Electronic Theses and Dissertations (Masters)

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    Virological response in children and adolescents switching to dolutegravir based regimens in Johannesburg, South Africa – A Longitudinal Cohort Study
    (University of the Witwatersrand, Johannesburg, 2023) Mafora, Tshiamo; Technau, Karl
    Introduction: Dolutegravir (DTG) was introduced into South African HIV management guidelines in November 2019, and has since been the mainstay of both adult and paediatric first line antiretroviral treatment (ART) regimens. Following its rapid and widespread introduction we assessed the rate of virological suppression over two years in paediatric patients switching to DTG as part of first line treatment. Methods: We performed a retrospective cohort study at Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa. Children and adolescents already on first line ART who switched to DTG (between November 2019 and November 2021) were included. Baseline characteristics (at DTG switch) included age, weight, gender, viral load (VL), CD4, and pre-switch regimen. Past ART exposure and past viraemic periods (years VL >1000 copies/ml) were assessed and VL suppression rates (< 50 copies/ml) were calculated at 6, 12 and 24 months post-switch. Associations with non-suppression were assessed using uni- and multivariate analysis. Results: Of the 747 participants that were switched to DTG, 724 (97%) qualified for a VL and 697 (96%) of those had at least one VL done after switch. Overall, 83% (450/543) were suppressed at 6 months, 86% (434/504) at 12, 91% (487/534) at 24 months. Overall, at a median of 637 days after switch, 90% (624/697) were suppressed at their last VL. Factors associated with not being suppressed at the last VL included: missing a follow-up visit by more than 90 days post-switch to DTG (OR: 3.2 [CI:1.5-6.8], p=0.003), switching to DTG with a VL of 50-1000 rather than <50 copies/ml (OR 2.0 [CI:1.1-3.9], p=0.042), having the blood test done during July December (OR 2.0 [CI:1.2-3.4], p=0.011), and having had exposure to viraemia ≥1000 copies/ml for more than two years between first ART start and DTG switch (OR: 1.9 [CI: 0.9-3.7], p=0.071). Conclusion: In our population, similar to other studies, VL suppression was effectively maintained in the majority of patients after switching to DTG. The switch did however result in a loss of suppression in some patients and caution is needed in children and adolescents with missed visits and extensive prior viraemia
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    Clinicopathological spectrum of cutaneous malignancies at the skin tumour clinic, charlotte Maxeke Johannesburg academic hospital in Johannesburg, South Africa: a 5-year retrospective review
    (University of the Witwatersrand, Johannesburg, 2023) Gwinji, Tapiwa Munyaradzi; Modi, Deepak
    Background Skin cancer is the most common malignancy in South Africa, incidence of which continues to rise. This disease remains a consistent problem in South Africa due to a multifactorial risk complex arising mainly from the high levels of year-round Ultraviolet (UV) exposure, high burden of HIV and late health seeking behaviour leading to poly-etiological skin cancers. Despite the ever-present danger that is cancer, the data and literature surrounding skin cancers among different races and ethnic groups remains inadequate as there are few population-based cancer registries in South Africa and only histologically confirmed cancers are logged into the national cancer registry. Objectives To describe the nature, extent and demographic characteristics of patients with histologically confirmed skin cancer seen at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) multidisciplinary skin cancer clinic during the period of January 2015 to December 2019 and to add to the body of literature concerning skin cancers in South Africa. Methods A retrospective chart review identified all patients who were managed for histologically confirmed malignant skin tumours at CMJAH skin tumour clinic. Types, quantity and distribution of common invasive malignancies by population group, age, gender, anatomical site and risk factor were explored. Result A total number of 531 participants with histologically confirmed skin cancers were identified. The most common malignancies were Kaposi’s sarcoma(KS) (53.2%), squamous cell carcinoma (SCC) (27.0%), basal cell carcinoma (BCC) (10.4%), cutaneous melanoma (CM) (7.4%) and mycosis fungoides (MF) (4.2%). SCC and AIDS-associated KS were the most common skin cancer in the white and black population respectively. Conclusion This study provides valuable scientific data on the distribution and patient demographics of skin cancer in the public health system in Johannesburg, South Africa, on which further research can be based. This study highlights the burden of HIV associated skin cancer in this region. There is a need for further research and equitable appropriation of resources and public health awareness efforts towards strengthening UV and HIV-related skin cancer prevention initiatives in SA.
