Bibliography on HIV/AIDS in Ethiopia and Ethiopians in the Diaspora: The 2015 Update

No Abstrac

HIV associated hypocalcaemia among diarrheic patients in northwest Ethiopia : a cross sectional study

Background: Hypocalcaemia, defined by serum calcium level less than 8.5 mg/dl, could be caused by human immunodeficiency virus (HIV) and diarrheal diseases. In Ethiopia, while morbidities from diarrheal diseases and HIV are serious health problems, studies assessing the interactions amongst of the three do not exist. Therefore, the present study was undertaken to investigate the level of calcium among diarrheic patients with and without HIV co-infection. Methods: Consecutive diarrheic patients attending Gondar University Hospital in Ethiopia were enrolled and screened for HIV, intestinal parasites, Shigella and Salmonella. Concentration of calcium in serum was determined using an inductively coupled plasma mass spectrometer. Results: A total of 206 diarrheic patients were included in the study (109 = HIV positive, 97 = HIV negative). Intestinal parasites and Shigella species were detected in 32.2% and 8.5% of the patients, respectively. The serum calcium levels in the patients who were found positive for Shigella species or intestinal parasites was not significantly different by the presence or absence of HIV co-infection. HIV infected diarrheic patients had significantly lower mean serum calcium levels (7.82 ± 1.23 mg/dl) than those negative for HIV (8.38 ± 1.97) (P = 0.015). The age groups 25–35 and greater than 45 years showed significantly lower mean serum calcium levels (7.77 ± 1.55 mg/dl) in comparison to the other age groups (7.84 ± 1.41 mg/dl, P = 0.009). On the other hand, females presented with significantly lower mean serum calcium levels (7.79 ± 1.60 mg/dl, P = 0.044) than males (8.26 ± 1.65 mg/dl). Conclusion: There is high prevalence of hypocalcaemia among diarrheic patients in northwest Ethiopia. And HIV stood out to be a major risk factor for development of hypocalcaemia among the diarrheic patients in northwest Ethiopia. Further studies are required to substantiate and characterize the mechanisms and consequences of calcium metabolism disorders among HIV infected individuals in the study area

Spectrum of Opportunistic Infections in People Living with HIV: A Tertiary Care Center Experience from North India

: Patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are proneto opportunistic infections (OIs) given their immunosuppressed state. OIs continue to cause morbidity and mortality in HIV/AIDS patients even after highly-active antiretroviral therapy (HAART); hence, attainment of the goals on health care programs,particularly in resource-poor countries, is hard to achieve. The prevalence of specific OIs varies in different countries and evenin different areas within the same country. Little information is available about the prevalence of OI in HIV patients fromdeveloping countries, especially India. Early diagnosis and prompt treatment contribute to increased life expectancy amonginfected patients delaying progression to AIDS. Hence, the present study was carried out to elucidate current frequencies andspectrum of OIs in HIV seropositive adult patients in Haryana and to evaluate the associated risk factors for OIs. Materialsand methods: This was a cross-sectional study carried out at the Dept. of General Medicine in a tertiary care hospital in NorthIndia. Basic demographic details, anthropometric measurements, symptoms of HIV/OI, clinical examination, biochemicalinvestigations and treatment details were recorded. Patients aged 18 to 70 years and HIV seropositive subjects were includedin the study. Results: The study found that about 53.21% of HIV/AIDS patients on ART had one or more OIs. Tuberculosis(TB) was the predominant OI identified, with a prevalence of 25.71%. Candidiasis and herpes zoster were the second and thethird most prevalent OIs at 13.8% (101/731) and 7.25% (53/731), respectively. Age (43.4 ± 10.7 years), low income, illiteracy,low socioeconomic status, initial 4 months since initiation of ART, CD4 count <200/mm3, body mass index of <18.5 kg/m², poorART adherence, hemoglobin, albumin were strongly associated with OIs. Conclusion: The present study shows that TB is thecommonest OI in adults and the overall population of people living with HIV (PLHIV) in Haryana and proves that OIs acrossdifferent patient groups vary significantly. Various factors like adherence to HAART, socioeconomic and education status ofpatients can influence the occurrence and outcome of these deadly infections

Prevalence and determinants of anemia amongst HIV positive pregnant women in a tertiary Hospital in Nigeria

