HIV symptom severity and associated factors among young people with HIV in Ghana.

ABSTRACTAdolescents and young adults (young people) with HIV (YPWH) often struggle with treatment self-management. Many have symptoms due to HIV disease, medication side-effects, or comorbid conditions. Our study investigated the severity of HIV-related symptoms among YPWH aged 18-24 with detectable viral loads from an HIV clinic in Ghana (N = 60) and potential correlates of severity across a range of factors. Results indicated that YPWH currently experienced, on average, 13 symptoms (SD = 12.33). Six of the 10 most common symptoms were from two domains: fatigue and psychological. The most common symptoms were headaches (62%), weakness (53%), and fear/worries (52%). No differences were observed in number or severity of symptoms between youth based on HIV transmission status. Bivariate correlates of symptom severity were found with six that remained significant or approached significance in a multivariate model predicting severity: living with a parent/guardian, higher perceived access to HIV care, and higher treatment readiness were associated with lower severity while greater travel time to the HIV clinic, psychological distress, and more missed clinic appointments were associated with higher severity. Our findings suggest that interventions to address symptoms among YPWH should be multilevel and include strategies (e.g., telehealth, home care) to increase access to care.

Prevalence and patterns of echocardiographic abnormalities among people living with HIV on anti-retroviral therapy in Kumasi, Ghana.

BACKGROUND: Echocardiography can be used to screen, confirm, and assist in the management of some cardiovascular diseases in people living with human immunodeficiency virus (HIV) (PLWH). Thus, complications from subclinical cardiovascular conditions or more apparent conditions, such as massive pericardial effusion with tamponade, can be promptly identified and managed to minimize cardiovascular morbidity and mortality associated with HIV infection. Since the introduction of antiretroviral therapy (ART) in Ghana approximately two decades ago, studies on the prevalence and patterns of echocardiographic abnormalities among PLWH on ART have been limited. This study was designed to assess the prevalence and patterns of echocardiographic abnormalities among PLWH on ART. METHODS: This was a cross-sectional study. PLWH on ART (cases) attending the HIV clinic at Komfo Anokye Teaching Hospital (KATH) and HIV-negative blood donors (controls) were consecutively recruited and enrolled in this study. The interviews were performed via a standardized questionnaire. After a clinical examination was performed, all patients underwent two-dimensional (2D) and Doppler transthoracic echocardiograms. The prevalence and patterns of echocardiographic abnormalities were characterized. RESULTS: There were 117 patients in each arm of the study. There were more females than males among both the cases (92 (78.6%) and controls (80 (68.4%)); however, the sex distribution was similar between the two groups (p = 0.075). For clinical characteristics such as age, weight, height and blood pressure, there were no statistically significant differences between the cases and controls. Echocardiographic abnormalities were more frequently observed and demonstrated a statistically significant difference between cases and controls, with an overall prevalence of 35.0% among cases and 19.7% among controls (p = 0.008). The echocardiographic abnormalities that demonstrated significant differences between the cases and controls were left ventricular (LV) diastolic dysfunction (28.2% versus 8.6%; p = 0.000) and LV hypertrophy (7% versus 0.9%; p = 0.017). CONCLUSION: Nearly 1 in 3 PLWH on ART had an echocardiographic abnormality in this Ghanaian study. Echocardiograms are recommended as helpful screening modalities for diagnosing cardiac abnormalities among PLWH on ART.

Clinical profile and predictors of viral suppression in HIV-infected older adults at a University Hospital in Kumasi, Ghana.

