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3.
Afr Health Sci ; 18(3): 512-522, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30602982

RESUMO

Background: HIV infection and opportunistic infections cause oxidative stress (OS), which is associated with tissue damage. Anti-retroviral therapy (ART) is used to treat HIV and decrease the risk of opportunistic infections, but it is unclear whether ART reduces OS. Association of ART with OS was investigated. Methods: We stratified a convenience sample of frozen serum or plasma from HIV-infected, ART-naïve (n=21); HIV-infected, ART-treated (n=14); HIV and PTB co-infected, ART-naïve (n=21); HIV and PTB co-infected, ART-treated (n=25) patients. Controls (n=21) were HIV-negative adults without TB symptoms. Concentration of OS markers namely: transaminases (ALT and AST), gamma glutamyl transpeptidase (GGT), albumin, total protein, malondialdehyde (MDA), vitamin C, and total anti-oxidant status (TAS) were determined. Results: AST (p<0.001), GGT (p<0.001), total protein (p=0.001) and MDA (p<0.001) were higher in HIV patients compared to controls. Vitamin C (P<0.0001) and albumin (p<0.01) were lower in HIV-patients relative to controls. ART was only associated with higher albumin (p=0.001), higher GGT (p=0.02) and lower vitamin C (p=0.009). HIV and PTB co-infection was only significantly associated with higher GGT (p=0.01) and AST (p=0.03). Conclusion: We identified severe OS among HIV-patients. ART was associated with both increased and reduced markers of OS hence suggesting that ART may not attenuate OS.


Assuntos
Antirretrovirais/uso terapêutico , Biomarcadores/sangue , Coinfecção/epidemiologia , Infecções por HIV/tratamento farmacológico , Estresse Oxidativo/efeitos dos fármacos , Tuberculose/complicações , Infecções Oportunistas Relacionadas com a AIDS/sangue , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Antituberculosos/uso terapêutico , Feminino , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , HIV-1/efeitos dos fármacos , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/efeitos dos fármacos , Estresse Oxidativo/fisiologia , Tuberculose/sangue , Tuberculose/tratamento farmacológico , Tuberculose/microbiologia , Uganda/epidemiologia
4.
Afr Health Sci ; 17(2): 301-307, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29062323

RESUMO

INTRODUCTION: Both Human Immunodeficiency Virus (HIV) and S.mansoni infections are common in Uganda and can cause liver disease. No study has determined co-infection significance in Uganda. We carried out a study on the burden, pattern and factors that contribute to peri-portal fibrosis (PPF) in HIV infected patients attending a Primary healthcare setting at Pakwach. METHODOLOGY: We conducted a cross-sectional study in the HIV clinic at Pakwach health centre IV. Data on demographics, contact with the Nile, CD4+ cell count, ART and alcohol use were collected. Urinary Circulating Cathodic Antigen (CCA), was done for S. Mansoni detection. Liver scan was done for presence and pattern of PPF. HBsAg testing was performed on all participants. Data was analyzed using Stata Version 10. RESULTS: We enrolled 299 patients, median age 39 years (IQR 16), most were female, 210 (73%). Overall, 206 (68.9%) had PPF, majority 191 (92.7%) had pattern c, either alone (63 participants) or in combination with pattern d (128 participants). Age of 30-50 years was significantly associated with PPF (OR 2.28 p-value-0.003). CONCLUSION: We found high prevalence of S. mansoni and PPF in the HIV infected population and age was a significant factor for PPF. We recommend all HIV infected patients be examined routinely for S. mansoni infection for early anti-schistosomal treatment.


Assuntos
Coinfecção/epidemiologia , Infecções por HIV/complicações , Cirrose Hepática/etiologia , Esquistossomose mansoni/complicações , Adolescente , Adulto , Idoso , Animais , Coinfecção/parasitologia , Coinfecção/virologia , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Cirrose Hepática/epidemiologia , Cirrose Hepática/parasitologia , Cirrose Hepática/virologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Rural/estatística & dados numéricos , Schistosoma mansoni , Esquistossomose mansoni/epidemiologia , Uganda/epidemiologia , Adulto Jovem
5.
AIDS ; 31(6): 781-786, 2017 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-28099188

