High mortality among adolescents with HIV reflects delays and failures in the care cascade. We sought to elucidate critical missed opportunities and barriers to care among adolescents hospitalized with HIV at Botswana’s tertiary referral hospital. We enrolled all HIV-infected adolescents (aged 10–19 years) hospitalized with any diagnosis other than pregnancy from July 2015 to January 2016. Medical records were reviewed for clinical variables and past engagement in care. Semi-structured interviews of the adolescents (when feasible) and their caregivers explored delays and barriers to care. Twenty-one eligible adolescents were identified and 15 were enrolled. All but one were WHO Clinical Stage 3 or 4. Barriers to diagnosis included lack of awareness about perinatal HIV infection, illness or death of the mother, and fear of discrimination. Barriers to adherence to antiretroviral therapy included nondisclosure, isolation, and mental health concerns. The number of hospitalized HIV-infected adolescents was lower than expected. However, among those hospitalized, the lack of timely diagnosis and subsequent gaps in the care cascade elucidated opportunities to improve outcomes and quality of life for this vulnerable group.
Dolutegravir (DTG) is the most recently introduced integrase inhibitor for the treatment of HIV infection and is preferred for its superior tolerability and efficacy in both new and pre-treated patients, and infrequent drug interactions. Since January 2017, Botswana has adopted a ‘treat-all’ approach with a DTG-based antiretroviral (ARV) regimen as first-line treatment. We report a 29-year-old man with clinical stage 1 HIV infection who had been started on DTG, tenofovir and emtricitabine eight months prior, and who was admitted following a suicidal overdose of 1500 mg of DTG. He reported only minor symptoms including vomiting, epigastric pain and dizziness; which promptly resolved following supportive treatment. On admission, full blood count, liver function tests and electrocardiography were unremarkable. However, there was a non-progressive increase in serum creatinine. After a month off ARVs, he was successfully restarted on antiretroviral therapy without any serious adverse effect.
Background: Pernicious anaemia (PA) describes megaloblastic anaemia resulting from cobalamin deficiency that is due to the absence of intrinsic factor (IF). Most cases are autoimmune in origin, with antibodies to parietal cells, IF or the cobalamin -IF complex. Methods: We report the clinical features, investigation and treatment of a patient in whom the first presentation of PA was demyelinating brain lesions. The patient presented with clinical features initially of neurological impairment and subsequently anaemia. Imaging studies were consistent with demyelinating lesions extending from the cortex to the midbrain. Peripheral blood and bone marrow findings were consistent with megaloblastic anaemia, which were confirmed by subnormal serum cobalamin levels. The patient was treated with parenteral cobalamin and oral folic acid. Results: The patient responded with complete resolution of anaemia and complete clinical neurological response. Conclusion: Clinical, laboratory and radiologic findings are important in the screening of patients presenting with demyelinating lesions, as these may help in the diagnosis of rare cases of PA. These tests are just as relevant even in the young African female population.
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