Cytopenias among ART-naive patients with advanced HIV disease on enrolment to care and treatment services at a tertiary hospital in Tanzania: A crosssectional study

Background: HIV/AIDS causes high morbidity and mortality through both immunosuppression and complications not directly related to immunosuppression. Haematological abnormalities, including various cytopenias, occur commonly in HIV through immune and non-immune pathways. Though these complications could potentially cause serious clinical implications, published literature on the magnitude of this problem and its associated factors in Tanzania is scarce. This study aimed at determining the prevalence and risk factors of HIV-associated cytopenias among ART-naive patients enrolling for care and treatment services at Bugando Care and Treatment Centre (CTC) in Mwanza, Tanzania.Methods: This was a cross-sectional clinic-based study done between March 2015 and February 2016, involving all antiretroviral therapy (ART)-naive adult HIV positive patients enrolling for care and treatment services at Bugando CTC. Patients younger than 18 years and those with missing data were excluded. Data were analysed using Stata version 11 to determine the prevalence and risk factors of cytopenias.Results: A total of 1205 ART-naive patients were included. Median age was 41 years (interquartile range [IQR] 32 to 48). Most participants were female (n = 789; 65.6%), with a female-to-male ratio of 2:1. The median baseline CD4 count was 200 cells/μL (IQR 113 to 439). About half (49%) of the study participants had baseline CD4 counts less than 200 cells/μL. Anaemia, leucopenia, and thrombocytopenia were found in 704 (58.4%), 285 (23.6%), and 174 (14.4%) participants, respectively, and these were strongly associated with advanced HIV infection.Conclusions: The magnitude of cytopenias is high among ART-naive HIV-positive adults, and cytopenias are more marked with advanced HIV infection. Early diagnosis of HIV and timely initiation of ART could potentially reduce the number of people living with advanced HIV disease and its associated complications, including the cytopenias investigated in this study. Patients with cytopenias should undergo thorough screening for tuberculosis, which is an important and treatable correlate of cytopenia, in addition to close follow-up for any potential negative outcomes

Prevalence and Risk Factors of Delayed Sputum Conversion among Patients Treated for Smear Positive PTB in Northwestern Rural Tanzania: A Retrospective Cohort Study

Introduction. Smear positive TB carries high morbidity and mortality. The TB treatment aims at sputum conversion by two months of antituberculous. Patients who delay sputum conversion remain potentially infectious, with risk of treatment failure, drug resistance, and mortality. Little is known about the magnitude of this problem in our setting. This study was designed to determine the prevalence and risk factors of delayed sputum conversion in northwestern rural part of Tanzania. Methods. This was a retrospective cohort study involving smear positive TB patients at Sengerema DDH in 2015. Demographic data, HIV status, and sputum results at TB diagnosis and on TB treatment were collected and analyzed using STATA 11. Results. In total, 156 patients were studied. Males were 97 (62%); the median age was 39 [30–51] years. Fifty-five (35.3%) patients were HIV coinfected and 13 (8.3%) patients had delayed sputum conversion which was strongly associated with male gender (OR=8.2, p=0.046), age >50 years (OR=6.7, p=0.003), and AFB 3+ (OR=8.1, p=0.008). Conclusions. Delayed sputum conversion is prevalent in this study. These patients can potentially fail on treatment, develop drug resistance, and continue spreading TB. Strategies to reduce the rate of delayed sputum conversion could also reduce these potential unfavorable outcomes

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

Sub therapeutic drug levels among HIV/TB co-infected patients receiving Rifampicin in northwestern Tanzania: A cross sectional clinic based study

Background: Tuberculosis/Human Immunodeficiency Virus (TB/HIV) is a very common co-infection which carries a high mortality rate. Though World Health Organization recommends co-treatment of TB/HIV to improve its outcome, Rifampicin potentially induces metabolism and sub-therapeutic antiretroviral plasma levels of non nucleoside reverse transcriptase inhibitors and protease inhibitors which may cause inadequate virological suppression if corrections are not timely done. In Tanzania Therapeutic drug monitoring is not done; so the proportion of sub-therapeutic ARV plasma levels among TB/HIV patients co-treated with anti-tuberculous drugs is not known. The aim of this study was therefore to determine the magnitude and risk factors of sub-therapeutic ARV plasma levels among adult HIV patients co-treated with anti tuberculous Medications.Materials and methods: A cross sectional hospital based study was conducted among adult HIV patients on ARV and TB co-treatment for at least one month. Patients were serially enrolled through routine HIV care and treatment services until the sample size was reached. The information about demographic, clinical and adherence level, Anti-TB duration, viral load, baseline and enrollment CD4 counts, Hepatitis B co-infection and ARV plasma levels was collected and analyzed using STATA 12 software.Results: In total 118 patients were included in this study; of whom 26 (22%) had sub-therapeutic ARV plasma levels. The sub-therapeutic ARV levels were independently associated with adherence <95% (OR =6.8, p= 0.001), female gender (OR = 3.4, p= 0.028) and virological failure (OR= 3.8, p= 0.016). NVP based regimen was associated with sub-therapeutic drug levels on univariate model (OR = 2.1, p= 0.010).Conclusion: The magnitude of sub-therapeutic ARV plasma levels is high among adult HIV/TB coinfected patients on anti-TB co-treatment in Tanzania. These patients stand a high risk of inadequate virological suppression with a potential resistance development and a long term poor clinical outcome. Identifying at risk patients and adherence enhancement could potentially improve the overall outcome of this subgroup of patients in resource restricted setting like ours where TDM is not available.Keywords: HIV; HIV/TB co-infection; HIV/TB co-treatment Rifampicin; Antiretroviral therapy; Plasma ARV drug levels; Therapeutic drug monitorin

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. Methods. We 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. Conclusion. A remarkable number of HIV-infected patients present with liver fibrosis, predominantly those with hepatitis B infection

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