RESUMO

OBJECTIVE: Antiretroviral therapy (ART) may interfere with replication of hepatitis B virus (HBV), raising the hypothesis that HBV infection might be prevented by ART. We investigated the incidence and risk factors associated with HBV among HIV-infected adults in Rakai, Uganda. METHODS: We screened stored sera from 944 HIV-infected adults enrolled in the Rakai Community Cohort Study between September 2003 and March 2015 for evidence of HBV exposure. Serum from participants who tested anti-hepatitis B core-negative (497) at baseline were tested over 3-7 consecutive survey rounds for incident HBV. Poisson incidence methods were used to estimate incidence of HBV with 95% confidence intervals (CIs), whereas Cox proportional regression methods were used to estimate hazard ratios (HRs). RESULTS: Thirty-nine HBV infections occurred over 3342 person-years, incidence 1.17/100 person-years. HBV incidence was significantly lower with ART use: 0.49/100 person-years with ART and 2.3/100 person-years without ART [adjusted HR (aHR) 0.25, 95% CI 0.1-0.5, P < 0.001], and with lamivudine (3TC) use: 0.58/100 person-years) with 3TC and 2.25/100 person-years without 3TC (aHR 0.32, 95% CI 0.1-0.7, P =  < 0.007). No new HBV infections occurred among those on tenofovir-based ART. HBV incidence also decreased with HIV RNA suppression: 0.6/100 person-years with 400 copies/ml or less and 4.0/100 person-years with more than 400 copies/ml (aHR, 6.4, 95% CI 2.2-19.0, P < 0.001); and with age: 15-29 years versus 40-50 years (aHR 3.2, 95% CI 1.2-9.0); 30-39 years versus 40-50 years (aHR 2.1, 95% CI 0.9-5.3). CONCLUSION: HBV continues to be acquired in adulthood among HIV-positive Ugandans and HBV incidence is dramatically reduced with HBV-active ART. In addition to widespread vaccination, initiation of ART may prevent HBV acquisition among HIV-positive adults in sub-Saharan Africa.


Assuntos
Antirretrovirais/uso terapêutico , Quimioprevenção/métodos , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Estudos de Coortes , Anticorpos Anti-Hepatite B/sangue , Incidência , Fatores de Risco , Uganda/epidemiologia
6.
Afr Health Sci ; 17(4): 974-978, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29937867

RESUMO

Background: Co-infection with hepatitis B (HBV) and hepatitis D (HDV) is common among human immunodeficiency virus (HIV) infected individuals in developing countries and it aggressively accelerates progression of liver disease to cirrhosis and other complications. There is scarcity of data on HDV in sub-Saharan Africa .We investigated the sero-prevalence and factors associated with HDV antibody among HIV/HBV co-infected patients attending a large urban HIV clinic in Uganda. Methods: We screened 189 HIV/HBV co-infected individuals for anti-HDV immunoglobulin G (IgG) and performed logistic regression to determine the associated factors. Socio-demographic, clinical data, immunological status, and liver fibrosis (as determined by the Aspartate transaminase to platelet ratio index and transient elastography) were included. Results: Participants were predominately young and of sound immunologic status (median age 40 years, median CD4 440 cells/µl). 98% were on ART regimens containing anti-HBV active medications (95.2% were on TDF/3TC while 4.8% on 3TC containing regimen). Median duration on ART was 36 months (IQR 22-72). Anti-HDV was detected in 6/198, 3.2% (95% CI 1.14-6.92%), associated with male gender and a duration of more than 5 years since HIV diagnosis. Conclusions: The sero-prevalence of HDV antibodies among the HIV/HBV co-infected patients is low in a Ugandan urban cohort.


