| dc.description.abstract | Background: Sub-Saharan Africa with under 10% of the worldfs total population accounts for
60-70% of all HIV/AIDS cases. While these patients require HAART to manage the disease,
HAART is not universally available. Majority of the patients are in resource-constrained settings,
have multiple co- morbidities/infections, opportunistic infections, present late for treatment and
are in the advanced stages of the HIV/A}IDS
infection.
Objective: To describe the CD4+ cell counts, opportunistic infections and laboratory parameters
of a cohort of HIV positive, HAART-naive patients at first presentation.
Design: Cross sectional, prospective, descriptive, consecutive entry study.
Setting: Kisumu District Hospital wards (medical, surgical) and medical outpatient clinic,
Nairobi Rheumatology Clinic, Nairobi West Hospital and the Mater Hospital between January
2001 and December 2008.
Main outcome measures: Socio-demographic parameters, opportunistic infections, CD4+ cell
counts and complete blood count, biochemistry, HBsAg markers and anti- HCV serostatus.
Results: Eight hundred and thirty four (350 males and 484 females) patients were screened.
Three hundred and seventy (94 males and 276 females) patients were excluded. Four hundred
and sixty four (256 males and 208 females) patients were finally included in the study. The mean
age was 37.2 }10.6 years, range (12-78). The M: F ratio was 1.2:1. The mean CD4+ cell count
was 106.5 } 125.2 cells/μl manifesting severe immnosuppression. Fifteen (3.2%), 19(4.1%),
43(9.3%) and 387(83.5%) had CD4+ cell counts of > 500, 350-499, 200-349 and < 200 cells/ƒÊl
respectively. The mean white blood cell count was 8.63 } 8.8 ~ 103/ml (4.8-10.8 ~ 103/μl). Over
half (51.3%) patients had leucopaenia, white cell count < 4.8 ~ 103/μl, 35 (7.5%) had
leucocytosis and the rest 191 (41.2%) patients had normal white blood cell counts. The mean
haemoglobin level was 7.16 } 5.01 g/dl (12-18 g/dl) and 154 (33.2%) had haemoglobin level <
5g/dl manifesting severe anaemia. The patients had multiple co-morbidities and 248 (53.4%) had
. 2 co-morbidities.
Conclusion: The patients presented with severe immunosuppression evidenced by low CD4+
cell counts, anaemia and multiple co-morbidities. Majority presented late at which point the cost
of management is high and outcomes are likely to be poor. They required HAART and prompt
management of the co-morbidities to mitigate morbidity and reduce mortality. It would be
prudent to study treatment outcomes and their determinants overtime in patients with severe HIV
disease. Also, requiring study is how long such patients with severe HIV disease who commence
HAART would last on first line treatment before requirement of alternative treatment. | en_US |
