Patients Attending HIV Clinics Research Articles

Sex Differences in Response to Antiretroviral Therapy Among People Living With HIV/Aids Attending Art Clinic in Federal Medical Centre, Abuja

To assess gender differences in response to antiretroviral therapy among people living with HIV/AIDS attending ART Clinic in Federal Medical Center (FMC), Abuja. A retrospective cross-sectional study was conducted among 595 HIV-positive adult patients attending HIV clinic in FMC Abuja between January 2021 and December 2022. Data was retrieved from the database of ART Clinic, FMC Abuja, for patients who have been on TDF/3TC/DTG regimen for at least six months before viral load testing. A total of 1,150 registered People Living with HIV Aids (PLWHA) received care between January 2021 and December 2022 in FMC Abuja. Only 595 had viral load test within the study period, comprising of 205 (34%) males and 390 (66%) females in a ratio of 1:1.9. The viral load of the study participants ranged from 0 to 3,970,000.00 copies/ml with a standard deviation of 310,099.63 copies/ml. 571 (96%) of the total study participants had viral load less than 1,000 copies/ml, and 200 (35%) of them were males whereas 371 (65%) were females. The remaining 24 (4%) of the study participants who had viral load greater than 1,000 copies/ml were 8 (34%) males and 16 (66%) females. The dif-ferences in the means of viral load between males and females were not statistically significant, with a p-value of 0.054. This study found a very high viral suppression and females were equally virally suppressed as the males.

Obesity Defining Criteria, and Association with Cardiovascular Disease Risk Factors Among People Living with HIV in Jos, Nigeria.

Obesity is linked to non-communicable conditions. We looked at obesity using four definable criteria and their relationship to biochemical and inflammatory indicators of cardiovascular diseases (CVDs) in people living with HIV (PLHIV). This cross-sectional study involved 140 randomly selected HIV-infected patients attending HIV clinics at the Jos University Teaching Hospital and Faith Alive Foundation in Jos, Nigeria. Anthropometric measurements such as height, weight, waist circumference, and hip circumference were taken to identify those with obesity. Fasting plasma glucose, lipid profile, High-sensitivity CRP (hsCRP), and HIV-related markers were evaluated. The mean (SD) age of the participants was 42.5 (8.8) years, and the majority (71.4%) were females. The prevalence of Obesity based on Body-Mass-Index (BMI), International Diabetes Federation (IDF), Adult Treatment Panel (ATP), and Waist-Hip-Ratio (WHR) criteria were 18.6%, 50.7% 34.3%, and 45.7% respectively. Obesity concordance among the criteria for obesity was highest between IDF and ATP (Kappa= 0.673, p<0.001); and least between BMI vs WHR (Kappa= 0.124, p<0.073). Only 9.3% had obesity by all 4 criteria. BMI was independently associated with hypertension but not glycaemic status nor dyslipidaemia while Obesity by WHR was significantly associated with hypertension and dyslipidaemia, after adjusting for age and sex. There was no significant association between Obesity by all the criteria and HIV-related parameters such as duration of HIV infection, Antiretroviral (ARV) use, and CD4 counts (p>0.05). Our study urges a unified assessment of obesity and a more prominent use of parameters of central obesity, for assessing cardiovascular risk in PLHIV.

Incidence of Tuberculosis in HIV Sero-positive Patients at HIV Clinic at Kampala International University Teaching Hospital, Bushenyi District

