1
|
Semango GP, Charles RM, Swai CI, Mremi A, Amsi P, Sonda T, Shao ER, Mavura DR, Joosten LAB, Sauli E, Nyindo M. Prevalence and associated risk factors for Kaposi's sarcoma among HIV-positive patients in a referral hospital in Northern Tanzania: a retrospective hospital-based study. BMC Cancer 2018; 18:1258. [PMID: 30558571 PMCID: PMC6296123 DOI: 10.1186/s12885-018-5155-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/29/2018] [Indexed: 12/04/2022] Open
Abstract
Background Kaposi’s sarcoma (KS) is a multifocal angioproliferative tumor involving blood and lymphatic vessels, caused by Human Herpes Virus-8 (HHV-8). KS is an important AIDS-defining tumor with high prevalence in Sub-Saharan Africa, including Tanzania which has high HIV and HHV-8 sero-prevalence. It is critically important to monitor the prevalence of AIDS-defining tumors, such as KS, in the age of HIV/AIDS. We studied the prevalence of KS and associated risk factors among HIV-positive patients at Kilimanjaro Christian Medical Centre (KCMC), a referral hospital in northern Tanzania, over the period from January 2012 to December 2015. Methods This was a retrospective hospital-based cross-sectional study to determine the prevalence of KS among HIV/AIDS patients between 2012 and 2015. The study included 1100 HIV patients’ data which were collected at the Infectious Disease Clinic (IDC) from patients’ files. Stata version 13 (StataCorp LP, Texas 77,845 USA) was used for all statistical analyses. The prevalence of KS was calculated across levels of a number of categorical variables. Logistic regression was performed to determine relative risk of KS for all characteristics. We included all variables with p-values ≤10% in the multivariate analysis, including ART use, as this is considered to have an influence on KS. In the multivariate analysis, statistical significance was established based on a two-tailed p-value ≤5%. All patients’ notes were kept confidential as per the Helsinki declaration. Results Our results revealed a 4.6% prevalence of KS at KCMC hospital, between January 2012 and December 2015, 51(4.6%) patients were diagnosed with KS out of 1100 HIV-positive patients. The study further revealed that KS in HIV patients was most associated with low CD4 cell count (less than or equal to 200 cells/μl). Moreover, women were more likely than men to diagnosed with KS, with higher odds significantly associated with KS (OR 0.42, p < 0.009). Increased age, above 35 years, among the HIV seropositive patients was significantly associated with KS (OR 25.67, p < 0.007). HIV patients who were none smokers were more likely to suffer from KS compared to HIV smokers (OR 0.41, p < 0.010). Conclusion KS remains a common malignant vascular tumor commonly associated with HIV/AIDS in Tanzania. Our study highlights the need for continued efforts to combat HIV, as well as associated diseases such as KS. Continued availability of ART (Anti-Retroviral Therapy) to HIV/AIDS patients, and test reagents for CD4 cell count and viral load determination are important measures to alleviate the suffering of these patients. Furthermore, studies to gather more evidence on ART resistance are highly needed to guide treatment choices.
Collapse
Affiliation(s)
- George P Semango
- Kilimanjaro Christian Medical University College, P.O Box 2236, Moshi, Tanzania. .,Regional Dermatology Training Centre, Kilimanjaro Christian Medical Centre, P.O. Box 8332, Moshi, Tanzania. .,School of Life Sciences and Bioengineering, Nelson Mandela-African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania.
| | - Renard M Charles
- Kilimanjaro Christian Medical University College, P.O Box 2236, Moshi, Tanzania
| | - Consolata I Swai
- Kilimanjaro Christian Medical University College, P.O Box 2236, Moshi, Tanzania.,Regional Dermatology Training Centre, Kilimanjaro Christian Medical Centre, P.O. Box 8332, Moshi, Tanzania
| | - Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Tanzania
| | - Patrick Amsi
- Department of Pathology, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Tanzania
| | - Tolbert Sonda
- Kilimanjaro Christian Medical University College, P.O Box 2236, Moshi, Tanzania
| | - Elichilia R Shao
- Kilimanjaro Christian Medical University College, P.O Box 2236, Moshi, Tanzania.,Department of Medicine, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Tanzania
| | - Daudi R Mavura
- Regional Dermatology Training Centre, Kilimanjaro Christian Medical Centre, P.O. Box 8332, Moshi, Tanzania
| | - Leo A B Joosten
- Department of Internal Medicine, Radboud Center for Infectious diseases (RCI), Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.,Radboud Center for Infectious diseases (RCI), Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Elingarami Sauli
- School of Life Sciences and Bioengineering, Nelson Mandela-African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania
| | - Mramba Nyindo
- Kilimanjaro Christian Medical University College, P.O Box 2236, Moshi, Tanzania
| |
Collapse
|
2
|
Reduced bacterial skin infections in HIV-infected African children randomized to long-term cotrimoxazole prophylaxis. AIDS 2016; 30:2823-2829. [PMID: 27662556 PMCID: PMC5976221 DOI: 10.1097/qad.0000000000001264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether cotrimoxazole prophylaxis prevents common skin conditions in HIV-infected children. DESIGN Open-label randomized controlled trial of continuing versus stopping daily cotrimoxazole (post-hoc analysis). SETTING Three sites in Uganda and one in Zimbabwe. PARTICIPANTS A total of 758 children aged more than 3 years receiving antiretroviral therapy (ART) for more than 96 weeks in the ARROW trial were randomized to stop (n = 382) or continue (n = 376) cotrimoxazole after median (interquartile range) 2.1(1.8, 2.2) years on ART. INTERVENTION Continuing versus stopping daily cotrimoxazole. MAIN OUTCOME MEASURES Nurses screened for signs/symptoms at 6-week visits. This was a secondary analysis of ARROW trial data, with skin complaints categorized blind to randomization as bacterial, fungal, or viral infections; dermatitis; pruritic papular eruptions (PPEs); or others (blisters, desquamation, ulcers, and urticaria). Proportions ever reporting each skin complaint were compared across randomized groups using logistic regression. RESULTS At randomization, median (interquartile range) age was 7 (4, 11) years and CD4 was 33% (26, 39); 73% had WHO stage 3/4 disease. Fewer children continuing cotrimoxazole reported bacterial skin infections over median 2 years follow-up (15 versus 33%, respectively; P < 0.001), with similar trends for PPE (P = 0.06) and other skin complaints (P = 0.11), but not for fungal (P = 0.45) or viral (P = 0.23) infections or dermatitis (P = 1.0). Bacterial skin infections were also reported at significantly fewer clinic visits (1.2 versus 3.0%, P < 0.001). Independent of cotrimoxazole, bacterial skin infections were more common in children aged 6-8 years, with current CD4 cell count less than 500 cells/μl, WHO stage 3/4, less time on ART, and lower socio-economic status. CONCLUSION Long-term cotrimoxazole prophylaxis reduces common skin complaints, highlighting an additional benefit for long-term prophylaxis in sub-Saharan Africa.
Collapse
|