Availability of effective antiretroviral therapy (ART) has improved patient survival and older adults (≥50 years old) constitute 10% of the world's HIV population. However, data on this population are lacking, especially in sub-Saharan Africa. To identify the profile of older adults with HIV infection receiving ART and factors associated with viral suppression. A retrospective cross-sectional study involving HIV patients ≥50 years, registered at a University Hospital in Kumasi, Ghana from January 2010 to July 2020. All study participants had been on ARTs for ≥12 months. Data were analysed using STATA® and multivariate logistic regression was done to determine the association between variables. We recruited 132 study participants with a mean age of 58.1 years (±6.8). Non-communicable diseases (NCD) comprised the commonest comorbidity (67.4%; n = 89) and hypertension was the most prevalent (47.2%). The mean duration of ART was 63.2 months (±32.0) and approximately 84.1% (n = 111) achieved viral suppression (≤50 copies/ml). After adjustment, factors independently associated with viral suppression were widow(ed) (aOR = 0.23; 95% CI = 0.07-0.72) and good ART adherence (aOR = 3.51; 95% CI = 1.03-11.99). Hypertension is prevalent among this cohort of HIV patients. Approximately 84% of elderly patients on ARTs achieve viral suppression, influenced by widowhood and good drug adherence.

Attitudes of health care professionals towards interprofessional teamwork in Ashanti Region, Ghana.

BACKGROUND: Interprofessional collaboration ensures that high-quality health care is provided leading to improved health outcomes and provider satisfaction. Assessing the attitudes of health care professionals towards teamwork in Ghana is novel. OBJECTIVE: To examine the attitudes of health care professionals towards interprofessional teamwork and assess specific attributes influencing these attitudes in the Ashanti region, prior to implementing an in-service interprofessional HIV training programme. METHODS: A cross-sectional pre-training online survey using a modified Attitudes Toward Health Care Teams Scale was conducted among health care practitioners undergoing a two-day interactive interprofessional HIV training in Kumasi and Agogo from November 2019 to January 2020. Trainees were diverse health professional cadres selected from five hospitals in the Ashanti region of Ghana. Data was summarised using the mean and standard deviation for continuous variables, and frequencies and percentages for categorical variables. An exploratory factor analysis was conducted to categorise the 14 items of the modified attitudes scale. The Wilcoxon rank-sum (Mann-Whitney) and Kruskal-Wallis tests were used to test the mean attitude difference among the demographic characteristics. Statistical significance was set at p < 0.05. RESULTS: Altogether, 302 health professionals completed the survey. The ages ranged from 20-58 years, mean age 27.96 years (standard deviation 5.90 years). Up to 95% of the trainees agreed with the 14 statements on the modified attitudes scale. Three factors were identified; "quality of care", "team efficiency", and "time constraint" with Cronbach's alpha measures of 0.73, 0.50, and 0.45 respectively. The overall mean attitude score was 58.15 ± 6.28 (95% CI, 57.42-58.88). Attitude of health care professionals towards interdisciplinary teams for patient care varied significantly by age (p = 0.014), health profession cadre (p = 0.005), facility (p = 0.037), and professional experience (p = 0.034). CONCLUSION: Strengthening in-service interprofessional training for health practitioners especially early career professionals in the Ashanti region would be valuable.

Prevalence and incidence of pre-diabetes and diabetes mellitus among people living with HIV in Ghana: Evidence from the EVERLAST Study.

