scholarly journals Prevalence and Mortality of Cryptococcal Disease in Adults with Advanced HIV in an Urban Tertiary Hospital in Sierra Leone: A Prospective Study

2019 ◽  
Author(s):  
Sulaiman Lakoh ◽  
Hannah Rickman ◽  
Momodu Sesay ◽  
Sartie Kenneh ◽  
Rachael M. Burke ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cd4 Count ◽  
Sub Saharan Africa ◽  
World Health ◽  
Categorical Variables ◽  
Hiv Patients ◽  
Cross Sectional ◽  
Cryptococcal Disease

Abstract Background The global annual estimate for cryptococcal disease related deaths exceeds 180,000, with three fourth occurring in sub-Saharan Africa. The World Health Organization (WHO) recommends cryptococcal antigen (CrAg) screening in all HIV patients with CD4 count <100/µl. As there is no previous published study on the burden and impact of cryptococcal disease in Sierra Leone, research is needed to inform public health policies. We aimed to establish the seroprevalence and mortality of cryptococcal disease in adults with advanced HIV attending an urban tertiary hospital in Sierra Leone. MethodsA cross-sectional study design was used to screen consecutive adult (18 years or older) HIV patients at Connaught Hospital in Freetown, Sierra Leone with CD4 count below 100 cells/mm3 from January to April, 2018. Participants received a blood CrAg lateral flow assay (IMMY, Oklahoma, USA). All participants with a positive serum CrAg had lumbar puncture and cerebrospinal fluid (CSF) CrAg assay, and those with cryptococcal diseases had fluconazole monotherapy with eight weeks followed up. Data were entered into Excel and analysed in Stata version 13.0. Proportions, median and interquartile ranges were used to summarise the data. Fisher’s exact test was used to compare categorical variables. Results A total of 170 patients, with median age of 36 (IQR 30-43) and median CD4 count of 45 cells/mm3 (IQR 23-63) were screened. At the time of enrolment, 54% were inpatients, 51% were newly diagnosed with HIV, and 56% were either ART-naïve or newly initiated (≤ 30 days). Eight participants had a positive blood CrAg, giving a prevalence of 4.7% (95% CI: 2.4-9.2%). Of those with a positive CrAg, CSF CrAg was positive in five (62.5%). Five (62.5%) CrAg-positive participants died within the first month, while the remaining three were alive and established on ART at eight weeks. ConclusionA substantial prevalence of cryptococcal antigenaemia and poor outcome of cryptococcal disease were demonstrated in our study. The high mortality suggests a need for the HIV programme to formulate and implement policies on screening and pre-emptive fluconazole therapy for all adults with advanced HIV in Sierra Leone, and advocate for affordable access to effective antifungal therapies.

scholarly journals Prevalence and Mortality of Cryptococcal Disease in Adults with Advanced HIV in an Urban Tertiary Hospital in Sierra Leone: A Cross Sectional Study

2019 ◽  
Author(s):  
Sulaiman Lakoh ◽  
Hannah Rickman ◽  
Momodu Sesay ◽  
Sartie Kenneh ◽  
Rachael M. Burke ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cd4 Count ◽  
World Health ◽  
Categorical Variables ◽  
Sectional Study ◽  
Hiv Patients ◽  
Cross Sectional ◽  
Cryptococcal Disease

