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ABSTRACT: Epidemiologic data of HIV and viral hepatitis coinfection are needed in sub-Saharan Africa to guide health policy for hepatitis screening and optimized antiretroviral therapy (ART).
We screened 323 HIV-infected, ART-eligible adults for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCV Ab) at a tertiary hospital in Lusaka, Zambia. We collected basic demographic, medical, and laboratory data to determine predictors for coinfection.
Of 323 enrolled patients, 32 (9.9%; 95% CI=6.7-13.2%) were HBsAg positive, while 4 (1.2%; 95% CI=0.03-2.4%) were HCV Ab positive. Patients with hepatitis B coinfection were more likely to be <40 years (84.4% vs. 61.4%; P=0.01) when compared to those who were not coinfected. Patients with active hepatitis B were more likely to have mild to moderately elevated AST/ALT (40-199 IU/L, 15.8% vs. 5.4%; P=0.003). Highly elevated liver enzymes (>200 IU/L) was uncommon and did not differ between the two groups (3.4% vs. 2.3%; P=0.5). We were unable to determine predictors of hepatitis C infection due to the low prevalence of disease.
HIV and hepatitis B coinfection was common among patients initiating ART at this tertiary care facility. Routine screening for hepatitis B should be considered for HIV-infected persons in southern Africa.
Journal of global infectious diseases 07/2011; 3(3):269-74.
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ABSTRACT: Although the individual-level impact of antiretroviral therapy (ART) is well documented, there are few available data describing the public health impact of services for persons infected with human immunodeficiency virus in resource-constrained settings. We describe the methods and baseline results of a household survey that assessed the population-level impact of the national program for HIV care in Zambia and treatment in the city of Lusaka. The survey was timed with the staggered expansion of services and repeated cross-sectional surveys planned for pre-implementation and post-implementation comparisons made by community. In the initial survey round, which was performed during the early phases of the program (November-December 2004), 18,110 persons were enumerated from 3,600 households surveyed. Respondents were asked questions designed to evaluate community-level mortality and respondent knowledge and attitudes towards HIV. These findings will serve as a reliable reference in the future analysis of the population-level impact of this HIV treatment and care program in Zambia.
The American journal of tropical medicine and hygiene 05/2010; 82(5):971-7. · 2.59 Impact Factor
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Mwangelwa Mubiana-Mbewe,
Carolyn Bolton-Moore, Yolan Banda,
Namwinga Chintu,
Mutinta Nalubamba-Phiri,
Mark Giganti,
M Brad Guffey,
Pauline Sambo,
Elizabeth M Stringer,
Jeffrey S A Stringer,
Benjamin H Chi
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ABSTRACT: To describe the pattern of incident illness in children after initiation of antiretroviral therapy (ART) in a large public health sector programme in Lusaka, Zambia.
Systematic chart review to retrospectively extract data from medical records of children (i.e. <15 years) initiating ART in the Lusaka, Zambia public sector. Incident conditions were listed separately and then grouped according to broad categories. Predictors for incident diagnoses were determined using univariate and multivariable analysis.
Between May 2004 and June 2006, 1705 HIV-infected children initiated ART. Of these, 1235 (72%) had their medical records reviewed. Median age at ART initiation was 77 months and 554 (45%) were females. Eight hundred and forty-one (68%) children had an incident condition during this period, with a median time of occurrence of 64 days from ART initiation. Twenty-eight incident conditions were documented. When categorized, the most common were mucocutaneous conditions [incidence rate (IR): 70.6 per 100 child-years, 95% CI: 64.5-77.2] and upper respiratory tract infection (IR: 70.1 per 100 child-years; 95% CI: 64.0-76.7). Children with severe immunosuppression (i.e. CD4 < 10%) were more likely to develop lower respiratory tract infection (16.3%vs. 10.2%; P = 0.003) and mucocutaneous conditions (43.9% vs. 35.3%; P = 0.005) than those with CD4 > or = 10%.
There is a high incidence of new illness after ART initiation, emphasizing the importance of close monitoring during this period. Early initiation of ART and use of antimicrobial prophylaxis may also help to reduce the occurrence of such co-morbidities.