BACKGROUND: Available data from high-income countries suggest that people living with HIV (PLWH) have a four-fold higher risk of diabetes compared with HIV-negative people. In sub-Saharan Africa, with 80% of the global burden of HIV, there is a relative paucity of data on the burden and determinants of prevalent and incident dysglycaemia. OBJECTIVES: To assess the prevalence and incidence of pre-diabetes (pre-DM) and overt diabetes mellitus (DM) among PLWH in a Ghanaian tertiary medical centre. METHODS: We first performed a cross-sectional comparative analytical study involving PLWH on combination antiretroviral therapy (cART) (n = 258), PLWH not on cART (n = 244) and HIV-negative individuals (n = 242). Diabetes, pre-DM and normoglycaemia were defined as haemoglobin A1C (HBA1c) > 6.5%, in the range 5.7-6.4% and < 5.7% respectively. We then prospectively followed up the PLWH for 12 months to assess rates of new-onset DM, and composite of new-onset DM and pre-DM. Multivariate logistic regression models were fitted to identify factors associated with dysglycaemia among PLWH. RESULTS: The frequencies of DM among PLWH on cART, PLWH not on cART and HIV-negative individuals were 7.4%, 6.6% and 7.4% (P = 0.91), respectively, while pre-DM prevalence rates were 13.2%, 27.9% and 27.3%, respectively (P < 0.0001). Prevalent DM was independently associated with increasing age [adjusted odds ratio (95% confidence interval) (aOR, 95% CI) = 1.82 (1.20-2.77) for each 10-year rise], male sex [aOR = 2.64 (1.20-5.80)] and log(triglyceride/HDL cholesterol) [aOR = 8.54 (2.53-28.83)]. Prevalent pre-DM was independently associated with being on cART [aOR (95% CI) = 0.35 (0.18-0.69)]. There were a total of 12 cases of incident DM over 359.25 person-years, giving 33.4/1000 person-years of follow-up (PYFU) (95% CI: 18.1-56.8/1000), and an rate of incident pre-DM of 212.7/1000 PYFU (95 CI: 164.5-270.9/1000). The two independent factors associated with new-onset DM were having pre-DM at enrolment [aOR = 6.27 (1.89-20.81)] and being established on cART at enrolment [aOR = 12.02 (1.48-97.70)]. CONCLUSIONS: Incidence rates of pre-DM and overt DM among Ghanaian PLWH on cART ranks among the highest in the literature. There is an urgent need for routine screening and a multidisciplinary approach to cardiovascular disease risk reduction among PLWH to reduce morbidity and mortality from the detrimental effects of dysglycaemia.

Cost-effectiveness and budget impact of whole blood pathogen reduction in Ghana.

BACKGROUND: Despite the promise of pathogen reduction for reducing transfusion-associated adverse events in sub-Saharan Africa, no health-economic assessment is publicly available. STUDY DESIGN AND METHODS: We developed a mathematical risk reduction model to estimate the impact of nationwide whole blood pathogen reduction in Ghana on the incidence of six infectious and one non-infectious transfusion-associated adverse events. We estimated the lifetime direct healthcare costs and disability-adjusted life years lost for each adverse event. For HIV, HCV, and HBV, we simulated disease progression using Markov models, accounting for the likelihood and timing of clinical detection and treatment. We performed probabilistic and univariate sensitivity analysis. RESULTS: Adding whole blood pathogen reduction to Ghana's blood safety portfolio would avert an estimated 19,898 (11,948-27,353) adverse events and 38,491 (16,444-67,118) disability-adjusted life years annually, primarily by averting sepsis (49%) and malaria (31%) infections. One year of pathogen reduction would cost an estimated $8,037,191 ($6,381,946-$9,880,760) and eliminate $8,656,389 ($4,462,614-$13,469,448) in direct healthcare spending on transfusion-associated adverse events. We estimate a 58% probability that the addition of pathogen reduction would reduce overall direct healthcare spending. Findings were most sensitive to uncertainty in the probability that a bacterially contaminated blood donation causes sepsis. CONCLUSION: Whole blood pathogen reduction would substantially reduce the burden of known transfusion-associated adverse events in Ghana and may reduce overall healthcare spending. Additional benefits not captured by this analysis may include averting secondary transmission of infectious diseases, reducing non-medical costs, and averting new or re-emerging transfusion-transmitted infections.

Quality of life among patients with moderate to advanced chronic kidney disease in Ghana - a single centre study.

