Renal insufficiency in Ghanaian HIV infected patients: need for dose adjustment.

BACKGROUND: Antiretrovirals (ARVs) could lead to clinically significant nephrotoxicity and as such will require dose adjustments in the presence of renal insufficiency. OBJECTIVE: To explore renal function estimating equations as alternatives for glomerular filtration rate (GFR) measurement in a stable cohort of HIV-infected patients. METHOD: In estimating renal insufficiency in Ghanaian HIV-infected patients, GFR for 276 HAART-naïve patients and 166 patients on HAART was estimated with the Cockcroft-Gault, 4v-MDRD and CKD-EPI estimating equations. RESULTS: Females outnumbered males by 3 to 1 in the HAART-naïve group and 4 to 1 in subjects on HAART. The prevalence of renal insufficiency calculated with the Cockcroft-Gault, 4v-MDRD and CKD-EPI equations was 8.7%, 9.1% and 8.7% in HAART-naïve patients; 14.5%, 12.6% and 12.6% in patients on HAART; 7.7%, 11.5% and 11.5% in HAART-naïve males; 10.8%, 8.1% and 8.1% in males on HAART; 9.1%, 8.0% and 7.5% in HAART-naïve females and 15.5%, 14.0% and 14.0% in females on HAART. The CKD-EPI equation yielded lower bias when compared to the Cockcroft-Gault and 4v-MDRD equations. CONCLUSION: Renal insufficiency is not uncommon among HIV infected Ghanaian patients. A significant proportion (10 to 11%) will require ARV dose adjustment at the time of initiating therapy or sometime during on-going therapy.

Prevalence of anaemia and immunological markers among ghanaian HAART-naïve HIV-patients and those on HAART.

BACKGROUND: Highly active antiretroviral therapy (HAART) for people living with HIV/AIDS (PLWHA) has been generally accepted as the gold standard for the management of HIV patients but conflicting reports about the ability of HAART to improve upon the quality of life of HIV patients has cast doubts over the efficacy and the need for therapy. OBJECTIVE: This study was conducted to assess the efficacy and ability of HAART to resolve immunological and haematological abnormalities in HIV infected patients, existent sex variations in immunological and haematological parameters and CD4 predictive ability of the study parameters. METHODS: A total of 442 PLWHA consisting of 166 patients on HAART (28 males and 138 females) and 276 HAART-naïve patients (76 males and 200 females) were recruited for this study. Complete haemogram, immunological analysis (CD4 & CD3) and weight were measured for all the patients. RESULTS: HAART patients were older and heavier than their naïve counterparts. The incidence of anaemia (Hb less or equal to 10.5 (63%) and PCV < 30% (37.6%)) and lymphopoenia (16.7%) in HAART-naïve patients was significantly higher compared to their counterparts on HAART (46%, 15.2% and 5.3%) respectively. 70% of HAART-naïve females had anaemia in comparison to 44% in HAART-naïve males (P = 0.0001). The likelihood of developing microcytic hypochromic anaemia in HAART-naïve patients was 5 times more compared to those on HAART (P = 0.0002). Total lymphocyte count, haemoglobin, lymphocyte count and weight were significant predictors of CD4 counts and TLC values between 1.0 - 2.0 k µL(-1) was a significant predictor of CD4 <200 cells mm(-3). CONCLUSION: HAART has the capability of reducing the incidence of anaemia and lymphopoenia which are associated with disease progression and death in HIV infected patients. Total lymphocyte count, haemoglobin and weight could also serve as useful predictive tools in the management and monitoring of HIV infected patients in resource limited settings.

Prevalence of male sexual dysfunction among Ghanaian populace: myth or reality?

This study was designed to investigate the prevalence and type of sexual dysfunction (SD) in healthy sexually active Ghanaian men of fertile age. Sexual functioning was determined in 300 healthy Ghanaian men with the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire leaving in Kumasi metropolis, between December 2009 and April 2010. All men had a steady heterosexual relationship for at least 2 years before enrollment in the study. Of the 300 men selected, 255 (85%) completed the survey; the overall prevalence of SD in these subjects was 66%. The most prevalent areas of difficulty were infrequency (70.2%), premature ejaculation (64.7%), dissatisfaction with sexual acts (61.2%), impotency (59.6%), nonsensuality (59.2%), noncommunication (56.9%) and avoidance (49.0%). There were positive correlation between SD, impotence, dissatisfaction and age. The prevalence rate of SD in Ghanaian men is high and related to age.