This study on the prevalence of TB among HIV sero-positive was carried at the HIV CLINIC of Kampala International University Teaching Hospital (KIUTH), Ishaka Bushenyi district. A retrospective cross-sectional study design was used to conduct this research. The study targeted all patients attending KIUTH HIV/TB clinic. A standard structured and semistructured questionnaires were designed and pre-tested for validity and reliability at Kampala International University Teaching Hospital HIV/Tuberculosis clinic before being used for data collection. Data collection started by recruitment of qualified research assistants, appropriate training and orientation of the interviewers before the survey for example when reading the questions. Quantitative methods of data analysis was used in which data was presented in form of bar charts, graphs and tables. The prevalence of TB among HIV sero-positive patients attending HIV clinic at KIUTH stands at 8.06 per 100 participants. The study found that generally, people are aware about the modes of transmission of TB but there is still need for more awareness. Many patients are still not certain whether TB is curable in HIV patients. As seen from the above study, most of the people are not yet aware whether HIV goes hand in hand with tuberculosis. The prevalence of TB in HIV sero-positive attending HIV clinic at KIUTH is high. Generally, TB is affecting patients of all ages and most patients are still not aware if TB in HIV is curable. Most patients have a perception that all TB patients have HIV. Health workers in HIV clinic of KIU-TH should teach patients the modes of transmission and prevention of TB. KIUTH also need to provide easy access to TB screening services to patients. There is need for financial support by the government to the unemployed patients and low-income earners in order to curb TB infections. Keywords: Tuberculosis, HIV, Sero-positive, Bushenyi District

Hypertension and associated factors among patients attending HIV clinic at Korle-Bu Teaching Hospital.

This study determined the prevalence of hypertension and its associated factors among patients attending the HIV clinic at the Korle-Bu Teaching Hospital (KBTH). A hospital-based cross-sectional study was conducted at KBTH. The prevalence of hypertension was estimated among study participants, and socio-demographic, lifestyle, anthropometric, metabolic and HIV/ART-related factors associated with hypertension were determined by logistic regression modelling. Study participants were recruited from the HIV clinic at the KBTH. A total of 311 Persons Living with HIV were recruited as study participants. Simple random sampling technique was used to recruit study participants. A questionnaire adapted from the WHO STEPwise approach to chronic disease risk-factor surveillance was used to collect study participants' data. The prevalence of hypertension was 36.7%, and the factors associated with hypertension were increasing age, positive family history of hypertension, minimal exercising, current BMI ≥25.0 kg/m2, total cholesterol level ≥5.17 mmol/L, exposure to anti-retroviral therapy (ART) and increasing duration of ART exposure. This study shows a high prevalence of hypertension among patients attending the HIV clinic at KBTH, associated with exposure to ART and increasing duration of this exposure. Blood pressure monitoring should move from routine to a more purposeful screening of patients for hypertension. Patients with the identified risk factors should be encouraged to have regular blood pressure measurements at home and not only when they visit the HIV clinic. Office of Research, Innovation and Development (ORID) of the University of Ghana. The funding agency was not involved in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Occurrence of Malaria in HIV/AIDS Patients at Ishaka Adventist Hospital, Bushenyi District, Uganda.

The study assessed the prevalence of malaria in HIV/AIDS patients attending HIV clinic at Ishaka Adventist Hospital, the study objectives were to determine the proportion of HIV patients with malaria, to identify the clinical manifestations of malaria among HIV positive patients and to review different techniques used in diagnosis of malaria at Ishaka Adventist Hospital in Bushenyi district. A descriptive cross sectional study was used for known HIV positive patients attending Ishaka Adventist Hospital and involved systematic random sampling of participants. The study found out that malaria prevalence was high among HIV patients at 9.8%, nearly all patients who were diagonised with malaria reported having had fever previously 87.1% , the presentation of malaria can better be assesed as uncomplicated malaria and complicated malaria and in this study majority of the signs assessed were of uncomplicated malaria, diagnostic measures of laboratory remain the most perfect way of diagnosing malaria other than clinical assessment especially in HIV patients who are immunocompromised nd can be ill of various oppotunistic infection. Although various methods have been advanced to curb malaria epidemic , the prevalence is still high, so the the following are recommendation; the government should distribute more mosquito nets especially those whoare immunocompromissed like HIV patients, agencies for fighting malaria and those of HIV should work together inorder to reduce the number of HIV patients getting malaria infection, patients should be health educated on the main signs and symptoms of malaria such that they can quickly seek medical attention incase of the need, patients should be encouraged to take their ARVs to maintain their immunity relatively high so that they are not severely affected by malaria. Keywords: Ishaka, Adventist Hospital, Malaria, Immunocompromised, Infection.