BACKGROUND: The prevalence of chronic kidney disease (CKD) is increasing worldwide and in Africa. Health related quality of life (QOL) has become an essential outcome measure for patients with CKD and end stage renal disease (ESRD). There is growing interest worldwide in QOL of CKD patients but paucity of data in Ghana. This study sought to assess QOL in patients with moderate to advanced CKD (not on dialysis) and establish its determinants. METHODS: We conducted a cross sectional observational study at the renal outpatient clinic at Komfo Anokye Teaching Hospital (KATH). We collected demographic, clinical and laboratory data. A pretested self-administered Research and Development corporation (RAND®) 36-Item Health Survey questionnaire was administered and QOL scores in physical component summary (PCS) and mental component summary (MCS) were computed. Determinants of QOL were established by simple and multiple linear regression. P value of < 0.05 was considered statistically significant. RESULTS: The study included 202 patients with CKD not on dialysis. There were 118(58.5%) males. Mean age was 46.7 ± 16.2 years. The majority, 165(81.7%) of patients were on monthly salaries of less than GHS 500 (~USD 125). Chronic glomerulonephritis was the most common cause of CKD in 118 (58.5%) patients followed by diabetes mellitus in 40 (19.8%) patients and hypertension in 19 (9.4%) patients. The median serum creatinine was 634.2 µmol/L (IQR 333-1248) and the median eGFR was 7 ml/min/1.73m2 (IQR 3-16). The most common stage was CKD stage 5 accounting for 143 (71.1%), followed by CKD stage 4 with 45 (22.4%) of cases and 13 (6.5%) of CKD stage 3. The overall mean QOL score was 40.3 ± 15.4. MCS score was significantly lower than PCS score (37.3 ± 10.8 versus 43.3 ± 21.6, P < 0.001). Multiple linear regression showed that low monthly income (p = 0.002) and low haemoglobin levels (p = 0.003) were predictive of overall mean QOL. CONCLUSION: Patients with moderate to advanced CKD had low-income status, presented with advanced disease and had poor QOL. Anaemia and low-income status were significantly associated with poor QOL.

Quality of life among Ghanaian adolescents living with perinatally acquired HIV: a mixed methods study.

In Sub-Saharan Africa, increasing numbers of children with perinatally acquired HIV (PAHIV) are living into adolescence. These adolescents face numerous unique challenges such as parent illness/death and years of medication use. Optimizing care for these youth requires an understanding of the factors that contribute to physical health, psychological well-being, social relationships, and quality of life (QOL). This mixed methods study collected quantitative questionnaire data from 40 Ghanaian adolescents with PAHIV (50% female, 12-19 years old) who received care through an adolescent HIV clinic in Kumasi, Ghana. The study also presents results from qualitative interviews conducted with 20 adolescents. Results from quantitative analyses suggested that a significant number of participants were not virally suppressed (67%) and participants reported barriers to treatment adherence, limited social support, concerns about disclosure and HIV-related stigma, limited resources, and lower than expected QOL. Salient themes from the qualitative analyses included limited understanding of how HIV is transmitted, the interplay between food insecurity and treatment adherence and the need for developing safe relationships through which adolescents can discuss their illness without fear of accidental disclosure of their HIV status.

Helicobacter pylori Coinfection Is Associated With Decreased Markers of Immune Activation in ART-Naive HIV-Positive and in HIV-Negative Individuals in Ghana.

BACKGROUND: Helicobacter pylori coinfection in human immunodeficiency virus (HIV) patients has been associated with higher CD4+ cell counts and lower HIV-1 viral loads, with the underlying mechanisms being unknown. The objective of this study was to investigate the impact of H. pylori infection on markers of T-cell activation in HIV-positive and HIV-negative individuals. METHODS: In a cross-sectional, observational study, HIV patients (n = 457) and HIV-negative blood donors (n = 79) presenting to an HIV clinic in Ghana were enrolled. Data on clinical and sociodemographic parameters, CD4+/CD8+ T-cell counts, and HIV-1 viral load were recorded. Helicobacter pylori status was tested using a stool antigen test. Cell surface and intracellular markers related to T-cell immune activation and turnover were quantified by flow cytometry and compared according to HIV and H. pylori status. RESULTS: Helicobacter pylori infection was associated with decreased markers of CD4+ T-cell activation (HLA-DR+CD38+CD4+; 22.55% vs 32.70%; P = .002), cell proliferation (Ki67; 15.10% vs 26.80%; P = .016), and immune exhaustion (PD-1; 32.45% vs 40.00%; P = .005) in 243 antiretroviral therapy (ART)-naive patients, but not in 214 patients on ART. In HIV-negative individuals, H. pylori infection was associated with decreased frequencies of activated CD4+ and CD8+ T cells (6.31% vs 10.40%; P = .014 and 18.70% vs 34.85%, P = .006, respectively). CONCLUSIONS: Our findings suggest that H. pylori coinfection effectuates a systemic immune modulatory effect with decreased T-cell activation in HIV-positive, ART-naive patients but also in HIV-negative individuals. This finding might, in part, explain the observed association of H. pylori infection with favorable parameters of HIV disease progression. CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov NCT01897909.

