EPIDEMIOLOGY OF OPPORTUNISTIC INFECTIONS ASSOCIATED WITH HIV POSITIVE PATIENTS IN TERTIARY HEALTH FACILITIES
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CHAPTER ONE
INTRODUCTION
An opportunistic infection is an infection caused by opportunistic pathogens such as cytomegalovirus, Candida albicans, salmonella, Crystosporidia, Streptococcus pneumonica, Toxoplasma gondi, Mycobacterium tuberculosis. A compromised immune system presents an opportunity for the pathogen to infect. Opportunistic infections (OIs) occur frequently and are more severe in individuals with weakened immune system. Opportunistic infections are less common than they were in the early days of HIV and AIDS because better treatments have helped in reducing the viral load of infected people thereby improving their immunity. In HIV infection, there are four stages as classified by world health organization (WHO 2004). They range from the Asymptomatic to symptomatic. All these stages are both clinically and diagnostically ascertained especially with the monitoring of the patient’s CD4 cell count level.
Antiretroviral therapy (ART) is the cornerstone of the overall strategy to reduce mortality attributed to HIV related infections and other HIV related processes (WHO 2004). The clinical benefit of ART in reducing the risk for OIs over the short term has been demonstrated for those with CD4+ T lymphocyte count <200 cells/μl.(WHO, 2004). Studies also support the benefit in patients with CD4+ T lymphocyte counts >200 cells/μl.(CDC 2002;Benson et al, 2004 ) Improvements in specific measures of immune function, including pathogen-specific immunity have been well documented among the latter category (Austran et al, 1997; Connick et al 2000).
In addition to preventing OIs, ART can lead to resolution or improvement of certain OIs, most notably for those where specific treatment is not available.(Masur 2012). Treatment of patients with ART in the setting of an OI also can result in an exuberant inflammatory reaction that might require the use of anti-inflammatory agents for clinical management.
Patients who receive potent ART can have atypical presentations of OIs either early after the initiation of ART or after prolonged treatment. No randomized controlled trials exist that demonstrates that initiating ART improves outcome for patients being treated with specific therapy for their acute OI. Furthermore, no data demonstrate that initiation of ART in the setting of an acute OI worsens the prognosis or treatment for that OI.
Notwithstanding all this, certain patients in the developed and developing world do not have access to care and have opportunistic infections (Benson et al, 2004). Other patients do not have a sustained response to antiretroviral agents for multiple reasons including poor adherence, drug toxicities, drug interactions or initial acquisition of a drug-resistant strain of HIV. Owing to all this, opportunistic infections continue to cause morbidity and mortality in patients with HIV infection throughout the world (Benson et al, 2004).
1.1.1 STATEMENT OF PROBLEMS/JUSTIFICATION FOR STUDY
Clinically, Opportunistic Infections among HIV positive patients are associated with a lot of changes in the body which involves: HIV wasting syndrome, weight loss of more than 10% body weight plus either unexplained chronic diarrhea or chronic weakness and unexplained chronic fever, which can cause systemic involvement occasionally among people living with HIV/AIDS (WHO 2004).
The major clinical manifestation of Opportunistic Infections which have most direct bearing on the burden of HIV/AIDS infection in terms of public health is the lowering of CD4 T lymphocyte count of HIV positive patients and which leads to its progression to death and reduction of workforce thereby affecting the social economic output. (Corbert et al, 2003).
The predominance of certain Opportunistic Infection in one geographical location and not in others has been explained by variations in prevalence and virulence of strains of organisms coupled with Immune Interaction or cross-Immunity (Lucas, 1990). Hence there are significant differences between Opportunistic Infections prevalent in Africa and those prevalent in United States and Europe. (Batungwanayo et al 1992; Lucas et al, 1991). In Nigeria a lot of operational studies have been carried out in some part of the country like Northern Nigeria(Saidu et al 2009). Yet there is still paucity of information on the real status of opportunistic infections among HIV positive patients in South Eastern Nigeria, however there is no published information in Imo State, Nigeria. This makes it difficult for informed priority to be identified in planning control strategy.
It is against this background that this present work has been designed to provide accurate and adequate data on the epidemiology of Opportunistic Infections associated with HIV patients in tertiary health facilities in Imo State Nigeria. It is believed that the data from this work will aid the ministry of health in their planning of control strategy.
1.1.2 RESEARCH OBJECTIVES
1. To determine the distribution of Opportunistic Infections associated with HIV positive patients, with respect to age and sex.
2. To determine if opportunistic infections is affected by the level of CD4 cell count of HIV positive patients.
3. To determine the most prevalence opportunistic infection that affects HIV positive patients.
1.1.3 RESEARCH QUESTIONS
1. Is there any association between gender, age and prevalence of opportunistic infections in HIV patients in tertiary facilities in Imo State?
2. Are opportunistic infections affected by the level of CD4+ T cell count of HIV positive patients?
3. Is there any significant difference among the opportunistic infections that affects HIV positive patients?
1.1.4 HYPOTHESIS
In response to the afore listed research question null hypothesis (Ho) and alternative hypothesis (Hi) are formulated this.
RESEARCH QUESTION 1
Ho: There is no relationship between gender/Age and prevalence of opportunistic infection among HIV positive patients.
Hi: There is relationship between gender/Age and prevalence opportunistic infection among HIV positive patients.
RESEARCH QUESTIONS II
Ho: Opportunistic infections are not affected by the level of CD4 cell count.
Hi: opportunistic infections are affected by the level of CD4 cell count.
RESEARCH QUESTIONS III
Ho: There is no significant difference among the opportunistic infection affecting HIV positive patients.
Hi: there is significant difference among opportunistic infections affecting HIV positive patients.
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