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Pre treatment morbidities among HIV infected patients attending Colombo HIV clinic during the period of January 2010 to June 2013. Buddhakorale K1, Jayasuriya NDV2, Somawardhana HPSP3


 

Sri Lanka was able to provide ART free of charge since December 2004. Sri Lanka has limited treatment options. The selection of an ART regimen in the presence of co morbidities such as tuberculosis, anemia, liver disease, renal disease, metabolic disorders and in ART failure is a challenge to Sri Lanka.


ď ˝

ď ˝

To assess the pre treatment morbidities among HIV infected patients who were initiated ART during the period of January 2010 to June 2013 To assess the sociodemographic characteristics among the same population.


  

A descriptive cross sectional study . Carried out in HIV clinic Colombo. Exclusion criteria - patients less than 18 years old and the pregnant women. Data extracted from the Pre ART register ,ART register and patients’ clinical records . There were 148 patients.


ď ˝

Data analyzed by SPSS version 16 .


Sex Distribution n=148

32%

Males

Females 68%

Figure 1: Sex distribution


0.4

37%

0.35

35%

0.3

<20

0.25 0.2 0.15

20-29 16%

30-39 12%

0.1

40-50

>50

0.05 0 Age (years) Figure 2: Age distribution


ď ˝ ď ˝

Only 4% of the sample were illiterate. Majority (66%) were employed.


90% 77%

80% 70% 60% 50%

MSM

40%

Heterosexual

30%

Bisexual

20% 10%

16% 7%

0% Sexual behaviour Figure 3: Sexual behaviour


Pre ART Status


50%

44%

40% 30% 20%

21.50%

17.50%

17%

Stage 2

Stage 3

10% 0%

Stage 1

stage 4 Figure 5: WHO clinical stage


7%

12%

A ( Normal activity ) B (Bed ridden < 50%) C ( Bed ridden > 50% ) 81%

Figure 6: Performance scale


70.00%

64%

60.00% 50.00%

<18.5(under wt)

40.00%

18.5-25(normal)

30.00%

25.1-30(over wt)

20.00% 10.00%

15%

14.00% 7%

>30(obesity) Unknown

0.00%

BMI

Figure 7: BMI


60%

53%

50% 40%

<100 100-200

30% 20%

20%

15.50%

10%

201-350 11.50%

>350

0%

CD4 (cells/Âľl) Figure 8:CD4 count


Morbidities at Initiation of ART


OI

NO.

PCP

12

TB

22

Candidiasis

40

CMV retinitis

01

Cryptococcal meningitis

01

CNS lymphoma

01

Herpes zoster

07

Figure 9: Presentation of OIs

Commonest OIs 60% 48%

50% 40%

30% 20%

TB PCP

26% 14%

10%

12%

0%

Candidiasis Others

Ois Figure 10:Commonest OIs


10%

Oral candidiasis 90%

Oes. Candidiasis

Figure 12 :Candidal infection


Presentation No. TB

%

PTB

15

60%

EPTB

07

28%

Latent TB

03

Presentation of TB 12%

28%

12%

Figure11:Presentation of TB

PTB EPTB 60%

Latent TB


ď ˝

51 patients had dermatological manifestations

Skin manifestations 80% 64%

PPE

60%

34.5%

HZ 40% 20% 0%

Fungal I. 13%16% 6%

dermatitis others

1%

Figure 13: Skin manifestations


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31 patients had STIs 21%

Commonest STIs 50%

45%

40% 30% 20%

HSV

26% 16% 13%

10%

S4L GW Others

0%

STIs Figure 14:Commonest STIs


80%

75%

70% 60%

<8

50%

8.0-10.0

40%

10.1-11

30%

>11

20%

10%

3%

8%

12%

0%

Unknown 1%

Hb (g/dl) Figure 15: Hemoglobin level


90%

84%

80% 70% 60%

<100

50%

100-150

40%

>150

30%

Unknown

20%

10% 0%

4%

11%

1%

Platelet count ( x10 3 /ul)

Figure 16: Platelet count


Other morbidities

No.

%

DM

10

6.8%

Hyperlipidemia

06

4%

IHD

02

1.3%

HT

02

1.3%

Renal impairment

01

0.7%

Hepatic impairment

01

0.7%

Psychiatric dis.

02

1.3% Figure 17 : Other morbidities


Regimen stared

NO.

%

AZT+3TC+EFV

87

58%

AZT+3TC+NVP

19

13%

AZT+3TC+LOP/R

02

1.5%

TDF+FTC+EFV

38

26%

TDF+FTC+LOP/R

02

1.5%

Figure 18: ART regimes


Out come at the end of September

2013 N=148

100%

87%

80% 60% 40% 20% 0% OT1

3%

5%

5%

OT2

Death

LFU

Figure 19: Out come


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 

PCP (44%) HIV encephalopathy (14%) Renal failure (14%) Syndrome of Inappropriate secretion of ADH/ SIADH (14%) Unknown (14%)

Probable cause for death (n=7)

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Pregnancy(25%) NNRTI hypersensitivity (75%)

Reasons for switching to second line therapy (n=4)


Opportunistic infections are more commonly identified among study population than other co morbid factors. Majority of patients were initiated ART at a higher CD4 count (mean count 233cells/µl) How ever the most possible cause for more opportunistic infections in an ART era, can be due to late diagnosis.


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Most of the morbidities identified among study population can be prevented by early diagnosis and initiating ART at a higher CD4 count. To prevent late diagnosis;

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HIV should be considered as a differential diagnosis when a patient presents with oral candidiasis, TB, atypical pneumonia, certain dermatological conditions, unexplained anemia ,thrombocytopenia etc. Scaling up screening of HIV among most at risk population and other vulnerable groups.


Pre treatment morbidities among HIV infected patients attending  
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