76 research outputs found
Intractable Chronic Vulval Ulceration Presenting as Immune Reconstitution Inflammatory Syndrome in a Treatment-Failure Patient: A Case Observation
HIV-1 treatment-failure patients are increasingly being initiated on second-line antiretroviral therapy. The case we describe is of a treatment-failure patient who developed intractable chronic vulval ulceration presenting as immune reconstitution inflammatory syndrome (IRIS), following complete viral suppression with second-line highly active antiretroviral treatment (HAART). To the best of our knowledge, this is the first reported case of intractable vulval ulceration IRIS in an HIV-1 treatment-failure patient
Hepatic schistosomiasis, upper gastrointestinal bleeding, and health related quality of life measurements from the Albert Nile Basin
Background: Health related quality of life measurements are vital elements of public health surveillance that uncover unmet health needs and predict the success of health interventions. We described health related quality of life measurements using the EuroQoL 5-dimension (EQ-VAS/EQ-5D) instrument and associated factors among patients with upper gastrointestinal bleeding (UGIB) and hepatic schistosomiasis at a rural health facility in the Albert Nile Basin, Uganda.
Methods and materials: This was a cross-sectional study at Pakwach Health Centre IV. Participants included adult inpatients and outpatients with a history of UGIB and ultrasound evidence of hepatic schistosomiasis. We evaluated and recorded each participant’s medical history, physical examination, laboratory tests results, ultrasound results, and endoscopy fndings. We also recorded health related quality of life measurements using the EuroQoL 5-dimension instrument and derived disability weights from EQ-VAS and EQ-5D measurements. These were our dependent variables. Descriptive and inferential statistics were generated summarizing our fndings.
Results: We found 103 participants had a history of upper gastrointestinal bleeding and hepatosplenic schistosomiasis. Sixty percent were between the ages of 30–49 years, 59% were females, 74% were farmers, 92% had splenomegaly, 88% had varices at endoscopy, 22% were medical emergencies with acute variceal upper gastrointestinal bleeding, and 62% had anemia. Measures of the diferent dimensions of health from 101 participants with patient reported outcomes revealed 77 (76%) participants experienced problems in self-care, 89 (88%) participants reported anxiety or depression, and 89 (88%) participants experienced pain or discomfort. The median EQ-VAS derived disability weights and median EQ-5D index-derived disability weights were 0.3 and 0.34, respectively. Acute upper gastrointestinal bleeding, praziquantel drug treatment, and age by decade predicted higher EQ-VAS derived disability weights (p value\u3c0.05). Under weight (Body mass index≤18.5), acute upper gastrointestinal bleeding, ascites, age by decade, female gender, and praziquantel drug treatment predicted higher EQ-5D index- derived disability weights (p value\u3c0.05).
Conclusion: Adult patients with upper gastrointestinal bleeding and hepatic schistosomiasis from this primary health facility experience poor health and considerable health loss. Several factors predicted increased health loss
Low sero-prevalence of hepatitis delta antibodies in HIV/ hepatitis B co-infected patients attending an urban HIV clinic in Uganda.
Background: Co-infection with hepatitis B (HBV) and hepatitis D (HDV)
is common among human immunodeficiency virus (HIV) infected individuals
in developing countries and it aggressively accelerates progression of
liver disease to cirrhosis and other complications. There is scarcity
of data on HDV in sub-Saharan Africa .We investigated the
sero-prevalence and factors associated with HDV antibody among HIV/HBV
co-infected patients attending a large urban HIV clinic in Uganda.
Methods: We screened 189 HIV/HBV co-infected individuals for anti-HDV
immunoglobulin G (IgG) and performed logistic regression to determine
the associated factors. Socio-demographic, clinical data, immunological
status, and liver fibrosis (as determined by the Aspartate transaminase
to platelet ratio index and transient elastography) were included.