Abstract Background The global annual estimate for cryptococcal disease related deaths exceeds 180,000, with three fourth occurring in sub-Saharan Africa. The World Health Organization (WHO) recommends cryptococcal antigen (CrAg) screening in all HIV patients with CD4 count <100/µl. As there is no previous published study on the burden and impact of cryptococcal disease in Sierra Leone, research is needed to inform public health policies. We aimed to establish the seroprevalence and mortality of cryptococcal disease in adults with advanced HIV attending an urban tertiary hospital in Sierra Leone. Methods: A cross-sectional study design was used to screen consecutive adult (18 years or older) HIV patients at Connaught Hospital in Freetown, Sierra Leone with CD4 count below 100 cells/mm3 from January to April, 2018. Participants received a blood CrAg lateral flow assay (IMMY, Oklahoma, USA). All participants with a positive serum CrAg had lumbar puncture and cerebrospinal fluid (CSF) CrAg assay, and those with cryptococcal diseases had fluconazole monotherapy with eight weeks followed up. Data were entered into Excel and analysed in Stata version 13.0. Proportions, median and interquartile ranges were used to summarise the data. Fisher’s exact test was used to compare categorical variables. Results A total of 170 patients, with median age of 36 (IQR 30-43) and median CD4 count of 45 cells/mm3 (IQR 23-63) were screened. At the time of enrolment, 54% were inpatients, 51% were newly diagnosed with HIV, and 56% were either ART-naïve or newly initiated (≤ 30 days). Eight participants had a positive blood CrAg, giving a prevalence of 4.7% (95% CI: 2.4-9.2%). Of those with a positive CrAg, CSF CrAg was positive in five (62.5%). Five (62.5%) CrAg-positive participants died within the first month, while the remaining three were alive and established on ART at eight weeks. Conclusion: A substantial prevalence of cryptococcal antigenaemia and poor outcome of cryptococcal diseases were demonstrated in our study. The high mortality suggests a need for the HIV programme to formulate and implement policies on screening and pre-emptive fluconazole therapy for all adults with advanced HIV in Sierra Leone, and advocate for affordable access to effective antifungal therapies.

scholarly journals Diabetes and Hypertension among Patients Receiving Antiretroviral Treatment Since 1998 in Senegal: Prevalence and Associated Factors

ISRN AIDS ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Assane Diouf ◽  
Amandine Cournil ◽  
Khadidiatou Ba-Fall ◽  
Ndèye Fatou Ngom-Guèye ◽  
Sabrina Eymard-Duvernay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Antiretroviral Treatment ◽  
Cross Sectional Study ◽  
Older Age ◽  
World Health ◽  
Resource Constrained ◽  
Hiv Patients ◽  
Cross Sectional

Cardiovascular risk factors in people on antiretroviral treatment (ART) are poorly documented in resource-constrained settings. A cross-sectional study was conducted in 2009 to assess prevalence of diabetes and hypertension in a sample of 242 HIV-infected patients who had initiated ART between 1998 and 2002 in Dakar, Senegal (ANRS 1215 observational cohort). World Health Organization (WHO) criteria were applied to diagnose diabetes and hypertension. Multiple logistic regressions were used to identify factors associated with diabetes and hypertension. Patients had a median age of 46 years and had received ART for a median duration of about 9 years. 14.5% had diabetes and 28.1% had hypertension. Long duration of ART (≥119 months), older age, higher body mass index (BMI), and higher levels of total cholesterol were associated with higher risks of diabetes. Older age, higher BMI at ART initiation, and higher levels of triglycerides were associated with higher risk of hypertension. This study shows that diabetes and hypertension were frequent in these Senegalese HIV patients on ART. It confirms the association between duration of ART and diabetes and highlights the need to implement programs for prevention of cardiovascular risk factors in HIV patients from resource-constrained settings.

scholarly journals Renal Echogenicity as a Predictor of Human Immunodeficiency Virus–Associated Nephropathy: A Cross-Sectional Study at a Tertiary Hospital in Lagos, Southwest Nigeria

2018 ◽  
Vol 34 (4) ◽  
pp. 261-272
Author(s):  
Cletus Uche Eze ◽  
Charles Ugwoke Eze ◽  
Adekunle A. O. Adeyomoye
Keyword(s):  
Human Immunodeficiency Virus ◽  
Serum Creatinine ◽  
Area Under The Curve ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cd4 Count ◽  
Cross Sectional ◽  
Immunodeficiency Virus ◽  
Southwest Nigeria ◽  
Grade 3