Psychological and stigma profiles of HIV patients in a North-Central city of Nigeria.

ABSTRACTBackground:The World Health Organization defines health as a state of complete physical, mental, and social well-being and not merely the absence of infirmity and disease. Researchers and clinicians have mainly focused on health outcomes that are physically or laboratory measured. These, however, do not reflect how the affected individual feels and functions in daily life. This study assessed the psychological and stigma profiles of patients attending HIV clinics in a North-central State of Nigeria.Methods:The study design was descriptive cross-sectional. A total of 384 HIV-positive patients who were systematically recruited at 5 public service delivery sites in Ilorin, Kwara State, North-central Nigeria participated in the study. Data was analyzed using SPSS software version 20.0. Level of significance was pre-determined at P value < 0.05 at a confidence level of 95%.Results:Fifty-nine percent of respondents reported being anxious about their condition and 25.5% felt depressed. Eighty-six percent received adherence counselling and 82.3% received psychological care from support groups. In the psychological domain, majority (74.5%) of the respondents had high health-related quality of life (HRQoL). There was a statistically significant association between employment status and psychological domain of HRQoL. As regards stigma, majority experienced high stereotype stigma (73.7%) and 67.2% experienced high stigma as pertains disclosure.Conclusion:Health workers should promote psychological support of HIV patients, for example, in form of support groups and adherence counseling. Efforts by government and corporate bodies should be geared towards employment empowerment of PLWHA which may help improve quality of life.

Syphilis diagnosis and serological response to Benzathine Penicillin G among patients attending HIV clinics in N’Djaména, Chad

BackgroundSyphilis is endemic in the Sub-Saharan zone and disproportionately affects at-risk populations such as men who have sex with men, sex workers and HIV infected individuals. In this study, we measure the impact of syphilis among people living with HIV in the Republic of Chad, where no data are currently available. MethodOutpatients attending 2 HIV clinics in N’Djamena, Republic of Chad, were tested for syphilis. Subjects who tested positive for both non-treponemal (VDRL) and treponemal (TPHA) received a single dose of Benzathine Penicillin G, 2.4 MU. An additional VDRL test was performed 6 months after treatment to ensure appropriate serological response. ResultsOf 207 patients included, 29 (14%) tested positive for VDRL at the first visit, with moderate/low antibody titers (ranging from 1/2 to 1/8); 24 (82.6%) of these had treponemal immunization confirmed by TPHA test. Six months after Benzathine Penicillin treatment, 22/24 of the patients (91.6%) tested negative for VDRL, and 2 showed a 4-fold titer decline. ConclusionThis first study in the Republic of Chad suggests that syphilis infection is frequent among people living with HIV in this country. Systematic screening of syphilis should be considered in this population.

Hypertension and Associated Factors among Patients on HIV Antiretroviral Therapy at Korle-Bu Teaching Hospital

Background: The chronic nature of HIV infection requires lifelong Antiretroviral Therapy (ART) to continuously suppress HIV viral replication, reducing morbidity and mortality. Management of co-morbidities is one of the major challenges associated with the multi-drug regimens used for HIV therapy. Hypertension as a co-morbidity in Persons Living with HIV (PLHIV) has become an important public health challenge and importantly influence patient management and service delivery at HIV clinics. This study determined the prevalence of hypertension among patients attending HIV clinic at the Korle-bu Teaching Hospital (KBTH) and also explored the nature of the relationship between HIV/ART and hypertension in order to help identify individuals who could benefit from interventions to prevent or delay the onset of complications of hypertension and thereby improve the overall quality of life of PLHIV Methods: A simple random sampling technique was used to recruit study participants based on the routine clinic attendance sample frame. A questionnaire adapted from WHO STEPwise approach to chronic disease risk-factor surveillance was modified and used for the collection of study participants' data. The prevalence of hypertension was estimated among study participants. Socio-demographic, lifestyle, anthropometric, metabolic and HIV/ART-related factors associated with hypertension were determined by logistic regression modelling using the purposeful selection of covariates method. Results: A total of 311 PLHIV were recruited as study participants. The present study revealed that the prevalence of hypertension in patients attending HIV clinic at KBTH was 36.7% and the factors associated with hypertension were increasing age, positive family history of hypertension, minimal exercising, current BMI ≥25.0 kg/m2, total cholesterol level ≥5.17 mmol/L, exposure to ART and increasing duration of ART exposure. Conclusion: This study shows a high prevalence of hypertension among patients attending HIV clinic at KBTH which is associated with exposure to Antiretroviral Therapy and increasing duration of this exposure. Blood pressure monitoring should move from being routine at the HIV clinic to more purposeful screening of patients for hypertension. Patients should be encouraged to have regular blood pressure measurements at home and not only when they visit HIV clinic.

