Techalew Shimelis

Intestinal parasitic infections in relation to HIV/AIDS status diarrhea and CD4 T-cell count.

BackgroundHIV infection has been modifying both the epidemiology and outcome of parasitic infections. Hence, this study was undertaken to determine the prevalence of intestinal parasitic infection among people with and without HIV infection and its association with diarrhea and CD4 T-cell count.MethodsA cross-sectional study was conducted at Hawassa Teaching and Referral Hospital focusing on HIV positive individuals, who gave blood for CD4 T-cell count at their first enrolment and clients tested HIV negative from November, 2008 to March, 2009. Data on socio-demographic factors and diarrhea status were obtained by interviewing 378 consecutive participants (214 HIV positive and 164 HIV negative). Stool samples were collected from all study subjects and examined for parasites using direct, formol-ether and modified acid fast stain techniques.ResultsThe prevalence of any intestinal parasitic infection was significantly higher among HIV positive participants. Specifically, rate of infection with Cryptosporidium, I. belli, and S. stercoralis were higher, particularly in those with CD4 count less than 200 cells/μL. Diarrhea was more frequent also at the same lower CD4 T-cell counts.ConclusionImmunodeficiency increased the risk of having opportunistic parasites and diarrhea. Therefore; raising patient immune status and screening at least for those treatable parasites is important.

Sero-prevalence of latent Toxoplasma gondii infection among HIV-infected and HIV-uninfected people in Addis Ababa, Ethiopia: A comparative cross-sectional study

BackgroundToxoplasmosis in immuno-compromised hosts manifests primarily as a life threatening condition, toxoplasmic encephalitis. However, there is scarce information about the magnitude of Toxoplasma gondii infection among HIV-infected people in Ethiopia. This study was, therefore, conducted to determine the sero-prevalence of T. gondii infection among HIV-infected and HIV-uninfected subjects.FindingsSera were collected from people with and without HIV infection for the purpose of studying hepatitis B virus (HBV) at St. Paul Hospital, Addis Ababa, Ethiopia from 24 January 2007 to 15 February 2007. Among these sera, the first 330 consecutive sera, 165 from each HIV sero-group, were selected and tested for anti-T. gondii IgG antibodies using Enzyme Linked Immunosorbent Assay. The seroprevalence of Toxoplasma infection was assessed against socio-demographic characteristics, HIV and HBV serostatus and HBV-related risk factors. The overall sero-prevalence of latent T. gondii infection among the study subjects was 90.0%. Toxoplasma infection was observed with respective prevalence of 93.3% and 86.7% among HIV-infected and HIV-uninfected people. Though Toxoplasma infection seems to be influenced by age, gender and HIV serostatus, only HBV serostatus was significantly associated (OR 2.71, CI 1.12 to 6.57) in multivariate logistic regression analysis.ConclusionThe seroprevalence of latent T. gondii infection is high and similar by HIV status. Educating people to prevent acquisition of new Toxoplasma infection and minimizing the risk of disease manifestations among HIV-Toxoplasma co-infected individuals is important.

Cryptosporidium and Strongyloides stercoralis infections among people with and without HIV infection and efficiency of diagnostic methods for Strongyloides in Yirgalem Hospital, southern Ethiopia

BackgroundCryptosporidiosis and strongyloidiasis have been reported to be associated with HIV/AIDS. The present study was designed to determine the prevalence of Cryptosporidium and Strongyloides stercoralis infections among people with and without HIV infection and also assess the efficient methods for detection of Strongyloides.FindingsA cross-sectional study was conducted in Yirgalem Hospital, southern Ethiopia from March, 2007 to October, 2007. Demographic data and stool samples were collected from 384 individuals (192 from each HIV serogroup). Samples were processed using the modified Ziehl-Neelsen technique for detection of Cryptosporidium species. Stool samples were also processed using the direct saline mount, the formol-ether and the water-emergence techniques for diagnosis of S. stercoralis. The prevalence of Cryptosporidium and S. stercoralis among HIV infected individuals was 25% and 12.0%, respectively. HIV positive individuals had significantly higher rate of infection with Cryptosporidium (OR = 15.7; 95% CI 5.5 to 44.5) and S. stercoralis (OR = 6.4; 95% CI 2.2 to 18.9). Among the three diagnostic methods, the larvae of S. stercoralis were more efficiently detected by the water-emergence technique.ConclusionsIn this study, the prevalence of Cryptosporidium and S. stercoralis infections was significantly higher among people with HIV/AIDS. Educating HIV infected individuals to prevent acquisition of Cryptosporidium infection and screening for S. stercoralis using the water-emergence technique is likely to be helpful.

