Management of Fever in Ambulatory HIV-Infected Adults in Resource-Limited Settings

Brentlinger, Paula E.; Silva, Wilson P.; Buene, Manuel; Morais, Luís; Valverde, Emilio; Vermund, Sten H.; Moon, Troy D.

doi:10.1097/qai.0000000000000304

Cited by 6 publications

(4 citation statements)

References 11 publications

(14 reference statements)

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“…Indeed, among the three participating centers, only the CMSDS performed routine thick smears in suspected malaria cases at no cost to patients. Despite the high endemicity of malaria in the study area and the consistency of our results with those of some authors [ 29 ], we discussed the hypothesis of a possible overestimation of this diagnosis as confirmed by other studies [ 30 , 31 ]. Indeed one of the signs of serious illness was fever which is also one of the main signs of malaria.…”

Section: Discussionsupporting

confidence: 88%

Severe morbidity after antiretroviral (ART) initiation: active surveillance in HIV care programs, the IeDEA West Africa collaboration

et al. 2015

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BackgroundThe causes of severe morbidity in health facilities implementing Antiretroviral Treatment (ART) programmes are poorly documented in sub-Saharan Africa. We aimed to describe severe morbidity among HIV-infected patients after ART initiation, based on data from an active surveillance system established within a network of specialized care facilities in West African cities.MethodsWithin the International epidemiological Database to Evaluate AIDS (IeDEA) - West Africa collaboration, we conducted a prospective, multicenter data collection that involved two facilities in Abidjan, Côte d’Ivoire and one in Cotonou, Benin. Among HIV-infected adults receiving ART, events were recorded using a standardized form. A simple case-definition of severe morbidity (death, hospitalization, fever > 38°5C, Karnofsky index < 70%) was used at any patient contact point. Then a physician confirmed and classified the event as WHO stage 3 or 4 according to the WHO clinical classification or as degree 3 or 4 of the ANRS scale.ResultsFrom December 2009 to December 2011, 978 adults (71% women, median age 39 years) presented with 1449 severe events. The main diagnoses were: non-AIDS-defining infections (33%), AIDS-defining illnesses (33%), suspected adverse drug reactions (7%), other illnesses (4%) and syndromic diagnoses (16%). The most common specific diagnoses were: malaria (25%), pneumonia (13%) and tuberculosis (8%). The diagnoses were reported as syndromic in one out of five events recorded during this study.ConclusionsThis study highlights the ongoing importance of conventional infectious diseases among severe morbid events occurring in patients on ART in ambulatory HIV care facilities in West Africa. Meanwhile, additional studies are needed due to the undiagnosed aspect of severe morbidity in substantial proportion.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0910-3) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 88%

Severe morbidity after antiretroviral (ART) initiation: active surveillance in HIV care programs, the IeDEA West Africa collaboration

et al. 2015

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“…We conducted a prospective observational study between May and September, 2012 (NCT 01681914, www.clinicaltrials.gov ), at three health centers in Zambézia Province, Mozambique, to evaluate the performance of new Mozambican guidelines for non-physician clinician management of fever (or history of fever) in HIV-infected adults (previously described). [ 8 11 ] At enrollment, bacterial blood cultures were collected from all eligible subjects.…”

Section: Methodsmentioning

confidence: 99%

Identification of invasive Salmonella enterica serovar Typhimurium ST313 in ambulatory HIV-infected adults in Mozambique

