Hospitalised HIV Infected Patients Research Articles

Frequency of Aids Defining Opportunistic Infections in Hospitalized HIV Infected Patients

Background: Human Immunodeficiency virus patients with AIDS defined opportunistic infections with Pneumocystis jiroveci, cryptoccocal, disseminated TB, cytomegalovirus, and cytomegalovirus associated retinitis, and cryptospordiasis.
 Objective: To determine the frequency of AIDS defining opportunistic infections in hospitalized HIV infected patients.
 Methodology: This cross sectional study was conducted from 21st October 2018 to 20th April 2019 at Department of Medicine, Civil Hospital, Karachi. Total 154 diagnosed patients of HIV were included. For diagnosis of various AIDS defining illness, clinical, radiological and bacteriological evidence of disseminated tuberculosis chronic cough, and weight loss diagnosed by AFB smear/ gene experts. Pneumocystis jiroveci was diagnosed by bronchoalveolar lavage and CD4 counts. Cryptosporidiosis with watery diarrhea and stool sample microscopy, cerebral toxoplasmosis with headache, hemiparesis, vomiting, diagnosed by serology and cytomegalovirus retinitis with blurred vision diplopia, vision impairment and Cryptococcal meningitis with fever >98.6oF. Headache, stiff neck, photophobia diagnosed by microscopy, culture, or antigen was done. Descriptive statistics were calculated and stratification was done. Post stratification chi square test was applied. P value ≤0.05 was taken as significant.
 Results: There were 71.4% male and 28.6% female patient. The mean HIV duration was 15.25±5.09 months. The overall mean CD4 count was 174.17±12.85/cumm. 18.8% patient were found with disseminated tuberculosis, 31.2% with pneumocystis pneumonia, 12.3% with cerebral toxoplasmosis, 18.2% with cryptococcal meningitis, 3.9% with cryptospordiasis and 14.9% with cytomegalovirus retinitis.
 Conclusion: Pneumocystis pneumonia was the most prevalent infection followed by disseminated tuberculosis, cryptococcal meningitis, cytomegalovirus retinitis, cerebral toxoplasmosis, and cryptospordiasis.

Prevalence of renal dysfuntion among Hiv paediatric children attending DRRH

IntroductionWHO estimates 36.7 million people were living with HIV worldwide in 2016, of these 2.1 million (6%) were children under 15 years of age in 2015. Renal complications are important component of advanced HIV disease. About 30% of people with HIV may have kidney disease (UNSAID). Kidney disease is an important complication in HIV-infected individuals and is associated with an increased rise of morbidity and mortality. There are many factors for kidney disease in HIV infection include: African descent, female gender, older age, elevated creatinine, low CD4 counts, high viral load, prolong use of ART, nephrotoxic drugs and comorbidity. All of these factors had impacts on short and long-term prognosis of the patient with HIV. MethodologyIn this cross-sectional analytical study, we studied children including all children aged less than 17 years, infected with HIV, attending the pediatric HIV clinics at Dodoma regional referred hospital and Makole HIV clinic within Dodoma town. Demographics and clinical data were obtained by parental interview, clinical and laboratory assessments, and patient's files. Blood and urine samples and anthropometric data were obtained from each of the study participants. The serum creatinine levels were estimated and used in calculating eGFR.Renal dysfunction was defined as the presence of significant proteinuria of ≥1+ on dipstick and/or GFR <60 mL/min/1.73m2. An eGFR was calculated using modified bedside “Schwartz equation”. ResultsOf the 236 children recruited, 124 were males and 112 were females. The mean age of the children was 5.5 ± 3.5 years. All the children were on ART and majority were on treatment for less than 5 years. The overall prevalence of renal dysfunction among HIV infected children was 56%, with is statistically significant proteinuria, low CD4 and high viral load among the participant. The routine laboratory measurements like Serum creatinine and proteinuria, has played a significant role in recognizing the patients with early renal involvement. In view of the high prevalence of renal dysfunction among hospitalized HIV infected patients, it is recommended to use serum creatinine and urine deep-stick for proteinuria as routine screening tests in those who are HIV positive.