Prevalence of Increased QTc Dispersion Among Hypertensive Patients and Its Correlation to Clinical Risk Factors: A Hospital-Based Case-Control Study.

Background In Ghana and other sub-Saharan African countries, hypertension (HTN) prevalence is rapidly increasing. Hypertensive left ventricular hypertrophy (LVH) is associated with excess fibrous tissue deposition throughout the myocardium. This could lead to ventricular arrhythmias and sudden cardiac death. Increased corrected QT dispersion (QTcd) can cause ventricular repolarization and be used to identify patients at risk of ventricular tachyarrhythmia. The measurement of increased QTcd among hypertensive patients is a simple screening tool to stratify patients at cardiovascular risk. Methods A case-control hospital-based study was conducted on 200 consecutive hypertensive patients. Age- and sex-matched control groups of 200 normotensive individuals who gave informed consent were also recruited. The baseline clinical and demographic characteristics of participants were acquired using structured questionnaires. A physical examination and a resting 12-lead ECG were performed. Increased QTcd and LVH were determined. Results The mean age of hypertensive patients was 50.99±6.73 and 48.19±7.17 for the controls (p-value 0.63). The study population was predominantly female (1:2.4 male:female ratio). Higher mean values for QTcd and LVH (Sokolow-Lyon) were observed among hypertensive patients compared to controls. The prevalence of increased QTcd was 45.0% among hypertensive patients compared to 16.5% in controls (χ2 =38.14, p-value <0.0000001, odds ratio = 4.14). Conclusion Increased QTcd is prevalent among hypertensive Ghanaians. Its measurement can be an effective non-invasive screening tool to risk-stratify hypertensive patients.

Frequency & factors associated with elevated lipoprotein-a among Ghanaian stroke survivors.

BACKGROUND: Indigenous Africans are genetically predisposed to elevated lipoprotein-a (Lp(a)), a veritable risk factor for ischemic stroke. Recent studies have demonstrated the promising efficacy of therapeutic interventions for addressing elevated Lp(a) among patients at high risk of atherosclerotic cardiovascular events. It is important to assess the burden of elevated Lp(a) among stroke survivors of African ancestry aimed at addressing potential unmet therapeutic gaps for optimal secondary prevention. PURPOSE: To assess the frequency of elevated lipoprotein-a among Ghanaian stroke survivors and factors associated with it. METHODS: A prospective study conducted at the Neurology clinic of the Komfo Anokye Teaching Hospital among ischemic stroke survivors aged ≥18 years. Serum lipoprotein-a concentrations were measured using ELISA kits. A multivariate regression analysis was fitted to identify factors independently associated with elevated lipoprotein-a concentration > 30 mg/dl. RESULTS: Among 116 stroke survivors, 35 (30.2%) had elevated Lp(a). The adjusted odds ratio (95% CI) of factors associated with elevated Lp(a) were female sex 3.09 (1.05-9.12), p = 0.04, diabetes mellitus 3.52 (1.32-9.40), p = 0.01, urban dwelling 4.64 (1.61-13.39), p = 0.005 and total cholesterol 1.85 (1.28-2.67), p = 0.001. Whereas the LDL cholesterol significantly decreased from baseline to month 12 among a subset of participants, the Lp(a) levels significantly increased from a baseline value of 29.38 ± 15.32 mg/dl to 40.97 ± 29.72 mg/dl, p = 0.032. CONCLUSION: Approximately 1 in 3 Ghanaian ischemic stroke survivors harbor an elevated Lp(a) associated with female sex, urban residence, diabetes mellitus and raised cholesterol. This burden highlights an unmet therapeutic gap in secondary risk reduction in this resource-limited setting.

The Clinical Features and Immunological Signature of Cyclospora cayetanensis Co-Infection among People Living with HIV in Ghana.