Burden of metabolic syndrome among HIV-infected patients in Southern Ethiopia

BACKGROUND HIV infection and highly active antiretroviral therapy (HAART) can induce metabolic disturbances including lipodystrophy, dyslipidemia, and insulin resistance, which are reminiscences of metabolic syndrome (MS). However, little is known regarding the magnitude of MS in Ethiopian HIV population. This study, aimed to estimate the prevalence of MS among HIV positive patients with and without HAART. METHODS A cross-sectional study was conducted at Hawassa University Referral Hospital, southern Ethiopia between February 2012 and April 2013. Data on demographic and anthropometric characteristics were collected from a total of 374 HIV positive participants (188 on ART and 186 on Pre-ART) using WHO stepwise approach. Fasting blood glucose, total cholesterol, triglyceride, HDL-cholesterol and LDL-cholesterol was measured. The International Diabetes Federation (IDF) and the National Cholesterol Education Program: Adult Treatment Panel III (ATP) Criteria were used to define MS. RESULT Of the 374 study participants 68% were females, and 50.3% were receiving ART. Using the IDF criteria, metabolic syndrome was diagnosed in 25% of patients receiving ART compared to 22.5% of the ART naïve group (OR: 1.14 CI: 0.71-1.84). Using the ATP criteria, the prevalence of MS was 18.1% in the ART groups compared to 15.6% in ART naïve group (OR: 1.20, CI: 0.69-2.06). Patients receiving ART had significantly elevated Cholesterol, triglyceride, glucose and LDL-c levels but lower CD4(+) cell counts than the Pre-ART groups. Being a female, having BMI of at least 25, older age (i.e. age≥45 years) and having total cholesterol of at least 200mg/dl were significantly associated with the presence of MS. Using the ATP criteria to define MS, taking d4T-3TC-EFV regimen was significantly associated with higher odds of MS. CONCLUSION Almost a quarter of HIV patients on ART developed metabolic syndrome. Furthermore patients on ART had elevated lipid profile and glucose metabolism disturbance than the ART naïve.

Asymptomatic urinary tract infection among pregnant women attending the antenatal clinic of Hawassa Referral Hospital, Southern Ethiopia

BackgroundUntreated asymptomatic bacteriuria (ASB) during pregnancy may cause serious complications including pyelonephritis and delivery of premature or low-birth-weight infants. However, little is known about asymptomatic bacteriuria in pregnancy in Ethiopia. This study aimed to assess the prevalence of asymptomatic bacteriuria, bacterial agents, and their antibiotic susceptibility pattern in pregnant women attending antenatal clinic of the Hawassa Teaching and Referral Hospital.MethodsA cross-sectional study was conducted in a total of 244 pregnant women with no sign and symptom of urinary tract infection from March 2012 to September 2012. Clean catch mid-stream urine samples were collected from all study participants using sterile containers. Urine samples were cultured using standard bacteriological methods. Identification of suspected colonies and antibiotic sensitivity testing were done.ResultOut of 244 pregnant women, 46(18.8%) were positive for asymptomatic bacteriuria (Colony Forming Unit ≥ 105/mL). There was no difference in prevalence of asymptomatic bacteriuria with respect to age (p = 0.07) and trimester (p = 0.27).The most frequently isolated bacteria were coagulase negative Staphylococcus (32.6%), followed by Escherichia coli (26.1%), and Staphylococcus auerus (13%). The susceptibility rate of bacterial isolate was highest for norfloxacin (64.7%) and lowest for ampicillin (17.6%).ConclusionThe high prevalence of ASB in pregnant women warrant the need to screen all pregnant women and treat those infected with appropriate antimicrobial regimens in order to reduce its complications.

