Ofonime M. Ogba

The relationship between opportunistic pulmonary fungal infections and CD4 count levels among HIV-seropositive patients in Calabar, Nigeria

BACKGROUND Most HIV-seropositive people who develop AIDS die from an opportunistic infection, such as pulmonary mycosis, rather than the HIV infection itself. Data on the pattern of respiratory mycoses and the immunological profile of HIV-seropositive patients in Nigeria are scarce and uncoordinated, so we investigated respiratory mycosis and CD4 count among HIV-seropositive and AIDS patients attending the antiretroviral clinics at the University of Calabar Teaching Hospital and Lawrence Henshaw Hospital in Calabar, Nigeria. METHOD From May 2009 to July 2010 we carried out a prospective study of 331 individuals with respiratory symptoms, of whom 272 were HIV seropositive, aged 17-75 years and able to produce sputum and 59 were HIV non-reactive. Relevant samples were collected and subjected to direct microscopy, fungal culture and serology. RESULTS The overall prevalence of pulmonary mycoses was 36.0%, the most prevalent fungal pathogen being Candida albicans (11.8%). Pneumocystis jirovecii (7.4%) was confirmed as an important opportunistic fungal agent in HIV-infected individuals in Calabar. Patients aged 25-34 years were at the highest risk of pulmonary mycosis (43.9%). HIV-positive patients with mycoses had lower mean CD4 counts (142.3 ± 100.1 cells µl⁻¹) than those without mycoses (435.4 ± 249.1 cells µl⁻¹) (t = 10.5, p = 0.00). CONCLUSION Opportunistic pulmonary infections arise more frequently in HIV patients with lower CD4 counts. A more detailed comparative study with other opportunistic infections may help formalize the use of CD4 count as an indicator of HIV/AIDS with opportunistic mycoses.

Haematological Profile of HIV Infected Patients with Opportunistic Respiratory Mycoses in Relation to Immune Status-A Hospital Based Cohort from Calabar, Nigeria

Objectives: To study the spectrum of hematological manifestations and evaluate the relationship between various hematological manifestations and CD4 cell count among opportunistic respiratory mycoses positive adult HIV patients in Calabar, Nigeria. Materials and methods: The hematological and mycological profiles of the 272 HIV infected patients with respiratory symptoms attending the Anti Retroviral (ARV) and Infectious disease clinics in Calabar, from May 2009 to July 2010 were recorded. The relationship between hematological manifestations and CD4 counts among the respiratory mycoses positive subjects were analyzed. Results: The most common haematological abnormality was anaemia with 129(47.2%) subjects affected. Also among the mycoses positive subjects’ anaemia was more prevalent in females 32(43.8%) than males 26(46.4%), but there was no relationship between mycoses and anaemia among subjects (X2=4.3, p=0.6). All subjects infected with fungal pathogens had CD4 counts below 200 cells/μl of blood. Conclusion: Subjects with mycoses are more likely to develop haematological abnormalities like anaemia, neutropenia and lymphopenia due to further suppression of their immune status. This suggests that respiratory mycoses may affect haematological parameters of patients especially the lymphocytes and CD4 counts.