Clinical characteristics and outcome of HIV infected patients with chronic kidney disease in Sub Saharan Africa: an example from in Cameroon.

BACKGROUND: Chronic kidney disease (CKD) is one of the major complications of Human immune deficiency Virus (HIV) and a risk factor for poor outcome of these patients. We aimed to describe the profile and outcome of HIV positive patients with CKD in Douala general hospital in Cameroon. METHODS: HIV positive patients with CKD referred to the nephrologist from January 2007 to March 2013 were included. Socio demographic, clinical (history and stage of HIV, comorbidities, baseline nephropathy, used of c-ART), para clinical data at referral (serum urea, creatinine, full blood count, CD4 count, serum calcium, phosphorus, albumin), dialysis initiation and outcome at 1 year were collected from medical records. GFR was estimated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. CKD was defined and classified according to the Kidney Disease Improving Global Outcomes (KDIGO 2012). RESULTS: We included 156 patients (51.3% men) with a mean age of 45.4 ± 12.1 years. Hypertension (36.5%), diabetes (17.9%) and Hepatitis C (7.7%) were the main comorbidities. HIV associated nephropathy (27.6%), chronic glomerulonephritis (15.4%) diabetes (14.1%) and hypertension (13.5%) were the leading causes of kidney disease. Before referral HIV status was known by 109 (69.9%) patients, with 76 (69.7%) being on c-ART. Median CD4 count was 241 (117-438) cells/mm3. Prevalence of anemia (93.9%), hypocalcemia (68.6%) and Proteinuria (77.6%) was high, 94 (60.3%) patients were at CKD stage 5 at referral and 37 (23.7%) underwent emergency dialysis. After 1 year, 64 (41.0%) patients were lost to follow up. The mortality rate was 49% and 25 (28.7%) were maintenance hemodialysis, and being on c-ART was associated with a lower risk of death (HR: 0.45; 95% CI: 0.23-0.89; p = 0.021). CONCLUSION: HIV patients with CKD were referred late with high morbidity and need for urgent hemodialysis. HIVAN was the main etiology of CKD and mortality rate was high mainly due to the absence of c-ART at referral.

Survival of HIV infected patients on maintenance hemodialysis in Cameroon: a comparative study.

BACKGROUND: There are conflicting reports on the impact of HIV in the era of combined antiretroviral (c-ART) on survival of patient with ESKD. We aimed to compare the one-year survival of HIV positive patients to that of their HIV negative counterparts with ESKD on maintenance haemodialysis in Cameroon. METHODS: This was a retrospective cohort study conducted in the haemodialysis units of the Douala and Yaoundé General Hospitals. All HIV positive patients treated by maintenance haemodialysis between January 2007 and March 2015 were included. A comparative group of HIV negative patients with ESKD were matched for age, sex, co morbidities, year of dialysis initiation and haemodialysis unit. Relevant data at the time of haemodialysis initiation and during the first year of haemodialysis was noted. Survival was analysed using the Kaplan Meier and Cox regression hazard ratio estimator. A p value < 0.05 was considered statistically significant. RESULTS: A total of 57 patients with HIV and 57 without HIV were included. Mean age was 46.25 ± 11.41 years, and 52.6% were females in both groups. HIV nephropathy (50.9%) was the main presumed aetiology of ESKD in the HIV group, while chronic glomerulonephritis (33.3%) and diabetes (21.1%) were the main aetiologies in the HIV negative group. At initiation of dialysis, the median CD4 count was 212 cell/mm3 (IQR; 138-455) and 77.2% were receiving c-ART. The proportion of patients who initiated dialysis with a temporary venous catheter was similar in both groups (p = 0.06). After one year on haemodialysis, survival rate was lower in the HIV positive group compared to the HIV negative group (61.4%/78.9%, HR: 2.05; 95% CI: 1.03-4.08; p = 0.042).Kaplan Meier survival curve was in direction of a lower survival in HIV positive group (p = 0.052). CONCLUSION: The one year survival of HIV positive patients on maintenance haemodialysis in Cameroon seems to be lower compared to their HIV negative counterparts.

Ten Recommendations for Accelerating Hypertension and Diabetes Control to Reduce Stroke, Heart, and Renal Disease with the Aim to Save Lives in Cameroon Through Partnerships and Collaborations.