Assuntos
Coinfecção/virologia , Infecções por HIV/epidemiologia , Hepatite B/epidemiologia , Hepatite B/virologia , Hepatite D/epidemiologia , Vírus Delta da Hepatite/fisiologia , Adulto , Antirretrovirais/uso terapêutico , Coinfecção/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Anticorpos Anti-Hepatite , Hepatite B/diagnóstico , Antígenos de Superfície da Hepatite B/imunologia , Vírus da Hepatite B/imunologia , Hepatite D/imunologia , Hepatite D/virologia , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Soroepidemiológicos , Uganda/epidemiologia
7.
J Virus Erad ; 2(1): 19-21, 2016 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-27482430

RESUMO

BACKGROUND: The prevalence of hepatitis B virus (HBV) infection in Uganda is 10%. Hepatitis B virus genotypes impact on treatment response, rate of spontaneous recovery and progression of chronic HBV infection and hepatocellular carcinoma. There is little information on the HBV genotypic distribution in Uganda. OBJECTIVES: To determine HBV genotypes in Uganda. METHODS: The MBN clinical laboratory performs HBV viral load and genotype testing in Uganda. It receives hepatitis B surface antigen (HBsAg)-positive samples from all over the country for additional HBV testing. Samples are stored for 6 months before being discarded. Our study used delinked stored samples. PCR-positive samples had DNA extracted and used as template for HBV genome amplification by nested PCR. Reverse hybridisation was performed and genotypes were determined by the line probe assay method (INNO-LiPA). RESULTS: One hundred stored HBsAg-positive plasma samples with detectable viral loads were analysed. Of these, 93 samples showed PCR amplification products and gave genotype-specific probe lines on the INNO-LiPA assay. Of the patients, where gender was recorded, 60.9% were female, and the overall median age (IQR) was 25 (2-60) years. There was a predominance of HBV genotype D (47 patients; 50.5%), followed by genotype A, (16 patients; 17.2%). One patient (1.1%) had genotype E. In 28% of the samples mixed infections were detected with genotypes A/E (9.7%) and A/D (6.5%) being most common. Genotypes B, C, E and H only occurred as part of mixed infections. CONCLUSION: Hepatitis B genotypes D and A were predominant in our study population.

8.
Afr Health Sci ; 16(4): 1089-1093, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28479902

RESUMO

BACKGROUND: Co-infection with hepatitis B (HBV) and hepatitis D (HDV) is common among human immunodeficiency virus (HIV) infected individuals in developing countries and it aggressively accelerates progression of liver disease to cirrhosis and other complications. There is scarcity of data on HDV in sub-Saharan Africa .We investigated the sero-prevalence and factors associated with HDV antibody among HIV/HBV co-infected patients attending a large urban HIV clinic in Uganda. METHODS: We screened 189 HIV/HBV co-infected individuals for anti-HDV immunoglobulin G (IgG) and performed logistic regression to determine the associated factors. Socio-demographic, clinical data, immunological status, and liver fibrosis (as determined by the Aspartate transaminase to platelet ratio index and transient elastography) were included. RESULTS: Participants were predominately young and of sound immunologic status (median age 40 years, median CD4 440 cells/µl). 98% were on ART regimens containing anti-HBV active medications (95.2% were on TDF/3TC while 4.8% on 3TC containing regimen). Median duration on ART was 36 months (IQR 22-72). Anti-HDV was detected in 6/198, 3.2% (95% CI 1.14-6.92%), associated with male gender and a duration of more than 5 years since HIV diagnosis. CONCLUSIONS: The sero-prevalence of HDV antibodies among the HIV/HBV co-infected patients is low in a Ugandan urban cohort.


Assuntos
Infecções por HIV/complicações , Hepatite B/complicações , Hepatite D/complicações , Adulto , Antirretrovirais/uso terapêutico , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Anticorpos Anti-Hepatite/imunologia , Hepatite B/tratamento farmacológico , Hepatite B/imunologia , Hepatite D/imunologia , Humanos , Imunoglobulina G/imunologia , Cirrose Hepática/complicações , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Fatores Socioeconômicos , Fatores de Tempo , Uganda/epidemiologia
9.
J Med Virol ; 88(4): 674-80, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26334654