Epidemiological and clinical correlates of malaria-helminth co-infections in southern Ethiopia

BackgroundIn many areas of the world, including Ethiopia, malaria and helminths are co-endemic, therefore, co-infections are common. However, little is known how concurrent infections affect the epidemiology and/or pathogenesis of each other. Therefore, this study was conducted to assess the effects of intestinal helminth infections on the epidemiology and clinical patterns of malaria in southern Ethiopia where both infections are prevalent.MethodsA cross-sectional study was conducted in 2006 at Wondo Genet Health Center and Bussa Clinic, southern Ethiopia. Consecutive blood film positive malaria patients (N=230) and malaria negative asymptomatic individuals (N=233) were recruited. Malaria parasite detection and quantification was diagnosed using Giemsa-stained thick and thin blood films, respectively. Helminths were detected using direct microscopy and formol-ether concentration techniques. Coarse quantification of helminths ova was made using Kato Katz method.ResultsThe over all magnitude of intestinal parasitic infection was high irrespective of malaria infection (67% among malaria positive patients versus 53.1% among malaria non-infected asymptomatic individuals). Trichuris trichiura infection was associated with increased malaria prevalence while increased worm burden of helminths as expressed by egg intensity was associated with increased malaria parasitaemia which could be a potential factor for development of severe malarial infection with the course of the disease. Majority (77%) of the subjects had multiple helminths infection. T. trichiura, Ascaris lumbricoides, Schistosoma mansoni, and hookworm infestation accounted for 64.5, 57.7 %, 28.4%, and 12.2% of the infections, respectively.ConclusionsPopulations in malaria-endemic areas of southern Ethiopia are multi-parasitized with up to four helminths. Mass deworming may be a simple practical approach in endemic areas in reducing the risk of severe malarial attack particularly for those at high risk of both infections.

Prevalence and risk factors of Hepatitis C among individuals presenting to HIV testing centers, Hawassa city, Southern Ethiopia

BackgroundHepatitis C virus (HCV), either alone or in combination with Human Immunodeficiency virus (HIV), constitutes a major public health concern. This study was conducted to describe the prevalence and risk factors for HCV infection in people with and without HIV infection.MethodsBlood samples and data on socio-demographic and risk factors for HCV infection were collected from consecutive 400 HIV- positive and 400 HIV- negative individuals attending HIV testing centers in Hawassa city, from October to December, 2008. All sera were tested for antibody to HCV infection (anti-HCV) using enzyme linked immunosorbent assay (ELISA). Sera positive for anti-HCV were further tested for viral ribonucleic acid (RNA) levels using real-time polymerase chain reaction.ResultsThe rate of anti-HCV positivity was 10.5% in the HIV- infected individuals compared with 6% in the HIV negative group (p = 0.002). HCV-RNA was detected in 9.1% of anti-HCV positive samples and rates were comparable between HIV- infected and HIV- non- infected individuals. There was no significant difference in odds of HCV infection in participants with and without HCV risk factors in either HIV sero-group.ConclusionHIV infected individuals had significantly higher rate of anti-HCV although most of them showed no evidence of viraemia. Hence, while priority should be given for HIV infected patients, testing those with anti-HCV for HCV-RNA remains important.

The diagnostic performance evaluation of the SD BIOLINE HIV/syphilis Duo rapid test in southern Ethiopia: a cross-sectional study