The objective of this study was to determine the accuracy of sonography in a human immunodeficiency virus–associated nephropathy (HIVAN) diagnosis. A sample of 340 HIVAN patients underwent laboratory CD4+ count, serum creatinine/glomerular filtration rate (GFR) estimation, and sonographic echogenicity grading. The accuracy of sonography in predicting an HIVAN diagnosis was calculated. Mean CD4+ count, serum creatinine, and GFR for male and female HIVAN patients was 153.1 ± 103.2 cells/mm3 and 121.9 ± 91.0 cells/mm3, 218.4 ± 147.4 mmol/L and 222.0 ± 150.4 mmol/L, and 50.1 ± 23.6 mL/min/1.73 m2 and 39.3 ± 20.6 mL/min/1.73 m2, respectively; 56.9% of patients had echogenicity grade 3. On the basis of CD4+ count, serum creatinine, and GFR, the area under the curve was 0.76 and ≈ 1, respectively; the area under the curve was 0.63, 0.79, 0.70, 0.79 and 0.91, 0.99, 1, 1 for grades 0, 1, 2, and 3 echogenicity, respectively. With a high level of apathy to voluntary HIV/AIDS screening and late patient presentation, sonography (grade 3 renal echogenicity) can assist in predicting an HIVAN diagnosis.

scholarly journals Mastalgia: Prevalence at a Sub-Saharan African Tertiary Hospital

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
T. Makumbi ◽  
M. Galukande ◽  
A. Gakwaya
Keyword(s):  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Western World ◽  
African Countries ◽  
Breast Clinic ◽  
Cross Sectional ◽  
Ethical Approval ◽  
Sub Saharan ◽  
Cyclical Mastalgia

Introduction. Mastalgia is a common breast condition among women referred to breast clinics worldwide. Whereas the prevalence is known in the Western world and Asia, the prevalence of the disease is unknown in many African countries. The aim of this study therefore was to determine the prevalence and describe factors associated with mastalgia among women attending a tertiary hospital in sub-Saharan Africa. Methods. A cross-sectional study was done in Kampala, Uganda. Mastalgia was defined as self-reported breast pain (unilateral or bilateral) for a period not less than two months. A pretested questionnaire was used to collect the data and statistical analysis was performed using SPSS version 11. Ethical approval was obtained. Results. Out of the 1048 women who presented to the breast clinic during the study period, 168 (16%) were diagnosed with mastalgia in the absence of breast cancer. Noncyclical and cyclical mastalgia were 22/168 (13%) and 5/168 (3%), respectively. The onset of noncyclical category as compared to the cyclical type of mastalgia was observed to manifest before 24 years of age (P=0.006). Conclusion. Mastalgia was a common condition among women in this sub-Saharan African setting as is elsewhere. The early onset mastalgia in this sub-Saharan African study requires further exploration for determination of its risk factors.

scholarly journals Cryptococcal antigen carriage among HIV infected children aged 6 months to 15 years at Laquintinie Hospital in Douala

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253781
Author(s):  
Ginette Claude Mireille Kalla ◽  
Josette Farida Mboumnyemb ◽  
Jules Clément Nguedia Assob ◽  
Marcelle Nina Ehouzou Mandeng ◽  
Nelly Kamgaing Noubi ◽  
...  
Keyword(s):  
Strong Association ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
World Health ◽  
Treatment Center ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Cryptococcal Antigen ◽  
Severe Immunosuppression ◽  
Living With Hiv