RESUMO

Occult hepatitis B infection (OBI), the presence of low hepatitis B virus (HBV) deoxyribonucleic acid (DNA) levels in patients without detectable hepatitis B surface antigen (HBsAg), has significant implications for understanding the natural history of hepatitis B infection. We determined the prevalence of OBI in African patients using a sensitive polymerase chain reaction (PCR) assay and describe here the characteristics of OBI in an urban African hospital population. Routine serological testing as well as molecular studies were performed on sera from 314 patients who were part of a previous study from an urban hospital emergency room in Kampala, Uganda, detecting HBV DNA using a nested PCR with amplification of two regions of the HBV genome. HBV viral loads (VL) were determined by real-time PCR (rtPCR) and sequencing performed to determine HBV genotype and S gene mutations. Among 314 subjects tested, 50 (16%) had chronic HBV infection, 94 (30%) had detectable HBV DNA despite testing HBsAg negative (OBI), and 170 (54%) were not infected. VLs of OBI subjects were relatively low although 19 (20%) had VL exceeding 10(4) IU ml(-) . Subjects with chronic HBV infection had a higher median VL compared to OBI patients (P < 0.001). All chronic HBV sequenced (10) and 83/89 OBI sequences were genotype A, the remaining six being genotype D. S-gene mutations were present in some but not all OBI patients (48%). OBI is more prevalent among African patients than previously thought. This may have implications for clinical management and transfusion-related HBV transmission.


Assuntos
DNA Viral/sangue , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Genótipo , Antígenos de Superfície da Hepatite B/genética , Vírus da Hepatite B/classificação , Vírus da Hepatite B/genética , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Reação em Cadeia da Polimerase , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Uganda/epidemiologia , População Urbana , Carga Viral , Adulto Jovem
10.
Afr Health Sci ; 15(2): 328-33, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26124776

RESUMO

BACKGROUND: Hepatitis B virus (HBV) and HIV are endemic in Uganda. Co-infection is common and leads to rapid progression of liver disease. Burden of co-infection is unknown yet most patients are on lamivudine-only ART where resistance is frequent. Most patients are initiated on antiretroviral therapy (ART) without knowing their HBV status. OBJECTIVES: To determine burden of co-infection and HBV viral suppression among patients on ART in Northern Uganda. METHODS: We recruited HIV infected adult patients on ART in a cross-sectional study. Age, sex, ART regimen and duration were recorded. Hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBcAb) and liver panel were performed. For those HBsAg+, hepatitis B e antigen (HBeAg) and HBV DNA were performed. CD4 cell count was recorded. RESULTS: Three hundred patients were recruited. Twenty (6.7%) were co-infected, while 41% were anti-HBcAb+. Overall 188 (62.7%) were on lamivudine- only HBV active drug. Median ART duration 2 years (IQR 1-5), mean CD4+ cell count 317 cells/microlitre (SD 255-557). Of 20 HIV/HBV co-infected, 11/20 (55%) were on lamivudine-only ART, median duration 1.5 years. Nineteen (95%) had undetectable HBV DNA. Seventeen (85%) were HBeAg negative. Mean CD4+ cell count 327 cells/microlitre (SD 197-482). CONCLUSION: A large proportion of patients were on lamivudine- only HBV-active ART. Resistance may occur long term thus testing for HBV and correct ART is recommended.


Assuntos
Antirretrovirais/uso terapêutico , Coinfecção/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Hepatite B/tratamento farmacológico , Lamivudina/uso terapêutico , Adulto , Alanina Transaminase/sangue , Contagem de Linfócito CD4 , Coinfecção/virologia , Estudos Transversais , Quimioterapia Combinada , Feminino , Infecções por HIV/virologia , Hepatite B/diagnóstico , Anticorpos Anti-Hepatite B , Antígenos de Superfície da Hepatite B , Vírus da Hepatite B/genética , Humanos , Masculino , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Resultado do Tratamento , Uganda , Carga Viral
11.
Clin Gastroenterol Hepatol ; 13(2): 352-9, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25019700

