SOURCE:

Faculty: Biosences
Department: Applied Microbiology And Brewing

CONTRIBUTORS:

Oghotuamma, C. N;
Anyamene, C;

ABSTRACT:

Urinary Tract Infections are major cause of morbidity in people living with HIV. The advent of anti retroviral drug usage has been shown to have indirect but long lasting preventive effect against opportunistic infections; and has improved considerably the health and life expectancy of people living with HIV/AIDS by boosting CD4+ counts. However, the complexities, side effects and the possibility of drug treatment complications associated with antiretroviral usage may carry serious potential consequences on HIV positive patients. Studies were carried out on urinary tract infections among HIV individuals with particular reference to antiretroviral drug usage and host factors. Prevalence rates of UTI were compared between HIV positive ART users and HIV negative non ART users. A comparative, hospital – based, cross – sectional study was carried out at three different tertiary healthcare facilities in Enugu State, South East Nigeria. Two hundred and eighty five (285) patients were enrolled. Of these, one hundred and eighty five were HIV positive, ART users while one hundred were HIV negative, non ART users. Patient distribution was categorized according to the various host factors: CD4+ values, 17.5% of individuals had ˂200 cells/µl, 34.4% had 200 – 499 cells/µl while 48.1% had ˃500 cells/µl. Gender, 68.4% of the subjects, were females, while 31.6% males. Age groups, 34.7% of the subjects were within 18 – 38 years, 36.8% were within 39 – 59 years; while 28.5% were within 60 – 80 years. Previous history of urinary tract infections, 53.3% of individuals has had at least one previous episode of UTI, while 46.7% have had no previous history of urinary tract infection. Length of ART use, 6.5% of individuals were under one year of ART usage, 44.3% were within 1 – 3 years of ART usage; 41.1% were within 4 – 6 years of ART usage, while 8.1% had been on ART usage for over 6 years. Mid – stream urine and venous blood specimens were collected from subjects into sterile universal and EDTA bottles respectively. Validated questionnaires were also administered to each patient to elicit responses concerning patients’ host factors. Overall prevalence of UTI was 50.2%. Prevalence of UTIs was higher in HIV positive patients, 71.9% than in HIV negative patients, 28.1%. Prevalence of UTI was highest in patients with ˃500 cells/µl CD4+ values, 24.6%. Prevalence of UTI by gender was higher in females, 42.1% than in males; 10.8%. Prevalence of UTI by age was highest in the 18 – 30 years age groups, 18.9%. Prevalence of UTI by of length of ART usage was highest in those on ART between 1 – 3 years, 31.4%. Prevalence of UTI by previous history of UTI was higher in patients with previous history of UTI, 65.9%. Nine organisms were implicated as the cause of urinary tract infections in HIV positive individuals on antiretroviral therapy. Escherichia coli had the highest prevalence of 34.3%. Other implicated etiologic agents include Staphylococcus aureus, Klebsiella pneumonia, Proteus mirabilis, Streptococcus faecalis, Pseudomonas aeruginosa, Streptococcus pyogenes and Candida albicans. There was no direct relationship between ART usage (P = 0.780) and CD4+ values (P = 0.655) on the prevalence of UTI in patients. Other host factors like age (P = 0.157), gender (P = 0.199), previous history of urinary tract infections (P = 0.968) and length of anti retroviral drug usage (P = 0.124) had no significant impact in the prevalence of UTI in patients. In conclusion, study showed that there was high prevalence of urinary tract infections among HIV – infected patients on antiretroviral drugs. Although ART boosted CD4+ counts, it did not directly translate to reduced prevalence of urinary tract infections. High CD4+ counts and prevalence of opportunistic infections may not be directly related though a cofounding factor related to both might be responsible for the relationship, if any. There is strong possibility of drug usage/treatment failure, non – compliance and non – adherence to ART in patients. This will help extend our attention and understanding of possible treatment gaps, drug failures, behavioral/attitudinal factors that can sabotage therapy and host immunity. Consequently, a health strategy that focuses on these rationales will improve the rate of compliance and of therapy success, thereby drastically reducing urinary tract infection prevalence in HIV patients on antiretroviral therapy. UTI is therefore not a potent bacteriologic marker in monitoring HIV infection in HIV positive individuals on antiretroviral drugs.