Coping strategies among patients attending HIV clinics in a North-central State of Nigeria.

Nigeria ranks third among the countries with the highest HIV/AIDS burden in the world, next only to India and South Africa. The North-Central zone which Kwara State belongs to has the highest concentration of HIV prevalence rate of 7.5%, while the North-Western zone recorded the lowest prevalence of 2.1%; Kwara state has a prevalence rate of 2.2%. The study assessed the coping strategies adopted by patients attending HIV clinics in a North-central city of Nigeria. The study design was descriptive cross-sectional involving 384 HIV-positive patients who were systematically recruited at 5 public service delivery sites in Ilorin- a North-central city, Nigeria was used for the study. Coping strategies were measured using the Brief COPE scale. Data were analyzed using SPSS software version 20.0. Level of significance was pre-determined at P value <0.05 at a confidence level of 95%. Female respondents constituted 222 (58.0%) while males were 162 (42.0%). Respondents experienced varying proportion of coping strategies of which Self-distraction 288 (75.0%), active coping 249 (64.8%), emotional support 228 (59.4%), among others were the major strategies adopted by respondents. HIV is a chronic disease with heavy burden on both patients and health facility rendering services for the care of these patients. A good proportion of respondents interviewed adopted varying coping strategies. Sustained social and psychological support will improve further the coping strategies of living with HIV.

HAART THERAPY IN GHANA: COMPARATIVE ASSESSMENT OF THE EFFECTIVENESS OF DIFFERENT HAART COMBINATIONS AT KOMFO ANOKYE TEACHING HOSPITAL

Objective: Although all marketed antiretrovirals (ARVs) have proven efficacy, genetic differences can result in varied effectiveness. This study was conducted to determine the effectiveness of different Highly Active Antiretroviral Therapy (HAART) combinations among patients attending HIV clinic at a Major Teaching Hospital in Ghana.&#x0D; Methods: The study was a retrospective study involving 500 patients at an HIV clinic in the Ashanti Region of Ghana.&#x0D; Results: Twelve major antiretroviral combinations for HAART were prescribed at the study center. The most prescribed drug combinations were AZT+3TC+EFV and AZT+3TC+NVP. The study identified that HAART, irrespective of the kind of drug combination used, was effective at increasing CD4 count within the first 6 mo of therapy initiation in the study population. However, the magnitude of the increases differed from combination to combination. All HAART combinations with zidovudine as one of the drugs resulted in higher CD4 counts compared with combinations containing stavudine. HAART with nevirapine also resulted in a higher CD4 count than those with efavirenz. However, efavirenz-based combinations appeared to be more effective in critically ill patients and patients with mean CD4+T helper cells count below 100 cell/mm3. More importantly, efavirenz was common among all HAART combinations that resulted in treatment failure.&#x0D; Conclusion: There was significant variation in response to different HAART combination among Ghanaian HIV patients. However, there was no statistically significant difference in mean CD4 count between the two most predominately used HAART i. e AZT+3TC+EFV and AZT+3TC+NVP.

Adherence to tuberculosis preventive therapy measured by urine metabolite testing among people with HIV.