RESUMO

BACKGROUND & AIMS: Patients with acute liver failure (ALF) frequently develop renal dysfunction, yet its overall incidence and outcomes have not been fully assessed. We investigated the incidence of acute kidney injury (AKI) among patients with ALF, using defined criteria to identify risk factors and to evaluate its effect on overall outcomes. METHODS: We performed a retrospective review of data from 1604 patients enrolled in the Acute Liver Failure Study Group, from 1998 through 2010. Patients were classified by the Acute Kidney Injury Network criteria, as well as for etiology of liver failure (acetaminophen-based, ischemic, and all others). RESULTS: Seventy percent of patients with ALF developed AKI, and 30% received renal replacement therapy (RRT). Patients with severe AKI had higher international normalized ratio values than those without renal dysfunction (P < .001), and a higher proportion had advanced-grade coma (coma grades 3 or 4; P < .001) or presented with hypotension requiring vasopressor therapy (P < .001). A greater proportion of patients with acetaminophen-induced ALF had severe kidney injury than of patients with other etiologies of ALF; 34% required RRT, compared with 25% of patients with ALF not associated with acetaminophen or ischemia (P < .002). Of the patients with ALF who were alive at 3 weeks after study entry, significantly fewer with AKI survived for 1 year. Although AKI reduced the overall survival time, more than 50% of patients with acetaminophen-associated or ischemic ALF survived without liver transplantation (even with RRT), compared with 19% of patients with ALF attribute to other causes (P < .001). Only 4% of patients requiring RRT became dependent on dialysis. CONCLUSIONS: Based on a retrospective analysis of data from more than 1600 patients, AKI is common in patients with ALF and affects short- and long-term outcomes, but rarely results in chronic kidney disease. Acetaminophen-induced kidney injury is frequent, but patients have better outcomes than those with other forms of ALF.


Assuntos
Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/terapia , Falência Hepática Aguda/complicações , Diálise Renal , Acetaminofen/efeitos adversos , Acetaminofen/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antipiréticos/efeitos adversos , Antipiréticos/uso terapêutico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
12.
Transfusion ; 54(11): 2804-10, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24805348

RESUMO

BACKGROUND: Very little has been published about acute transfusion reactions (ATRs) in developing countries. This study was undertaken to determine the incidence, type, imputability, severity, and possible associated factors of ATRs observed in a university-affiliated hospital in Uganda. STUDY DESIGN AND METHODS: We prospectively followed the transfusion of blood units issued over a 7-week period from the hospital blood bank during regular working hours to nonbleeding patients. For each transfusion, we recorded the patient's status before, during, at the end of, and 4 hours after transfusion. Three physicians independently reviewed all reports of suspected ATRs and related hospital charts. Using predefined criteria, the presence, type, imputability, and severity of ATRs were adjudicated by consensus of two of three physicians. Factors potentially associated with ATRs were analyzed for statistical significance. RESULTS: A total of 507 transfusions were analyzed. Fifty-three acute transfusion events were recorded and 49 of 53 or 9.6% of the 507 transfusions were confirmed to be ATRs by physician consensus: 24 febrile, seven allergic, five hypertensive, three hypotensive, three transfusion-associated circulatory overload, two acute hemolytic, and five others. Imputability of ATRs was definite, probable, or possible in 45 of 49 ATRs (92% of ATRs or 8.9% of transfusions) and judged to be severe in nine of 45. No significant associated factors were identified. CONCLUSIONS: Our findings suggest that ATRs may occur more commonly in resource-limited settings than in high-income countries. Although some reactions are unavoidable, improved surveillance of transfusions and implementation of transfusion guidelines could improve the safety of transfusions in these settings.


Assuntos
Bancos de Sangue , Reação Transfusional , Doença Aguda , Adolescente , Adulto , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Uganda
13.
Afr Health Sci ; 14(4): 1069-73, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25834519

RESUMO

INTRODUCTION: Splanchnic venous thrombosis (SVT) has varied etiology with Philadelphia-negative myeloproliferative neoplasms (MPNs) being the most frequent underlying prothrombotic factor. Hematological indices often remain within normal range because of portal hypertension and its sequelae, causing diagnostic challenges. The high frequency of JAK2 mutation among patients with SVT reinforces the diagnostic utility of JAK2V617F testing. CASE REPORT: We report a case of a 62-year-old black man with progressive abdominal swelling and features of decompensated chronic liver disease found to have SVT-portal vein thrombosis and how JAK2 V617F was useful in unmasking an underlying myeloproliferative neoplasm. CONCLUSION: A high index of suspicion for an underlying prothrombotic factor is critical for patients presenting with thrombosis in unusual sites. This is useful in prognostic stratification and patient outcomes. JAK2 mutation screening is now part of the standard diagnostic workup in SVT.