Background Up to 15% of deaths of people living with HIV is attributable to meningeal cryptococcosis, with nearly 75% occuring in sub-Saharan Africa. Although rare in children, it is a major cause of morbidity and mortality in people living with HIV. A strong association between cryptococcal antigenemia and the development of meningeal cryptococcosis has been shown in adults. Thus, in 2018, the World Health Organization published an updated version of its guidelines for the diagnosis, prevention and management of cryptococcal infection in adults, adolescents and the HIV-infected child. Goal To determine the prevalence of cryptococcal antigenemia and to identify its determinants in children infected with HIV. Methods An analytical cross-sectional study was carried out at the approved treatment center of Laquintinie hospital in Douala over a period of 4 months. Children were recruited consecutively after informed parental consent. Cryptococcal antigenemia and CD4 assay were performed using a Cryptops® immunochromatographic rapid diagnostic test and flow cytometry, respectively. The data collected included the socio-demographic, clinical and paraclinical variables of the children, as well as their antecedents. Data analysis was performed using Epiinfo software version 3.1 and SPSS 21.0. The significance threshold was set at 5%. Results A total of 147 children were enrolled. The mean age was 9.8 ± 4.09 years. The majority were on antiretroviral therapy (142, 96.60%). Only 13 (8.80%) were in severe immunosuppression. No child showed signs of meningeal cryptococcosis. The prevalence of cryptococcal antigenemia was 6.12%. Severe immunosuppression [OR: 10.03 (1.52–65.91), p = 0.016] and contact with pigeons [OR: 9.76 (1.14–83.65), p = 0.037] were independent factors significantly associated with the carriage of the cryptococcal antigen. Conclusion We recommend screening for cryptococcal antigenemia and routine treatment with fluconazole of all HIV positive children with cryptococcal antigen whether symptomatic or not.

scholarly journals Mucocutaneous Manifestations of HIV and the Correlation with WHO Clinical Staging in a Tertiary Hospital in Nigeria

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Olumayowa Abimbola Oninla
Keyword(s):  
Skin Diseases ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Vaginal Candidiasis ◽  
Clinical Staging ◽  
Teaching Hospitals ◽  
Hiv Patients ◽  
Cross Sectional ◽  
Resource Limited ◽  
Clinical Stages

Skin diseases are indicators of HIV/AIDS which correlates with WHO clinical stages. In resource limited environment where CD4 count is not readily available, they can be used in assessing HIV patients. The study aims to determine the mucocutaneous manifestations in HIV positive patients and their correlation with WHO clinical stages. A prospective cross-sectional study of mucocutaneous conditions was done among 215 newly diagnosed HIV patients from June 2008 to May 2012 at adult ART clinic, Wesley Guild Hospital Unit, OAU Teaching Hospitals Complex, Ilesha, Osun State, Nigeria. There were 156 dermatoses with oral/oesophageal/vaginal candidiasis (41.1%), PPE (24.4%), dermatophytic infections (8.9%), and herpes zoster (3.8%) as the most common dermatoses. The proportions of dermatoses were 4.5%, 21.8%, 53.2%, and 20.5% in stages 1–4, respectively. A significant relationship (using Pearson’s Chi square withPvalue<0.05) was obtained between dermatoses and WHO clinical stages. Pearson’s correlation coefficient showed a positive correlation between the number of dermatoses and the WHO clinical stages. Dermatoses can therefore serve as diagnostic and prognostic markers in resource limited settings to initiate HAART in clinical stages 3 and 4.

scholarly journals Status of Anaemia and Malaria Co-infection With HIV From HAART Clinics in Federal Capital Territory, Nigeria: A Cross-Sectional Study

2020 ◽  
Vol 13 ◽  
pp. 117863612094768
Author(s):  
Nneoma Confidence JeanStephanie Anyanwu ◽  
David Jesutobi Oluwatimileyin ◽  
Peace Temitope Sunmonu
Keyword(s):  
Risk Factors ◽  
Enzyme Immunoassay ◽  
Cross Sectional Study ◽  
Cd4 Count ◽  
Blood Type ◽  
Health Concern ◽  
Sectional Study ◽  
Hiv Patients ◽  
Cross Sectional ◽  
Critical Public Health

