An Evaluation of Renal Care received by Human Immunodeficiency Virus(HIV) Patients admitted in a Tertiary Hospital in Sierra Leone

INTRODUCTION: The burden of HIV is on the rise and patientswith HIV are also vulnerable to renal impairment from bothacute and chronic causes. This study sets out to evaluate renalcare received by such patients.METHODS: The study was conducted at Connaught Hospital,the main tertiary hospital (for medical and surgical cases) in thecountry. A retrospective review of all admitted patients withHIV between January and December 2019. Data was collectedusing a well- structured study proforma. RESULTS: A total of 230 patients were admitted with HIV duringthe study period. The mean age of patients was 36.9 ± (11.5) years with a female preponderance of 61.3%. A vast majority ofthe patients (54.8%) could afford to do some renal investigationsand only 13.9% were seen by renal physicians; 69.1% of patientswith azotaemia died while on admission.CONCLUSION: The extent of renal care observed from thestudy was poor because the majority of the patients were notseen b y r e na l physic ia ns a nd co uld no t affor d r e na linvestigations. Also, the occurrence of renal impairment inpatients with HIV suggests a poor prognosis. WAJM 2022;39(11): 1193­1197.

Prevalence of Intestinal Parasites in HIV Seropositive Patients Attending an Integrated Counselling and Testing Centre

HIV infection is the most disastrous and invariably fatal disease. Its devastating effect is due to its relentless and eventually complete destruction of the immune system. As a result, people infected with HIV die not due to the virus itself, but rather due to plethora of opportunistic infections that characterize AIDS. Intestinal parasitic infections are a significant cause of morbidity and mortality in patients infected with HIV in which Diarrhoea is one of the most common clinical presentations.1 With this background, a prospective study was carried out to determine the prevalence of intestinal parasites in HIV seropositive patients attending an Integrated Counselling Testing Centre (ICTC) of a tertiary care hospital.METHODSA cross-sectional study was conducted in a tertiary care multispecialty teaching hospital for a period of one year. Stool specimens of 250 HIV seropositive patients above 18 years of age and belonging to all genders, were screened for intestinal parasites in the present study. The stool specimens submitted were processed using direct wet mounts, concentration technique of formol ether, sedimentation and saturated common salt solution, and permanent staining techniques using Modified Acid-Fast staining, Trichrome staining and Modified Trichrome staining methods.RESULTSThe prevalence of intestinal parasites in HIV seropositive patients was found to be 27.6% (69/250). Protozoan parasites were predominant and were detected in 81.15% (56/69), followed by intestinal helminths in 11.59% (8/69) and coccidian parasites in 7.24% (5/69).CONCLUSIONSIntestinal parasites are a common source of infection in HIV seropositive patients. These patients are a threat not only to themselves but also to others in the community as well. Hence routine screening of all HIV seropositive patients is a must in order to prevent and reduce morbidity and mortality in the community.

Isolation of Candida albicans among HIV Patients Presenting with Oral Thrush in Abuja, Nigeria

Background: Candida infections are known contributors to the high morbidity and mortality rates seen in HIV positive patients.Methodology: This was a descriptive cross-sectional study. The study was carried out at the Microbiology research laboratory, department of Medical Microbiology, University of Abuja Teaching Hospital, Gwagwalada. The population is made up of two hundred and ten (210) patients who presented with oral thrush between fifteen years and seventy years which comprises of 160 HIV seropositive and 50 non age and sex matched HIV seronegative patients. Culture, Microscopy and ELISA methods were used for isolation of Candida albicans. An interviewer-administered, structured questionnaire was used as the study tool Results: The mean age for the isolation of Candida albicanswas 30 ± 18.7 years, with the highest proportion of isolates within the age range of 21-30 years accounting for 27.1% of the study population recruited and the lowest proportion of isolates being 41-50 years accounting for 8.0%.From the 210 subjects withCandida albicansin the study, one hundred and sixty (160) representing 76.2 were isolated from HIV seropositive clients and Candida albicansisolation rate among HIV seronegative population was 23.8%.Conclusion: The sensitivity, specificity and positivepredictive value of using Grams reaction methods in the diagnosis of Candida albicanswas 22.9%, 95.2% and 82.6%. The sensitivity, specificity and positive predictive value of using ELISA methods was 25.7%, 86.7% and 65.9%.In this study, there was preponderance of Candida albicansisolate among the young and the old in HIV seropositive patients but largely isolated from older patients among HIV seronegative patients

A comparative study of methods of Pneumocystis Jiroveci pneumonia in HIV patients with CD4 count less than 200 and the clinical outcome in tertiary care hospital