Assuntos
Neoplasias Hematológicas/genética , Janus Quinase 2/genética , Mutação/genética , Trombose Venosa/genética , Evolução Fatal , Neoplasias Hematológicas/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Mieloproliferativos/complicações , Transtornos Mieloproliferativos/genética , Cromossomo Filadélfia , Veia Porta/diagnóstico por imagem , Circulação Esplâncnica , Ultrassonografia Doppler , Trombose Venosa/sangue , Trombose Venosa/etiologia
14.
Pan Afr Med J ; 15: 23, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24009799

RESUMO

INTRODUCTION: Uganda is among the top ten consumers of alcohol worldwide though there is little data on alcohol related liver disease. We describe alcohol use, alcohol misuse, and alcoholic liver disease among adults at the emergency admission service of a large urban hospital in Uganda. METHODS: All adults who consented were prospectively evaluated for alcohol use by inquiry and alcohol misuse by the "Cutting down, Annoyance, Guilt and Eye-opener- CAGE" questionnaire. Alcohol related hepatocellular liver injury was assessed using aspartate aminotransferase, and alanine aminotransferase levels. A combination of CAGE score ≥2 and De Ritis ratio ≥2 defined alcoholic liver disease (ALD). Human Immunodeficiency Virus (HIV), and viral hepatitis B and C serologies were evaluated in all the patients. Descriptive and inferential statistics were generated to answer our research questions. RESULTS: Three hundred and eighty individuals consented and participated in the study. Among these, 46.8% acknowledged use of alcohol while 21% and 10% met the study definition of alcoholic misuse and alcoholic liver disease respectively. Both alcohol misuse and alcoholic liver disease was significantly associated (p-value ≤ 0.05) with male gender, region of origin, number of life time sexual partners and serum albumin below 3.5 mg/dl after univariate and multivariate analysis. CONCLUSION: Alcohol misuse and alcoholic liver disease is frequent in this medical emergency unit. Our study suggests a link between alcohol misuse or alcoholic liver disease and male gender, region of origin, number of sexual partners, and serum albumin below 3.5mg/dl.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hepatopatias Alcoólicas/epidemiologia , Adulto , Alanina Transaminase/análise , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Aspartato Aminotransferases/análise , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Hospitais Urbanos , Humanos , Hepatopatias Alcoólicas/diagnóstico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores Sexuais , Parceiros Sexuais , Inquéritos e Questionários , Uganda/epidemiologia
15.
AIDS Patient Care STDS ; 26(2): 73-80, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22239101

RESUMO

Noninvasive markers of liver fibrosis, measured at baseline, have been shown to predict liver-related mortality. It remains unknown if a change in the value of the scores over time predicts mortality in patients with HIV and viral hepatitis. In this retrospective study, survival in HIV/hepatitis B virus (HBV; n = 67), HIV/hepatitis C virus (HCV; n = 43), and HIV/HBV/HCV (n = 41) patients was examined using Kaplan-Meier life table analysis. Aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and FIB-4 scores, two noninvasive markers of liver fibrosis, were calculated at baseline and at last available clinical follow-up to determine the change in fibrosis score. Factors associated with mortality were assessed by Cox proportional hazards, including the change in the noninvasive marker score between the two time points. All-cause mortality was determined by Social Security Death Index and chart review. Sixty-seven were coinfected with HIV/HBV, 43 with HIV/HCV, and 41 were triply infected (HIV/HBV/HCV). Kaplan-Meier analysis showed similar survival for the three groups at 7 years of follow-up (p = 0.10). However, median length of follow-up was lower in HIV/HCV (60.5; range 0-102) compared to HIV/HBV (75.7; 12.3-126.5) and HIV/HBV/HCV (80.0; 2.7-123) months, respectively, p = 0.02. Baseline fibrosis score (p = 0.002), an increase in the value for noninvasive measurements for fibrosis (p < 0.001), and the presence of HIV/HCV coinfection (p = 0.041) were each associated with higher risk for mortality. Baseline fibrosis score (p = 0.03) and an increase in FIB-4 score (p = 0.05) were independent predictors of all-cause mortality, but liver-related mortality was not evaluated. In this study, baseline fibrosis score was predictive of 7-year all-cause mortality. Further studies are needed in a prospective cohort to evaluate the predictive value of monitoring changes in fibrosis scores over time to predict mortality in patients with viral hepatitis.