Tuberculosis preventive therapy for people living with HIV is effective, widely recommended, and increasingly prescribed, but completion rates are less than ideal, and adherence is not typically monitored. We sought to quantify adherence to isoniazid preventive therapy using a urine metabolite assay. Two cross-sectional surveys. Rio de Janeiro, Brazil, 2008-2009; and Northwest Province, South Africa, 2018-2019. Two hundred and three Brazilian and 93 South African patients attending HIV clinics with active prescriptions for isoniazid preventive therapy MAIN OUTCOME MEASURES:: Self-reported isoniazid adherence, paired with semiquantitative measurement of urine isoniazid metabolites. By self-report, 90% of patients [95% confidence interval (CI) 86-93%] reported having taken a dose of isoniazid on the day of enrollment or the preceding day, and 91% (95% CI 87-94%) reported missing an average of one dose or fewer per week. By urine testing, only 65% (95% CI 59-70%) of all patients, and 69% (95% CI 63-74%) of those who reported having taken isoniazid on the current or preceding day, had detectable urine metabolites (expected in 95% of patients at 24 h). Longer time since starting preventive therapy was independently associated with a negative urine test for isoniazid metabolites (adjusted prevalence ratio 1.11 per month of isoniazid, 95% CI 1.05-1.18). Adherence to isoniazid preventive therapy among patients with HIV in Brazil and South Africa is inadequate, is overestimated by self-report, and declines with time on treatment. Shorter regimens for TB preventive therapy may improve adherence and completion, but adherence support for all patients may be necessary.

Assessment of quality of life among patients attending HIV clinics in Ilorin metropolis

Objectives : The Sub-Saharan Africa (SSA), is being hit hard by the epidemic of Acquired Immunodeficiency Syndrome (AIDS) and carries the globe's heaviest burden of HIV/AIDS. HIV/AIDS has been transformed into a chronic condition, albeit one with no cure, making it important to assess determinants of quality of life (QoL) and, if required, improve the QoL of People Living with HIV (PLHIV). The study assessed the determinants of quality of life of patients attending HIV clinics in Ilorin metropolis. Methods : The study was a descriptive cross sectional study. A sample size of 384 HIV positive patients who were systematically recruited at the 5 public service delivery sites in Ilorin. Data was analyzed using SPSS software version 20.0. Level of significance was pre-determined at p-value 30yrs (odds = 1.5), longer duration on Highly Active Anti-retroviral Therapy (HAART) >3yrs (Odds = 1.5), CD4 count >500cells/mm3 (Odds = 1.2), high monthly income (Odds=1.6) and low cost of care (Odds= 1.27) were found to determine good QoL. Conclusion : Government should therefore expand access to HIV care by considering more Primary Health Care facilities as Anti-Retroviral Therapy ( ART) treatment centers. Key words: Quality of life, Human Immunodeficiency Virus, Patients, Anti-Retroviral Therapy

