Correlation of WHO clinical staging with CD4 counts in adult HIV/AIDS patients at Kenyatta National Hospital, Nairobi.

OBJECTIVE: To determine the degree of correlation between the WHO clinical staging and CD4 T-cell counts in HIV/AIDS adults at Kenyatta National Hospital, Nairobi. DESIGN: Cross-sectional study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: One hundread and fifty two newly diagnosed HIV patients were recruited prospectively. Patients were first staged using the 2005 WHO clinical staging and then blood drawn for CD4 cell count. RESULTS: The mean age in the study was 35 years, with females comprising 52.6% of the study group. The mean CD4 counts were 455, 420, 203 and 92 for WHO Stage 1, 2, 3 and 4 respectively. The sensitivity of the WHO clinical staging to predict CD4 counts of > 350 cells/microl was 63% with a specificity of 82%. The most common HIV clinical events were bacterial infections (33%), severe weight loss (28%) and tuberculosis (27%). CONCLUSIONS: There was correlation between the WHO clinical staging and expected CD4 T-cell count. However, the sensitivity was low and missed over a third of the patients in need of HAART. Majority of the patients presented in severe disease in need of HAART at the onset of their HIV diagnosis with 107 (70.3%) of the patients with Stage 3 or 4 disease and 114 (75%) of patients with CD4 counts of < 350 cells/microl.

Clinical surprises and challenges of severe malaria at Kenyatta National Hospital, Kenya.

While conducting a clinical trial study from July, 1989 to February 1990, we noted with surprise some clinically challenging manifestations of severe falciparum malaria at Kenyatta National Hospital, Kenya. Of the 33 cases we studied, this paper summarises two fatal cases of malaria, one case presenting with hyperglycaemia and one with severe anaemia.

Quinine loading dose in severe Falciparum malaria at Kenyatta National Hospital, Kenya.

From July 1989 to February 1990, 17 non-pregnant patients with severe falciparum malaria, aged 14 years and above received an initial intravenous quinine dihydrochloride loading dose of 20 mg/kg in 500 mls of normal saline or 5% dextrose infused over 4 hours followed by 100mg/kg infused 8 hourly for at least 24 hours. Sixteen comparable controls were similarly treated but without an initial loading dose. Oral quinine bisulfate 10mg/kg 8 hourly was substituted for a total of 7 days when patients were well enough. There was no significant difference in clinical and parasitological response between the two groups. Fever clearance time in hours was 44.00 +/- 13.92 (mean +/- SD) in the study group and 51.43 +/- 19.63 (mean +/- SD) in the control group (p > 0.05). Parasite clearance time in hours was 42.40 +/- 9.75 (mean +/- SD) in the study group and 47.05 +/- 7.69 (mean +/- SD) in the control group (p > 0.05). One patient from each group died. Mild toxic effects were common in both groups. Transient partial hearing loss occurred significantly more in the study than control group (p < 0.05). Hypoglycaemia during treatment occurred in 3 (18%) patients in the study group and 1 (6%) in the control group. The mean trough and peak plasma quinine levels in 3 patients per group was persistently higher than 9mg/L after first infusion. We conclude that though fairly well tolerated, quinine loading dose appears to have no advantage over the standard treatment for severe falciparum malaria at Kenyatta National Hospital, Nairobi, Kenya.

Potassium supplementation versus bendrofluazide in mildly to moderately hypertensive Kenyans.

Eighty-four consecutive black patients who had confirmed but untreated hypertension participated in a double-blind randomized clinical trial involving potassium supplement (64 mmol/day) versus bendrofluazide (10 mg/day). Diastolic blood pressure (DBP) of the 42 patients receiving potassium supplementation (group A) decreased from a mean (+/- SD) of 108 +/- 3 to 88 +/- 4 mm Hg (p less than 0.001; paired t test) after 28 weeks of medication. DBP of the 42 patients receiving bendrofluazide (group B) decreased from a mean of 108 +/- 2 to 84 +/- 4 mm Hg (p less than 0.001; paired t test). There was no statistically significant difference between the magnitude of decrease in DBP in group A and B patients (unpaired t test). No clinical, biochemical, or ECG abnormalities occurred in group A patients. Eight group B patients showed hyperuricemia; 4 patients in the same group had hyperglycemia and 3 other patients had hypokalemia. The results support the notion that potassium supplementation may be an effective therapeutic approach to mildly hypertensive blacks.

Efficacy of Kemron (low dose oral natural human interferon alpha) in the management of HIV-1 infection and acquired immune deficiency syndrome (AIDS).

One hundred and ninety nine symptomatic and 5 asymptomatic patients seropositive for the human immunodeficiency virus type 1 (HIV-1) were treated with KEMRON, a natural human interferon alpha (nHIF alpha) stabilized in a complex polysacchariche carrier. Treatment was given for at least 10 weeks at a daily oral dose of approximately 2.0 IU of nHIF alpha per kg body weight. Karnofsky performance score increased from an average of 60.5 on entry into the study to 100 by the 10th week after treatment. Similarly, common clinical complaints associated with HIV-1 infection rapidly reduced per patient from an average of 3.8 to 0.05 and 0 by week 8 and 10 of treatment. Eighteen of the patients serodeconverted by both ELISA and western blot assays during the study period. These observations suggest that KEMRON used as recommended is beneficial in HIV-1 seropositive individuals.

Treatment of HIV infections and AIDS: new horizons.

