Radiological Imaging Results in HIV-Infected Patients in Mogadishu-Somalia: A Four-Year Retrospective Review

Abstract

Somalia, which is one of the countries that has been trying to integrate with the rest of the world in terms of many socio-economic parameters, including the field of health in recent years, still faces some important health problems. One of these problems is the difficulties encountered in the early diagnosis and treatment of patients with human immunodeficiency virus (HIV) infection, primarily due to social discrimination and limited treatment access. In this study, it was aimed to examine the findings detected in the radiological imaging examinations requested during the first examination in patients who were diagnosed with HIV for the first time by detecting HIV seropositivity in tests performed for different clinical reasons, and to determine the pathologies caused by advanced disease in patients who did not receive treatment. The study includes 235 patients who were diagnosed for the first time out of 269 patients with HIV confirmed by two different serological diagnostic tests during a previous comprehensive seroepidemiological study, and 14 patients with a suspicious test result for HIV infection but the presence of infection cannot be definitively proven in the absence of molecular diagnostic methods. In retrospective examinations, it was determined that 117 (49.8%) and 13 (92.9%) patients in both groups had radiological imaging (magnetic resonance imaging-MRI, computed tomography-CT, ultrasonography, and chest X-ray), respectively. While 16 of 117 HIV-infected patients had non-specific radiological findings and 53 had normal radiological findings, at least one radiological imaging of 48 patients revealed abnormal radiological imaging findings that may be associated with HIV infection. In these 48 patients, pneumonia findings in thorax CT and chest X-ray examinations, and encephalitis-related findings in patients with central nervous system involvement were the most common anomalies. In addition of these, other abnormal radiological findings included mass lesions compatible with neoplasia, lesions compatible with metastasis, lymphadenopathies, hepatosplenomegaly, and lesions indicating spleen involvement. The presence of similar findings (lesions compatible with pneumonia, encephalitis, and neoplasia) in 9 of 13 patients whose HIV infection could not be confirmed indicates that radiological tests can make significant contributions to clinical evaluations in the management of patients with suspicious laboratory results. The data we present from a region where significant obstacles are encountered in the diagnosis and follow-up of HIV infections due to the fear of discrimination (stigma) of the patients and the lack of molecular tests draw attention to the fact that many patients have advanced lesions when they are diagnosed, and this situation will have negative effects in the patient management and treatment process.