Objective To determine the diagnostic performance of the SD BIOLINE HIV/syphilis Duo rapid test. Design A hospital-based cross-sectional study. Setting This evaluation was conducted at one of the largest hospitals in southern Ethiopia. Participants Serum samples obtained from clients attending the antiretroviral therapy and voluntary counselling and testing centres were used. Sera were originally collected for the purpose of investigating syphilis epidemiology. The performance of the test to detect HIV was evaluated using 400 sera (200 HIV positives and 200 HIV negatives). Also, its performance to detect syphilis was evaluated using 85 syphilis positive and 100 syphilis negative serum samples. Individuals <15 years of age or syphilis treated or those with ≤50 cells/µL CD4 cell count were originally excluded. Outcome measures HIV screening was carried out according to the national rapid diagnostic testing (RDT) algorithm: Shenghai Kehua Bioengineering (KHB) test kit as a screening test, followed by the HIV1/2 STAT-PAK assay if positive. Where the result of the STAT-PAK is discordant with KHB, Unigold HIV is used as a tiebreaker to determine the result. We also used ELISA to resolve discordant HIV results. Syphilis serostatus was determined using the Treponema pallidum haemagglutination assay (TPHA). Results The respective sensitivity, specificity, positive predictive value and negative predictive value of the SD BIOLINE HIV/syphilis Duo test were 100, 99.5, 99.5 and 100% for HIV and 97.6, 96, 95.4 and 98% for syphilis testing, respectively. In reference to TPHA, the test kit reported 4 false positives and 2 false negative results for syphilis. The κ values were 0.99 for HIV testing and 0.94 for syphilis testing. Conclusions The excellent performance of the SD BIOLINE HIV/syphilis Duo test to detect HIV as well as syphilis facilitates the integration of syphilis testing and treatment to the already established HIV prevention programme, ultimately contributing to the dual HIV and syphilis elimination goal.

Seroprevalence of Helicobacter pylori infection and its related risk factors in symptomatic patients in southern Ethiopia

BackgroundHelicobacter pylori is the main etiology of peptic ulcers and chronic gastritis. Various studies showed that blood type ‘O’ is more common among patients with peptic ulcer. The aim of this study was to determine the seroprevalence of H. pylori antibodies and its relationship with ABO/Rhesus blood groups, age, sex and residence of symptomatic patients in southern Ethiopia.MethodsA cross-sectional study was conducted in a total of 408 consecutive patients with upper abdominal complaints at Hawassa University Hospital from October 2012 to January 2013. Data on demographic factors was collected from all participants using questionnaires. Blood samples were also collected and tested for ABO and Rh blood group phenotype using hemagglutination test and for anti-H. pylori antibody (IgG) using two different ELISAs..ResultsThe overall seroprevalence of H. pylori infection was 83.3% (340/408), and it was significantly higher in rural (71.2%) compared to urban residents (28.8%) (p = 0.008). Participants with blood group AB, A, O, B, and Rh positive had H. pylori prevalence of 88.9, 84.2, 83.7, 80.9, and 83.5%, respectively. H. pylori infection was not significantly influenced by age, sex, occupation, educational status and ABO/ Rh status (p >0.05).ConclusionThe high seroprevalence of H. pylori infection especially among rural residents calls for immediate intervention measures so that its clinical consequences could be minimized. ABO/Rh blood group was not found to be associated with H. pylori infection.

Seroprevalence of syphilis among HIV-infected individuals in Addis Ababa, Ethiopia: a hospital-based cross-sectional study

Objective To determine the prevalence of syphilis and its risk factors among people with HIV at a hospital in Ethiopia. Design A hospital-based cross-sectional study. Setting This study was conducted at one of the largest public hospitals in Addis Ababa , Ethiopia. Participants A consecutive 306 HIV-positive patients were recruited prospectively from January to March 2010. For comparative purposes, 224 HIV-negative consecutive attendees at the voluntary counselling and testing centre in the same period were also included. Participants under 15 years of age and treated for syphilis and with a CD4 T-cell count below 50 cells/mm3 were excluded. Outcome measures Blood samples and data on sociodemographic and risk factors for syphilis were collected. Sera were screened for syphilis using rapid plasma reagin (RPR) test, and those positives were retested using Treponema pallidum haemagglutination assay (TPHA) test. Results The seroprevalence of syphilis among HIV-infected individuals was 9.8% compared with 1.3% among HIV-uninfected individuals, OR 8.01 (95% CI 2.4 to 26.6; p=0.001). A comparable rate of syphilis was found among men (11%) and women (8.9%) with HIV infection. Syphilis prevalence non-significantly increased with age, with the highest rate in 40–49 years of age (16.9%). Except a history of sexually transmitted infections, which was associated with syphilis OR 2.25 (95% CI 1.03 to 4.9; p=0.042), other risk factors did not raise the odds of infection. Conclusions The high prevalence of syphilis among people with HIV infection highlights the need to target this population to prevent the transmission of both infections. Screening all HIV-infected people for syphilis and managing those infected would have clinical and epidemiological importance.