The burden and characteristics of HIV-infected COVID-19 patients at a tertiary care hospital in sub-Saharan Africa—A retrospective cohort study

Background: After the first case of COVID-19 caused by the novel SARS-CoV-2 virus was discovered in Wuhan, China, in December 2019, the disease spread viciously throughout the world. Little is known about the impact of HIV infection on the clinical outcomes of patients co-infected with SARS-CoV-2. Studying the characteristics and outcomes of COVID-19 among HIV-positive patients is key to characterising the risk of morbidity and mortality of HIV-positive patients from COVID-19. Methods: In this retrospective cohort study, we included patients admitted to Aga Khan University Hospital, Nairobi, with laboratory-confirmed COVID-19 infection and who had consented to HIV screening. We compared the prevalence and characteristics of HIV patients with those of non-HIV patients and described the results for both groups. Results: In our sample of 582 patients, the mean age was 49.2 years (SD = 15.2), with 68% of the sample being men. The cumulative HIV prevalence was 3.7%, and the most common symptoms were cough (58.1%), fever (45.2%), difficulty in breathing (36.8%) and general body malaise (23.9%). The most common comorbidities included hypertension (28.5%), diabetes mellitus (26.1%), and heart disease (4.1%). Most participants (228 or 49.5%) had mild COVID-19, and the mortality rate was 5%. Overall, there were no statistically significant differences in demographic characteristics, clinical characteristics, and outcomes between HIV-positive and HIV-negative patients. Conclusions: There was a 3.7% prevalence of HIV in COVID-19 positive patients. Demographic characteristics and clinical outcomes were similar between the two groups. Future studies should seek to achieve larger samples, include multiple study sites and conduct subgroup analyses based on the immunologic status of HIV-positive patients

Human Rights in the United States: Legal Aid Alleges that Denying Access to Migrant Labor Camps is a Violation of the Human Right to Access Justice

It is estimated that there are more than 86 million migrant workers worldwide, the vast majority of whom suffer poor living and working conditions. In the United States, more than 3 million migrant farmworkers, including at least 100,000 children, are estimated to labor in fields every year, many of whom lack access to justice, earn sub-living wages, and exist in dehumanizing circumstances. Farmworkers are among the most exploited and vulnerable populations in the United States; yet, distressingly, they are also the least protected by U.S. law and law enforcement. Legal aid advocates in the United States attempt to raise awareness and educate this starkly poor, mobile, and isolated population about the legal protections and remedies available to them, only to have employers either outright deny access or prevent meaningful communication with farmworkers in the migrant labor camps where migrants and their families often reside during the course of their employment. One nonprofit law firm that provides such services, Maryland Legal Aid Bureau, spearheaded the submission of a joint legal aid complaint on the issue to the U.N. Special Rapporteur on Extreme Poverty and Human Rights. The advocates, who reach out to and represent migrant farmworkers, argue that the lack of federal law mandating access to migrant labor camps, combined with discriminatory treatment of migrant farmworkers under U.S. labor laws and lackluster enforcement of those laws that would apply, violates a panoply of farmworkers’ human rights, including their right to access justice. The complaint, which is the basis for this Article, is notable because it is the first-ever joint effort among U.S. legal aid organizations to utilize the Special Procedures provided through the Office of the U.N. High Commissioner of Human Rights to shine an international spotlight on an entrenched local issue. It comes on the heels of a new partnership between Maryland Legal Aid, Texas RioGrande Legal Aid, and the Center for Human Rights and Humanitarian Law at the Washington College of Law (the “Center”) at American University. One of the the Center’s programs, the Local Human Rights Lawyering Project, aims to normalize human rights at the state and local level and help legal aid lawyers integrate human rights into their daily work. Such partnerships are part of a larger push among social justice advocates in the United States to galvanize a domestic human rights movement so as to bring human rights home, rather than only applying them oversees, as has thus far been more common. As described more fully below, the joint legal aid complaint submitted to the U.N. Special Rapporteur on Extreme Poverty and Human Rights argues that the denial of access to migrant labor camps ostensibly equals an inability for the farmworkers to access justice, as well as other human rights, especially the right to health and the right to family and community. The complaint argues that the United States, as a State Party to various human rights treaties, is required to protect, respect, and fulfill the human rights of all people, including migrants. By refusing to uphold the right to access to justice for farmworkers in the United States, the U.S. government, as well as state and local governments, violate human rights law, thereby allowing millions of farmworkers to continuously suffer inhumane conditions and assaults on human dignity

