Immune reconstitution inflammatory syndrome among HIV/AIDS patients during highly active antiretroviral therapy in Addis Ababa, Ethiopia.

Suppression of viral replication is followed by increases in CD4+ lymphocytes, and this has been shown to result in decreased susceptibility to opportunists after initiation of highly active antiretroviral therapy (HAART). However, clinical aggravations after the initiation of HAART have been thought to be due to the restored ability to mount an inflammatory response, or the immune reconstitution inflammatory syndrome (IRIS). The degree of IRIS observed in human immunodeficiency virus (HIV)-infected patients following initiation of HAART is variable. This prospective study was aimed at determining the proportion of IRIS and the pattern of opportunistic infections among 186 HIV/AIDS patients receiving HAART between December 2006 and July 2007 at Zewditu Memorial Hospital, Addis Ababa, Ethiopia. The proportion of IRIS was 17.2% (32/186). The mean number of days of IRIS occurrence for each disease ranged from 26 to 122 days with a mean of 80. Opportunistic diseases associated with IRIS were tuberculosis (68.8%, 22/32), herpes zoster rash (12.5%, 4/32), cryptococcosis (9.4%, 3/32), toxoplasmosis (6.3%, 2/32) and bacterial pneumonia (3.1%, 1/32). Compared to baseline readings there were significant increases in CD4 count, aspartate aminotransferase and alanine aminotransferase levels while hemoglobin values decreased during the development of IRIS. In summary, the proportion of IRIS and the pattern of opportunistic infections in HAART-treated patients in Ethiopia mirrored those reported in other countries. Further prospective surveys on epidemiological, immunological, microbial and clinical studies are imperative to assess the proportion and pattern of IRIS and effect of HAART in Ethiopia.

Retrospective review of antiretroviral therapy program data in accredited private hospitals in Addis Ababa City Administration, Ethiopia

Background: Ethiopia is committed to improving access to human immunodeficiency virus (HIV) care and antiretroviral therapy (ART) service. In May 2005; some private hospitals in Addis Ababa City Administration received accreditation to provide ART services to eligible patients. Objective: To examine and describe the achievements of the ART Program in accredited private hospitals. Methods: Descriptive retrospective analyses of reported ART Program Data from accredited private hospitals; between May 2005 and 31st December 2009. The aggregate data was obtained from Addis Ababa Regional Health Bureau and consisted of information about patients enrolled for care; those who started ART; and those presently are on ART. Results: During the study period; 10;849 patients were enrolled for care; 9;442 who had just started ART and 5;608 already on it across the study private facilities. In general close to 75of the total patients enrolled for care at five facilities. Although the majority (87) had started treatment in the past; only 59.4were currently on treatment. Overall; the program retained 66.4of the patients (n=6;270) and attrition was 32(n=3;021). Conclusions: Differences in patient enrollment for care; ART initiation and retention were observed across facilities. A significant number of patients discontinued treatment and their outcome status was unclear. A better monitoring and reporting of ART Program Data will improve program quality. An effective strategy is needed to enhance patient retention and tracing in the accredited private hospitals in Addis Ababa City Administration