Trends in Hospitalization for Human Immunodeficiency Virus in a Tertiary Hospital in Dar es Salaam, Tanzania: A Case study

Background:Reports on systematic evaluation of the impact of antiretroviral therapy(ART) on patients' hospitalisation in Sub Saharan Africa (SSA) and Tanzania in particular are scarce. We aimed at documenting the trends of hospital admissions at Muhimbili National Hospital (MNH) following scale up of free access to ART in Tanzania.Methods:Records for all admissions at MNH from June 2005 to June 2015 were reviewed. We extracted data from Hospital Information Management System as well as from patients' charts. Data extracted included diagnosis at discharge, reason for admission and thereafter assessed admission trends over the decade. We summarised the data as frequency and percentages. We compared proportions using Chi squared test, P<0.05 was deemed significant.Results:Overall there were 209,101 admissions during the study period (June 2005 to June 2015) and 7864/209,101 (3.8%) were due to HIV infection. Whereas 598/4,519 (13.2%) of all admissions in 2005 were due to HIV, only 345/13,119 (2.6%) of admissions in 2015 were HIV-related; showing a significant drop over time (P value for trend < .001). Generally, females 3887/6679 (58.2%) were more likely to be admitted than males (41.8%). Median CD4 count for admitted HIV patients was 143 cells/µl. Majority of admissions occured in the medical wards 3643/5310 (68.6%). Discharge diagnoses were Tuberculosis 1396/6482 (21.5%), anaemias 1016/6482 (15.6 %), malignancies 789/6482(12.2%), CNS infections 541/6482 (8.3%) and chronic kidney disease 308/6482 (4.8%). Three leading AIDS defining malignancies among hospitalised patients included Kaposi's sarcoma 380/789 (48.2%), carcinoma of the cervix 77/789 (9.8%), and Non-Hodgkin's lymphoma 44/789 (5.6%).Conclusion:Despite drastic drop of HIV related admissions at Muhimbili National Hospital over the years, the infection remains a problem of the adults, largely females suffering from medical conditions and presenting with severe immunosuppression. Tuberculosis remained the most common opportunistic infection among hospitalized HIV infected patients. Anaemia and cancers became more important causes of admission than was diarrhoea which had been the most common among HIV infected patients in pre- ART era.

Higher serum 25-hydroxyvitamin D concentrations are associated with active pulmonary tuberculosis in hospitalised HIV infected patients in a low income tropical setting: a cross sectional study

BackgroundThe inherent risk of developing tuberculosis (TB) in HIV- infected individuals is further enhanced by hypovitaminosis D. Interventions that offset HIV-associated immune deterioration potentially arrest disease progression and incidence of opportunistic infections including TB. Despite conflicting reports on association between vitamin D deficiency (VDD) and risk of TB, vitamin D (VD) supplementation remains a promising intervention.MethodsWe conducted a comparative cross-sectional study on 145 HIV+/pulmonary TB+ (PTB) and 139 HIV+/PTB− hospitalised patients to investigate association of vitamin D status and risk of PTB. Stratified random sampling was used to select archived serum specimens from participants enrolled in a randomised controlled trial (RCT) conducted to investigate the impact of using a point-of-care urine lipoarabinomannan strip test for TB diagnosis. PTB status was confirmed using sputum smear microscopy, culture or GeneXpert MTB/RIF. Serum 25-hydroxyvitamin D [25(OH) D] concentrations were assayed by competitive chemiluminescent immunoassay prior to commencement of anti-TB treatment. Effect of VD status on duration of hospital stay and patient outcomes on follow up at 8 weeks were also investigated. Median serum 25(OH) D concentrations were compared using Mann-Whitney test and covariates of serum VD status were assessed using logistic regression analysis.ResultsOverall VDD prevalence in the cohort was 40.9% (95% CI: 35.1–46.8). Median serum 25(OH)D concentrations were significantly higher in HIV+/PTB+ group (25.3 ng/ml, IQR:18.0–33.7) compared to the HIV+/PTB− group (20.4 ng/ml, IQR:14.6–26.9), p = 0.0003. Patients with serum 25(OH) D concentration ≥ 30 ng/ml were 1.9 times more likely to be PTB+ compared to those with serum 25(OH) D concentrations < 30 ng/ml (odds ratio (OR) 1.91; 95% CI 1.1–3.2). PTB-related death was associated with higher odds of having 25(OH) D levels≥30 ng/ml. Age, gender, CD4+ count, combination antiretroviral therapy (cART) status, efavirenz based cART regimen and length of hospital stay were not associated with vitamin D status.ConclusionsThe finding of an association between higher serum 25(OH) D concentrations and active PTB and TB-related mortality among hospitalised HIV-infected patients in the present study is at variance with the commonly reported association of hypovitaminosis and susceptibility to TB. Our findings though, are in concordance with a small pool of reports from other settings.

