Liver and Renal Profiles in Kala-azar, HIV and Kala-azar patients co-infected with HIV in Gedarif and Sinnar States. Sudan.
Liver and Renal Profiles in Kala-azar, HIV and Kala-azar patients co-infected with HIV in Gedarif and Sinnar States. Sudan.
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Date
2015-04-19
Authors
Ali, Ayman
Journal Title
Journal ISSN
Volume Title
Publisher
UOFK
Abstract
Background: Visceral Leishmaniasis (VL) presents a major health problem
in several states in Sudan. VL/HIV co-infection is an emerging health
problem which has been reported to be associated with renal and liver
dysfunction.
Design: A descriptive study and cross sectional studies also were performed.
Setting: The study was conducted at Tabarak-Allah Rural Hospital Gedarif
state and Al- Azaza Centre, Sinnar State.
Objectives:
General objective: To study the prevalence of VL/HIV co-infection in the
Sudan
Specific objective: To determine the liver and renal profiles in VL, HIV and
VL/HIV co-infected patients.
Material and methods: A total of 99 VL parasitologicaly confirmed cases
in Tabarak-Allah Rural Hospital (Gedarif state, Eastern Sudan) and Al-
Azaza Centre (Sinnar State) and. There were 57(57.6%) males and
42(42.4%) females, their ages ranged from 2-75 years (mean of ages was 16
years),30 HIV seropositive individuals from Al Gadarif Teaching Hospital
were studied, 23 (76.7%) of them were males, and 7 (23.3%) were females.
Their age ranged between 30 and 54 years (mean of age was 40 years). All
serum samples from VL samples were analyzed for renal and liver profiles
using chemistry analyzer and were also screened for HIV by third generation
ELISA kits. The 30 HIV seropositive samples were analyzed for liver and
renal profiles and for CD4 cell count by flowcytometry.
Results: Of the 99 VL confirmed cases jaundice was detected in Nine
(9.1%), elevated AST activity in 85(85.9%), elevated ALT in 19(19.2%),
VII
elevated ALP in 55(556%) , low albumin level in 78(78.8%),
hyperprotienamia in 40 (40.4%), azotamia in 7 (7.3%), hypocalcaemia in 48
(48.5%), hyponatraemia in 89(899%), hypokalamia in 29(29.3%) and
hyperkalaemia in 11(11.1%). Two (2.4%) patients had renal failure.
Seven (7.1%) of the 99 confirmed VL patients were HIV co-infected. One
(14.3%) of those 7 HIV/ VL co-infected cases had elevated ALT, 7(100%)
had elevated AST, 6(85.7%) had elevated ALP activity, 2(28.6%) had
hyperprotienamia, 5(71.4%) had hypoalbuminaemia, 3(42.9%) had
hypocalcaemia, 7(100%) had hyponatraemia, 2(28.6%) had hypokalamia
and 1(14.3%) had hyperkalaemia.
Of the 30 HIV seropositive individuals, 3(10%) were jaundiced,12(40%)
had elevated ALT,11(36.7%) had elevated AST , 11(36.7%) had elevated
ALP, 6(20%) had hyperprotiemaemia,3(10%) had hyperprotienamia,
19(63.3%) had hypoalbuminaemia, 3(10%) had Azotamia, 16(60%) had
hyponatraemia, 2(6.7%) had hyperkalaemia, 10(33.3%) had hypokalamia,
13(43.3%) had hyperuricaemia , 1(3.3%) had hypouricaemia ,16(53.3%)
had hypocalcaemia and one (3.3%) had renal failure.
The comparison of liver profile between confirmed VL and VL/coinfected
cases showed significant differences in in ALT , ALP ,AST ,
T.Protien and Albumin Levels ( P.Value < 0.05) but there was no
significant difference in T.Bilirubin and D.Bilirubin levels ( P.Value >
0.05). In the renal profile creatinine and sodium levels, were also
significantly different between the two groups (P.Value < 0.05). However,
there was no significant difference in urea, calcium and potassium levels
(P.value > 0.05).
VIII
Conclusion and Recommendation: In view of the results of the present
study it is concluded that VL and VL/HIV co-infection can be associated
with impairment in renal and liver functions; .The prevalence of VL /HIV
co-infection is increasing in Sudan. Accordingly, it can be recommended
that renal and liver profiles should be determined before treatment in all VL
cases that show clinical features of renal or liver dysfunction. Urine analysis
is recommended to be a routine test in VL as an indicator for any
abnormality in renal function. Due to the limited number of VL/HIV coinfected
cases in the present study further studies involving larger sample
size are required.
Description
143page
Keywords
Liver, Renal, Profiles,Kala-azar, HIV,co-infected,Visceral ,Leishmaniasis