Title: Causes of Bacteremia among HIV1 infected individuals with Waisting Syndrome in Hati
1Causes 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,
2Introduction
- 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.
3HIV 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
4HIV 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
5Objectives
- Assess the importance of bacteria including
mycobacteria among HIV-infected individuals
presenting with the wasting syndrome.
6Methodology
- 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
7Screening 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
8Tuberculosis 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
9Case 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)
10Evaluation
- All those with the wasting syndrome were
evaluated for TB with sputum smear and TB culture
and blood culture by the BACTEC 9000 machine.
11Results of the study on the Causes of Bacteria
among HIV-infected individuals with Wasting
Syndrome in HaitiAugust 1999- September 2002
12Inclusion CriteriaN43
- HIV
- Agegt 18
- Weight loss gt 10 from baseline
- Fever Tº gt38º C
- Negative sputum smear
13Results
14Results (cont)
15Results (cont)
16CD4 Level?
17Chest X-RAY
18Causes of Bacteremia?
19Causes of Bacteremia?
20Correlation between CD4 level and bacteremia?
21Conclusion
- 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.
22Recommendations
- Therefore, it is important to screen patients
with the wasting syndrome for bacteria including
tuberculosis even those with negative sputum
smear and culture