HIV infection and tuberculosis comorbidity: what is the cause of death?

The aim . The purpose of this study was to analyze causes of deaths of hospitalised HIV infected patients with tuberculosis. Methods . Medical reports of patients with tuberculosis who died in a specialized hospital of Samara city in 2013 were analyzed using the total sampling method. Results . Ninety per cent of deaths in hospitalised HIV infected TB patients were caused by end stage AIDS with the high proportion (82%) of miliary tuberculosis, involvement of multiple organs (53%) and drug dependence (88%). Conclusion . Improving interaction of TB specialists and experts on HIV infec tion is needed to improve statistic analysis of morbidity of and mortality from tuberculosis and to reduce mortality from these comorbid diseases.

Screening of kidney disease in HIV infected hospitalised patients

Objectives: To study the renal disease in newly diagnosed HIV infected hospitalized patients and to look for possible correlation of CD4 count with prevalence of renal disease. Materials and Methods: The prospective study was conducted in Department of Medicine/Endocrinology in tertiary care health center in western U.P during the study period of one year. The patients were evaluated clinically and biochemically after obtaining the informed consent. Result: The study was conducted on 100 HIV/AIDS patients, out of which 68 (68%) were males and 32 (32%) females with a Highest incidence of HIV/AIDS (51%) in the age group of 25-35 years. Microalbuminuria was present in 20 (20%) HIV patients with majority (60%) being in the age group 25-35 years. Prevalence of microalbuminuria among males was 55% and among females 45%. Microalbuminuria was further evaluated by calculating the ratio of microalbumin to urinary creatinine, 83% patient had ratio &gt;10 mg/mmol and 17% had this ratio &lt;10 mg/mmol. The ratio of microalbumin to urinary creatinine &gt;10 mg/mmol was 60% in age 25-35 year, 25% in the age group of 36-45 year followed by 15% in the age group of 45-55 year patients. Chi-square test was used to calculate the significance of the correlation between CD4 counts with the presence of microalbuminuria in HIV patients. There was a significant correlation between CD4 count &lt;200/μL and presence of microalbuminuria (p =0006). Statistically significant proteinuria (30-300 mg/24 hour) was found in 15 patients with CD4 count &lt;200/μL of those patients found positive for microalbuminuria. Protein/ creatinine ratio was &lt;0.2 in 18 patients, 2 had ratio in the range of 0.2-3.5 and none in the nephrotic range (&gt;3.5). Conclusion: Study evaluation shows that there is statistically significant microalbuminuria in HIV/AIDS infected patients and this is more prevalent in patients with CD4 count &lt;200/μL as compared to patients with CD4 count &gt;200/μL in keeping with previous studies. The routine laboratory measurements like serum creatinine and proteinuria fail to recognize the patients with early renal involvement. In view of the high prevalence of renal dysfunction among hospitalized HIV infected patients, it is recommended to use microalbuminuria as routine screening tests in those who are HIV positive. DOI: http://dx.doi.org/10.3126/ajms.v6i3.11376 Asian Journal of Medical Sciences Vol.6(3) 2015 58-62

Neurological disorders in hospitalized HIV infected patients: Experience from a European Central Hospital

Neurological disorders in hospitalized HIV infected patients: Experience from a European Central Hospital

Prevalence and Factors Associated with Renal Dysfunction in HIV Positive and Negative Adults at the University Teaching Hospital, in Lusaka.

