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

Fighting; no battling for child survival in Sierra Leone; what ammunition?

The sustainability of the child survival and development interventions has always been an imoprtant concern and an awareness of its crucial importance has led to greater efforts to integrate them into PHC programmes. But the cynic will ask: what after UCI in 1990? What after achieving our national coverage of 80 per cent immunization rate? What of the other child saving measures? Without doubt reaching a state of herd community will more than half the alarming infant morbidity and mortality rates and can be a significant benchmark on the road to Health For All by Year 2000. The government of Sierra Leone/UNICEF social mobilization drive; without doubt; has created the awareness in every nook and cranny in Sierra Leone that the GOBBI/FFF septet is very crucial to children's survival and development