Background: In pregnancy, anemia is associated with increased risk of both maternal and fetal morbidity and mortality especially in HIV situation. To determine the prevalence and determinants of anemia in HIV positive compared to HIV negative women.Methods: This was a cross sectional study carried out from June 2016 to December 2017 amongst pregnant women who presented to the antenatal clinic. Information on socio-demographic variables and laboratory test to determine the hemoglobin levels and CD4 count (for the HIV positive women) were carried out. A total of 350 subjects with equal number of HIV positive and HIV negative pregnant women were recruited. Variables were compared between the two groups using software package for social sciences version 20. P values<0.05 at 95% confidence interval are considered statistically significant.Results: The mean age for HIV positive and negative were 31.54 ±4.1 and 29.03 respectively while, mean gestational age at booking for HIV positive and negative were 20.41±8.61 and 22.37±7.4 weeks respectively. The HIV positive group had a mean parity of 2.02±1.5, and 2.56±1.2 was that of the HIV negative group. The mean hemoglobin statuses at booking were 9.92±1.8 g/dl and 10.6±1.1 g/df HIV positive and HIV negative women respectively. The mean CD4+ at booking for HIV positive group was 478±251 per microliter. The overall prevalence of anemia irrespective of HIV status was 36.6%. The prevalence of anemia in HIV positive and negative women were 44.6% and 28.6% respectively. There was statistically significant relationship between anemia and HIV status (p=0.002).Conclusions: There was inverse relationship between CD4+ count and anemia. Low CD4+ count and non-use of HAART at booking were important determinants of anemia among the HIV

Evaluation of individual and combined markers of urine dipstick parameters and total lymphocyte count as a substitute for CD4 count in low-resource communities in Ghana

We evaluated the individual and combined levels of urine dipstick and total lymphocyte count (TLC) as surrogate markers for CD4 count in a low-resource community in Ghana. This cross-sectional study recruited 200 HIV-infected patients from the Saint Francis Xavier Hospital, Assin Fosu, Ghana. Complete blood count, CD4 count, and urine dipstick analysis were measured for participants. The threshold values were determined as

Morbidity and mortality in the modern antiretroviral treatment era in a tertiary teaching hospital in Durban, South Africa.

Masters Degree. University of KwaZulu-Natal, Durban.Background: Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) is recognized as the chief cause of morbidity and mortality in Sub-Saharan Africa. South Africa is known to bear the highest number of people living with HIV globally, while KwaZulu-Natal is the worst affected province in this country. Aim: To identify the determinant of morbidity and mortality in the modern antiretroviral therapy (ART) era in South Africa. Study design: A cross-sectional study. To achieve the objective, a mixed data acquisition method was applied using qualitative and quantitative data. These included a systematic review and a retrospective chart review. Data collection and analysis: For the systematic review, relevant studies were searched from the following databases: Google Scholar, PubMed, CINAHL. Two review authors independently screened titles abstracts and full-text articles in duplicate, extract data and assess the bias. Discrepancies were resolved by discussion or arbitration of a third review author. The study used the Preferred Reporting Item of Systematic Review (PRISMA 2015) guideline. This study used R software version 3.6.2. to synthesis the data, graphic displays were used to visually compare the prevalence of comorbidities across the study region. With the retrospective chart review, we conducted a study of all patients admitted at King Edward medical wards, Durban, South Africa from January to December 2018. Data were obtained from medical records, including demographic profile, clinical attributes and laboratory records. Data were analysed using R software version 3.6.2. In addition, the association between the covariates was tested either with the Chi-Square test, Kruskal Wallis or Wilcoxon rank-sum test depending on the type of variables. A p-value < 0.05 was used as a benchmark for determining the level of statistical significance Results: For the systematic review a total of 409 articles were obtained from the database search, finally12 articles were eligible for data extraction. All 12 studies included were published between 2008 and 2018 in English and they were conducted in Sub-Saharan Africa. Among them, three were conducted in Nigeria, two were conducted in Uganda, three were conducted in South Africa, one in Gabon, one in Ethiopia, one in Ghana, and one in Burkina Faso. In most of the included studies, tuberculosis was the first commonest causes of hospitalization accounted for 40.7% followed by anaemia with 34.2% and toxoplasmosis with 29.3%. It was as well the first cause of death accounted for 44.3% followed by anaemia with 30.2% and toxoplasmosis 27.5%. Contrary one study reported anaemia as the first causes of hospitalization and two studies reported each respectively wasting syndrome and meningitis as the first causes of death. With regards to the chart review, a total of 577 (50.6%) females and 564 (49.4%) males were included in the study. The mean age of all the participants was 39.6±12.2, 506 (44.3%) patients had CD4 less than 200 cells /mm3 and 273 (23.9%) had VL ˃ 1000 copies/ml. Male gender [OR 1.39(1.07-1.8) p=0.015], age [OR1.02(1.01-1.03) p˂ 0.001], CD4 <200 cells/mm3 [OR 2.14(1.37-3.45) p=0.001], VL ˃ 1000 copies/ml [ OR 1.93(1.08-3.63) p=0.032] were associated with mortality among HIV infected patients admitted in the cohort. Tuberculosis (TB) was the most common diagnosis on admission and the leading cause of death which accounted for 257 (22.5%) and 73 (24.3%) respectively, followed by kidney disease with 83(7.2%) for admission and with 38(12.6) for death. Only 70% of patients had been reported to be on ART. Age, men gender, CD4 cell and viral load were associated with mortality. Association between CD4 cell count and viral load was found. Conclusion: Despite the recent improvement of modern antiretroviral treatment, HIV/AIDS still causes hospitalization and death among HIV infected patients. For the systematic review as well as for the chart review, tuberculosis was the commonest cause of hospitalization and death in Sub-Saharan Africa and South Africa, but it was always followed by other opportunistic infection and other non-AIDS related conditions. There is a need to prevent opportunistic infection (especially tuberculosis) and to tackle the non-communicable disease related to HIV infection. Also, a need to start antiretroviral treatment early for patients living with HIV. Keywords: Morbidity, Mortality, Antiretroviral therapy, Sub-Saharan Africa, South Africa

