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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.
Spectrum of clinical disease in a series of 135 hospitalised HIV-infected patients from north India
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. email@example.com
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.
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