Background: There is a paucity of information on the contemporary burden, disease patterns, and immunological profile of people living with HIV who are co-infected with C. cayetanensis in the post-antiretroviral therapy era. Methods: For this cross-sectional study, stool samples of 640 HIV-positive and 83 HIV-negative individuals in Ghana were tested for C. cayetanensis. Additionally, sociodemographic parameters, clinical symptoms, medical drug intake, and immunological parameters were assessed. Results: The prevalence of C. cayetanensis was 8.75% (n = 56) in HIV-positive and 1.20% (n = 1) in HIV-negative participants (p = 0.015). Within the group of HIV-positive participants, the prevalence reached 13.6% in patients with CD4+ T cell counts below 200 cells/µl. Frequencies of the clinical manifestations of weight loss and diarrheal disease were significantly higher in patients with C. cayetanensis compared to those without co-infection (36.36% vs. 22.59%, p = 0.034 and 20.00% vs. 4.90%, p < 0.001, respectively). The expression of markers of immune activation and exhaustion of T lymphocyte sub-populations was significantly elevated in patients colonized with C. cayetanensis. Conclusions: In the modern post-combined antiretroviral therapy (cART) era, the acquisition of C. cayetanensis among PLWH in Ghana is driven largely by the immunosuppression profile characterized by high expression of markers of immune activation and immune exhaustion.

Short Communication: Low seroprevalence of cryptococcal antigenaemia in patients with advanced HIV infection enrolling in an antiretroviral programme in Ghana.

OBJECTIVES: To determine the prevalence of cryptococcal antigenaemia in a clinic population with advanced HIV infection, with a view to giving antifungal therapy to those testing positive. METHODS: Serum samples from adults with CD4 count <100 cells/mm(3) presenting to a large HIV clinic in Kumasi, Ghana, were tested retrospectively for cryptococcal antigenaemia using a latex agglutination assay, and clinical and demographic data extracted from case notes. RESULTS: Of 92 samples tested, two were positive thus giving a prevalence of 2% (95% CI, 0-5.2%). CONCLUSIONS: The prevalence of cryptococcal antigenaemia in patients with advanced HIV infection enrolling in an antiretroviral programme appears to be low in Kumasi, suggesting that the value of routine testing of outpatients diagnosed with advanced HIV infection may be limited in this population.

Factors associated with incidence of stroke and heart failure among people living with HIV in Ghana: Evaluating Vascular Event Risk while on Long-Term Antiretroviral Suppressive Therapy (EVERLAST) Study.

People living with HIV (PLWH) have a two-fold higher risk of cardiovascular diseases (CVDs) compared with HIV-negative populations. Although 70% of the global HIV population reside in Africa, data on CVD outcomes among PLWH are scarce. We seek to evaluate factors associated with incidence of stroke and heart failure in a prospective cohort of Ghanaian PLWH. We followed up a cohort of PLWH on antiretroviral therapy for 12 months to assess rates of clinically adjudicated stroke, and heart failure. We calculated incidence rates of events/1000 person-years and fitted Cox proportional hazards regression models to identify factors associated with incident stroke and heart failure as a combined outcome measure and as separate outcome measures. Among 255 participants, the mean age was 46 years and 211 (82.7%) were female. The participants contributed 245 years of follow-up data with mean follow-up duration of 11.5 months. There were three incident strokes giving an incidence rate of 12.24 per 1000 person-years (95% CI: 3.13-33.33) and two heart failure events with an incidence rate of 8.16 (95%CI: 1.37-26.97) per 1000 py. The combined event rate was 20.41 (95% CI: 7.48-45.24) per 1000 py. Being hypertensive was associated with aHR of 8.61 (1.32-56.04) of the combined outcome while each 100 cells/mm3 rise in CD4 count was associated with aHR of 0.56 (0.35-0.88). Carotid bulb intimal media thickness was independently associated with stroke occurrence with aHR of 12.23 (1.28-117.07). People living with HIV on long-term cART in this Ghanaian sample have high rates of clinically adjudicated cardiovascular diseases driven by uncontrolled hypertension and persisting immunosuppression. Integration of CVD care into routine HIV management may help alleviate this untoward confluence of rising CVDs among PLWH.

