Active tuberculosis among adult HIV-infected patients accessing antiretroviral therapy in a tertiary health facility in Lafia, northcentral Nigeria

*1Audu, E. S., 2Adiukwu, C., 3Bello, S., 4Abdulmajid, S., 4Anyuabaga, B., 5Ashuku, Y. A., and 6Anazodo, M.

1Department of Medical Microbiology/Special Treatment Clinic, Dalhatu Araf Specialist Hospital, Lafia

2Department of Internal Medicine, Dalhatu Araf Specialist Hospital, Lafia

3Department of Paediatrics/Special Treatment Clinic, Dalhatu Araf Specialist Hospital, Lafia

4Special Treatment Clinic, Dalhatu Araf Specialist Hospital, Lafia

5College of Medicine, Federal University, Lafia

6Research Unit, Dalhatu Araf Specialist Hospital, Lafia

*Correspondence to: estanamo@gmail.com

Abstract:
Background: Tuberculosis and Human Immunodeficiency Virus (HIV) co-infection is a major problem in Nigeria and other countries that are ravaged by a high burden of both diseases. The World Health Organization (WHO) reports that the risk of developing active tuberculosis (TB) among people living with HIV is 16-27 times that of HIV negative persons. Although antiretroviral therapy (ART) reduces the risk of developing TB, there are factors which predispose those on ART to TB. This study sought to determine the prevalence of TB among adults on ART in our facility and identify the predisposing factors.

Methodology: This was a retrospective study utilizing data from clinical records (folders and electronic) of adult HIV patients who are accessing ART in our facility and have been on ART for at least 6 months. A proforma was used to collect data including demographic, clinical, ART and laboratory information of the patients. The data were entered into SPSS version 23 and analyzed using descriptive statistics and bivariate analysis. Associations were tested using Chi square with 95% confidence level.

Results: A total of 457 patients were studied, aged 18-69 years (mean age 38.3± 10 years), and 72.4% females. Majority were married (81%), unemployed (53.8%), had mean baseline CD4 cell count of 267.4 ± 185 cells/mm3 and a mean duration on ART of 100.9± 39 months. Seventeen point three percent of the patients had a previous history of TB before or within 6 months of commencement of ART. Thirteen (2.8%) of the patients had active TB while on ART. Majority of those who had active TB were females (76.9%), married (76.9%), unemployed (46%), had no previous history of TB (53.8%), baseline CD4 cell count of ≤ 350 cells/mm3 and were on first line ART medication. There was however no significant statistical association of active TB with any of these factors.

Conclusion: Few patients had active TB while on ART in this study. The high frequency of TB in those who had low baseline CD4 cell count and baseline WHO stage shows the importance of early initiation of ART in people living with HIV (PLHIV). There is need for regular screening of PLHIV for TB and innovative approaches to get people with HIV to know their TB status as well as early commencement of ART.

Keywords: Human immunodeficiency virus, Active Tuberculosis, Antiretroviral therapy.

Received Dec 9, 2019; Revised March 15, 2020; Accepted March 18, 2020

Copyright 2020 AJCEM Open Access. This article is licensed and distributed under the terms of the Creative Commons Attrition 4.0 International License <a rel=”license” href=”//creativecommons.org/licenses/by/4.0/”, which permits unrestricted use, distribution and reproduction in any medium, provided credit is given to the original author(s) and the source.

Tuberculose active chez des patients adultes infectés par le VIH ayant accès à un traitement antirétroviral dans un établissement de santé tertiaire à Lafia, au centre-nord du Nigéria

*1Audu, E. S., 2Adiukwu, C., 3Bello, S., 4Abdulmajid, S., 4Anyuabaga, B., 5Ashuku, Y. A., et 6Anazodo, M. Continue reading “Active tuberculosis among adult HIV-infected patients accessing antiretroviral therapy in a tertiary health facility in Lafia, northcentral Nigeria”

The Prevalence of Intestinal Coccidian Parasites Burden in HIV/AIDS Patients on Antiretroviral Therapy in HIV Centers in Mubi, Nigeria

