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Spectrum of clinical disease in a series of 135 hospitalised HIV-infected patients from north India

Sharma SK, Kadhiravan T, Banga A, Goyal T, Bhatia I, Saha PK - BMC Infect. Dis. (2004)

Bottom Line: Two cases of HIV-associated lymphoma were encountered.A wide spectrum of disease, including both OIs and non-infectious opportunistic diseases, is seen in hospitalised HIV-infected patients from north India.Tuberculosis remains the most common OI and is the commonest cause of death in these patients.

Affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. sksharma@aiims.ac.in

ABSTRACT

Background: Literature on the spectrum of opportunistic disease in human immunodeficiency virus (HIV)-infected patients from developing countries is sparse. The objective of this study was to document the spectrum and determine the frequency of various opportunistic infections (OIs) and non-infectious opportunistic diseases, in hospitalised HIV-infected patients from north India.

Methods: One hundred and thirty five consecutive, HIV-infected patients (age 34 +/- 10 years, females 17%) admitted to a tertiary care hospital in north India, for the evaluation and management of an OI or HIV-related disorder between January 2000 and July 2003, were studied.

Results: Fever (71%) and weight loss (65%) were the commonest presenting symptoms. Heterosexual transmission was the commonest mode of HIV-acquisition. Tuberculosis (TB) was the commonest OI (71%) followed by candidiasis (39.3%), Pneumocystis jiroveci pneumonia (PCP) (7.4%), cryptococcal meningitis and cerebral toxoplasmosis (3.7% each). Most of the cases of TB were disseminated (64%). Apart from other well-recognised OIs, two patients had visceral leishmaniasis. Two cases of HIV-associated lymphoma were encountered. CD4+ cell counts were done in 109 patients. Majority of the patients (82.6%) had CD4+ counts <200 cells/microL. Fifty patients (46%) had CD4+ counts <50 cells/microL. Only 50 patients (37%) received antiretroviral therapy. Twenty one patients (16%) died during hospital stay. All but one deaths were due to TB (16 patients; 76%) and PCP (4 patients; 19%).

Conclusions: A wide spectrum of disease, including both OIs and non-infectious opportunistic diseases, is seen in hospitalised HIV-infected patients from north India. Tuberculosis remains the most common OI and is the commonest cause of death in these patients.

A – Chest radiograph of a patient with Pneumocystis jiroveci pneumonia showing bilateral, diffuse interstitial infiltrates B – Contrast enhanced computed tomographic (CT) scan of chest showing mediastinal lymphadenopathy in a patient with disseminated tuberculosis. Typical central necrosis evident as low attenuation areas (arrows) is seen C – Contrast enhanced CT scan of brain showing ring enhancing lesions in the basal ganglia bilaterally (arrows). Serology was positive for toxoplasma infection D – Ophthalmoscopic image of a patient with cytomegalovirus retinitis E – Non-Hodgkin's lymphoma in a HIV-infected lady presenting as unilateral maxillary swelling F – Contrast enhanced CT scan of abdomen reveals an oedematous and enlarged pancreas (asterisk) suggestive of acute pancreatitis. The patient was on didanosine and improved following withdrawal of the same and supportive treatment.
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Figure 2: A – Chest radiograph of a patient with Pneumocystis jiroveci pneumonia showing bilateral, diffuse interstitial infiltrates B – Contrast enhanced computed tomographic (CT) scan of chest showing mediastinal lymphadenopathy in a patient with disseminated tuberculosis. Typical central necrosis evident as low attenuation areas (arrows) is seen C – Contrast enhanced CT scan of brain showing ring enhancing lesions in the basal ganglia bilaterally (arrows). Serology was positive for toxoplasma infection D – Ophthalmoscopic image of a patient with cytomegalovirus retinitis E – Non-Hodgkin's lymphoma in a HIV-infected lady presenting as unilateral maxillary swelling F – Contrast enhanced CT scan of abdomen reveals an oedematous and enlarged pancreas (asterisk) suggestive of acute pancreatitis. The patient was on didanosine and improved following withdrawal of the same and supportive treatment.

Mentions: Three symptoms namely fever, weight loss and diarrhoea were the common symptoms at presentation (70.4%, 65.2% and 23.7% respectively). Productive cough and dyspnoea were present in about a fourth of patients (Table-2). Two-thirds of patients (66.7%) were malnourished (body mass index <19 kg/m2) and generalised lymphadenopathy was present in a considerable proportion of patients (16.3%). Poor performance on mini mental status examination (MMSE score <23) was not uncommon (20.7%). Altered sensorium and focal neurologic deficit were encountered occasionally. Anaemia was present in about half of the patients (50.5%) and among those who where anaemic, 17 (21.8%) patients were on zidovudine. A considerable number of patients were leucopenic and in 22% of patients ALC was less than 1200/μL (Table-3). CD4+ cell counts were done in 109 patients. The distribution of CD4+ cell counts is shown in Figure-1. Most of the patients (n = 90; 82.6%) had CD4+ counts less than 200 cells/μL. Fifty patients (46%) had CD4+ counts less than 50 cells/μL. The correlation of ALC with CD4+ count was not significant (r = 0.14; P = 0.18). HIV viral load estimation was done in only four patients (range 33752–289176 RNA copies/mL). Twenty patients (14.8%) had hypoxaemia. Of these, five patients had PCP (Figure 2-A), ten had DTB, three had extensive PTB and one patient had massive unilateral tuberculosis pleural effusion.

