ugandan patients were determined using the dye test (DT) and the latex agglutination test (LAT). The geographical variation in seroprevalence rates noted in western countries was also found in these African countries; with Zambia showing significantly lower rates than Uganda. 34pc of Ugandan (64/186) and 4pc of Zambian (8/187) patients infected with HIV; compared with 27pc of Ugandan (26/93) and 11pc of Zambian (20/189) HIV-negative persons; had anti-Toxoplasma immunoglobulin G antibodies. With the LAT; 13pc of the Ugandan and 7pc of the Zambian sera gave a false positive result. The relevance of Toxoplasma serology in Africa is discussed

Possible effects of acquired immunologic deficiency syndrome (AIDS) on tuberculosis in industrial and developing countries

Tuberculosis is the most frequent infectious complication of AIDS and HIV infection in countries where che prevalence of tuberculous infection is high. HIV infection is the strongest risk factor for developing tuberculosis in individuals infected removly or recently with tubercle bacilli. An increased incidence of tuberculosis has been already documented in several African countries with a high prevalence of both tuberculous and HIV infections (Tanzania; Malawi). The increase in the incidence of tuberculosis is mainly due to the depression of cellular immunity caused by HIV infection in subjects infected with M. tuberculosis. The occurrence of tuberculosis in HIV-seropositive persons is more frequent in those remotely infected than in those recently infected or reinfected with M. tuberculosis. In developed countries; HIV infection will cause tuberculosis in only a relatively small number of persons; since the prevalence of tuberculosis infection is low in the age group up to approximately 45 years. HIV infection will; therefore; not substantially increase the number of tuberculosis cases