Human Rights in the United States: Legal Aid Alleges that Denying Access to Migrant Labor Camps is a Violation of the Human Right to Access Justice

It is estimated that there are more than 86 million migrant workers worldwide, the vast majority of whom suffer poor living and working conditions. In the United States, more than 3 million migrant farmworkers, including at least 100,000 children, are estimated to labor in fields every year, many of whom lack access to justice, earn sub-living wages, and exist in dehumanizing circumstances. Farmworkers are among the most exploited and vulnerable populations in the United States; yet, distressingly, they are also the least protected by U.S. law and law enforcement. Legal aid advocates in the United States attempt to raise awareness and educate this starkly poor, mobile, and isolated population about the legal protections and remedies available to them, only to have employers either outright deny access or prevent meaningful communication with farmworkers in the migrant labor camps where migrants and their families often reside during the course of their employment. One nonprofit law firm that provides such services, Maryland Legal Aid Bureau, spearheaded the submission of a joint legal aid complaint on the issue to the U.N. Special Rapporteur on Extreme Poverty and Human Rights. The advocates, who reach out to and represent migrant farmworkers, argue that the lack of federal law mandating access to migrant labor camps, combined with discriminatory treatment of migrant farmworkers under U.S. labor laws and lackluster enforcement of those laws that would apply, violates a panoply of farmworkers’ human rights, including their right to access justice. The complaint, which is the basis for this Article, is notable because it is the first-ever joint effort among U.S. legal aid organizations to utilize the Special Procedures provided through the Office of the U.N. High Commissioner of Human Rights to shine an international spotlight on an entrenched local issue. It comes on the heels of a new partnership between Maryland Legal Aid, Texas RioGrande Legal Aid, and the Center for Human Rights and Humanitarian Law at the Washington College of Law (the “Center”) at American University. One of the the Center’s programs, the Local Human Rights Lawyering Project, aims to normalize human rights at the state and local level and help legal aid lawyers integrate human rights into their daily work. Such partnerships are part of a larger push among social justice advocates in the United States to galvanize a domestic human rights movement so as to bring human rights home, rather than only applying them oversees, as has thus far been more common. As described more fully below, the joint legal aid complaint submitted to the U.N. Special Rapporteur on Extreme Poverty and Human Rights argues that the denial of access to migrant labor camps ostensibly equals an inability for the farmworkers to access justice, as well as other human rights, especially the right to health and the right to family and community. The complaint argues that the United States, as a State Party to various human rights treaties, is required to protect, respect, and fulfill the human rights of all people, including migrants. By refusing to uphold the right to access to justice for farmworkers in the United States, the U.S. government, as well as state and local governments, violate human rights law, thereby allowing millions of farmworkers to continuously suffer inhumane conditions and assaults on human dignity

Case Report of Kikuchi-Fujimoto Disease from Sub-Saharan Africa: An Important Mimic of Tuberculous Lymphadenitis

Kikuchi-Fujimoto disease (KFD) is a rare form of painful lymphadenopathy, usually cervical, which is more common in Southeast Asia and rarely reported from Africa. Symptoms are usually nonspecific (fever, night sweats, etc.), and can mimic more common diseases such as tuberculosis (TB) in endemic areas. We report a case of a 29-year-old black African woman who was admitted with headache, neck pain, fever, and lymphadenopathy. She was found to have aseptic meningitis, eventually attributed to TB based on cervical node biopsy, although further histology suggested KFD. Blood tests for systemic lupus erythematosus (SLE) were negative; she had already been commenced on anti-TB treatment and had responded well and so was continued with this therapy. She was also later diagnosed with Hashimoto’s thyroiditis 3 months after her diagnosis of KFD. Five months after stopping TB treatment, she was readmitted with the same symptoms and associated painless lymphadenopathy. Repeat biopsy was morphologically similar to that of 2017, and repeat evaluation confirmed SLE. She has since been managed by a rheumatologist and continues to do well

