Characteristics, immunological response & treatment outcomes of HIV-2 compared with HIV-1 & dual infections (HIV 1/ 2) in Mumbai.

Background & objectives: Information available on HIV-2 and dual infection (HIV-1/2) is limited. This study was carried out among HIV positive individuals in an urban referral clinic in Khar, Mumbai, India, to report on relative proportions of HIV-1, HIV-2 and HIV-1/2 and baseline characteristics, response to and outcomes on antiretroviral treatment (ART). Methods: Retrospective analysis of programme data (May 2006-May 2009) at Khar HIV/AIDS clinic at Mumbai, India was done. Three test algorithm was used to diagnose HIV-1 and -2 infection. Standard ART was given to infected individuals. Information was collected on standardized forms. Results: A total of 524 individuals (male=51%; median age=37 yr) were included in the analysis over a 3 year period (2006-2009) - 489 (93%) with HIV-1, 28 (6%) with HIV-2 and 7(1%) with dual HIV-1/2 infection. HIV-2 individuals were significantly older than HIV-1 individuals (P<0.001). A significantly higher proportion of HIV-2 patients and those with dual infections had CD4 counts <200 cells/µl compared to HIV-1. HIV-2 individuals were more likely to present in WHO Clinical Stage 4. Of the 443 patients who were started on ART, 358 (81%) were still alive and on ART, 38 (8.5%) died and 3 were transferred out. CD4 count recovery at 6 and 12 months was satisfactory for HIV-1 and HIV-2 patients on protease inhibitor based regimens while this was significantly lower in HIV-2 individuals receiving 3 nucleoside reverse transcriptase inhibitors. Interpretation & conclusions: In an urban HIV clinic in Mumbai, India, HIV-2 and dual infections are not uncommon. Adaptation of the current national diagnostic and management protocols to include discriminatory testing for HIV types and providing access to appropriate and effective ART regimens will prevent the development of viral resistance and preserve future therapeutic options.

WHO Stage 3 Disease Conditions and Outcomes in Patients Started on Antiretroviral Therapy in Malawi

Background: In Malawi; WHO stage 3 is the commonest reason for HIV-infected patients to be started on antiretroviral therapy (ART). The aim of the study was to document disease conditions with which patients are classified in Stage 3 and their relationship to 6-month treatment outcomes. Methodology: A retrospective survey was carried out examining ART patient treatment cards and ART registers in 6 publicsector health facilities in Southern Malawi. Results: There were 490 adult patients in Stage 3 who were started on ART; of whom 458 (93.5) were started due to one disease condition. Of these patients; symptomatic conditions (unexplained weight loss or chronic/intermittent fever for more than 1 month or chronic diarrhea for more than 1 month) were documented in 216 (47.2) patients; and active and previous tuberculosis in 148 (32.3) patients. There were no patients with oral hairy leukoplakia; severe mouth ulceration; or haematological abnormalities. At 6 months; 75of patients were alive on ART; 14were dead; 6were lost to follow-up and 4were transferred out. Adverse outcomes of death and lost to follow-up were more common in the group with a symptomatic condition (24.9) compared with the group with a specific disease condition (17.6) - OR 1.55 [95CI 0.95-2.53]. Conclusions: Nearly half the ART patients in Stage 3 started therapy due to a symptomatic condition; with outcomes inferior to those starting with a specific diagnosis. A better assessment of patients is needed so that serious; unrecognized diseases; forexample tuberculosis; are not missed before starting ART

Helicobacter Pylori: Ten Questions and Answers

This article answers ten questions on Helicobacter- What it is; How it was discovered; how humans become infected with the organism; how common the organism is in the population and in patients with gastro-intestinal disease etc

Helicobacter Pylori: Ten questions and answers

This article answers ten questions on Helicobacter- What it is; How it was discovered; how humans become infected with the organism; how common the organism is in the population and in patients with gastrointestinal disease etc

Unusual cause of coma

This article presents an unusual cause of coma; which after diagnosis and treatment resulted in complete recovery of the patient

Duration of sputum storage for diagnosis of tuberculosis

These two separate studies were conducted to investigate the length of time that sputum can be kept before bacilli lose their acid fast-ness

Diabetes mellitus and hypertension in Malawian adults

This study explores the relationship between diabetes mellitus which is the endocrine problem seen in the medical outpatient department and hypertension which is one of the commonest medical problems encountered in medical outpatients; and clinicians often encounter the two diseases in the same patient

Stevens-Johnson syndrome during anti-tuberculosis chemotherapy in HIV-seropositive patients: report on six cases