Background: Pneumocystosis is an opportunistic fungal infection of the respiratory system leading to interstitial plasma cell pneumonia, caused by a taxonomically unique fungus Pneumocystis jiroveci. Major developmental stages of the organism include the small (1 to 4 μm) pleomorphic trophozoite or trophic form; the 5 to 8 μm cyst, which has a thick cell wall and contains up to eight intra cystic bodies; and the precyst, an intermediate stage. The life cycle of P. jiroveci probably involves asexual replication by the trophic form and sexual reproduction by the cyst, which ends in the release of the intra cystic bodies an intracellular stage has not been identified. Aim of study: Comparing the role of clinical diagnosis, chest radiography, sputum microscopy and polymerase chain reaction for Pneumocystis jiroveci Pneumonia in HIV seropositive patients with CD4 less than 200, to know the clinical outcome of PCP patients after treatment. 151 HIV seropositive patients were recruited for study as per inclusion criteria. Materials and methods: The study was conducted in the Department of TB and Chest Medicine, Government Stanley Medical College, Chennai from 2016-2017. Thorough clinical examination G. Allwyn Vijay, S.B. Sivaraja. A comparative study of methods of Pneumocystis Jiroveci pneumonia in HIV patients with CD4 count less than 200 and the clinical outcome in tertiary care hospital. IAIM, 2019; 6(3): 148-155. Page 149 including general and systemic examination was done meticulously with vital signs monitoring and SpO2 was measured with pulse oximetry. Results: Out of 151 HIV seropositive patients examined clinically, 81 individuals were diagnosed as PCP patients. But the sputum microscopy with Gomori methenamine silver staining which was taken as gold standard test, diagnosed 41 cases of PCP only. PCR was positive in 2 more patients who were missed in GMS staining. Sputum PCR was having the highest sensitivity (100%), highest specificity (97%), highest positive predictive value (93%) and also the highest negative predictive value (100%). Among 90 PCP patients diagnosed clinically, 74 of 90 (82.2%) patients recovered from the illness after treatment and 16 of 90 (17.8%) patients died due to illness. Conclusion: As revealed in our study, induced sputum analysis is a simple procedure, without significant adverse effects, and with a good diagnostic yield for P. jiroveci pneumonia determination in HIV-positive patients. IFAT is very sensitive and specific, though the expensive method for the detection of this organism.

Association between serum B12 and folate levels and manifestations of oral lesions in HIV adult patients

@#Introduction: Micronutrient deficiencies are common in Human Immunodeficiency Virus (HIV) infection. The long-term side effects of antiretroviral therapy (ART), specifically Azidothymine (AZT), include low serum levels of vitamin B12 and folate, which in turn, lead to megaloblastic anaemia and oral lesions. Methods: A crosssectional study was conducted to determine the associations between manifestation of oral lesions and serum vitamin B12 and folate levels in HIV-adult patients with or without receiving ART therapy. Oral lesions were determined based on the ECClearinghouse diagnostic criteria. Serum vitamin B12 and folate were assessed by electrochemiluminescence immunoassay (ECLIA). Sixty participants (48 males and 12 females) aged 20 to 51 years were recruited from a private hospital in Bandung, Indonesia. Results: Subnormal levels of serum vitamin B12 and folate were found in 16.6% and 6.7% HIV patients, respectively. Significantly lower serum levels of vitamin B12 and folate were shown in HIV patients receiving ART than those without ART. Oral lesions were found in all the participants with subnormal levels of serum vitamin B12 and folate. Presence of oral lesions was significantly associated with low levels of serum vitamin B12 in HIV patients with ART, but not with low folate levels. Conclusion: Low levels of serum vitamin B12 and folate were shown in HIV patients, indicating the need for early nutritional intervention to ensure optimal nutritional status and prevention of oral lesions in HIV patients.

Evaluation of the effects of passion fruit peel flour (Passiflora edulis fo. flavicarpa) on metabolic changes in HIV patients with lipodystrophy syndrome secondary to antiretroviral therapy

ABSTRACT This study evaluated the effects of using passion fruit peel flour together with diet therapy and counseling in 36 patients with HIV lipodystrophy who were in an ambulatory clinic in a university hospital. The patients were divided into two groups. One received 30 g of passion fruit peel flour daily for 90 days and diet therapy counseling. The other group received only diet therapy counseling. The metabolic changes were analyzed before and after the intervention, with a significance level predetermined at p ≤ 0.05. The use of passion fruit peel flour was effective in reducing total cholesterol and triacylglycerides after 30 days. The concentrations of LDL-C decreased, while HDL-C increased in the blood of lipodystrophy patients after 90 days passion fruit peel flour treatment. No significant differences in food consumption were seen between groups. The use of 30 g of passion fruit peel flour for 90 days together with diet therapy counseling was effective in improving plasma concentrations of total cholesterol, LDL-C, HDL-C and triacylglycerides.

Study Of Sociodemographic & Clinical Features Of Tuberculosis Cases In HIV Patients.