Clinical Characteristics of Peripheral Neuropathy in Kenyan Patients with HIV Infection Compared with Patients with Concurrent HIV Infection and Diabetes Mellitus

Introduction: Persons living with human immunodeficiency virus (HIV) are living longer and at risk of non-communicable diseases, including diabetes mellitus (DM). Both HIV and DM place patients at risk of peripheral neuropathy (PN). Our aim was to demonstrate the prevalence and characteristics of PN in our population of patients with HIV infection compared with concomitant HIV and DM. Methods: A prospective cross-sectional study was performed at the Aga Khan Hospital in Nairobi, Kenya. Data were collected on demographics and characteristics of DM and HIV. Symptoms and signs of PN were evaluated by Neuropathy Symptom Score, Neuropathy Disability Score, and 10 g monofilament testing. Results: Two groups were recruited, each consisting of 68 patients: (1) HIV only, (2) HIV and DM. The median age of patients was 51 years (IQR 42.8–58.6) and 55% were male. Median duration for HIV was 10 years (IQR 5–12) with a median CD4 count of 524 cells/mm3 (IQR 369–731). Median duration for DM was 1 year with a median glycosylated hemoglobin of 6.7% (IQR 6.6–7.6). Sixty-nine percent of patients with HIV had suppressed viral loads, and 9 patients (6.6%) had a history neurotoxic antiretroviral therapy use. PN was detected in 11 (16%) HIV-only patients, and in 17 (25%) participants who had both HIV and DM (Fisher exact test chi-square = 0.4). Univariate analysis demonstrated older age, high body mass index, and long duration of HIV were associated with an OR of 1.07 (95% CI 1.02–1.11), 1.21 (95% CI 0.46–3.11), and 1.07 (95% CI 0.99–1.15) in the overall group, respectively. Conclusion: Our study demonstrates a higher but non-significant prevalence of PN in patients with both HIV and DM when compared to HIV alone. HIV disease control had no association with PN presence

HIV Prevalence and Characteristics Among Patients With AIDS-Defining and Non–AIDS-Defining Cancers in a Tertiary Hospital in Kenya

Purpose: Antiretroviral therapy (ART) has resulted in a higher life expectancy of persons living with HIV. This has led to an aging population at risk for both non–AIDS-defining cancers (NADCs) and AIDS-defining cancers (ADCs). HIV testing among patients with cancer in Kenya is not routinely performed, making its prevalence undefined. The aim of our study was to determine the prevalence of HIV and the spectrum of malignancies among HIV-positive and HIV-negative patients with cancer attending a tertiary hospital in Nairobi, Kenya. Materials and Methods: We conducted a cross-sectional study between February 2021 and September 2021. Patients with a histologic cancer diagnosis were enrolled. Demographic data and HIV- and cancer-related clinical variables were obtained. HIV pretest counseling and consent were done, and testing was performed using a fourth-generation assay. Positive results were confirmed using a third-generation assay. Results: We enrolled 301 patients with cancer; 67.8% (204 of 301) were female; the mean age was 50.7 ± 12.5 years. From our cohort, 10.6% (95% CI, 7.4 to 14.7, n = 32 of 301) of patients were HIV-positive with the prevalence of a new HIV diagnosis of 0.7% (n = 2 of 301). Of the HIV-positive patients, 59.4% (19 of 32) had a NADC. The commonest NADC was breast cancer (18.8%; 6 of 32), whereas non-Hodgkin lymphoma (18.8%; 6 of 32) and cervical cancer (18.8%; 6 of 32) were the most prevalent ADCs among HIV-positive patients. Conclusion: The prevalence of HIV infection among patients with cancer was twice the Kenya national HIV prevalence. NADCs comprised a larger percentage of the cancer burden. Universal opt-out HIV testing of patients attending for cancer care regardless of cancer type may facilitate early recognition of HIV-infected patients and aid in appropriate selection of ART and cancer therapies and preventive strategies