Background: Malaria and HIV are 2 significant infections of critical public health concern globally. Malaria infection is one of the preceding causes of morbidity and mortality in endemic developing countries, and its co-infections in HIV patients worsen prognosis; with anaemia being the most common haematologic outcome of the infections. Context and Purpose of Study: This study was aimed at determining the prevalence of anaemia and malaria co-infection among HIV-infected patients attending selected hospitals in Abuja between February and July 2019. Methods: A cross-sectional study was carried out to detect malaria in 420 HIV-positive patients who were 12 to 67 years old, using enzyme immunoassay and microscopy. A structured questionnaire was used to capture socio-demographic and risk factors ([Frequency of] Use of Malaria preventive Measures, History of anaemia, Blood type, malaria antecedents, and CD4+ Count) while packed cell volume was checked using micro haematocrit reader to determine anaemia status. Data were analysed using IBM SPSS v25. Results: The mean age of the study participants was 37.5 (±12.48). A total of 142 (33.8%) samples were positive for malaria, and 68 of the HIV-infected patients (16.2%) were anaemic; 4.8% of the 420 patients had malaria co-infection and anaemia simultaneously. More male participants had malaria co-infection (36.0%, P = .617) while more female participants had anaemia (22.7%, P = .058). Patients aged 61 to 70 years had the highest rates of malaria and those aged 51 to 60 years were most anaemic. Except for patients with normal CD4+ count, those who were more exposed to the evaluated risk factors were more co-infected and anaemic. Malaria co-infection did not significantly affect the onset of anaemia. Test for the validity of Microscopy against Enzyme Immunoassay (EIA) showed 83.1% sensitivity and 98.6% specificity. No association was observed between the variables and the parasitaemia density of the patients. Conclusions: This study highlighted higher rates of malaria co-infection and anaemia among HIV patients when compared with previous reports in the region although co-infection did not significantly affect anaemia status. Given this trend, strategies must be put in place to checkmate these ailments. Population studies are also advocated.

scholarly journals Use and pattern of previous care received by infertile Nigerian women

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Amina Mohammed-Durosinlorun ◽  
Joel Adze ◽  
Stephen Bature ◽  
Amina Abubakar ◽  
Caleb Mohammed ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Previous Treatment ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Fertility Treatment ◽  
Care Needs ◽  
Cross Sectional ◽  
Nigerian Women ◽  
Sub Saharan

Abstract Background Prevalence of infertility in sub-Saharan Africa is high yet fertility care, its development and access is limited in resource-poor countries like Nigeria so infertile women resort to different forms of treatment. This study aimed to determine the use and pattern of previous treatments. Methodology This was a descriptive Cross Sectional study conducted at a tertiary hospital in North-Western Nigeria. Interviewer administered pretested questionnaires were administered to 236 consenting clients seen at their first visit to the gynaecology clinic with complaints of inability to conceive, between January 2016 to March 2018. We collected information on demographic and reproductive characteristics, previous fertility treatment and other data relevant to infertility. Descriptive analysis was done using SPSS software version 22. Results Two hundred and thirty six clients participated in the study and majority were 20–29 years (44.5%), with a mean age of 31.5 ± 7.4, while the mean age of their husbands was 41 ± 8.0. More clients were educated up to secondary level or above (80.9%), with more Muslims (65%) than Christians. All clients were married except one, most clients had been married for 5 years or more, 18.2% were in their second order of marriage and 28% were in polygamous marriages. Many of the clients were homemakers (46.6%) and earned an average monthly income of less than fifty thousand naira. About 59.3% of clients presented with primary infertility, with 15.7% being infertile for duration of more than 10 years. One hundred and forty six respondents (61.9%) had received previous hospital treatments before presentation to our facility, 37% had visited more than three hospitals, 70% did not have adequate investigations done, treatment was successful in 15% while 40.7% received traditional treatments. Husbands of women receiving previous treatment were slightly older (p value < 0.05). Conclusion Majority of woman have multiple and unnecessary visits to several hospitals for infertility care with little positive results despite time and resources spent. Quality of infertility care needs to be improved.

scholarly journals A cross-sectional study of socio-demographic and clinical profile of HIV patients at ART plus centre, Sawai Man Singh Hospital, Jaipur, India