Management of Renal Disease: utility of a joint HIV-renal clinic

Although there has been a decrease in the incidence of HIV-associated nephropathy, the incidence of chronic kidney disease (CKD) is increasing in patients attending HIV clinics. Traditional risk factors for CKD, including diabetes, hypertension and coinfection with hepatitis C virus, are overrepresented in this population, making it difficult to distinguish the contribution of HIV infection 1. HIV-infected patients are at risk of renal dysfunction caused by HIV and by antiretroviral treatment (ART) toxicity. In particular, tenofovir disoproxil fumarate (TDF) has been associated with proximal renal tubular dysfunction 2. In 2014 locally in Brighton we had a cohort of 2150 HIV-infected patients, 90% of whom were on ART with 910 of 1935 (47.0%) on regimens including TDF. In addition to using a written protocol for monitoring renal function in patients on antiretrovirals (ARVs) and a standardized operating policy for investigation of abnormal blood tests and urinalysis, we run a ‘one-stop shop’ HIV-renal specialist clinic with an HIV physician and renal physician working together seeing referrals from the general HIV clinic. This study aimed to investigate the utility of this clinic and to describe renal disease in this cohort. We reviewed all patient records of patients seen in a specialist HIV-renal clinic between 2012 and 2014. Demographics, HIV history, number of visits, the indication for referral and outcome information were collected using a standardized proforma. Sixty-five patients, with a median age of 51 years (28–88 years) and a median duration of HIV infection of 163 months (20–335 months), were seen. Forty-two were taking TDF for a mean of 55.8 months (9–122 months). A total of 42 of 65 patients were reviewed once with a median number of visits of 1 (1–4). There were 98 appointments, 54 of which were virtual. The did-not-attend (DNA) rate was 11.4%. Referred patients were categorized as having: proteinuria on TDF (38 of 65 patients; 59%), proteinuria not on TDF (12 of 65 patients; 18%) and raised creatinine without proteinuria (15 of 65 patients; 23%). Of the 38 patients on TDF with proteinuria, five (13.2%) had TDF toxicity diagnosed and TDF was discontinued immediately, and 27 continued with close monitoring with a further seven subsequently discontinuing; the total number discontinuing was 12 of 38 (32%). Addition or up-titration of medications for poorly controlled hypertension was the commonest intervention overall in the joint HIV-renal clinic (23 of 65 patients; 35.4%), in particular in the non-TDF proteinuria group (eight of 12 patients; 66.7%). Renal calculi were a frequent contributor to renal dysfunction and four of 65 patients (6%) had a new glomerular diagnosis after undergoing renal biopsy [two had focal segmental glomerulosclerosis, one had immunoglobulin A (IgA) nephropathy and one had glomerulonephritis with granulomata]. In four patients (6%), the creatinine rise was attributed to nonsteroidal anti-inflammatory drug (NSAID), creatine or protein supplement usage. TDF toxicity was the commonest reason for referral but only a minority of referred patients (13.2%) needed to discontinue immediately. Optimizing blood pressure control was the most frequent outcome, suggesting that this is an underappreciated priority among HIV physicians.

Access to palliative care in HIV services in Cape Town

ABSTRACTThis paper examines access to palliative care (PC) for patients with HIV, part of a study investigating access to PC for patients with chronic diseases. Studies highlight gaps in symptom management and psychosocial care for People living with HIV (PLHIV) and thus the need to integrate PC into HIV services. The aim of the study was to describe the access of patients with advanced chronic illness to PC services. Methodology: this was a prospective cohort study conducted over six months. Participants were recruited from patients living with HIV with CD4 counts of <200 cells/mm3, patients with advanced cancer and patients diagnosed with motor neurone disease. All HIV patients were on anti-retroviral treatment. Participants responded to a questionnaire including the APCA African Palliative Outcome Scale (POS), a validated palliative outcome scale, as a measure of care at first visit and telephonically once a month for 6 months. Results: Seventy-nine HIV patients were recruited to the study. During the study 6 PLHIV died and no HIV patients were referred to PC services. A significant finding is that most patient outcomes improved for HIV patients. Pain reduced from 1.83 to 0.86; symptoms reduced from 2.41 to 0.49; worry reduced from 2.17 to 0.35. Spiritual well-being also improved – life worthwhile from 3.56 to 4.74 and at peace from 3.63 to 4.86; all measures out of 5. A small sub-set of this cohort (7.7%) experienced high pain levels not controlled during the study. Discussion: Few patients were referred to PC services despite 6 HIV deaths during the study. Patients attending HIV clinics received good PC in conjunction with HAART, suggesting that PC appears to be well integrated into routine HIV care. It is suggested that patients with severe problems including those who died would have benefitted from referral to PC.