Assuntos
Síndrome de Imunodeficiência Adquirida/patologia , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Hepatite B/patologia , Hepatite C/patologia , Cirrose Hepática/patologia , Síndrome de Imunodeficiência Adquirida/enzimologia , Síndrome de Imunodeficiência Adquirida/mortalidade , Adulto , Biomarcadores/sangue , Estudos de Coortes , Coinfecção , Feminino , Seguimentos , Hepatite B/enzimologia , Hepatite B/mortalidade , Hepatite C/enzimologia , Hepatite C/mortalidade , Humanos , Estimativa de Kaplan-Meier , Cirrose Hepática/enzimologia , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Valor Preditivo dos Testes , Análise de Sobrevida , Adulto Jovem
16.
Dig Dis Sci ; 57(5): 1349-57, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22198704

RESUMO

BACKGROUND AND AIMS: The efficacy of nucleoside(tide) analogues (NA) in the treatment of acute liver failure due to hepatitis B virus (HBV-ALF) remains controversial. We determined retrospectively the impact of NAs in a large cohort of patients with HBV-ALF. METHODS: The US Acute Liver Failure Study Group, a 23-site registry, prospectively enrolled 1,413 patients with ALF with different etiologies between 1998 and 2008. Of those, 105 patients were identified as HBV-ALF patients, of whom we excluded those without data on NA use or with co-infection with hepatitis C, leaving 85 patients, 43 of whom had received NA treatment. HBV-DNA on admission was quantified by real time polymerase chain reaction. RESULTS: The treated and untreated groups were similar in most respects but differed significantly in regard to higher aminotransferase and bilirubin levels and hepatic coma grades, all being observed in the untreated group. Median duration of NA treatment was 6 days (range, 1-21 days). Overall survival in the NA treated and untreated groups were 61 and 64%, respectively (P = 0.72). Rates of transplant-free survival were 21 and 36% in the treated and untreated groups, respectively (P = 0.42). Multivariate analysis revealed that not using a NA [odds ratio (OR) 4.4, 95% CI 1.1-18.1, P = 0.041], hepatic coma grade I or II [OR 14.4, 95% CI 3.3-62.8, P < 0.001] and prothrombin time (PT) [OR 0.59, 95% CI 0.39-0.89, P = 0.012] were predictors of improved transplant-free survival. CONCLUSIONS: Patients who are admitted with established HBV-ALF do not appear to benefit from viral suppression using nucleoside(tide) analogues presumably because of rapid disease evolution and short treatment duration. Despite the lack of benefit, NAs should still be given to transplantation candidates since viral suppression prevents recurrence after grafting.


Assuntos
Antivirais/química , Antivirais/farmacologia , Encefalopatia Hepática , Hepatite B/complicações , Falência Hepática Aguda , Transplante de Fígado/métodos , Nucleosídeos/química , Nucleosídeos/farmacologia , Replicação Viral/efeitos dos fármacos , Adulto , Idoso , Bilirrubina/sangue , Feminino , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/etiologia , Hepatite B/virologia , Vírus da Hepatite B/fisiologia , Humanos , Falência Hepática Aguda/etiologia , Falência Hepática Aguda/metabolismo , Falência Hepática Aguda/mortalidade , Falência Hepática Aguda/fisiopatologia , Falência Hepática Aguda/terapia , Masculino , Pessoa de Meia-Idade , Tempo de Protrombina/métodos , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Sobrevida , Transaminases/sangue , Resultado do Tratamento
17.
Curr Opin HIV AIDS ; 6(6): 539-45, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21918435

RESUMO

PURPOSE OF REVIEW: To provide an update on the epidemiology and management of HIV and hepatitis C virus (HCV) in resource-limited settings (RLSs). RECENT FINDINGS: The global prevalence of HIV is 33.3 million people of whom 22.5 million live in sub-Saharan Africa. Hepatitis C affects 170 million people globally with majority of the infected persons living in sub-Saharan Africa and other RLSs. Transmission of these viruses varies greatly even within the RLSs. In the RLSs in Europe, Asia and Central/South America, most transmissions occur through injection drug use, whereas in Africa use of needles for medical treatment and blood transfusion may be the main modes of transmission. However, generally there is a rise in injection drug use even in RLSs. SUMMARY: Hepatitis C and HIV are common infections and are more prevalent in RLSs, but there are regional differences in transmission even in RLSs. Treatment is difficult in some of the RLSs and prevention by screening donor blood as well and use of sterile instruments in treatment of patients will be important in curbing transmission in some of these settings.


