ABSTRACT
In 914 consecutive medical admissions to Komfo Anokye Teaching Hospital, the prevalence of infection with Human Immunodeficiency Virus type I (HIV-I) and Human Immunodeficiency Virus type 2 (HIV-2) was 12.6%. The prevalence in females was twice that found in males. The infection rate was maximum in the age group 25-29 years for females (45%) and 30-34 years for males (29%). There were 7 cases infected with HIV-2 alone, 55 cases infected with HIV-I alone and 53 cases with dual infection. The cases with HIV-2 infection tended to be older than those with HIV-I infection. For detecting HIV seropositivity in our patients the World Health Organization recommended case definition for AIDS in Africa gave a sensitivity of 32%, a specificity of 93% and a positive predictive value of 42%. The case definition gave the highest specificity and positive predictive values when cases of tuberculosis were not included in the analysis.
PIP: During November 1989-January 1990 in Ghana, medical officers clinically examined and took blood samples from 914 consecutive admissions to Komfo Anokye Teaching Hospital in Kumasi to determine seroprevalence of HIV and different clinical features of HIV infection as well as to assess the value of the World Health Organization (WHO) clinical case definition for AIDS. 12.6% of the admissions were infected with HIV-1 and/or HIV-2. Females were more than two times likely to be infected with HIV than males (17.6% vs. 8.8%). Overall, 25-29 year old women had the highest HIV infection rate (45%). 30-34 year old men had the highest HIV infection rate among males. 56.5% of HIV-infected females and 30.4% of HIV-infected males were infected with both HIV-1 and HIV-2. 7 cases (5 females and 2 males) were infected with just HIV-2. Their ages ranged from 35 to 75 years. When the researchers applied the WHO clinical case definition to all HIV seropositive cases, they found its sensitivity to be 32%, specificity to be 93%, and positive predictive value to be 42%. Sputum-positive tuberculosis (TB) accounted for much of the false positives (28/53). 15% of the 76 sputum positive TB cases were HIV infected. When the researchers excluded all confirmed or suspected TB cases from the analysis, the specificity and positive predictive value increased to a maximum of 97% and 61%, respectively; sensitivity was 28%. Many HIV seropositive cases were not diagnosed with HIV infection either by the case definition or clinically by ward physicians. They probably were asymptomatic. Clinicians should suspect patients diagnosed with pneumonia or meningitis to be HIV infected, as was the case in this study (20% and 17% of HIV seropositive cases who were case definition negative, respectively).