Background: Infection with HIV is the most potent risk factor for progression to active tuberculosis. Mycobacterium tuberculosis only have an approximately 10% lifetime risk of developing TB compared with 60% or more in persons infected with HIV and TB. Methodology: 100 HIV infected patients having symptoms of Tuberculosis were taken up for the study for a period of 18 months, meeting the criteria for the present study. Diagnosis of tuberculosis was based on clinical evaluation, sputum smear. Results: 100 HIV patients studied for period of 18 months . Majority of patients were in the age group of 30-41 years. 64% were males and 36% females. Labourers are commonly affected. Common presenting symptoms were fever(74%) cough (72%) and weight loss(62%). Associated clinical findings were pallor(63%), (12%) and oral thrush(14%). Pulmonary TB (69%) is the most common form. Conclusion: Majority of patients were in the age group of 30-41 years, 64% were males 36% females. Most common occupation affected was labourers. Fever (74%), cough (72%) and weight loss (62%), pallor (63%), lymphadenopathy (12%) and oral thrush (14%). Most common form of tuberculosis was pulmonary TB (69%). Among extra pulmonary tuberculosis pleural effusion (8%) was the most common presentation.

Molecular analysis of methicillin-resistant Staphylococcus aureus dissemination among healthcare professionals and/or HIV patients from a tertiary hospital

Abstract INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen in community settings. MRSA colonized individuals may contribute to its dissemination; the risk of MRSA infection is increased in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients, although the prevalence of colonization in this group is not well established. The present study addressed this issue by characterizing MRSA isolates from HIV/AIDS patients and their healthcare providers (HCPs) to determine whether transmission occurred between these two populations. METHODS: A total of 24 MRSA isolates from HIV-infected patients and five from HCPs were collected between August 2011 and May 2013. Susceptibility to currently available antimicrobials was determined. Epidemiological typing was carried out by pulsed-field gel electrophoresis, multilocus sequence typing, and Staphylococcus cassette chromosome (SCCmec) typing. The presence of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) and heterogeneous daptomycin-resistant Staphylococcus aureus (hDRSA) was confirmed by population analysis profile. Isolates characterized in this study were also compared to isolates from 2009 obtained from patients at the same hospital. RESULTS: A variety of lineages were found among patients, including ST5-SCCmecII and ST30-SCCmecIV. Two isolates were Panton-Valentine leukocidin-positive, and hVISA and hDRSA were detected. MRSA isolates from two HCPs were not related to those from HIV/AIDS patients, but clustered with archived MRSA from 2009 with no known relationship to the current study population. CONCLUSIONS: ST105-SCCmecII clones that colonized professionals in 2011 and 2012 were already circulating among patients in 2009, but there is no evidence that these clones spread to or between HIV/AIDS patients up to the 7th day of their hospitalization.

Occult hepatitis B virus infection in Moroccan HIV infected patients.

Background: The purpose of this study is to assess the prevalence of Occult hepatitis B virus Infection (OBI) among antiretroviral treatment naïve HIV-1 infected individuals in Morocco and to determine factors favouring its occurrence. Methods: The retrospective study was conducted in the Mohammed V military teaching hospital in Rabat between January 2010 and June 2011. It included patients with confirmed HIV infection, tested negative to serological detection of HBV surface antigen (HBsAg) and did not received antiviral treatment or hepatitis B vaccine. All samples were tested for anti-HBc, anti-HBs and anti-HCV antibodies using enzyme immunoassay (ELISA). The detection of HBV DNA was performed by real-time PCR using two specific primers for a gene in the region C of the viral genome. The sensitivity of the technique was 20 copies/ml. Results: A total of 82 samples were analyzed, 19 (23 %) were found to have isolated anti-HBc, 07 (8.5%) with associated anti-HBc and Anti-HBs. No anti-HCV marker was detected on these screening samples. The HBV DNA was detected in 48 (58%) samples, of which, males constituted 58% (28/48). The mean age of these patients was 38 ± 8.2 (29-56), the median HIV-1 viral load and CD4 cell count HIV-1 infected patients were 127500 (54108-325325) copies/ml and 243 [80-385] cells/mm3 respectively and 27.1% (13/48) of these patients were found to have isolated anti-HBc. A significant correlations between DNA HBV and HIV viral load higher than 100000 copies/ml (P = 0.004), CD4 cell count lower than 400 cells/mm3 (P = 0.013, P = 0.006) and isolated anti-HBc samples (P <0.005) were founded. However there was no significant association with age, sex, transmission mode and clinical stage. Conclusion: The consequences of this high prevalence of OBI in Morocco need to be considered in laboratory diagnosis of HBV infection in HIV infected patients and the PCR seems to be inevitable for a better diagnosis and therapy.