Intestinal Colonization with Tropheryma whipplei-Clinical and Immunological Implications for HIV Positive Adults in Ghana.

BACKGROUND: Recent studies demonstrated higher prevalence rates of Tropheryma whipplei (T. whipplei) in HIV positive than in HIV negative subjects. However, associations with the immune status in HIV positive participants were conflicting. METHODS: For this cross-sectional study, stool samples of 906 HIV positive and 98 HIV negative individuals in Ghana were tested for T. whipplei. Additionally, sociodemographic parameters, clinical symptoms, medical drug intake, and laboratory parameters were assessed. RESULTS: The prevalence of T. whipplei was 5.85% in HIV positive and 2.04% in HIV negative participants. Within the group of HIV positive participants, the prevalence reached 7.18% in patients without co-trimoxazole prophylaxis, 10.26% in subjects with ART intake, and 12.31% in obese participants. Frequencies of clinical symptoms were not found to be higher in HIV positive T. whipplei carriers compared to T. whipplei negative participants. Markers of immune activation were lower in patients colonized with T. whipplei. Multivariate regression models demonstrated an independent relationship of a high CD4+ T cell count, a low HIV-1 viral load, and an obese body weight with the presence of T. whipplei. CONCLUSIONS: Among HIV positive individuals, T. whipplei colonization was associated with a better immune status but not with clinical consequences. Our data suggest that the withdrawal of co-trimoxazole chemoprophylaxis among people living with HIV on stable cART regimen may inadvertently increase the propensity towards colonization with T. whipplei.

A forgotten parasitic infestation in an immunocompromised patient-a case report of crusted scabies.

Crusted scabies is a rare and highly contagious form of Sarcoptes scabiei var hominis infestation whose incidence may increase in the near future due to increasing use of immunosuppressive therapies and a general lack of awareness about the condition. It is misdiagnosed as psoriasis, irritant dermatitis or eczema. Delays in diagnosis lead to widespread transmission amongst contacts leading to potential community outbreak. Crusted scabies is extremely difficult to treat and there are growing concerns of possible resistance to current treatment. This case report describes a 44-year-old Ghanaian woman with human immunodeficiency virus (HIV) infection and diagnosed with skin scrapings. Treatment was initiated but the patient died from HIV related complications. Crusted scabies, though rare, should be an issue of global concern due to the potential for widespread dissemination. Adequate resources need to be channeled into scabies eradication as well as education of health personnel to promptly identify and treat cases.

Molecular Characterization and Clinical Description of Non-Polio Enteroviruses Detected in Stool Samples from HIV-Positive and HIV-Negative Adults in Ghana.

In the post-polio eradication era, increasing attention is given to non-polio enteroviruses. Most of the data about enteroviruses in sub-Saharan Africa are related to acute flaccid paralysis surveillance and target the pediatric population. This study aimed to investigate the presence of enterovirus in PLHIV (people living with HIV) and HIV-negative individuals in Ghana. Stool samples from HIV-positive individuals (n = 250) and healthy blood donors (n = 102) attending the Komfo Anokye Teaching Hospital in Kumasi, Ghana, were screened by real-time PCR for enterovirus. Molecular typing of the VP1 region was performed. Enterovirus-positive samples were tested for norovirus, adenovirus, rotavirus, sapovirus, and cosaviruses. Twenty-six out of 250 HIV-positive subjects (10.4%) and 14 out of 102 HIV-negative individuals (13.7%) were detected enterovirus-positive, not showing a significant different infection rate between the two groups. HIV-negative individuals were infected with Enterovirus C strains only. HIV-positive participants were detected positive for species Enterovirus A, Enterovirus B, and Enterovirus C. Co-infections with other viral enteric pathogens were almost exclusively detected among HIV-positive participants. Overall, the present study provides the first data about enteroviruses within HIV-positive and HIV-negative adults living in Ghana.

Sustained immunological responses to highly active antiretroviral therapy at 36 months in a Ghanaian HIV cohort.

