Background Late presentation and delayed treatment initiation is associated with poor outcomes in patients with HIV. Little is known about the stage at which HIV patients present at HIV clinics in Tanzania.Aim: This study aimed at determining the proportion of HIV patients presenting with WHO clinical stages 3 and 4 disease, and the level of immunity at the time of enrollment at the care and treatment center.Methods A retrospective cross-sectional study was conducted among 366 HIVinfected adults attending HIV clinic at Mwananyamala Hospital in Dar es Salaam, Tanzania. Data were obtained from the care and treatment clinic database.Results Late stage disease at the time of presentation was found in 276 (75.4%) of the patients; out of whom 153 (41.8%) presented with CD4 count <200 cells/ul and 229 (62.6%) presented with WHO clinical stage 3 or 4 at the time of clinic enrollment. Strategies to improve early diagnosis and treatment initiation should be improved.

A previously healthy 19-year old female presented to the gynaecological clinic with gradual abdominal distension for six months, associated with progressive abdominal discomfort. There was no history of nausea, vomiting, weight loss, or anorexia. She reported no changes in bowel habits and denied genitourinary symptomatology. Menarche occurred at 14 years of age, and her menstrual periods had always been regular. She denied recent sexual activity and was not currently taking oral contraceptives. The remainder of the patient's history, including a focused family history, was non-contributory. Physical examination revealed the presence of a somewhat firm, irregular, nontender, and mobile mass arising from the pelvis, corresponding in size to a pregnant uterus of 24 weeks' gestation. Laboratory analysis showed a blood haemoglobin concentration of 12.6 g/dL. The remainder of her laboratory results were within physiological parameters, and pregnancy was excluded. Transabdominal ultrasonography revealed globular uterine enlargement and a hypoechoic mass measuring 18 cm × 14 cm. The ovaries and adnexa were not visualized because they were obscured by the enlarged, bulky uterus. Neither ascites nor hydronephrosis was noted. The patient was counselled about the diagnosis of uterine fibroid and underwent exploratory laparotomy after proper counselling and written informed consent. Intraoperatively, the uterus was grossly enlarged by a large fibroid measuring 16 cm x 10 cm ( Figure 1 and Figure 2). Both ovaries and fallopian tubes were normal. The uterus was elevated out of the abdominal cavity and myomectomy of the large tumour was achieved through a fundal incision. The excision site was closed with continuous catgut sutures, and the abdomen was closed in layers. Cut section of the gross specimen revealed whitish nodules with a whorled appearance and fibroelastic consistency suggestive of benign leiomyoma (Figure 3). The specimen was sent for formal histopathology. Results of histopathological examination confirmed the diagnosis of a benign fibroid of the uterus. The patient's postoperative course was uneventful, and she was discharged on postoperative day seven. A six-month follow-up with repeat ultrasonography was arranged. Counselling regarding recurrence and future fertility was offered before discharge. Though our client was an adolescent and denied being sexually active, she was offered family planning counselling and advised not to conceive for at least one year to allow wound healing and full recovery. DiscussionUterine leiomyomas (also called fibroids) are benign growths that represent the most common neoplasms of the uterus, affecting 20% to 30% of women between the ages of 30 and 50 years.1-4 Their occurrence in the adolescent population (under the age of 20 years) is infrequent and relatively few cases have been documented in the literature. 5-12The aetiology of leiomyomas in adolescents and adults is generally unknown, but leiomyomas are known to grow in response to both oestrogen and progesterone stimulati...