Intestinal parasitic infections and the level of immunosuppression in HIV seropositive individuals with diarrhoea in Kilimanjaro, Tanzania: A cross- sectional study

original research 52 Background: Opportunistic and non-opportunistic intestinal parasites play a significant role in the morbidity and mortality of HIV/AIDS-infected patients. The frequency of their occurrence strongly correlates with the patient's level of immunity. The most common clinical manifestation of these intestinal parasites is diarrhoea. Prevalence of intestinal parasites among HIV-infected patients has been found to be as high as 95%. Objective: To determine the prevalence of intestinal parasites among HIV-infected participants presenting with diarrhoea and association with CD4 cell counts, ART and cotrimoxazole prophylaxis. Methods: A prospective cross-sectional study was conducted in four HIV clinics in Moshi district, Kilimanjaro Region, Tanzania. Stool samples were collected and analyzed from participants presenting with three or more episodes of loose stool per day or a single bloody bowel movement. The identification of parasites was done using direct microscopy and staining techniques. Demographic data, CD4 counts and stool results were recorded. Data analysis was done using STATA IC/11.1. Results: The study included 83 adult HIV positive patients. There were 36 males (43.4%) and 47 females (56.6%), with a median age of 36 years (range 30-43). The baseline CD4 count was 150 cells/ul (range 72-295 cells/ul). Of our participants, 47 (56.6%) had a baseline CD4 cell count < 200 cell/uL. Only 6(7.2%) had CD4 counts above 500cells/uL. Of the whole group, 62(74.7%) were on ARV therapy and 33(39.8%) were on cotrimoxazole prophylaxis. Intestinal parasites were detected in 25 of our participants. Among these 25 participants, Ascaris lumbricoides was found in 52%, Giardia lamblia in 32% and Entamoeba histolytica in 16%. The frequency of intestinal parasites was significantly associated with CD4 cell counts <200 cells/ul (p=0.02). There was no significant difference in parasitic infections associated with ART status or cotrimoxazole use. Conclusion: The prevalence of parasitic infection is high in HIV-infected patients presenting with diarrhoea despite the use of ART and other prophylactic medications. Intestinal parasites should not be overlooked in HIV-infected patients presenting with diarrhoea

Antiretroviral Therapy, Renal Function among HIV-Infected Tanzanian, Adults, HIV/AIDS, .

Data regarding the outcomes of HIV-infected adults with baseline renal dysfunction who start antiretroviral therapy are conflicting. We followed up a previously-published cohort of HIV-infected adult outpatients in northwest Tanzania who had high prevalence of renal dysfunction at the time of starting antiretroviral therapy (between November 2009 and February 2010). Patients had serum creatinine, proteinuria, microalbuminuria, and CD4(+) T-cell count measured at the time of antiretroviral therapy initiation and at follow-up. We used the adjusted Cockroft-Gault equation to calculate estimated glomerular filtration rates (eGFRs). In this cohort of 171 adults who had taken antiretroviral therapy for a median of two years, the prevalence of renal dysfunction (eGFR <90 mL/min/1.73 m(2)) decreased from 131/171 (76.6%) at the time of ART initiation to 50/171 (29.2%) at the time of follow-up (p<0.001). Moderate dysfunction (eGFR<60 mL/min/1.73 m(2)) decreased from 21.1% at antiretroviral therapy initiation to 1.1% at follow-up (p<0.001), as did the prevalence of microalbuminuria (72% to 44%, p<0.001). Use of tenofovir was not associated with renal dysfunction at follow-up. Mild and moderate renal dysfunction were common in this cohort of HIV-infected adults initiating antiretroviral therapy, and both significantly improved after a median follow-up time of 2 years. Our work supports the renal safety of antiretroviral therapy in African adults with mild-moderate renal dysfunction, suggesting that these regimens do not lead to renal damage in the majority of patients and that they may even improve renal function in patients with mild to moderate renal dysfunction

HIV Infection in the Elderly: Arising Challenges

Globally there is an increase in the number of people living with HIV at an advanced age (50 years and above). This is mainly due to prolonged survival following the use of highly active antiretroviral therapy. Living with HIV at an advanced age has been shown to be associated with a number of challenges, both clinical and immunological. This minireview aims at discussing the challenges encountered by elderly HIV-infected patients

Preparedness of lower-level health facilities and the associated factors for the outpatient primary care of hypertension: Evidence from Tanzanian national survey.

Sub-Saharan Africa is experiencing a rapid rise in the burden of non-communicable diseases in both urban and rural areas. Data on health system preparedness to manage hypertension and other non-communicable diseases remains scarce. This study aimed to assess the preparedness of lower-level health facilities for outpatient primary care of hypertension in Tanzania.This study used data from the 2014-2015 Tanzania Service Provision Assessment survey. The facility was considered as prepared for the outpatient primary care of hypertension if reported at least half (≥50%) of the items listed from each of the three domains (staff training and guideline, basic diagnostic equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Data were analyzed using Stata 14. An unadjusted logistic regression model was used to assess the association between outcome and explanatory variables. All variables with a P value < 0.2 were fitted into the multiple logistic regression models using a 5% significance level.Out of 725 health facilities involved in the current study, about 68% were public facilities and 73% located in rural settings. Only 28% of the assessed facilities were considered prepared for the outpatient primary care of hypertension. About 9% and 42% of the assessed facilities reported to have at least one trained staff and guidelines for hypertension respectively. In multivariate analysis, private facilities [AOR = 2.7, 95% CI; 1.2-6.1], urban location [AOR = 2.2, 95% CI; 1.2-4.2], health centers [AOR = 5.2, 95% CI; 3.1-8.7] and the performance of routine management meetings [AOR = 2.6, 95% CI; 1.1-5.9] were significantly associated with preparedness for the outpatient primary care of hypertension.The primary healthcare system in Tanzania is not adequately equipped to cope with the increasing burden of hypertension and other non-communicable diseases. Rural location, public ownership, and absence of routine management meetings were associated with being not prepared. There is a need to strengthen the primary healthcare system in Tanzania for better management of chronic diseases and curb their rising impact on health outcomes

Factors associated with preparedness for outpatient management of hypertension diseases, adjusted for confounding variables, Tanzania SPA 2014–15 (N = 725).

<p>Factors associated with preparedness for outpatient management of hypertension diseases, adjusted for confounding variables, Tanzania SPA 2014–15 (N = 725).</p