Hypertension and diabetes are currently the most common, treatable, and controllable cardiovascular and metabolic risk factors for stroke, heart, and renal diseases in Cameroon. Hypertension affects 30% of adults aged ≥ 20 years with 90% as uncontrolled cases, while type 2 diabetes affects 6% of the same population, with 70% remaining underdiagnosed. Despite publication of the first Roadmap on raised blood pressure by the World Heart Federation in 2015, the Pan African Society of Cardiology Roadmap in 2017, and the technical package for cardiovascular disease management in primary health care (WHO-HEARTS) in 2020, very little progress has been made in improving the diagnosis, treatment, and control of cardiovascular risk factors and diseases in Cameroon. The Cameroon Cardiac Society and a dozen Cameroon non-communicable diseases societies, national organizations from the community and the civil society, along with researchers and members of academia and the health sector, came together under the patronage of representatives of the government to propose new strategies to improve hypertension and diabetes control and save lives in Cameroon. Two simple and practical algorithms for the management of hypertension and diabetes were developed. The ten recommendations tailored to be efficiently implemented in our country were summarized under the acronym 'A SMART VIEW' (Awareness, Screening, Manufacture, Activity, Research, Task-shifting, HIV/AIDS, Insurance, Education, and WHO-HEARTS). It is our hope that all stakeholders will further collaborate to remove barriers and enhance facilitators to deploy the proposed actions and reduce the burden of uncontrolled hypertension and untreated diabetes in Cameroon.

Hypertension and diabetes are very common, yet treatable, cardiovascular, and metabolic risk factors for stroke, heart, and renal diseases in Cameroon. One-third of all adults aged 20 years or more in Cameroon have hypertension, in most of whom it remains uncontrolled. In addition, while 6% of these adults have type 2 diabetes, more than two-thirds remain underdiagnosed. Despite efforts to improve the diagnosis, treatment, and control of cardiovascular risk factors and diseases in Cameroon, minimal progress has been made. The Cameroon Cardiac Society, supported by input from Cameroon non-communicable diseases societies, national institutions/organizations, and representatives from the community, research, academia, and the health sector, has now developed two practical algorithms and ten recommendations specific to the Cameroonian population in an attempt to improve the control of hypertension and diabetes in Cameroon. It is hoped that these stakeholders will further collaborate to ensure the efficient implementation of these recommendations across the country, with the ongoing aim of monitoring their effectiveness over the next five years.

Factors predicting in-hospital all-cause mortality in COVID 19 patients at the Laquintinie Hospital Douala, Cameroon.

BACKGROUND: Despite being a global pandemic, little is known about the factors influencing in-hospital mortality of COVID-19 patients in sub-Saharan Africa. This study aimed to provide data on in-hospital mortality among COVID-19 patients hospitalized in a single large center in Cameroon. METHODS: A hospital-based prospective follow-up was conducted from March 18 to June 30, 2020, including patients >18 years with positive PCR for SARS-COV-2 on nasopharyngeal swab admitted to the Laquintinie Douala hospital COVID unit. Predictors of in-hospital mortality were assessed using Kaplan Meir survival curves and Weibull regression for the accelerated time failure model. Statistical significance was considered as p < 0.05. RESULTS: Overall 712 patients (65,7% men) were included, mean age 52,80 ± 14,09 years. There were 580 (67,8% men) in-hospital patients. The median duration of hospital stay was eight days. The in-hospital mortality was 22.2%. Deceased patients compared to survivors were significantly older, had a higher temperature, respiratory rate, and heart rate, and lowest peripheral oxygen saturation at admission. After adjusting for age, sex, and other clinical patient characteristics, increased heart rate, increased temperature, decreased peripheral oxygen saturation. The critical clinical status was significantly associated with increased in-hospital mortality. In contrast, hospitalization duration greater than eight days and the use of hydroxychloroquine (HCQ) + azithromycin (AZM) therapy was associated with decreased risk of in-hospital mortality. CONCLUSION: One in five hospitalized COVID-19 patients die in a low-middle income setting. Critical clinical status, dyspnea, and increased heart rate were predictors of in-hospital mortality. This study will serve as a prerequisite for more robust subsequent follow-up studies. Also, these results will aid in revising national guidelines for the management of COVID-19 in Cameroon.

Clinical and epidemiological characteristics and outcomes of patients hospitalized for COVID-19 in Douala, Cameroon.