Evaluation of Individual and Combined Markers of Urine Dipstick Parameters and Total Lymphocyte Count as a Substitute for CD4 Count in Low-Resource Communities in Ghana

We evaluated the individual and combined levels of urine dipstick and total lymphocyte count (TLC) as surrogate markers for CD4 count in a low-resource community in Ghana. This cross-sectional study recruited 200 HIV-infected patients from the Saint Francis Xavier Hospital, Assin Fosu, Ghana. Complete blood count, CD4 count, and urine dipstick analysis were measured for participants. The threshold values were determined as <350 cells/μl for CD4, <1200 cells/μl for TLC, and ≥+ on urine dipstick analysis. The mean age of participants was 43.09 years. Proteinuria ≥ + [aOR = 4.30 (3.0–18.5)], leukocyturia ≥ + [aOR = 2.91 (1.33–12.5)], hematuria ≥ + [aOR = 2.30 (1.08–9.64)], and TLC < 1200 cells/μl [aOR = 3.26 (3.94–15.29)] were significantly associated with increased risk of CD4 count < 350 cells/μl. Using the individual markers, the best substitute marker for predicting CD4 count < 350 cells/μl was proteinuria at a cutoff point ≥ 2++, AUC of 0.973, sensitivity of 97.6%, specificity of 100.0%, PPV of 100.0%, and NPV of 89.1%. A combination of ≤ 1200 TLC + ≥ 2++ (leukocyturia + proteinuria + hematuria) yielded an AUC of 0.980, sensitivity (72.8%), specificity (100.0%), PPV (100.0%), and NPV (97.9%). Proteinuria could serve as a noninvasive screening tool, but the combination of proteinuria, leukocyturia, hematuria, and TLC serves as a better substitute marker for CD4 count in monitoring the disease progression among HIV patients in low-resource communities

Prevalence and burden of HBV co-infection among people living with HIV:A global systematic review and meta-analysis

Globally, in 2017 35 million people were living with HIV (PLHIV) and 257 million had chronic HBV infection (HBsAg positive). The extent of HIV-HBsAg co-infection is unknown. We undertook a systematic review to estimate the global burden of HBsAg co-infection in PLHIV. We searched MEDLINE, Embase and other databases for published studies (2002-2018) measuring prevalence of HBsAg among PLHIV. The review was registered with PROSPERO (#CRD42019123388). Populations were categorized by HIV-exposure category. The global burden of co-infection was estimated by applying regional co-infection prevalence estimates to UNAIDS estimates of PLHIV. We conducted a meta-analysis to estimate the odds of HBsAg among PLHIV compared to HIV-negative individuals. We identified 506 estimates (475 studies) of HIV-HBsAg co-infection prevalence from 80/195 (41.0%) countries. Globally, the prevalence of HIV-HBsAg co-infection is 7.6% (IQR 5.6%-12.1%) in PLHIV, or 2.7 million HIV-HBsAg co-infections (IQR 2.0-4.2). The greatest burden (69% of cases; 1.9 million) is in sub-Saharan Africa. Globally, there was little difference in prevalence of HIV-HBsAg co-infection by population group (approximately 6%-7%), but it was slightly higher among people who inject drugs (11.8% IQR 6.0%-16.9%). Odds of HBsAg infection were 1.4 times higher among PLHIV compared to HIV-negative individuals. There is therefore, a high global burden of HIV-HBsAg co-infection, especially in sub-Saharan Africa. Key prevention strategies include infant HBV vaccination, including a timely birth-dose. Findings also highlight the importance of targeting PLHIV, especially high-risk groups for testing, catch-up HBV vaccination and other preventative interventions. The global scale-up of antiretroviral therapy (ART) for PLHIV using a tenofovir-based ART regimen provides an opportunity to simultaneously treat those with HBV co-infection, and in pregnant women to also reduce mother-to-child transmission of HBV alongside HIV

Bibliography on HIV/AIDS in Ethiopia and Ethiopians in the Diaspora: The 2006 Update

No Abstract. The Ethiopian Journal of Health Development Vol. 21 (1) 2007: pp. 70-9