Relationship between combination antiretroviral therapy regimens and diabetes mellitus-related comorbidities among HIV patients in Gaborone Botswana

BackgroundCombination antiretroviral therapy (cARTs) regiments are known to prolong the recipients’ life even though they are risk factors for diabetes mellitus-related comorbidities (DRCs). We sought to: (i) examine cART relationship with DRCs among patients attending HIV clinics in Gaborone, Botswana (which cART regimens are associated with shorter/longer time to the event), (ii) characterize patients’ underlying biomedical and demographic risk factors of DRC and identify the most important, (iii) investigate survival of patients on different cART regimens in the presence of these risk factors.MethodsData from two major HIV clinics in Botswana were reviewed. Relationships between different cART regimens and DRCs were investigated among 531 recipients. Recipients’ DRC risk factors were identified. Cox regression model was run. Unadjusted and adjusted hazard ratios were computed, and hazard and survival functions for different cART regimens were plotted.ResultsMajor findings were: patients on second- and third-line cART were less likely to develop DRCs earlier than those on first-line cART. Patients with CD4 count ≤ 200 cells/mm3 at cART initiation were more likely to develop DRCs earlier than those who had CD4 count > 200 cells/mm3. Overweight patients at cART initiation had a higher risk of developing DRCs earlier than those who had normal body mass index. Males had a lower risk of developing DRCs earlier than females.ConclusionThe risk of new onset of DRC among cART recipients is a function of the type of cART regimen, duration of exposure and patients’ underlying biomedical and demographic DRC risk factors. The study has provided a survival model highlighting DRCs’ significant prognostic factors to guide clinical care, policy and management of recipients of cARTs. Further studies in the same direction will likely improve the survival to the development of DRC of every cART recipient in this community.

Liver Fibrosis and Hepatitis B Coinfection among ART Naïve HIV-Infected Patients at a Tertiary Level Hospital in Northwestern Tanzania: A Cross-Sectional Study.

Background Liver fibrosis which is a common complication of chronic hepatitis B infection is rarely diagnosed in low-resource countries due to limited capacity to perform biopsy studies. Data on the utilization of noninvasive techniques which are feasible for diagnosis of liver fibrosis in these settings among HIV-infected patients is scarce. The objective of this study was to establish the magnitude of liver fibrosis by using both aspartate-aminotransferase-to-platelets ratio and fibrosis-4 scores with associated hepatitis B coinfection among antiretroviral therapy naïve HIV-infected patients. MethodsWe reviewed data of 743 adult patients attending HIV clinic with available hepatitis B surface antigen test results. Baseline clinical information was recorded and aspartate-aminotransferase-to-platelet ratio and fibrosis-4 scores were calculated. The cut-off values of 1.5 and 3.25 were used for diagnosis of significant fibrosis by aspartate-aminotransferase-to-platelets ratio and fibrosis-4 scores, respectively. Results The prevalence of liver fibrosis was 3.5% when aspartate-aminotransferase-to-platelet score was used and 4.6% with fibrosis-4 score and they were both significantly higher among patients with hepatitis B coinfection. Younger patients with HIV advanced disease and elevated liver transaminases had increased risk of having hepatitis B coinfection. ConclusionA remarkable number of HIV-infected patients present with liver fibrosis, predominantly those with hepatitis B infection.

Prevalence and Socio-demographic Determinants of Depression among Patients Attending HIV/AIDS Clinic in a Teaching Hospital in Imo State, Nigeria

Background: Depression is one of the most common psychiatric complications associated with HIV disease. In Nigeria depression has been found to be five times more common among People Living with HIV AIDS (PLWHA) than in apparently healthy populations. Aim: To assess the prevalence, socio-demographic determinants and phenomenology of depressive disorder among HIV patients attending HIV clinic in Imo State University Teaching Hospital Orlu, Imo State, Nigeria. Methodology: This we did through a cross-sectional descriptive survey, carried out on 271 patients aged 18years and above receiving Highly Active Antiretroviral Treatment (HAART). We used Patient Health Questionnaire 9 to assess depressive disorder. The associations between depressive disorder and socio-demographic profiles among the genders were explored. Results: About 39.1% of the participants were found to be depressed, out of which 24.5% were mildly depressed, 50% moderately depressed and 24.5% severely depressed. More female participants, (28.0%) were found to be depressed than their male counterparts, (11.1%) although this difference was not statistically significant, (χ2=0.21, p=0.65). The rate (χ²=4.14, p=0.04) and severity (χ2=8.64, p=0.04) of concentration impairment was significantly higher in females compared to males. Conclusion: We concluded that the relatively high prevalence of depressive disorder among attendees at the HIV/AIDS clinic underscores the need for routine depression screening in these patients.