Results: Participants were predominately young and of sound immunologic
status (median age 40 years, median CD4 440 cells/\u3bcl). 98% were on
ART regimens containing anti-HBV active medications (95.2% were on
TDF/3TC while 4.8% on 3TC containing regimen). Median duration on ART
was 36 months (IQR 22-72). Anti-HDV was detected in 6/198, 3.2% (95% CI
1.14-6.92%), associated with male gender and a duration of more than 5
years since HIV diagnosis. Conclusions: The sero-prevalence of HDV
antibodies among the HIV/HBV co-infected patients is low in a Ugandan
urban cohort
The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic
Background: Variceal upper gastrointestinal bleeding (UGIB) is common
in sub-Saharan Africa (SSA). However, poor access to endoscopy services
precludes the diagnosis of varices. Objectives: We determined the
diagnostic accuracy of routine clinical findings for detection of
esophageal varices among patients with UGIB in rural SSA where
schistosomiasis is endemic. Methods: We studied patients with a history
of UGIB. The index tests included routine clinical findings and the
reference test was diagnostic endoscopy. Multivariable regression with
post-estimation provided measures of association and diagnostic
accuracy. Results: We studied 107 participants with UGIB and 21% had
active bleeding. One hundred and three (96%) had liver disease and
86(80%) varices. Factors associated with varices (p-value <0.05)
were 65 4 lifetime episodes of UGIB, prior blood transfusion,
splenomegaly, liver fibrosis, thrombocytopenia, platelet count spleen
diameter ratio <909, and a dilated portal vein. Two models showed an
overall diagnostic accuracy of > 90% in detection of varices with a
number needed to misdiagnose of 13(number of patients who needed to be
tested in order for one to be misdiagnosed by the test). Conclusion:
Where access to endoscopy is limited, routine clinical findings could
improve the diagnosis of patients with UGIB in Africa
Low sero-prevalence of hepatitis delta antibodies in HIV/ hepatitis B co-infected patients attending an urban HIV clinic in Uganda.
Background: Co-infection with hepatitis B (HBV) and hepatitis D (HDV)
is common among human immunodeficiency virus (HIV) infected individuals
in developing countries and it aggressively accelerates progression of
liver disease to cirrhosis and other complications. There is scarcity
of data on HDV in sub-Saharan Africa .We investigated the
sero-prevalence and factors associated with HDV antibody among HIV/HBV
co-infected patients attending a large urban HIV clinic in Uganda.
Methods: We screened 189 HIV/HBV co-infected individuals for anti-HDV
immunoglobulin G (IgG) and performed logistic regression to determine
the associated factors. Socio-demographic, clinical data, immunological
status, and liver fibrosis (as determined by the Aspartate transaminase
to platelet ratio index and transient elastography) were included.
Results: Participants were predominately young and of sound immunologic
status (median age 40 years, median CD4 440 cells/\ub5l). 98% were on
ART regimens containing anti-HBV active medications (95.2% were on
TDF/3TC while 4.8% on 3TC containing regimen). Median duration on ART
was 36 months (IQR 22-72). Anti-HDV was detected in 6/198, 3.2% (95% CI
1.14-6.92%), associated with male gender and a duration of more than 5
years since HIV diagnosis. Conclusions: The sero-prevalence of HDV
antibodies among the HIV/HBV co-infected patients is low in a Ugandan
urban cohort
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Prevalence and Factors Associated With Liver Fibrosis Among Adult HIV-Infected Patients Attending Urban and Rural Care Clinics in Uganda.
BACKGROUND: Liver fibrosis is common among HIV-infected patients. Risk factors vary by location. Understanding this variation may inform prevention strategies. We compared the prevalence and correlates of liver fibrosis among HIV-infected patients attending care clinics in Uganda. METHODS: This was a cross-sectional study involving 2030 HIV-infected patients attending care clinics in urban and rural Uganda. Liver fibrosis was defined as liver stiffness measurement (LSM) >7.1 KPa. Proportions and correlates of liver fibrosis were assessed and compared using logistic regression stratified by gender and site. RESULTS: Prevalence of liver fibrosis was higher among participants in the rural clinic (15% vs 11%; P = .017). History of tobacco use (urban P = .022; rural P = .035) and serologic evidence of hepatitis C infection (HCV; urban P = .028; rural P = .03) was associated with liver fibrosis in all men. Elevated liver transaminases (urban P = .002; rural P = .028) and increasing age (urban P = .008; rural P = .052) were risk factors among all women. Tobacco use among women was only a risk factor in those attending the rural clinic (P = .003), and detectable HIV viral load (P = .002) for men in the urban clinic. CONCLUSIONS: Liver fibrosis is prevalent among HIV-infected persons in Uganda. HIV viral suppression and avoiding tobacco may be strategies to prevent liver fibrosis and cancer risk
Uptake of hepatitis B-HIV co-infection screening and management in a resource limited setting.
