Vasculitis in HIV: report of eight cases.

OBJECTIVE: To describe vasculitis in HIV patients, their CD4 levels, anatomical sites affected and clinical patterns. DESIGN: Prospective, descriptive study. SETTING: Kisumu District Hospital and Nairobi Rheumatology Clinic between January 2002 and May 2005. SUBJECTS: Eight patients with HIV and vasculitis. RESULTS: Eight patients (four males and four females) were recruited with an age range of 24-61 years, mean 33.13 years. Five had central nervous system vasculitis and three had peripheral vasculitis. The CD4 counts were low, range 2-200 cells/mm3 (mean of 79.25 cells/mm3), normal levels of CD4 are 355-1298 cells/mm3, indicating severe immunosuppression. Two patients tested positive for HBV (hepatitis B virus). CONCLUSION: HIV associated vasculitis is recognised and may be complicated by coinfection with hepatitis viruses. It occurs at low CD4 counts. Central nervous system involvement is a common site. Management is multidisciplinary.

Halothane induced hepatitis: case report.

Halothane as a cause of hepatitis is rare and may be overlooked when evaluating a patient with sudden onset jaundice. A 34-year-old lady, a nurse, presented to the liver clinic with sudden onset non-pruritic jaundice. Viral and collagen serological tests were all normal, malaria and sickling tests were negative, but transaminases were elevated. She reported inadvertent exposure to halothane in surgical theatre where she works. She improved on conservative management, then had a re-exposure to halothane after three weeks and developed a similar clinical picture, which improved on conservative management. In an area endemic of malaria, hepatitis and haemolysing conditions like sickle cell anaemia, the diagnosis of halothane hepatitis requires high index of suspicion. The mechanism of halothane-induced hepatic damage in this patient is very likely idiosyncratic. This is because of the modest dose at first exposure and more severe clinical picture at re-exposure.

HBV, HIV co-infection at Kisumu District Hospital, Kenya.

BACKGROUND: Patients with dual infection of HBV and HIV are increasingly being recognised. The two viruses, HBV and HIV share the same route of transmission and HBV is more efficiently transmitted than HIV. There is evidence that HBV will contribute significantly to continuing morbidity and mortality within the HIV infected population over the coming years. This is due to the widespread use/accessibility of the highly active anti-retroviral (HAART) drugs hence patients live longer. There are few published data in the tropical region on these patients especially in regions where HBV and HIV are endemic. OBJECTIVES: To determine the prevalence of HBV, HIV co-infection in patients who presented with jaundice and the pattern of CD4 cell counts in these patients. DESIGN: A prospective, cross-sectional, descriptive study of all consecutive patients included in the study. SETTING: Medical wards, medical outpatient clinic and liver clinic, Kisumu District Hospital, Western Kenya. SUBJECTS: Five hundred and nineteen (261 females and 258 males) patients who had jaundice were screened for the study. One hundred and eighty five (110 males and 75 females) patients were excluded. Three hundred and thirty four patients 151 (45.2%) males and 183 (54.8%) females were included and completed the study between August 2002 and October 2003. MAIN OUTCOME MEASURES: Socio-demographic data, HBsAg positive, HIV serology (positive or negative), CD4 cell counts, ALT and AST, IgG anti-HBc and IgM anti-HBc. RESULTS: The age range was 7-76 years with a mean of 36 (+/-13) years. The mean age for males and females was 37 (+/-13) years and 35 (+/-12) years respectively. One hundred and seventy seven (53%) had co-infection and 157 (47%) had HBV mono-infection. IgG anti-HBc and IgM anti-HBc were detected in 17 (5%) and 317 (95%) patients respectively. Of the 317 patients with IgM anti-HBc, 177 (55.8%) had co-infection while 140 (44.2%) had HBV mono-infection (p=0.05). The overall mean CD4 cell count for the whole population was 391 (+/-314) cells/mm3. The mean CD4 cell count for patients with co-infection was lower, (120 (+/-112) cells/mm3) than for patients with HBV mono-infection, 694 (+/-140) cells/mm3. The transaminases were uniformly elevated in both groups with mean AST of 207 (+/-147) U/L and ALT of 356 (+/-177) U/L. In the co-infection and mono-infection groups, AST was 286 (+/-117) U/L and 306 (+/-175) U/L (p=0.23) and is not statistically significant, and the ALT was 338 (+/-135) U/L and 375 (+/-213) U/L respectively p=0.05 and the difference is statistically significant. CONCLUSION: HBV and HIV co-infection is recognised in this region, which is endemic for both viral infections. The patients with dual infection had very low CD4 cell counts. This will influence the choice of highly active anti-retroviral therapy (HAART) in favour of Lamivudine containing combinations to cover the HBV infection.

Seroprevalence of hepatitis B and C in maintenance dialysis in a public hospital in a developing country.

BACKGROUND: Patients with end-stage renal disease (ESRD) on maintenance dialysis are predisposed to hepatitis B virus (HBV) infection for a number of reasons. In a similar way, the prevalence of anti-hepatitis C virus (HCV) antibodies among patients on chronic haemodialysis and peritoneal dialysis is consistently higher than in healthy populations. There are few published data on these diseases in patients undergoing maintenance dialysis in sub-Saharan Africa. OBJECTIVE: To determine the seroprevalence of HBV and HCV in patients on maintenance dialysis. SETTING: Renal Unit, Kenyatta National Hospital, the largest public referral and teaching hospital in Kenya. DESIGN: Cross-sectional descriptive study. STUDY POPULATION: All 100 patients on maintenance dialysis during the 9-month study period were evaluated. METHOD: The following information was obtained from all the patients: socio-demographic data, date of diagnosis of ESRD and commencement of dialysis, and number of blood transfusions. Additionally, a history suggestive of hepatitis in spouses was looked for and physical examination for tattoos and other scars was carried out. Laboratory investigations included urea, electrolytes and serum creatinine, liver enzymes, hepatitis B surface antigen (HBsAg), immunoglobulin M anti-hepatitis B core antibody (IgM anti-HBc), hepatitis B e antigen (HBeAg) and anti-HCV antibodies. Student's t-test was used to assess the significance of the data collected. RESULTS: The results were expressed as mean (+/- SD). Fifty-seven males and 43 females were studied. Mean age was 44.3 +/- 14.6 years. Ten patients (10%) had elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (> 40 U/l for both). HBsAg was found in 8 patients (8%), IgM anti-HBc in 2%, and HBeAg in none. Anti-HCV antibody was found in 5%. Six of the HBsAg-positive patients were on haemodialysis, the other 2 on continuous ambulatory peritoneal dialysis (CAPD). There was no coexistence of HBV and HCV markers. Longer duration of dialysis and the number of blood transfusions were associated with an increased seroprevalence of HBV and HCV. CONCLUSION: There is a low seroprevalence of HBV and HCV in our dialysis population. This should not lead to complaisance in screening for these potentially lethal complications.