Tropical Medicine & International Health 09/2009; 14(10):1190-8. · 2.80 Impact Factor
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ABSTRACT: To describe the association between 6-month weight gain on antiretroviral therapy (ART) and subsequent clinical outcomes.
A retrospective analysis of a large programmatic cohort in Lusaka, Zambia.
Using Kaplan-Meier analysis and Cox proportional hazards models, we examined the association between 6-month weight gain and the risk of subsequent death and clinical treatment failure. Because it is a known effect modifier, we stratified our analysis according to body mass index (BMI).
Twenty-seven thousand nine hundred fifteen adults initiating ART were included in the analysis. Patients in the lower BMI categories demonstrated greater weight gain. In the post 6-month analysis, absolute weight loss was strongly associated with mortality across all BMI strata, with the highest risk observed among those with BMI <16 kg/m (adjusted hazard ratio 9.7; 95% CI: 4.7 to 20.0). There seemed to be an inverse relationship between weight gain and mortality among patients with BMI <16 kg/m. Similar trends were observed with clinical treatment failure.
Weight gain after ART initiation is associated with improved survival and decreased risk for clinical failure, especially in the lower BMI strata. Prospective trials to promote weight gain after ART initiation among malnourished patients in resource-constrained settings are warranted.
JAIDS Journal of Acquired Immune Deficiency Syndromes 09/2009; 53(4):507-13. · 4.43 Impact Factor
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ABSTRACT: To determine the influence of body mass index (BMI) on pregnancy outcomes of HIV-infected and HIV-uninfected Zambian women and to assess the possible role of BMI on mother-to-child transmission rate of HIV.
We analysed data from a clinical trial on nevirapine administration for the prevention of mother-to-child transmission of HIV in Lusaka, Zambia. Demographic characteristics, medical information and pregnancy outcomes were used in this secondary analysis.
A total of 1211 women were included in this analysis and 36% were HIV-infected. Among HIV-infected women, maternal parity and prior stillbirths increased with increasing BMI in univariate analysis. Mean birth weight rose as well at 28.3 g [95% confidence interval (CI)=14.0-42.6] of infant weight per BMI unit. Transmission of HIV from mother to child appeared inversely related to BMI when compared according to BMI quartile (P for trend=0.07). In the HIV-uninfected group, infant birth weight increased with increasing BMI, at 32.7 g (95% CI=23.5-41.9) of infant weight per BMI unit.
Birth weight increased alongside BMI in both HIV-infected and HIV-uninfected women. There is a suggestion that women with lower BMI have a greater risk of perinatal HIV transmission, even after adjustments for HIV viral load and CD4 count.
Tropical Medicine & International Health 08/2007; 12(7):856-61. · 2.80 Impact Factor
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ABSTRACT: We studied the prevalence of and predictors for traditional medicine use among pregnant women seeking care in the Lusaka, Zambia public health system.
We surveyed 1128 pregnant women enrolled in a clinical trial of perinatal human immunodeficiency virus (HIV) prevention strategies at two district delivery centers.
Postpartum questionnaires were administered to determine demographic characteristics, behavioral characteristics, HIV knowledge, and prior use of traditional medicines.
Of the 1128 women enrolled, 335 (30%) reported visiting a traditional healer in the past; 237 (21%) reported using a traditional healer during the current pregnancy. Overall, 54% believed that admitting to a visit to a traditional healer would result in worse medical care. When women who had used traditional medicines were compared to those who had not, no demographic differences were noted. However, women who reported use of traditional medicine were more likely to drink alcohol during pregnancy, have >or=2 sex partners, engage in "dry sex," initiate sex with their partner, report a previously treated sexually transmitted disease, and use contraception (all p < 0.01). HIV-infected women who reported using traditional healers were also less likely to adhere to a proven medical regimen to reduce HIV transmission to their infant (25% versus 50%, p = 0.048).
Use of traditional medicine during pregnancy is common, stigmatized, and may be associated with nonadherence to antiretroviral regimens. Health care providers must open lines of communication with traditional healers and with pregnant women themselves to maximize program success.
The Journal of Alternative and Complementary Medicine 13(1):123-7. · 1.59 Impact Factor