Background: WHO hepatitis B guidelines recommend testing all new HIV patients, treating them accordingly
or providing immunization. At the Infectious Diseases Institute (IDI) following an audit done in 2012, only 46%
patients had been screened for hepatitis B with variable management plans therefore new internal guidelines
were implemented. This study describes the uptake of hepatitis B screening and management of patients
with hepatitis B and HIV con-infection after the implementation.
Methods: Data included for all HIV positive patients in care at IDI by October 2015. Data are expressed as median with
interquartile range (IQR) and percentages were compared using the chi square test. Statistical analysis was performed
using STATA version 13. The IDI laboratory upper limit of normal for alanine aminotransferase (ALT) and aspartate
aminotransferase (ASTs) was 40 IU/ml.
Results: Number of hepatitis B screening tests increased from 800 by 2012 to 1400 in 2015. By 2015 8042/8604(93.5%)
patients had been screened for hepatitis B. Overall hepatitis B positive were 359 (4.6%). 166 (81.4%) hepatitis B positives
were switched to a tenofovir (TDF) containing regimen.
Conclusion: Our study confirms the importance of screening for hepatitis B and of using ART regimens containing
tenofovir in hepatitis B co-infected patients. Whilst our program has made improvements in care still 18.6% of patients
with hepatitis B were not on tenofovir regimens, 98.1% had no hepatitis B viral loads done. Clinicians should recognize
the potential for hepatitis B in HIV positive patients and the importance of early diagnosis and treatment to ensure
optimal management of cases and follow up
Upper gastrointestinal diseases in patients for endoscopy in South-Western Uganda
Background: There is a paucity of published data regarding upper
gastrointestinal diseases in Ugandans with upper gastrointestinal
symptoms referred for endoscopy. Objectives: To study the presenting
complaints, pathology and Helicobacter pylori prevalence among
patients with upper gastrointestinal symptoms in South-Western Uganda.
Methods: Patients presenting with upper gastrointestinal symptoms
underwent upper endoscopy and a urease test for Helicobacter Pylori,
all suspicious lesions were biopsied for histopathology review as
appropriate. Results: The most common presenting complaints were
epigastric pain (51.6%), dysphagia (13.6%) and odynophagia (7.1%). The
most common endoscopy finding was gastritis (40.2%), followed by normal
examination (15.2%), oesophageal cancer (13.6%), gastric ulcer (7.6%)
and gastric cancer (7.1%). Patients older than 40 years (n=110) had
significant findings including gastritis (50.9%), oesophageal cancer
(22.7%) and gastric cancer (11.8%). However in younger patients, with
the age range of 18-40 years (n=74), most examinations were normal
(92.9%). Of the 176 patients able to undergo Helicobacter pylori
testing 75.6% were positive. Helicobacter pylori infection was
associated with statistically significant increase in gastritis,
oesophageal cancer, gastric ulcer, gastric cancer, and duodenal ulcers
(p-values< 0.05). Conclusion: Gastritis, ulcerative disease, and
upper gastrointestinal malignancies are common in South-Western
Ugandans and are associated with a high prevalence of Helicobacter
pylori
The burden, pattern and factors that contribute to periportal fibrosis in HIV-infected patients in an S. mansoni endemic rural Uganda.
Introduction: Both Human Immunodeficiency Virus (HIV) and S.mansoni
infections are common in Uganda and can cause liver disease. No study
has determined co-infection significance in Uganda. We carried out a
study on the burden, pattern and factors that contribute to peri-portal
fibrosis (PPF) in HIV infected patients attending a Primary healthcare
setting at Pakwach. Methodology: We conducted a cross-sectional study
in the HIV clinic at Pakwach health centre IV. Data on demographics,
contact with the Nile, CD4+ cell count, ART and alcohol use were
collected. Urinary Circulating Cathodic Antigen (CCA), was done for S.
Mansoni detection. Liver scan was done for presence and pattern of PPF.
HBsAg testing was performed on all participants. Data was analyzed
using Stata Version 10. Results: We enrolled 299 patients, median age
39 years (IQR 16), most were female, 210 (73%). Overall, 206 (68.9%)
had PPF, majority 191 (92.7%) had pattern c, either alone (63
participants) or in combination with pattern d (128 participants). Age
of 30-50 years was significantly associated with PPF (OR 2.28
p-value-0.003) Conclusion: We found high prevalence of S. mansoni and
PPF in the HIV infected population and age was a significant factor for
PPF. We recommend all HIV infected patients be examined routinely for
S. mansoni infection for early anti-schistosomal treatment
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