Initiation of antiretroviral therapy in HIV-infected adults with skin complaints in northern Tanzania.

Abnormal skin findings are identified in over 90% of human immunodeficiency virus (HIV)-infected persons globally. A prospective cohort study of HIV-infected patients with skin complaints commencing antiretroviral therapy (ART) in northern Tanzania was undertaken. Consecutive HIV-infected subjects presenting with skin complaints, who met criteria for ART initiation, were recruited at a Tanzanian Regional Dermatology Training Center. A single dermatologist evaluated all subjects; baseline skin biopsies were performed, and CD4(+) cell counts and plasma HIV RNA levels were measured. All subjects received a fixed-dose combination of stavudine, lamivudine, and nevirapine. A total of 100 subjects were enrolled; 86 subjects completed six months of follow-up. Median baseline CD4(+) cell counts and plasma HIV RNA levels were 120 cells/µl and 5.2 log10 copies/ml. The most common dermatologic condition was papular pruritic eruption (47%). The median baseline score on the Burn Scale was 38%. After six months, 10 subjects had achieved the complete resolution of skin abnormalities. In those without complete resolution, the median Burn Scale score improved to 7%. Five patients developed new eruptions by month 3, which in two cases were attributed to drug reactions. In the 86 subjects remaining on ART after six months, the median CD4(+) cell count had increased to 474 cells/µl, and plasma HIV RNA levels were <400 copies/ml in 85 (99%) subjects. Patients with HIV infection with skin complaints experienced marked clinical improvements following ART initiation.

Managing skin disease in resource-poor environments - the role of community-oriented training and control programs.

Programs that have been devised to improve the lot of patients with skin disease, or disease presenting with skin signs and symptoms, in resource-poor regions have focused mainly on education and training or community-oriented control measures. However, both have in common an objective of managing disease at population level. Training has been delivered in different ways both by direct teaching for varying periods of time or by web-based and electronic communication; control measures have been less in evidence and there is a great need for more support from funding agencies. Despite this, there is now a growing number of successful initiatives in health improvement for skin conditions that cover many parts of the world. This report describes many of these schemes as an example of what can be done to help patients.

Hearing impairment in Tanzanians with albinism.

Community-based studies have suggested that those affected with albinism, an important condition in East Africa, may be at a greater risk of developing hearing problems. This study shows that the prevalence of hearing loss is increased in Tanzanians with albinism and that hearing loss is associated with fewer years in education. 64 participants with albinism and 90 controls without were recruited from clinics held in the Western Kilimanjaro area. Hearing was evaluated using pure-tone audiometry at frequencies between 250 Hz to 8000 Hz and patients completed a questionnaire to evaluate their educational history. Of the participants with albinism, 33 (51.6% [95% CI: 39.3-63.8%]) had hearing impairment. This was significantly greater than the control group, where 20 (22.2% [95% CI: 13.6-30.8%]) had a similar hearing impairment (P < 0.001). Within the albinism group those with hearing impairment spent a mean of 6.9 years in education compared with those with normal hearing who spent a mean of 8.3 years in education (P = 0.046). Further studies are now required to determine the cause of these differences. Healthcare providers should be aware of hearing impairments when managing those with albinism and make the appropriate specialist referrals if further evaluation and treatment is required.