Causes of Bacteremia among HIV1 infected individuals with Waisting Syndrome in Hati

1
Causes of Bacteremia among HIV-1 infected
individuals with Waisting Syndrome in Haïti

• A Multicultural Caribbean United Against HIV/AIDS
• Dominican Republic
• 5 7 March 2004
• Joseph P,Fitzgerald D,Sévère.P,Timothée M,De
  Matéis.P Ferdinand.S, Goh.K.S,Wright.PJohnson
  WD, Rastogi et. JW Pape,

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Introduction

• Haiti is the poorest country in the Western
  hemisphere.
• HIV fuels the tuberculosis epidemic
• In Haiti, Tuberculosis is the Most common
  Opportunistic infection in HIV/AIDS patients.

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HIV and Tuberculosis in Haiti

• 54 of TB patients followed at GHESKIO Center are
  HIV infected (2003)
• No data on MDR TB at the national level
• Study conducted at GHESKIO on MDR TB will be
  published shortly

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HIV and Tuberculosis in Haiti

• The diagnosis of TB in HIV positive patients is
  often difficult
• HIV and TB share common clinical signs and
  symptoms
• The Wasting syndrome is present in advanced HIV
  disease and carries a poor prognosis
• Finding infections other than HIV that are
  associated with the wasting syndrome is important

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Objectives

• Assess the importance of bacteria including
  mycobacteria among HIV-infected individuals
  presenting with the wasting syndrome.

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Methodology

• GHESKIO operates the national HIV testing and
  counseling center in central Port au Prince
• Every person who comes to GHESKIO is also offered
  a package of services including screening
  for tuberculosis, screening for sexually
  transmitted diseases, and reproductive health
  counseling

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Screening of TB cases

• 6 of all persons coming for HIV testing have
  active TB.
• gt 30 of all those with cough have active TB
• All those with active TB are offered same day
  diagnosis and treatment

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Tuberculosis Screening
New patients coming for HIV testing
No Cough
Cough
Smear negative
(Same day screening) Smear positive
Culture and Chest X-Ray
Weight loss and HIV
No weight loss and HIV-
If Fever gt 38 O BACTEC Hemoculture
Low risk for TB Culture and Chest X-Ray in
special situation
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Case definition

• Patients with the wasting syndrome
• weight loss (gt 10 body weight from baseline)
• chronic diarrhea ( at least 2 loose stools/day
  for more than 30 days)
• or chronic weakness and fever (intermittent or
  constant for more than 30 days)

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Evaluation

• All those with the wasting syndrome were
  evaluated for TB with sputum smear and TB culture
  and blood culture by the BACTEC 9000 machine.

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Results of the study on the Causes of Bacteria
among HIV-infected individuals with Wasting
Syndrome in HaitiAugust 1999- September 2002
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Inclusion CriteriaN43

• HIV
• Agegt 18
• Weight loss gt 10 from baseline
• Fever Tº gt38º C
• Negative sputum smear

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Results
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Results (cont)
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Results (cont)
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CD4 Level?
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Chest X-RAY
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Causes of Bacteremia?
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Causes of Bacteremia?
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Correlation between CD4 level and bacteremia?
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Conclusion

• In Haiti, tuberculosis may go undiagnosed in HIV
  positive patients presenting with the wasting
  syndrome.
• 37 of patients with the wasting syndrome had
  documented bacteremia
• 19 of patients with wasting syndrome and a
  negative sputum smear and culture had documented
  m.tuberculosis.

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Recommendations

• Therefore, it is important to screen patients
  with the wasting syndrome for bacteria including
  tuberculosis even those with negative sputum
  smear and culture