2021 ◽  
Vol 4 (1) ◽  
pp. 321-326
Author(s):  
Charu Jain ◽  
Lokendra Sharma ◽  
Uma Advani ◽  
Munesh Kumar ◽  
Amit Tak ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Cross Sectional Study ◽  
Clinical Profile ◽  
Reproductive Age ◽  
World Health ◽  
Clinical Staging ◽  
Sectional Study ◽  
Skilled Workers ◽  
Hiv Patients ◽  
Cross Sectional

Background: This study aimed to understand the regional variation in the socio-demographic and clinical profile of human immunodeficiency virus (HIV) infected patients at antiretroviral therapy plus centre of Sawai Man Singh (SMS) hospital, Jaipur, India.  Methods: A descriptive cross-sectional study was conducted on HIV patients from January to December 2019. The HIV-positive patients of all age groups and all categories were included in the study. The socio-economic status was assessed by BG Prasad classification-based consumer price index. However, the clinical staging was done according to the World Health Organization (WHO) classification of HIV/AIDS. Data were expressed as mean ± standard deviation. Results: Among 525 HIV patients 59.16% were males, 40.26% females and 0.57% intersex. About half (51.0%) in the reproductive age group with mean age 36 ±13 years. The commonest mode of HIV transmission was heterosexual (89.77%). Maximum belonged to social class I (57.84%) and class II (26.05 %) of BG Prasad's socioeconomic status. Each of the non-agricultural laborers and semi-skilled workers constitutes 18.0%, and the housewives were 23.6%. At the time of presentation, baseline CD4+Tcell count was <350 /mm3 in 55.0% of HIV patients. Pulmonary tuberculosis and skin involvement were the most predominant secondary opportunistic infections accounting for 24.8% and 7.8%, respectively. More than half (52.09%) of patients were in WHO clinical stage I of HIV disease. Conclusion: Socio-demographic and clinical profile of study participants reflect an impact of early case detection and timely institution of highly active antiretroviral therapy.

scholarly journals Quality of life of the HIV patients in Agra: a cross sectional study

2018 ◽  
Vol 5 (5) ◽  
pp. 1869
Author(s):  
Sunil K. Meena ◽  
Sunil K. Misra ◽  
Shailendra S. Chaudhary
Keyword(s):  
Quality Of Life ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
People Living With Hiv ◽  
Sectional Study ◽  
Hiv Patients ◽  
Cross Sectional ◽  
Factors Influencing ◽  
Modifiable Factors

Background: With antiretroviral therapy (ART) for human immunodeficiency virus infection (HIV) coming into picture, quality of life (QOL) has gained importance. Knowledge on the factors affecting QOL would be helpful in making important policy decisions and health care interventions. The aim of this study is to assess the quality of life of people living with HIV and to identify the factors influencing their QOL.Methods: The Cross-sectional study was done among 160 HIV patients registered with ART Centre, at SNMC Agra (UP), India. QOL was assessed using HIV specific WHOQOLHIV-BREF questionnaire which has six domains. Association were find out by using chi square test for categorical variables and ANOVA were used for comparisons means scores among continuous variables. Correlation between continuous quantitative variables was found out by Pearson correlation coefficient.Results: Mean age of the study subjects was 37.89 years and 61.2% of the participants were males. Quality of life score was highest in level of independence domain (12.79±2.28) and lowest in SRPB domain (10.51±3.63). A significant negative correlation (-0.49) was observed between age and physical domain. Male Subjects had significant better mean score in social and environmental domain. Family support associated with social relationship and psychological domain. Higher CD4 count is associated with better in psychological and SRPB domain. Younger age, female gender, rural background, shorter duration of HIV, non-intake of ART were the high risk factors of poor QOL.Conclusions: Interventions such as ART, family, vocational and peer counselling would address these modifiable factors influencing QOL, thereby improving the QOL of PLWH.

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