Open Access Original Research Article

Prevalence and Factors Associated with Opportunistic Infections in HIV Positive Patients on Antiretroviral Therapy in Uganda

John Rubaihayo, Nazarius M. Tumwesigye, Joseph Konde-Lule, Henry Wamani, Edith Nakku-Joloba, Fredrick Makumbi

International Journal of TROPICAL DISEASE & Health, Page 1-13
DOI: 10.9734/IJTDH/2015/18953

Introduction: Opportunistic infections (OIs) remain the single main cause of ill-health and death among HIV/AIDS patients in resource poor countries. We assessed the prevalence of 17 OIs and associated factors among HIV positive patients on highly active antiretroviral therapy (HAART) in Uganda.

Methods: Observational data from 2004 to 2013 for adult HIV positive patients (>=15yrs) obtaining care and treatment from the AIDS support organization (TASO) in Uganda were reviewed.  Electronic data were obtained from TASO HIV clinics representing 4 different geographical areas of Uganda. Descriptive statistics were summarized in terms of frequencies and percentages. Logistic regression was used to assess the factors associated with occurrence of OIs.

Results: Between 2004 and 2013, a total of 36,133 HIV patients were enrolled on HAART of which two thirds (66%) were female and one third (34%) were male.  In univariate analysis, significant differences were observed between male and female ART clients with men being older (median age 36yrs IQR 29-43 vs 32 yrs IQR 26-39, p<0.0001); likely to be more educated(>secondary 31% vs 19%, p<0.0001);  likely to be more severely ill(CD4 count<100 26% vs 21%, p<0.0001); were more likely to be married (65% vs 42%, p<0.0001) and were more likely to be formally employed (27% vs 12%,  p<0.0001). Mean annual prevalence for any OI in 2004 was 57.6% and in 2013 was 27.5% (X2trend = 122, b= -0.0283, p <0.0001). The most commonly encountered OIs were geohelminths (35%), diarrhea<1 month (18%) and mycobacterium tuberculosis (11%). Factors associated with any OI after HAART were male gender, if from Northern Uganda, low education (<primary), baseline WHO stages III&IV, stavudine ART regimen, baseline CD4 count <100cells/µl, low baseline weight <55 kg and period 2004-2008 (p<0.05).

Conclusion and Recommendations: In these settings, the burden of OIs is still high in spite of increased access to HAART. The prevalence of geohelminthes and diarrhoea is worrying among HIV patients on HAART. Men remain at greater risk of OIs and should be the main target for early HAART initiation.

Open Access Original Research Article

Detection and Species Identification of Malaria Parasites by Nested-PCR: Comparison with Light Microscopy and with SD BIOLINE Malaria Ag Test in Luanda, Angola

García Nazaré Pembele, Lázara Rojas Rivero, Jorge Fraga

International Journal of TROPICAL DISEASE & Health, Page 1-13
DOI: 10.9734/IJTDH/2015/18744

Background: Malaria is the infectious disease causing the highest morbidity and mortality in Angola. Existing tools for the diagnosis of malaria include microscopy, rapid diagnosis tests (RDTs) and molecular tools. Nested-PCR is commonly used as a reference technique in the diagnosis of malaria due to its high sensitivity and specificity. The present study aims to evaluate the accuracy of light microscopy and SD BIOLINE Malaria Ag in the detection of Plasmodium spp. infection, using the nested-PCR as a reference method, and to determine the Plasmodium species in the study populations (Luanda, Angola) using this molecular tool.

Methods: Blood samples were obtained from patients with clinical suspicion of malaria. Malaria was diagnosed by light microscopy, SD BIOLINE Malaria Ag and nested-PCR, used as a reference method, with Plasmodium falciparum, P. vivax, P. malariae, P. ovale and P. knowlesi being detected when possible. The sensitivity, specificity, positive, and negative predictive values (PPV and NPV) of microscopy and SD BIOLINE Malaria Ag were compared using the McNemar’s test and the weighted generalized score Chi-squared test for paired data.

Results: A total of 225 subjects were studied. SD BIOLINE Malaria Ag was significantly more sensitive than microcopy (87.65% versus 71.60%), and was substantially correlated (κ = 0.64) with the reference method. Nested-PCR detected 36.0% (81/225) cases, 80 cases (98.8%) infected with P. falciparum and 1 case as P. malariae (1.2%), with no mixed infections.

Conclusion: The findings of this study support the need to use RDT in the diagnosis of Plasmodium. PCR could appear to be a useful method for detecting Plasmodium parasites during active malaria surveillance in Angola. This study contributes to wide knowledge about the presence of Plasmodium species in Angola.

