AbdeI-Goad, EH

Akhlar, S

Bereaky, ZB

Chetty, P

English

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TABLE I. HIV PREVALENCE RATES IN PROVINCES OF SOUTH AFRICAHHRUARY 200 I ----------- THf SOUTHfRN AFRICAN JOURNAL OF HIV MfOICINfA. INFECTIONSitive in 1999, compared with about 3.6 million in 1998• this means that more than 1 in 10 South Africansare positiveA Atypical bacterial and non-bacterial infections.B. Unusual malignancies.C. Impaired renal function.D. Voiding dysfunction.The urological manifestations of AIDS can bebroadly classified into four categories:'• of the women attending public health antenatalclinics, 22.4% were HIV-positive• the highest incidence of HIV/AIDS was found to be inKwaZulu-Natal (Table I).'According to Anthony Kinghorn and Malcom Steinbergof the HIV management services, projection indicatesthat by the year 2002, 250 000 South Africans will dieof AIDS each year, and this figure will rise to more than1 000000 deaths per year by 2008. Average life expec-tancy will fall from 60 years to 40 years between 1998and 2008.• 15 - 2lJ'1b of males with AIDS have symptomaticbacterial urinary tract infections (UTls) (KEH -unpublished data, 1999).••> __ c. ::••~!!.l~o :l••J J I I J J J I If ! J • • °1•P....."..STATISTICSIn South Africa all urologists are at some stage likely to befaced with management of an AIDS patien~ because ofthe high incidence of the disease in this country. Despitethorough research, there still exists a paucity of dataworldwide concerning the urological manifestations.INTRODUCTIONZ B Bereaky, MD rSurg), MD rUrol), FCUrolP Chetty, ME ChBS 5 Akhlar, ME BS, FCUrolEH AbdeI-Goad, MB ChBDepartment of Urology, Nelson R MDndela School of Medicine, University of Notol, DurbanUROLOGYOur experience in the Durban academic hospitals revealsthat AIDS is associated with multiple opportunistic in-fections, unusual malignancies, voiding dysfunction aswell as metabolic disturbances.UNUSUAL UROLOGICALPRESENTATIONS OF HIV/AIDS ATKING EDWARD VIII HOSPITALThe natural history of the disease process is frequentlyinfluenced by the patient's underlying immune status.Therefore, management of these conditions must take intoconsideration the patient's underlying HIV and immunestatus.The joint United Nation Programme on HIV/AIDS(UNAIDS) and the World Health Organisation (WHO) hasestimated that at the end of 1999 there were 33.4million people infected with the virus. Approximately96'lb of people with HN/AIDS live in the developingworld; 7lJ'1b live in sub-Saharan Africa.Local statistics,' according to the Department of Health,estimated that in 1998 there were approximately:• 3 million HIV-positive South Africans• it is estimated that 4.2 million people were HIV-pos-FIG. 4.DiffusEscrotolobsces5FIG.2.erscan af the abdamen, shawing a left perinephric abscess.FIG. 3.Extensive scrotal and lower abdominal Fournier's gangrene.FIG. 1.erscon showing bilateral renal abscesses.THE SOUTHEIlN AFRICAN JOUIlNAL Of HIV MEDICINE -----------HBIlUAIlY 200 IDIAGNOSIS OF OPPORTUNISTIC INFECTIONSDIAGNOSIS OF UTI IN AIDSTREATMENT OF UTls• A high index of suspicion must be maintained espec-ially where symptoms persist despite negative cultures.• Blood and body fluids must be cultured and stainedusing special techniques.• Radiographical modalities such as IVP/TRUS/ultra-sound/CT scan and MRI must be employed and insome cases only tissue biopsies may be conclusive(CMV cystitis/HIV-associated nephropathy [HIVAN)).'The following collection of slides (Figs 1 - 7) serve toillustrate and substantiate what has been discussedthus far.This is usually difficult as broad-spectrum antibiotics usedto treat concurrent infections suppress culture growth.• Must be culture-specific, i.e. the correct antibioticat the correct dose.• Broad-spectrum antibiotics must be avoided as thisrapidly leads to resistance.• The treatment is ineffective in the setting ofdisseminated infection and in the presence ofmultiple simultaneous infections.• Although Escherichia coli is the most common organ-ism implicated in the general population, it accountsfor 25"10 of infections in HIV-positive patients.• The most common bacteria is Pseudomonasaeruginosa, found in up to 33% of infections.'• The prevalence of UTls is directly related to thestage of immunosuppression as confirmed by thepatient CD4 count together with their viral load.• There is an increased incidence of bacteriuria if theCD4 count is < 200/~1.HHRUARY 2001----------- THE SOUTHfRN AFRICAN JOURNAL O~ HIV MEDICINEAG.9.Characteristic purple-red papule afKapasi's sarcomaaf the anterior chest wall.... continued on page 28FIG. 8.Kaposi's sarcoma af the left upper thigh.As expected, unusual malignancies have been reportedin AIDS patients;1. Kaposi's sarcoma (KS):• Is the most common neoplasm seen in AIDSpatients. Approximately 300/0 of all AIDS patientswill present with or subsequently develop KS duringthe course of their illness.'• However, about 500/0 of all homosexual men withAIDS will eventually have KS.• There is a strong association between Kaposisarcoma and herpes virus 8, called KS associatedwith HV (KSAHV).B. UNUSUAL MALIGNANCIESASSOCIATED WITH AIDS• KS involves the reticulo-endothelial system andmanifests as a neovascular tumour.• Histological examination reveals extensive spindlecells and increased vascularity infiltrated by plasmacells with extravasation of red blood cells.• Macroscopically it presents as a purplish red papuleof the skin.• Disseminated KS involves the kidney, bladder,epididymis, prostate, vulva and penis' (Figs 8 - 12).FIG. 6.Enlarged inguinal lymph node secondary toIymphogranulama venereum.AG.7.Bladder biopsy specimen with characteristicinclusian badies ofCMVinfectian.FIG. 5.Voiding cysto-urethrogram demonstrating urethral stricturewith scratol fistula and urethral diverticulum.

Unusual urological presentations of HIV/AIDS at King Edward VIII Hospital

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Unusual urological presentations of HIV/AIDS at King Edward VIII Hospital

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