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Spectrum of clinical disease in a series of 135 hospitalised HIV-infected patients from north India

Sharma SK, Kadhiravan T, Banga A, Goyal T, Bhatia I, Saha PK - BMC Infect. Dis. (2004)

A – Chest radiograph of a patient with Pneumocystis jiroveci pneumonia showing bilateral, diffuse interstitial infiltrates B – Contrast enhanced computed tomographic (CT) scan of chest showing mediastinal lymphadenopathy in a patient with disseminated tuberculosis. Typical central necrosis evident as low attenuation areas (arrows) is seen C – Contrast enhanced CT scan of brain showing ring enhancing lesions in the basal ganglia bilaterally (arrows). Serology was positive for toxoplasma infection D – Ophthalmoscopic image of a patient with cytomegalovirus retinitis E – Non-Hodgkin's lymphoma in a HIV-infected lady presenting as unilateral maxillary swelling F – Contrast enhanced CT scan of abdomen reveals an oedematous and enlarged pancreas (asterisk) suggestive of acute pancreatitis. The patient was on didanosine and improved following withdrawal of the same and supportive treatment.
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Figure 2: A – Chest radiograph of a patient with Pneumocystis jiroveci pneumonia showing bilateral, diffuse interstitial infiltrates B – Contrast enhanced computed tomographic (CT) scan of chest showing mediastinal lymphadenopathy in a patient with disseminated tuberculosis. Typical central necrosis evident as low attenuation areas (arrows) is seen C – Contrast enhanced CT scan of brain showing ring enhancing lesions in the basal ganglia bilaterally (arrows). Serology was positive for toxoplasma infection D – Ophthalmoscopic image of a patient with cytomegalovirus retinitis E – Non-Hodgkin's lymphoma in a HIV-infected lady presenting as unilateral maxillary swelling F – Contrast enhanced CT scan of abdomen reveals an oedematous and enlarged pancreas (asterisk) suggestive of acute pancreatitis. The patient was on didanosine and improved following withdrawal of the same and supportive treatment.
Mentions: Three symptoms namely fever, weight loss and diarrhoea were the common symptoms at presentation (70.4%, 65.2% and 23.7% respectively). Productive cough and dyspnoea were present in about a fourth of patients (Table-2). Two-thirds of patients (66.7%) were malnourished (body mass index <19 kg/m2) and generalised lymphadenopathy was present in a considerable proportion of patients (16.3%). Poor performance on mini mental status examination (MMSE score <23) was not uncommon (20.7%). Altered sensorium and focal neurologic deficit were encountered occasionally. Anaemia was present in about half of the patients (50.5%) and among those who where anaemic, 17 (21.8%) patients were on zidovudine. A considerable number of patients were leucopenic and in 22% of patients ALC was less than 1200/μL (Table-3). CD4+ cell counts were done in 109 patients. The distribution of CD4+ cell counts is shown in Figure-1. Most of the patients (n = 90; 82.6%) had CD4+ counts less than 200 cells/μL. Fifty patients (46%) had CD4+ counts less than 50 cells/μL. The correlation of ALC with CD4+ count was not significant (r = 0.14; P = 0.18). HIV viral load estimation was done in only four patients (range 33752–289176 RNA copies/mL). Twenty patients (14.8%) had hypoxaemia. Of these, five patients had PCP (Figure 2-A), ten had DTB, three had extensive PTB and one patient had massive unilateral tuberculosis pleural effusion.

Bottom Line: Two cases of HIV-associated lymphoma were encountered.A wide spectrum of disease, including both OIs and non-infectious opportunistic diseases, is seen in hospitalised HIV-infected patients from north India.Tuberculosis remains the most common OI and is the commonest cause of death in these patients.

Affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. sksharma@aiims.ac.in

ABSTRACT

Background: Literature on the spectrum of opportunistic disease in human immunodeficiency virus (HIV)-infected patients from developing countries is sparse. The objective of this study was to document the spectrum and determine the frequency of various opportunistic infections (OIs) and non-infectious opportunistic diseases, in hospitalised HIV-infected patients from north India.

Methods: One hundred and thirty five consecutive, HIV-infected patients (age 34 +/- 10 years, females 17%) admitted to a tertiary care hospital in north India, for the evaluation and management of an OI or HIV-related disorder between January 2000 and July 2003, were studied.

Results: Fever (71%) and weight loss (65%) were the commonest presenting symptoms. Heterosexual transmission was the commonest mode of HIV-acquisition. Tuberculosis (TB) was the commonest OI (71%) followed by candidiasis (39.3%), Pneumocystis jiroveci pneumonia (PCP) (7.4%), cryptococcal meningitis and cerebral toxoplasmosis (3.7% each). Most of the cases of TB were disseminated (64%). Apart from other well-recognised OIs, two patients had visceral leishmaniasis. Two cases of HIV-associated lymphoma were encountered. CD4+ cell counts were done in 109 patients. Majority of the patients (82.6%) had CD4+ counts <200 cells/microL. Fifty patients (46%) had CD4+ counts <50 cells/microL. Only 50 patients (37%) received antiretroviral therapy. Twenty one patients (16%) died during hospital stay. All but one deaths were due to TB (16 patients; 76%) and PCP (4 patients; 19%).

Conclusions: A wide spectrum of disease, including both OIs and non-infectious opportunistic diseases, is seen in hospitalised HIV-infected patients from north India. Tuberculosis remains the most common OI and is the commonest cause of death in these patients.

View Similar Images In: Results  - Collection
View Article: MedlinePlus - PubMed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=535567&rFormat=json&query=null&req=5