Assuntos
Controle de Doenças Transmissíveis/métodos , Países em Desenvolvimento , Infecções por HIV/complicações , Infecções por HIV/terapia , Hepatite C/complicações , Hepatite C/terapia , Abuso de Substâncias por Via Intravenosa/complicações , África/epidemiologia , Ásia/epidemiologia , Coinfecção , Europa (Continente)/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , Recursos em Saúde , Hepacivirus/efeitos dos fármacos , Hepatite C/epidemiologia , Hepatite C/virologia , Humanos , Prevalência , América do Sul/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Reação Transfusional
18.
S Afr Med J ; 99(12): 876-80, 2009 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-20459998

RESUMO

BACKGROUND: Anaemia increases morbidity and mortality in patients with congestive cardiac failure (CCF). Few studies have examined the prevalence of anaemia and its impact among patients with CCF in sub-Saharan Africa. We assessed the prevalence of anaemia and its influence on treatment outcome in patients with CCF attending a large referral hospital in Kampala, Uganda. METHODS: Echocardiography was done and haemoglobin levels were determined in 157 patients with CCF admitted to Mulago Hospital. The patients were followed up for 2 weeks and their treatment outcome was recorded. RESULTS: Of the 157 patients, 101 (64.3%) had anaemia (mean haemoglobin concentration

Assuntos
Anemia/epidemiologia , Insuficiência Cardíaca/complicações , Hemoglobinas/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/diagnóstico , Anemia/etiologia , Intervalos de Confiança , Estudos Transversais , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Uganda/epidemiologia , Adulto Jovem
19.
Curr Opin Crit Care ; 14(2): 198-201, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18388683

RESUMO

PURPOSE OF REVIEW: Acute liver failure remains a unique syndrome that results from massive loss of hepatocytes or hepatocyte function due to a variety of etiologies: viruses, drugs, toxins and other genetic and autoimmune conditions. The resulting clinical picture is remarkably similar across the different etiologies, reflecting common patterns of response of the innate immune system and the resulting inflammatory response. This review highlights developments in the delineation of etiologies of this relatively rare condition. RECENT FINDINGS: The contribution of different etiologies to the overall picture varies by country. Europe and North America demonstrate a large proportion of cases due to acetaminophen and to idiosyncratic drug reactions, whereas reports from emerging countries in Asia and Africa are more likely to feature viral illnesses, particularly hepatitis B and E. Recent studies have suggested ever more exotic etiologies, new drugs and viruses. SUMMARY: A careful search for the cause of acute liver failure in each case is of value in determining whether there are specific antidotes available and what the prognosis might be.


Assuntos
Falência Hepática Aguda/etiologia , Acetaminofen/efeitos adversos , Antibacterianos/efeitos adversos , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Antirretrovirais/efeitos adversos , Hepatite Viral Humana/complicações , Humanos , Inflamação , Falência Hepática Aguda/induzido quimicamente , Prognóstico , Fatores de Risco
20.
Fam Med ; 39(9): 623-6, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17932794

RESUMO

Sub-Saharan Africa is probably the region with the worst health indices in the region. Although health problems in this region are largely preventable through a good primary health care system, efforts to implement such a system have not been so successful and neither have reforms suggested by the World Bank. However, there are new efforts to improve delivery of health care by introducing family medicine in the region through decentralized health care systems. Uganda is at the forefront of these efforts, and ways to integrate family physicians into the health system are still being debated. This paper reviews the potential role of family medicine/general practice in the health care systems of sub-Saharan Africa and in Uganda in particular and offers suggestions based on successes made in other countries.


Assuntos
Atenção à Saúde/organização & administração , Medicina de Família e Comunidade , Papel (figurativo) , África ao Sul do Saara , Humanos , Qualidade da Assistência à Saúde , Uganda
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