Tetralogy of Fallot and HIV infection in pregnancy: A case report.

Tetralogy of Fallot (TOF) is the commonest congenital heart abnormality beyond the age of one year. Cases of Tetralogy of Fallot can present during pregnancy following successful surgical repair in childhood or occasionally as uncorrected TOF presenting for the first time during pregnancy, indeed the most frequently encountered congenital cyanotic heart lesion during pregnancy is cyanotic TOF. Most adult congenital heart disease in Africa is uncorrected due to widespread unavailability of cardiothoracic surgical services on the continent. Pregnancy is associated with significant haemodynamic alterations affecting both the systemic and pulmonary circulatory beds. These are more likely to have deleterious effects in pregnant women with underlying heart disease or with risk factors for pulmonary hypertension. We describe here the case of a 22 year old pregnant woman with acyanotic tetralogy of Fallot and HIV infection who had an uncomplicated parturition. We discuss possible reasons why this potentially fatal combination was well tolerated by the patient.

Pneumomediastinum in an HIV-infected patient with cytomegalovirus pneumonitis.

A pneumomediastinum is an unusual complication of respiratory infections in HIV-positive patients, usually reported in association with pneumocystis pneumonia. We describe a case of an HIV-positive patient with a pneumomediastinum who had cytomegalovirus pneumonitis. This is an important reminder to clinicians, since cytomegalovirus pneumonitis and pneumocystis pneumonia have a similar clinical and radiological presentation.

Renal dysfunction among anti-retroviral therapy naïve HIV infected patients in Zimbabwe.

BACKGROUND: The prevalence and determinants of renal dysfunction among HIV infected adults in the outpatient in Zimbabwe setting is unknown. OBJECTIVE: To determine the proportion of patients with evidence of renal dysfunction among anti-retroviral treatment naive HIV infected patients in a tertiary outpatient setting. DESIGN: Cross sectional study. SETTING: HIV outpatients' clinic (Family Care Centre) at Parirenyatwa hospital. SUBJECTS: 159 Anti-retroviral therapy (ART) naive HIV infected adults. METHODS: A cross-sectional study was carried out on ART-naive HIV infected willing adult participants, > or = 18 years old. WHO clinical staging was conducted on all participants. Urine was examined using urinary dipsticks and proteinuria quantification by calculating its protein: creatinine ratio. Serum creatinine and CD4 cell counts were measured. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault formula. MAIN OUTCOME MEASURES: The primary endpoint was renal dysfunction defined as CrCl < 60 ml/min. Protenuria, defined as > or = + dipstick positive and/or protein to creatinine ratio > 20 mg/mg was a secondary outcome. RESULTS: Renal dysfunction defined as CrCl < 60 ml/min was found in 7.5% [95% CI 3.4-11.7] (12/159) of the participants. Risk factors for renal dysfunction were age [OR 1.14, (95% CI 1.06-1.22)], BMI [OR 0.77 (95% CI 0.61-0.94)] andproteinuria [OR 7.45 (95% CI 1.58-35.26)]. Proteinuria was common, occurring in 45.9% of the participants. CONCLUSIONS: [corrected] A high prevalence of proteinuria (45.9%) was found in this study, while the prevalence of reduced creatinine clearance was relatively low (7.5%). Screening for proteinuria is strongly recommended in ART naive HIV infected patients and should be complemented by measurement of serum creatinine and calculation ofcreatinine clearance.