Hypersensitivity reactions may occur during antituberculous chemotherapy. Severe reactions are rare; and in the three years 1983-86 during which we have both worked in Africa managing large numbers of patients with tuberculosis we only saw one or two cases with severe and generalised cutaneous hypersensitivity. In the last 12 months; however; there have been a number of cases with severe Stevens-Johnson syndrome which developed during antituberculous chemotherapy and has invariably been associated with seropositivity to HIV (human immunodeficiency virus)

Clinical features in the diagnosis of peptic ulcer in Malawian adults

The predictive value of clinical features in the diagnosis of peptic ulcer diseases was studied in 104 Malawian adults (mean age 36 years) with epigastric pain who were consecutively investigated by fiber-optic endoscopy. In 40 patients with peptic ulcer and 64 with a normal investigation; clinical features with a positive predictive value greater than 50 percent included: male subject; farming occupation; cigarette smoking; alcohol consumption; episodic pain; vomiting and hematemesis. The triad of smoking plus episodic pain plus nocturnal pain gave a predictive value of 90 percent. Attention in the history to these clinical features should allow a more accurate clinical diagnosis of peptic ulcer in patients presenting with epigastric pain

Medical admissions to Kamuzu Central Hospital; Lilongwe; Malawi in 1986: comparison with admissions to Queen Elizabeth Central Hospital; Blantyre in 1973

A retrospective survey was carried out on adult medical admissions to Kamuzu Central Hospital; Lilongwe; Malawi during the period January to December 1986; and results compared with those obtained in Queen Elizabeth Central Hospital; Blantyre in 1973. There were 4700 admissions which was more than twice the number seen in Blantyre. However; the age distribution; the pattern of disease and the overall hospital mortality were similar. Infections (malaria; pneumonia; tuberculosis; gastroenteritis/dysentery and meningitis) were the most common cause of admission; and the major causes of death were still tuberculosis; pneumonia and meningitis. Smoking related diseases were uncommon; and there was no documented case of ischaemic heart disease. The reasons for the importance of periodic surveys; such as the present study; are discussed

Upper gastrointestinal bleeding in Malawian adults and value of splenomegaly in predicting source of haemorrhage

Fibreoptic endoscopy was carried out on 100 Malawian adults consecutively admitted to the department of medicine; Kamuzu Central Hospital; Lilongwe; with acute upper gastrointestinal bleeding. The principal causes of haemorrhage were oesophageal varices (45 percent ); duodenal ulcer (16 percent ); gastritis/erosions (9 percent ) and gastric ulcer (7 percent ). 69 percent of 29 patients with oesophageal varices who were investigated had S. mansoni infection. A palpable spleen positively predicted oesophageal varices in 91 percent of cases; while no palpable spleen predicted a source of haemorrhage other than varices in 97 percent of cases. In Malawi oesophageal varices are the major cause of upper gastrointestinal bleeding in adults; and the presence or absence of splenomegaly is a useful clinical pointer respectively to the presence or absence of oesophageal varices

Malaria prophylaxis amongst British residents of Lilongwe and Kasungu districts; Malawi

Questionnaires on various aspects of malaria prophylaxis were distributed to all British residents (adults and children) of Lilongwe and Kasungu districts; Malawi; and were completed and returned by 293 (response rate 89 percent ). Almost all residents used some measures to reduce mosquito contact; and 96 percent used chemoprophylaxis. Eight different chemoprophylactic regimens were used. Proguanil; alone or with chloroquine; was the most popular agent despite being associated with mouth ulcers in 25 percent of residents. Residents on this regimen had in general obtained their advice from a British source; and 75 percent considered they were adequately informed on the subject. This regimen was the most effective in preventing malaria attacks in the previous 12 months; even though over half those on proguanil alone were taking an inadequate dose. Residents on other chemoprophylactic regimens in general obtained their advice elsewhere; considered they were inadequately informed; and had a higher incidence of malaria. Whatever the regimen; 27 percent of adult residents would discontinue prophylaxis prematurely on return to the United Kingdom. Results suggest that more needs to be done to provide regular; precise and up-to-date information on malaria prophylaxis to British residents in malaria endemic areas

Massive splenomegaly in Malawi

An analysis of consecutive admissions with massive splenomegaly to KCH in Lilongwe with the aim of providing simple guidelines to diagnosis and treatment of it in Malawi

Pulmonary tuberculosis in Malawian adults: why delay in diagnosis?

A study undertaken to determine the factors which lead to long delays between the symptoms and the diagnosis of pulmonary tuberculosis which seems to occur in Malawi