Anemia and risk factors in HAART naïve and HAART experienced HIV positive persons in south west Ethiopia: a comparative study.

BACKGROUND: Human immunodeficiency virus (HIV) infection and its treatment cause a range of hematological abnormalities. Anemia is one of the commonly observed hematologic manifestations in HIV positive persons and it has multifactorial origin. OBJECTIVE: We aimed to determine the prevalence and risk factors of anemia in highly active antiretroviral therapy (HAART) naïve and HAART experienced HIV positive persons. METHODS: A facility-based comparative cross sectional study was conducted in Jimma University Specialized Hospital from February 1 to March 30, 2012. A total of 234 HIV positive persons, 117 HAART naïve and 117 HAART experienced, were enrolled in this study. Blood and stool specimens were collected from each participant. Blood specimens were examined for complete blood count, CD4 count and blood film for malaria hemoparasite; whereas stool specimens were checked for ova of intestinal parasites. Socio-demographic characteristics and clinical data of the participants were collected using pre-tested questionnaire. Statistical analysis of the data (Chi-square, student's t-test, logistic regression) was done using SPSS V-16. RESULTS: The overall prevalence of anemia was 23.1%. The prevalence of anemia in HAART naïve and HAART experienced persons was 29.9% and 16.2%, respectively (P = 0.014). Presence of opportunistic infections (P = 0.004, 95% CI = 1.69-15.46), CD4 count <200 cells/µl (P = 0.001, 95% CI = 2.57-36.89) and rural residence (P = 0.03, 95% CI = 1.12-10.39) were found to be predictors of anemia for HAART naïve participants. On the other hand, HAART regimen (ZDV/3TC/NVP) (P = 0.019, 95% CI = 0.01-1.24) and the duration of HAART (P = 0.007, 95% CI = 0.003-0.40.24) were found to be predictors of anemia for HAART experienced groups. CONCLUSION: The prevalence of anemia in HAART naïve persons was higher than HAART experienced persons. Risk factors for anemia in HAART naïve and HAART experienced HIV positive persons were different. Hence, there is a need for longitudinal study to further explore the causes of HIV associated anemia and the pattern of hemoglobin changes with initiation of HAART

Mean values of hematological and immunologic parameters of HIV positive patients stratified by HAART status, South west Ethiopia, 2012.

<p>SD* = standard deviation, CI* = confidence interval, RBC = red blood cell count, Hgb = Hemoglobin, Hct = Hematocrit, MCV = mean cell volume, MCH = mean cell hemoglobin, MCHC = mean cell hemoglobin concentration, RDW = red cell distribution width. CD = cluster of differentiation.</p

Multiple logistic regression analysis for predictors of anemia in HAART experienced HIV patients involved in the study, south west Ethiopia, 2012.

<p>NB: ZDV = Zidovudine, d4T = Stavudine, 3TC = Lamivudine, NVP = Neverapine, TDF = Tenofovir, EFV = Efavirenz.</p

Socio-demographic and clinical variables of HIV positive participants, South West Ethiopia, 2012.

<p>OI = Opportunistic infection, IP = Intestinal parasites, BMI = Body mass index, chronic illness*(Blood pressure, Diabetes, Epilepsy).</p

Multiple logistic regression analysis for predictors of anemia in HAART naïve HIV patients involved in the study, South west Ethiopia, 2012.

<p>NB: COR* = Crude Odds ratio, AOR* = adjusted odds ratio, CI* = Confidence interval.</p

Uropathogenic bacterial profile and antibiotic susceptibility pattern of isolates among gynecological cases admitted to Jimma Medical Center, South West Ethiopia