Moon

Johnson

Foster

et al. 2015

J Global Infect Dis

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Introduction:Despite evidence describing the burden of invasive non-typhoidal salmonella (iNTS) disease in sub-Saharan Africa, iNTS is not recognized as a priority within global health policy institutions. Recently, Salmonella enterica serovar Typhimurium, sequence type (ST) 313, has been identified as the predominant cause of iNTS disease in multiple sub-Saharan African countries.Materials and Methods:We conducted multilocus sequence typing (MLST) to determine the prevalence of the ST313 genotype in a sample of blood isolates from ambulatory HIV-infected Mozambican adults with iNTS disease.Results:Of the 29 samples of NTS obtained and analyzed by MLST, all (29/29) were assigned the ST313 sequence type based on the set of allele types derived from each of the seven loci. For quality control, five randomly selected strains taken from the original cultures were confirmed as ST313, and the positive control strain SL3261 (taken from the original culture) was categorized as S. Typhimurium ST19.Conclusion:S. Typhimurium ST313 is an important example of a widely distributed pathogen that lacks a coordinated strategy for control. The highly vulnerable populations at risk for ST313 infection in Mozambique, and within the region, would benefit greatly from the development of new policy and on-the-ground capacity to support increased surveillance, prevention, and treatment initiatives.

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“…42,43 Study coordinators recorded subjects' demographic and medical information. Study clinicians reviewed medical histories (including TB screening questions) and laboratory data, conducted physical examinations, and determined the most likely cause(s) of each subject's anemia.…”

Section: Methodsmentioning

confidence: 99%

“…For patients concurrently eligible for a parallel study of Mozambican fever guidelines, 43 blood culture specimens (one set per subject) were collected at the first fever-study visit. We have described our methods for pathogen identification, antibiotic susceptibility testing, and quality control of blood cultures elsewhere.…”

Section: Methodsmentioning

confidence: 99%

Practical Management of HIV-Associated Anemia in Resource-Limited Settings: Prospective Observational Evaluation of a New Mozambican Guideline

Brentlinger¹,

Silva

Vermund

et al. 2016

AIDS Research and Human Retroviruses

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Mozambique's updated guideline for management of HIV-associated anemia prompts clinicians to consider opportunistic conditions, adverse drug reactions, and untreated immunosuppression in addition to iron deficiency, intestinal helminthes, and malaria. We prospectively evaluated this guideline in rural Zambézia Province. Likely cause(s) of anemia were determined through prespecified history, physical examination, and laboratory testing. Diagnoses were ''etiologic'' if laboratory confirmed (sputum microscopy, blood culture, Plasmodium falciparum malaria rapid test) or ''syndromic'' if not. To assess hemoglobin response, we used serial point-of-care measurements. We studied 324 ambulatory, anemic (hemoglobin <10 g/dl) HIV-infected adults. Study clinicians treated nearly all [315 (97.2%)] for suspected iron deficiency and/or helminthes; 56 (17.3%) had laboratory-confirmed malaria. Other assigned diagnoses included tuberculosis [30 (9.3%)], adverse drug reactions [26 (8.0%)], and bacteremia [13 (4.1%)]. Etiologic diagnosis was achieved in 79 (24.4%). Of 169 (52.2%) subjects who improved (hemoglobin increase of ‡1 g/dl without indications for hospitalization), only 65 (38.5%) received conventional management (iron supplementation, deworming, and/or antimalarials) alone. Thirty (9.3%) died and/or were hospitalized, and 125 (38.6%) were lost to follow-up. Multivariable linear and logistic regression models described better hemoglobin responses and/or outcomes in subjects with higher CD4 + T-lymphocyte counts, pre-enrollment antiretroviral therapy and/or co-trimoxazole prophylaxis, discontinuation of zidovudine for suspected adverse reaction, and smear-positive tuberculosis. Adverse outcomes were associated with fever, low body mass index, bacteremia, esophageal candidiasis, and low or missing CD4 + T cell counts. In this severely resource-limited setting, successful anemia management often required interventions other than conventional presumptive treatment, thus supporting Mozambique's guideline revision.

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Management of Fever in Ambulatory HIV-Infected Adults in Resource-Limited Settings

Cited by 6 publications

References 11 publications

Severe morbidity after antiretroviral (ART) initiation: active surveillance in HIV care programs, the IeDEA West Africa collaboration

Severe morbidity after antiretroviral (ART) initiation: active surveillance in HIV care programs, the IeDEA West Africa collaboration

Identification of invasive Salmonella enterica serovar Typhimurium ST313 in ambulatory HIV-infected adults in Mozambique

Practical Management of HIV-Associated Anemia in Resource-Limited Settings: Prospective Observational Evaluation of a New Mozambican Guideline

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