Secondary Infections in Patients with COVID-19 Pneumonia Treated with Tocilizumab Compared to Those Not Treated with Tocilizumab: A Retrospective Study at a Tertiary Hospital in Kenya

Introduction: From the first case of SARS-Co-2 in Wuhan, China, to the virus being declared as a pandemic in March 2020, the world has witnessed morbidity and mortality on a global scale. Scientists have worked at a record pace to deliver a vaccine for the prevention of this deadly disease. Tocilizumab, an interleukin-6 (IL-6) blocker, received an emergency use authorization (EUA) by the Federal Drug Agency (FDA) in June 2021.Methods: This retrospective observational cohort study was conducted at the Aga Khan University Hospital, Nairobi, from March 8, 2020, to December 31, 2020. All patients with PCR confirmed COVID-19 pneumonia were included. Data were obtained from the medical records, and the admission registry was used to identify the patients, and both their electronic and paper-based files were retrieved from the medical records. Patient demographic data, medical history, baseline comorbidities, clinical characteristics, and outcome data were collected to study the infectious complications of Tocilizumab in patients affected by COVID-19 pneumonia.Results: A total of 913 patients who were diagnosed with COVID-19 were included. The overall superinfection infection rate among the COVID-19 patients was 6%. Superinfection in patients who received the Tocilizumab was 17.2% and in the non-Tocilizumab group was 4.8%. The superinfection rate among severe and critically ill patients was even higher at 41.8% and 69.9% (Tocilizumab group) and 2.1% and 11.8% (non-Tocilizumab group), respectively (p \u3c 0.001). There was no difference in mortality observed between the groups (p = 0.846). Infection among HIV co-infection was very low at 2.3%.Conclusion: Contrary to some studies, a higher rate of infection was observed among the Tocilizumab group, and no difference in mortality was observed between Tocilizumab and the non-Tocilizumab group. Infection among patients with HIV remains low in this susceptible population

HIV, hepatitis B and hepatitis C coinfection in Kenya

There are few data regarding hepatitis and HIV coinfection in Africa. In 378 HIV seropositive individuals in Nairobi, 23 (6%) were hepatitis B virus (HBV) and HIV coinfected, four (1%) were hepatitis C virus (HCV) and HIV coinfected and one patient was infected with all three viruses. Coinfected individuals were more likely to be men and older; a lack of HBV vaccination was a risk factor for HIV/HBV coinfection (PU0.001) and tenofovir containing regimens appeared most effective at reducing HBV viral load

The association between asymptomatic and mild neurocognitive impairment and adherence to antiretroviral therapy among people living with human immunodeficiency virus

Background: Asymptomatic cognitive impairment in human immunodeficiency virus (HIV)-infected patients has recently been recognised as part of HIV-associated neurocognitive disorders. This has been implicated as one of the causes of poor adherence to antiretroviral therapy (ART). Objective: To assess the association between neurocognitive impairment (asymptomatic and mild forms) and adherence to ART. Methods: This was a cross-sectional survey involving 218 participants consecutively sampled from those attending the HIV treatment clinic at Aga Khan University Hospital in Nairobi. Data collected included quantitative primary data on pre-defined baseline characteristics, neurocognitive assessment by Montreal Cognitive Assessment (MoCA) tool (Appendix 1), instrumental activities of daily living by Lawton score and objective and subjective adherence measures by medication possession ratio (MPR) and simplified medication adherence questionnaire (SMAQ) (see Appendix 2). Univariate and bivariate analyses were conducted to determine the strengths of association between predictor and the outcome variables. Results: Among the 218 participants in the study, a total of 69% had asymptomatic to mild neurocognitive impairment as assessed by the MoCA tool, while a total of 66% were determined as being adherent to ART by objective measures (by MPR) compared to subjective rates of 77% as assessed by SMAQ. However, no statistically significant association was observed between the presence of asymptomatic or mild neurocognitive impairment and likelihood of adherence to ART (p \u3e 0.05). Conclusion: Even though asymptomatic and mild forms of cognitive impairment are prevalent in the population studied, there was no significant association between cognitive impairment and adherence to treatment