ACN Djieyep, FD Djieyep, BT Pokam, DL David, HLF Kamga

 

Abstract

Background: Intestinal coccidia are group of protozoa which parasitize the epithelial cells of the intestinal tract of their hosts. Most infections usually produce mild, self-limiting infections in man, but they now constitute a serious public health problem, especially in developing countries with inadequate sanitary conditions coupled with widespread HIV/AIDS infection.
Objective: To determine the Prevalence of intestinal coccidian parasites burden in HIV/AIDS patients on antiretroviral therapy in HIV Centers in Mubi, Nigeria
Materials and Methods: This was a hospital-based cross-sectional study in which stool specimens from  IV-positive patients on ART were examined for the presence ofoocysts of intestinal coccidian parasitesusing Modified Acid Fast Stain technique. In addition, patients’ blood samples were analyzed for CD4 count by flow cytometry and packed cell volume (PCV) through microhaematocrit centrifugation.
Results A total of 305 specimens examined, 236(77.4%) were positive for Cryptosporidium parvum, Isospora belli and Microsporidium species. Patients within the age group of 21 – 30 were the most infected. Generally, the  duration of ART influenced the prevalence of the intestinal coccidian parasites. There was a highly significant  association between the CD4 count and prevalence coccidian parasites (p ˂ 0.05). There was a significant  negative correlation (r = -0.95) between the duration of the ART and the prevalence of coccidian presence.
Conclusion: Routine screening of HIV-positive patients for intestinal parasites is advocated as standard operative procedure (SOP) before antiretroviral therapy (ART) is given. Construction of public health facilities, toilets and boreholes as well as public enlightenment campaign is recommended for more effective management of these patients.

Keywords: intestinal coccidian parasites, antiretroviral therapy, Mubi

 

Contexte: Les coccidies intestinales sont un groupe de protozoaires qui parasitent les cellules épithéliales du tube digestif de leurs hôtes. La plupart des infections humaines sont d’habitude peu sévères et autolimitées, mais elles constituent de nos jours un véritable problème de santé publique, particulièrement dans des pays en voie de développement où les conditions sanitaires sont inadéquates, et couplées à l’infection répanduedu VIH/SIDA.

Objectif: Déterminer la fréquence de coccidies intestinales chezles patients atteints de VIH/SIDA sous traitement antirétroviral dans les Centres de contrôle de VIH de Mubi au Nigeria.
Matérielset Méthodes: Il s’agissait d’une étude transversale dans laquelle les spécimens de selles des patients séropositifs au VIH et sous traitement antirétroviralétaient examinés en vue d’en dépister là la présence  d’oocystes de coccidies intestinales grâce à la technique de de coloration acido-résistante modifiée. De plus, les  prélèvements de sang des patients étaient analysés pour en déterminer le taux de CD4 et le taux demicro-hématocrite par les techniques de flux cytométrique et de centrifugation respectivement.
Résultats: Untotal de 305 spécimens ont été examinés, 236 (77.4 %) étaient positifs pour le Cryptosporidiumparvum,le Isospora belli et les espèces de Microsporidie. Les patients dans la tranche d’âge de 21 – 30 ans étaient les plus infectés. Généralement, la durée du traitement antirétroviralinfluençait la fréquence des coccidies intestinales. Il y avait une association fortement significative entre le taux de CD4 et les infections(p< 0.05). Il existait une corrélation négative significative (r =-0.95) entre la durée detraitement antirétroviralet la fréquence de coccidies intestinales.
Conclusion: Le dépistage de routine des patients séropositifs pour des parasites intestinaux est préconisé dans la procédure opératoire standard avant toute administration de thérapie antirétrovirale. La construction d’installations de santé publique, des toilettes et des puits de forage ainsi que des campagnes  d’éducationsanitaire sontfortement recommandées en vue d’une prise en charge effectivedes patients atteints de VIH.

Mots-clés : coccidies intestinales, thérapie antirétrovirale, Mubi

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The Prevalence of Intestinal Coccidian Parasites Burden in HIVAIDS Patients on Antiretroviral Therapy in HIV Centers in Mubi, Nigeria