Abstract Urinary tract infection (UTI) is one of the most common bacterial infections in women; about 50% of women get during their life time. Moreover, it is a common health problem in patients with gynecological pathologies, which increases the chance of acquiring infection. The aim of this study was to determine the bacterial profile that causes UTI and their antibiotic susceptibility pattern among admitted gynecological cases. A cross-sectional study was conducted in south west Ethiopia region. A total of 386 patients admitted with gynecological cases were recruited by sequential sampling technique and structured questionnaire was used to collect socio-demographic and risk factor-related data. About 10 ml freshly voided midstream and catheterized urine specimens were collected using sterile containers. Identification of isolate was done using culture characteristics, gram staining, and a series of biochemical tests. The antibiotic susceptibility test was performed as per the Kirby–Bauer disc diffusion technique. The data obtained were entered into EpiData Version 3.1 and analyzed using SPSS Version 25. A P value of less than 0.05 was used as a level of significance. In this study, the overall prevalence of UTI was 25.4%. Escherichia coli was the most frequently isolated bacteria, which accounted for 38 (37.6%), followed by Klebsiella species 22 (21.8%), CONS 14 (13.9%), Staphylococcus aureus 10 (9.9%), Enterobacter species 6 (5.9%), Citrobacter species 5 (4.9%), Proteus mirabilis 4 (4%), and Pseudomonas aeroginosa 2(2%). Histories of UTI (AOR = 1.977, 95% CI 1.06, 3.68, P = 0.032) and catheterization (AOR = 2.38, 95% CI 1.28, 4.45, P = 0.006) were found to be statistically associated with significant bacteriuria. Gram-negative isolates showed a high level of resistance, 88.3% for ampicillin and 66.2% for tetracycline, and a relatively low level of resistance against ceftazidime, 22.1%, and meropenem, 3.9%. Gram-positive uropathogens showed a high level of resistance to penicillin, 91.6%, whereas all isolates were sensitive 100.0% to nitrofurantoin. Furthermore, 80 (79.2%) of the isolates had multidrug resistance, and 16 (26.7%) of both E. coli and Klebsiella spp. produced Extended spectrum β-lactamase (ESBL). In this study, a high prevalence of uropathogenic bacteria and multidrug resistance for commonly prescribed drugs were observed with a significant number of ESBL producers. Therefore, screening admitted gynecological patients, especially for those who have history of catheterization and UTI, by urine culture and antimicrobial susceptibility testing is important

Reference intervals for hematology test parameters from apparently healthy individuals in southwest Ethiopia

Background: Clinical laboratory reference intervals are an important tool to identify abnormal laboratory test results. The generating of hematological parameters reference intervals for local population is very crucial to improve quality of health care, which otherwise may lead to unnecessary expenditure or denying care for the needy. There are no well-established reference intervals for hematological parameters in southwest Ethiopia. Objective: To generate hematological parameters reference intervals for apparently healthy individuals in southwest Ethiopia. Methods: A community-based cross-sectional study was conducted involving 883 individuals from March to May 2017. Four milliliter of blood sample was collected and transported to Jimma University Medical Center Laboratory for hematological analysis and screening tests. A hematological parameters were measured by Sysmex XS-500i hematology analyzer (Sysmex Corporation Kobe, Japan). The data were analyzed by SPSS version 20 statistical software. The non-parametric independent Kruskal–Wallis test and Wilcoxon rank-sum test (Mann–Whitney U test) were used to compare the parameters between age groups and genders. The 97.5 percentile and 2.5 percentile were the upper and lower reference limit for the population. Results: The reference interval of red blood cell, white blood cell, and platelet count in children were 4.99 × 10 12 /L (4.26–5.99 × 10 12 /L), 7.04 × 10 9 /L (4.00–11.67 × 10 9 /L), and 324.00 × 10 9 /L (188.00–463.50 × 10 9 /L), respectively. The reference interval of red blood cell, white blood cell, and platelet count in adults was 5.19 × 10 12 /L (4.08–6.33 × 10 12 /L), 6.35 × 10 9 /L (3.28–11.22 × 10 9 /L), and 282.00 × 10 9 /L (172.50–415.25 × 10 9 /L), respectively. The reference interval of red blood cell, white blood cell, and platelet count in geriatrics were 5.02 × 10 12 /L (4.21–5.87 × 10 12 /L), 6.21 × 10 9 /L (3.33–10.03 × 10 9 /L), and 265.50 × 10 9 /L (165.53–418.80 × 10 9 /L), respectively. Most of the hematological parameters showed significant differences across all age groups. Conclusion: Most of the hematological parameters in this study showed differences from similar studies done in the country. This study provided population-specific hematological reference interval for southwest Ethiopians. Reference intervals should also be established in the other regions of the country