INTRODUCTION: the coronavirus disease (COVID-19) is a disease that originated from Wuhan in December 2019. It rapidly spread across the globe causing high mortality especially among the elderly. Africa though not spared has limited studies regarding its effects on its population. We therefore sought to describe the epidemiological and clinical characteristics of COVID-19 in Douala, Cameroon. METHODS: we conducted a single-centre, retrospective, and observational study by reviewing records of patients managed for COVID-19 between the 8th March 2020 and 31st, May 2020. Cases were confirmed by real-time reverse transcriptase - polymerase chain reaction and were analysed for epidemiological, demographic, clinical, and radiological features. Outcomes were either clinical improvement by Day-28 or in-hospital mortality. RESULTS: we analyzed 282 case files, 192 were males (M: F=2: 1). The mean age was 52 (+/- 15) years. Hypertension and diabetes accounted for 75% of the chronic medical conditions identified. Main presenting complaints were dyspnea, cough, asthenia, and fever (55-60%). Radiographic analysis showed a ground-glass appearance in 85% of cases. Chloroquine/Hydroxychloroquine was the most (91.8%) frequently used drug in management protocols, 35% needed oxygen supplementation while 6 patients were intubated. Severe pneumonia (11.3%) was the commonest complication. They were 91 admissions in the intensive care unit. The average length of hospital stay was 10 (+/- 5) days. The mortality rate was 32%. CONCLUSION: our findings are concordant with universally reported data of COVID-19 hospitalised patients. These parameters are essential in designing effective prevention and control programs aimed at reducing the impact of the COVID-19 pandemic particularly in countries with limited resources.

Seroprevalence, attitudes and practices of the Baka Pygmies of eastern Cameroon towards HIV and AIDS.

INTRODUCTION: The vulnerable health status of Pygmies is the result of their continual exposure to the modern world. The purpose of this study was to determine the prevalence of HIV and the attitudes and practices of Baka populations towards HIV infection. METHODOLOGY: A descriptive and cross-sectional study was conducted over a five-month period in 12 Pygmy camps. A questionnaire was completed to collect information, and anonymous screenings were held. For screening, whole blood was collected. The Determine HIV-1/2 test was used as the rapid test, and the SD Bioline HIV-1/2 test was used as the second test. Associations between variables were checked. RESULTS: A total of 560 Baka were recruited. The sex ratio was 0.92. Among the means of transmission, sexual intercourse was the most frequently cited (37.6%). A minority (28.5%) knew where to undergo an HIV test, 24.2% did not know that there exists treatment enabling patients to have a higher quality of life, and 75.7% had never used a condom. A total of 86.9% had never been tested for HIV. Subjects who had sex with the Bantu were three times more likely to be infected (p = 0.02), as well as those who had had more than three sexual partners. CONCLUSIONS: The changes affecting contemporary societies are inevitably influenced by the dominant factors of modernity, particularly progress, development, and social dynamics in all their aspects. Baka knowledge about HIV/AIDS is limited. Educational efforts, increased awareness, and guidance are needed.

Intestinal parasitic and candida infection associated with HIV infection in Cameroon.

INTRODUCTION: HIV causes progressive impairment of the cellular immune system leading to increased susceptibility to infectious agents. Parasitic infestations are common in HIV-infected patients and usually lead to diarrhoea. Few studies have addressed the issue of intestinal parasites among HIV-infected persons in Cameroon.  This investigation was conducted in Douala, Cameroon, to assess the prevalence of gastrointestinal parasites in HIV-infected patients, taking into account their immune status and treatment course. METHODOLOGY: Stool and blood samples were collected from 201 HIV-positive patients for the investigation of intestinal pathogens and CD4+ counts. RESULTS: Fifty-six (27.9%) patients harbored pathogens. The most frequent pathogens were Candida spp. (14.9%), Cryptosporidium spp. (7.5%), Entamoeba histolytica, and Entamoeba dispar (3%). The presence of pathogens was significantly associated with diarrhoea, as they were found in 48.6% of diarrhoeic stools and 23.2% of non-diarrhoeic stools (OR = 3.14, p= 0.0018). Prevalence of pathogens and diarrhoea were significantly higher in patients with CD4+ counts ≤ 200 cells/µL (OR = 2.17, p = 0.0349 and OR = 8.46, p = 0.000019 respectively). CONCLUSIONS: This study highlights the need for investigating intestinal pathogens in HIV-infected patients presenting with diarrhoea, especially when their CD4+ counts are low.