Understanding the Impact of Hazardous and Harmful Use of Alcohol and/or Other Drugs on ARV Adherence and Disease Progression.

The objective of this study was to understand the impact of hazardous and harmful use of alcohol and/or other drugs on ARV adherence and disease progression among HIV patients. A cross-sectional study design was used. A total of 1503 patients attending HIV clinics in Cape Town, South Africa were screened for problematic substance use. A sub-sample of 607 patients (303 patients who screened positive for problematic substance use and 304 who did not) participated in this study. Hazardous or harmful alcohol use and problematic drug use predicted missing and stopping ARVs which, in turn, was associated with a decrease in CD4 counts and more rapid HIV-disease progression and poorer health outcomes in people living with HIV/AIDS (PLWHA). The findings of this study underscore the need for an integrated approach to managing substance-use disorders in PLWHA.

Epidemiological and Clinical profile of HIV-infected patients attending HIV clinic at Sekou Toure Referral and Teaching Hospital in Mwanza, Tanzania: 4 years review

Background : Treatment and care services for HIV patients in Tanzania began 2004 with free access to anti-retroviral therapy (ART). More than 1000 HIV clinics have been established to-date. Each clinic is obliged to provide statistical and clinical feedback for further improvement. Broad objective : The objective of this study was to establish baseline epidemiological and clinical characteristics of patients who are ART naive attending Sekou Toure Regional and Referral HIV clinic. Methodology: We retrospectively analyzed data for four years between 2004 and 2008 from the Sekou Toure HIV clinic database. We included all patients aged 18 and above who were eligible to commence ART. All pregnant women and patients being transferred in or out of the centre were excluded from this study. The statistical data analysis was performed using STATA program, version 14 (College Station, Texas). Results : We analyzed 726 patients, and among them 487 (67.2%) were females. The median age was 38 (IQR= 33-44) years.. The majority of these patients (58%) were in advanced clinical HIV stages (III and IV) with low baseline CD4 cell count (118cells/µl [IQR 46-200]. Tuberculosis was the leading opportunistic infection (OI) in over 80% of patients who had at least one OI at enrolment. Conclusion and recommendation : This study is important, as it has established the baseline data for further research and follow-up of these patients especially with the current improvement of Care and Treatment services in the country as compared to the previous time.

Skin cancer risk factor reduction in Africa: Assessment of use of antiretroviral therapy services by human immunodeficiency virus positive albinos

AimThe aim of this study was to assess how effectively HIV positive albinos make use of free and available Antiretroviral therapy services. BackgroundAn earlier study showed an unusually high proportion of albino patients to be living with HIV. Materials and methodThis prospective study was carried out in the Maxillofacial Surgery Unit and the HIV clinic of the National Hospital Abuja, Nigeria from July 2010 to June 2012. Survey of clinic attendance for head and neck skin cancer patients living with HIV was carried out. The same was done for head and neck skin cancer patients attending HIV clinic. Proportions of normal-pigmented patients and albinos were noted in both clinics. Data was summarized using numbers and percentage of values obtained in both groups. ResultsTwo normal-pigmented and 35 albino patients were seen. Both of the former attended HIV clinic while only 1 albino did. Thirty-four albinos stayed away from the HIV clinic due to stigma and easy identification in a Negroid community. 10,499 patients in HIV clinic were normal-pigmented and 2 suffered head and neck skin cancer. The only albino who attended the HIV clinic had both basal and squamous cell carcinoma. ConclusionAlbinos make very poor use of free and available antiretroviral therapy services. They fear being easily identified and further stigmatized by members of the community.