Open Access Original Research Article

Antituberculosis Drug - Induced Elevation in Serum Alanine Aminotransferase (ALT) Levels: A Comparison between Patients with and without HIV Seropositivity in Yenagoa, Nigeria

Peter Ogie Ikuabe, J. Jumbo, I. D. Ebuenyi, D. Ogoina, T. C. Harry

International Journal of TROPICAL DISEASE & Health, Page 1-6
DOI: 10.9734/IJTDH/2015/19448

Introduction: The prevalence of rifampicin, isoniazid and pyrazinamide induced elevations in serum alanine aminotransferase (ALT) levels were compared in a cohort of Nigerians with and without HIV seropositivity.

Methods: Records of all the patients with pulmonary tuberculosis (251 HIV positive and 205 HIV negative), aged above 15 years treated in the TB program of the Federal Medical Centre, Yenagoa from January 2013 to December 2014 were analysed for this study. The WHO 4 grades of hepatotoxicity using ALT were used. ALT of less than 50 U/L was taken as normal. Grade 1 (very mild hepatotoxicity): <2.5 x upper limit of normal (ULN) i.e. ALT 51-125 U/L. Grade 2 (mild): 2.6 – 5 x the ULN (ALT 126-250 U/L). Grade 3 (moderate): 5-10 x the ULN (ALT 251 – 500 U/L). Grade 4 (severe) >10 x the ULN (ALT > 500 U/L).

Results: No patient with or without HIV seropositivity had ALT value in the grade 3 and 4 category ≥251 U/L. There was no statistically significant difference in ALT values between cohorts with or without HIV in the 3 ALT categories obtained while on antituberculous drugs (P = 0.761, 0.367 and 0.197).

Conclusion: All the observed hepatotoxicity were mild. The average rate of hepatotoxicity in the HIV uninfected pulmonary tuberculosis cohort was 16.6%, 9.8% and 5.4% for ALT1, ALT2 and ALT3 respectively. The rate in the HIV infected cohorts was 15.5%, 8.8% and 16.4% for ALT1, ALT2 and ALT3.  It is encouraging to find a low rate of antituberculosis drug induced hepatotoxicity than one would expect based on the high prevalence of risk factors in our environment.

Open Access Review Article

A Review Article on Helicobacter pylori Antibiotic Resistance Profile in Iran

Shirin Eyvazi, Mojdeh Hakemi-Vala

International Journal of TROPICAL DISEASE & Health, Page 1-12
DOI: 10.9734/IJTDH/2015/18719

Now a day, antibiotic resistance is a global health threat which is considered as the major cause of treatment failures in bacterial infection. H. pylori (Helicobacter pylori) is a spiral-shaped gram negative bacterium that colonizes in gastric mucosa and is responsible for serious gastrointestinal diseases including peptic ulcers and gastric cancer. Appearance and increasing of antibiotic resistance in the recent years, mainly to metronidazole (in developing countries) and clarithromycin (in developed countries) have decreased the efficacy of H. pylori treatment regimens. The prevalence of H. pylori antibiotic resistance is not the same in all over the world and shows geographical variations. So, antibiotic treatment regimens should be administrating according to local antibiotic susceptibility pattern. Iran is a developing country in Middle East with the high prevalence of H. pylori infection about 80%. Many Iranian researchers from different provinces have investigated the susceptibility of H. pylori isolates to common antibiotics. So, the aim of this review paper was survey on the existence reports of Iranian authors to access an accurate antibiotic profile of H. pylori for efficient eradication therapy in the future.

Open Access Review Article

Outbreaks, Pathogen Containment and Laboratory Investigations of Lassa fever in Nigeria: How Prepared Are We?

Idris Abdullahi Nasir, Fatima Muhammad Sani

International Journal of TROPICAL DISEASE & Health, Page 1-10
DOI: 10.9734/IJTDH/2015/19391

Lassa is a highly contagious and devastating re-emerging vector-borne disease transmitted primarily by Mastomys natalensis. Lassa fever virus (LFV) and its vector are largely conserved to West African communities hence they experience frequent sporadic outbreaks. Lassa are usually associated with high mortality rates partly because cases are usually presented late to healthcare centers and its high virulence. The transmission rate of LFV is usually very high in affected areas in Nigeria due to poor pathogen containment, a necessity in medical care of infected individuals and inadequate and/or delayed laboratory confirmation of cases, consequently placing immediate communities and healthcare providers at higher risk of contracting LFV. Laboratory diagnose for Lassa are crucial because of similarities of clinical features it presents with other more frequent fever-causing infections such as severe malaria, typhoid and fulminant hepatitis. Understanding its basic virology, ecology, transmission pattern and immunology are crucial in embarking on appropriate infection control strategies and diagnostic protocols. In view of these, we sought to present this mini-review to summarize the pertinent literatures for healthcare providers especially in endemic locations, suggest the need to use the information from epidemiologic and laboratory findings to incorporate international best practices into community health and clinical practice in Nigeria.