Despite having the highest disease burden of HIV, Sub-Saharan Africa has limited data on HIV related kidney disease with most available data coming from the developed countries. Kidney disease is a recognised complication in HIV infected patients presenting with acute renal failure (ARF) or chronic kidney disease (CKD). This study investigated the prevalence and risk factors associated with renal dysfunction among hospitalised HIV infected patients at the University Teaching Hospital (UTH), Lusaka. We conducted a cross sectional study at the University Teaching Hospital Lusaka, in Zambia. Inclusion criteria were hospitalised patients aged 16years and above who consented to the study. Both HIV infected and uninfected patients were included in the study. After obtaining demographic information, study participants were screened for HIV upon their consenting for the test. A full clinical history and examination was done by study physician to determine factors associated with renal dysfunction. Of the 300 recruited hospitalised patients in this cross sectional study, 142(47%) were HIV infected. We observed a high prevalence of renal dysfunction among hospitalised HIV infected patients compared to uninfected patients (42% vs. 27%, adjusted OR 1.99, 95% CI 1.20-3.28). They had a twofold increased likelihood of developing kidney dysfunction (OR 1.96,95 CI%; 1.21-3.17). The presence of vomiting was strongly associated with renal dysfunction in both HIV positive (AOR 7.77, 95% CI 2.46-24-53) and negative (AOR4.83, 95%CI 1.40-16.66) subgroups. WHO stage III was associated with renal dysfunction in HIV infected patients. Tenofovir use, (a first line antiretroviral drug in Zambia) and hypotension were not significant factors associated with kidney disease after adjusting for other clinical parameters. Renal dysfunction is significantly higher among hospitalised HIV infected compared to uninfected, however tenofovir and hypotension were not associated with renal dysfunction.

Pneumocystis colonisation is common among hospitalised HIV infected patients with non-Pneumocystis pneumonia

Pneumocystis colonisation is common among hospitalised HIV infected patients with non-Pneumocystis pneumonia

Pneumocystis colonisation is common among hospitalised HIV infected patients with non-Pneumocystis pneumonia

Background:When Pneumocystis DNA is recovered from respiratory specimens of patients without Pneumocystis pneumonia (PCP), patients are said to be colonised with Pneumocystis, although the significance of this state is unknown....

Bacterial infections in hospitalized HIV patients

A prospective screening of 473 hospitalized HIV infected patients gave 253 bacterial infections in 169 patients. Pneumonia was the most frequent infection (n=106). Infections were documented in 111/253 (44%) episodes. The most frequent isolated pathogens were Staphylococcus sp. (n=25), Pseudomonas aeruginosa (n=21), Escherichia coli (n=20), and Streptococcus pneumoniae (n=18). Factors associated with infections were: intravenous drug use (RR: 1.38; 95% CI: 1.07–1.77, p<0.004), CD4<100 (RR: 1.39; 95% CI: 1.09–1.64, p<0.007), and previous AIDS (RR: 1.43; 95% CI: 1.1–1.867, p<0.002). However, IV drug use (RR 1.8; 95% CI 1.31–2.46, p<10−3) was the only significant factor for community acquired infections while CD4<100 (RR 4.54; 95% CI: 1.86–11.07, p<10−3) and AIDS (RR 4.71, 95% CI 2.05–10.85, p<10−4) were significant only for nosocomial infections. We conclude that the main risk factors for community acquired and nosocomial infections are intravenous drug use and AIDS, respectively. Les infections bactériennes ont été évaluées prospectivement chez 473 patients hospitalisés infectés par le VIH dont 169 ont présenté 253 infections. Le site pulmonaire était le plus souvent en cause (n=106). Une documentation bactériologique a été obtenue dans 111/253 (44%) épisodes. Les pathogènes le plus souvent isolés étaient: Staphylococcus sp. (n=25), Pseudomonas aeruginosa (n=21), Escherichia coli (n=20) et Streptococcus pneumoniae (n=18). Les facteurs associés à la présence d'une infection bactérienne étaient: la toxicomanie intraveineuse (RR: 1,38; IC95: 1,07–1,77, p<0.004), des CD4<100 (RR: 1,39; IC95: 1,09–1,64, p<0.007), et un SIDA (RR: 1,43; IC95: 1,1–1,86, p<0.002). La toxicomanie intraveineuse était le seul facteur restant significatif pour les infections communautaires (RR 1,8; IC95: 1,31–2,46, p<10−3) alors que le taux de CD4 (RR 4,54; IC95: 1,86–11,07, p<10−3) et le stade SIDA (RR 4,71 IC95: 2,05–10,85, p<10−4) n'étaient significatifs que pour les infections nosocomiales. La toxicomanie intraveineuse est ainsi le principal facteur de risque d'infection bactérienne communautaire et le SIDA le principal facteur de risque d'infection nosocomiale.

P.44 Total parenteral nutrition in hospitalizedHIV-infected patients

P.44 Total parenteral nutrition in hospitalizedHIV-infected patients