Treatment of HIV infections has involved the use of antiviral drugs as well as those drugs that act against opportunistic infections. Immune modulators have also been used. A review of these drugs is reported emphasizing on those which have great promise in the clinical management of HIV infections in the light of our present knowledge on immunopathology of the disease.

Outcome of intervention with or without low dose oral interferon alpha in thirty-two HIV-1 seropositive patients in a referral hospital.

Thirty two critically ill patients were admitted to Kenyatta National Hospital with a diagnosis of HIV-1 seropositivity on both ELISA and Western Blot between October 1989 and January 1990. Sixteen of the patients received low dose oral interferon alpha while the other 16 patients received intensive supportive management alone. Of the 16 patients who received low dose interferon alpha, 14 were discharged from the Hospital within 2 to 4 weeks of admission in a reasonable state of health while two of the patients died after 18 and 42 days from the time of admission. All the 16 patients who received intensive supportive management alone were dead within 4 weeks of entering the Hospital, their mean (+/- SD) stay after admission being 8.6 +/- 6.8 days. These results suggest that low dose oral interferon alpha may be of value in the care of critically ill HIV-1 seropositive patients.

Low dose oral alpha-interferon therapy for patients seropositive for human immunodeficiency virus type-1 (HIV-1).

Thirty eight symptomatic and two asymptomatic patients seropositive for human immunodeficiency virus type-1 (HIV-1) were treated with a natural human interferon alpha (HuIFN alpha). Patients were given 2 IU/kg HuIFN alpha orally once daily in powdered maltose held in the mouth to promote mucosal absorption. This oral immunomodulating HuIFN alpha therapy resulted in an increase in CD4+ lymphocytes, an increase in weight, and a dramatic alleviation of clinical symptoms related to HIV-1 infection.

Efficacy and tolerability of long term oxprenolol and chlorthalidone singly and in combination in hypertensive blacks.

Sixty two black patients who had confirmed but untreated hypertension participated in a double blind clinical trial of the efficacy and tolerability of slow-release oxprenolol in a daily dose of 160 mg initially and 320 mg subsequently versus chlorthalidone 50 mg daily. Thereafter, a combination of oxprenolol with chlorthalidone in an initial dose of 160 mg and 25 mg and a subsequent dose of 320 mg and 50 mg, respectively, was administered and the effects compared with those of the same drugs given singly. The trial lasted for 3 years, but each participant took active medication for 1 year. Oxprenolol as monotherapy had no effect on the blood pressure, irrespective of the dose. Chlorthalidone as monotherapy produced a significant fall in blood pressure (p less than 0.01). Combining the 2 drugs enhanced their blood pressure lowering effects (p less than 0.001). Oxprenolol as monotherapy and as part of combination therapy was well tolerated by all patients. Chlorthalidone as monotherapy was well tolerated by most patients while a fraction of the patients developed biochemical derangements. These results confirm the findings that a beta-blocker alone may be ineffective in lowering blood pressure in hypertensive blacks. The results also show that the efficacy and tolerability of a beta-blocker and a diuretic are enhanced by their combined administration. Finally, the results show that increasing the dose of a beta-blocker or a diuretic does not produce a further increase in its blood pressure lowering effect.

Placebo-controlled trial of potassium supplements in black patients with mild essential hypertension.

Forty-eight black patients with mildly increased blood pressure (BP) that had not yet been subjected to treatment took part in a double-blind clinical trial of the efficacy and tolerability of oral potassium supplements (64 mmol daily) versus a matching placebo (made of starch with coating) in a 16-week study. Potassium supplements produced a significant decrease in mean supine and standing BP within 4 weeks after treatment inception. Urinary potassium excretion increased significantly in the 24 patients who received potassium supplements (p less than 0.001). No significant changes occurred in plasma sodium and potassium concentrations or in urinary excretion of sodium during the study. All patients completed the trial without experiencing any notable untoward effects. These results are consistent with the premise that oral potassium supplements may exert hypotensive effects of clinically significant degree in patients with mild hypertension.

Effects of chlorthalidone, oxprenolol, and their combination in hypertensive blacks: a randomized double-blind crossover study.

One hundred twenty black patients with mild to moderate essential hypertension participated in a double-blind placebo-controlled crossover study of the efficacy and tolerability of slow release oxprenolol versus chlorthalidone singly and in combination. Oxprenolol as monotherapy produced no effect on blood pressure as compared with placebo even after doubling the dose. Chlorthalidone as monotherapy produced a significant decrease in blood pressure (p less than 0.01). Combining oxprenolol with chlorthalidone yielded hypotensive effects in excess of those of either of the components given singly. Oxprenolol produced a significant decrease in plasma renin activity (PRA) whereas chlorthalidone produced a significant increase in PRA. These results indicate that a beta-blocking agent alone is ineffective in lowering blood pressure in hypertensive blacks, even when the dose is high. Oxprenolol may increase the hypotensive effect of chlorthalidone by counteracting the hypokalemic effect of the diuretic and by attenuating the diuretic-induced increase in plasma renin activity.

Body mass index in non-insulin dependent diabetics in Kenya.

Weights and heights of 674 consecutive non-insulin dependent diabetics and 358 control urban healthy Kenyans were recorded prospectively. Weights and heights of a further 162 healthy rural adults were compared retrospectively. The body mass index (weight/height2) of the non-insulin dependent diabetic was lower than that of the corresponding urban control subject. The body mass index of the rural folk was consistently lower than that of the urban dweller. This study concluded that obesity may not be a significant factor in non-insulin dependent diabetes in the African black.