Two hundred thirty-seven Ghanaian human immunodeficiency virus-infected patients who were starting antiretroviral therapy underwent clinical and immunological monitoring for 3 years. Seventy-eight percent of patients had disease classified as World Health Organization stage III or IV. The mean increase in the CD4 cell count was 395 cells/mm(3), 13% of patients experienced immunological failure, and 8% of patients switched treatment to a second-line regimen. However, two-thirds of patients who experienced immunological failure did not switch treatment, and 31% of all patients were lost to follow-up.

Assessing Reproductive Decision-making Among HIV-Positive Women in Kumasi, Ghana.

BACKGROUND OR OBJECTIVES: HIV-positive women have higher rates of unmet need for contraception and unintended pregnancy and face unique obstacles in accessing family planning services, such as healthcare-related stigma and disclosing HIV status to partners. This study characterizes factors that influence the reproductive decision-making of women living with HIV and identifies areas for improvement in reproductive counseling in Kumasi. METHODS: In this cross-sectional study, HIV-positive women, ages 18 to 45 years, presenting for care at Komfo Anokye Teaching Hospital between June and August 2017 were interviewed using structured surveys. Information gathered included demographics, method of contraceptive use, initiation of anti-retroviral therapy (ART), knowledge and use of contraception, and future reproductive plans. The primary outcome was current family planning use and future reproductive desire. Univariate analysis was used to characterize the demographics of the study group. Bivariate analysis including Chi-squared test was employed to assess the association between use of family planning between women with an HIV-positive and HIV-negative partner, with significance set at p < 0.05. RESULTS: A total of 88 women were interviewed. The unmet need for contraception was 10%. Among all sexually active women, 26% did not use contraception. Fewer women with HIV-negative or untested partners were using contraception (65% and 67%, respectively), compared to women with HIV-positive partners (93%). Partner preference was the most common reason cited for not using a method of contraceptive (46%). Similar trends were found in future reproductive desires based on age cohorts, partner status, and use of family planning. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Significant barriers to family planning use among HIV-positive women remain, especially those with a serodiscordant partner. Most partners were aware of their partner's HIV status. This highlights an important opportunity to include partners in HIV and contraceptive counseling.

Characteristics of hypertension among people living with HIV in Ghana: Impact of new hypertension guideline.

Data on the burden of hypertension among people living with HIV (PLWH) in Africa are limited, especially after new expert consensus hypertension guidelines were published in 2017. The authors sought to assess the prevalence and factors associated with hypertension among PLWH. This is a cross-sectional study involving PLWH on combination antiretroviral therapy (cART) (n = 250) compared with sex-matched cART-naïve PLWH (n = 201) in Ghana. Hypertension was defined as blood pressure ≥ 140/90 mm Hg or use of antihypertensive drugs. The authors also assessed the prevalence and predictors associated with hypertension using the recent guideline recommended cutoff BP ≥ 130/80 mm Hg. Multivariate logistic regression models were fitted to identify factors associated with hypertension among PLWH. The mean age of PLWH on cART was 45.7 ± 8.6 years, and 42.9 ± 8.8 years among PLWH cART-naive with 81% of study participants being women. The prevalence of hypertension among PLWH on cART and PLWH cART-naïve was 36.9% and 23.4%, P = 0.002 at BP ≥ 140/90 mm Hg and 57.2% and 42.3%, respectively, P = 0.0009, at BP ≥ 130/80 mm Hg. Factors associated with hypertension at BP ≥ 140/90 mm Hg in the PLWH group with adjusted odds ratio (95% CI) were increasing age, 2.08 (1.60-2.71) per 10 years, and body mass index, 1.53 (1.24-1.88) per 5 kg/m2 rise. At BP ≥ 130/80 mm Hg, cART exposure, aOR of 1.77 (95% CI: 1.20-2.63), family history of hypertension, aOR of 1.43 (1.12-1.83), and hypertriglyceridemia, aOR of 0.54 (0.31-0.93), were associated with hypertension. Among PLWH, cART exposure was associated with higher prevalence of hypertension per the new guideline definition, a finding which warrants further investigation and possible mitigation.