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    Patterns of liver injury in HIV-positive patients in the medical admissions ward at Chris Hani Baragwanath Academic Hospital (CHBAH)
    (University of the Witwatersrand, Johannesburg, 2024) Ndwambi, Rudzani Wendy; Ally , Reidwaan; Chopdat, Nazeer
    Background Human immunodeficiency virus (HIV) infection is a major global public health concern, with approximately 37.9 million people living with HIV and acquired immunodeficiency syn- drome (AIDS) as of 2018. There has been an increase in HIV prevalence globally, with the African sub-Saharan region carrying a disproportionate burden, accounting for more than 70% of this burden. In 2018 South Africa had 7.52 million people living with HIV/AIDS (PLWHA), with approximately 115167 AIDS-related illnesses. In PLWHA, liver disease and failure contribute to more significant morbidity, mortality and higher cost of care. Aim And objectives To recognise and categorise the patterns of liver injury in people living with HIV and AIDS (PLWHA). To ascribe an etiology to the pattern of liver injury in PLWHA. Method This was a retrospective cohort, conducted at CHBAH medical admissions ward in Soweto Gauteng province, of patients living with HIV and AIDS with liver injury. All patients admitted to the medical admissions ward were selected and their hospital numbers retrieved from the admission register. Each hospital number was entered into the NHLS labtrack system to retrieve the LFT results. Any patient with abnormal LFT was checked for their HIV status. The two variables (abnormal LFT and HIV test) were matched and confirmed. After ethics approval was obtained, files were recorded and analysed. A data collection sheet was populated with all serological, histological and radio logical investigations documented. Results This study included 208 patients (PLWHA) admitted to the medical admissions ward at CHBAH, with abnormal liver enzymes between January 2019 and March 2020, aged above 18 years. One hundred and five, 50.5% were males with a mean of 43.7 years, and 49.5% (n=103) were females with a mean of 39.9 years. One hundred and forty-three, 81.3% were taking antiretroviral therapy (ART), with the majority, 88.4% (n=107), on the first-line regimen. The most common pattern of liver injury was infiltrative, accounting for 67.8% (n=141), followed by mixed at 22.1% (n=46), hepatocellular at 7.7% (n=16), and lastly was cholestatic with 2.4% (n=5). Irrespective of the pattern of the liver injury, 36.1% (n=75) of the patients had Mycobacterium tuberculosis (MTB) infection, and 22.5% (n=40) of them were on antituberculosis treatment (ATT), 6.3% (n=13) had hepatitis B viral (HBV) infection, 0.5% (n=1 ) had hepatitis C ( HCV) infection, while lymphomas (Hodgkin and non-Hodgkin lymphomas) contributed 1,9%(n=4) and 6,3% (n=13) respectively. Twelve, 5.7% (n=12) had drug induced liver Injury (DILI), and retroviral disease (RVD) cholan giopathy contributed 1.4% (n=3). A significant number of patients, 34.1% (n=71), contributed to at least one-third of patients in the study, wherein the diagnosis was either unknown or not directly related to the liver injury. Those were, Other opportunistic infections accounting for 7.7% (n=16), other diagnoses made up 13% (n=27), and no diagnosis at 13.4% (n=28). Of the infiltrative pattern, 33.13% (n=47) had MTB infection, 5.6% (n=8) had HBV, 0.3% (n=1) had HCV infection, 7.8% (n=11) had non-Hodgkin lymphoma, with Hodgkin lym- phoma, and DILI both accounting for 1,4%(n=2). Only 5.7% (n=12) of PLWHA had liver biopsies done. Conclusion Liver injury is common in PLWHA. The most common pattern of liver injury is an infiltrative pattern, and the most common etiology was MTB infection in this study.
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    The Effect of HIV on the Microbiology of Adult Patients Presenting with Septic Arthritis at Chris Hani Baragwanath Academic Hospital
    (University of the Witwatersrand, Johannesburg, 2024) Gqamana, Loyiso; Ramokgopa, M.T.
    Background: Septic arthritis is an orthopaedic emergency that can result in severe morbidity and mortality if not managed timeously. Risk factor assessment of these patients is crucial in early diagnosis of the disease. Inflammatory septic markers (White cell count, C-reactive protein, and Erythrocyte sedimentary rate) have been found to assist in the process of making an early diagnosis. Human Immunodeficiency Virus (HIV) infection is known as a risk factor for septic arthritis. Immunosuppression that is observed with the HIV infection may lead to low septic marker values, resulting in a delay in confirming the diagnosis of septic arthritis. The markers of HIV infection such as Cluster of Differentiation 4 (CD4+) count and the viral load can be used to assist in the prediction of infection. Method: We conducted a retrospective study of patients who presented to the orthopaedic department at Chris Hani Baragwanath Academic Hospital (CHBAH) from 01 January 2015 to 30 June 2019 with septic arthritis. The clinical presentation; serological inflammatory marker; retroviral status with CD4+ count and viral load count; and post arthrotomy microbiology, culture and sensitivity were analysed. The sensitivity, specificity and likelihood ratios (LLR) for the inflammatory markers were calculated and compared to data published in the literature. The impact or association of the retroviral status with some of the categorical and continuous variables were assessed, to study if there were any differences in those variables when comparing the HIV-infected and HIV-non-infected patients. Finally, the microbiological growth results were compared between the HIV-negative, HIV-unknown and HIV-positive groups. Results: The prevalence of HIV-infected patients presenting with an osteoarticular infection was found to be 31.7% in our study population. A median CD4+ count of 281 cells per cubic millimeter with a median Viral Load (VLL) value of 2350 copies per millilitre was observed in our study sample. As a diagnostic test C-reactive protein, was found to have the best sensitivity (95%) and specificity (4.1%) out of all the inflammatory markers studied. However, the Likelihood ratio (LLR) for the diagnosis of septic arthritis by all inflammatory markers studied was low, making them poor diagnostic measures for the diagnosis of septic arthritis. Across the three groups of retroviral status in our study, i.e. HIV-negative, HIV-positive, and HIV-unknown; a finding of similar microbiological culture and sensitivity was observed. Gram-positive bacteria were cultured in 50% of the cases, with Staphylococcus aureus being the commonest bacteria grown. Despite having not occurred commonly pathogens such as Mycobacterium Tuberculosis (MTB), Acinetobacter Baumani, and Haemophilus influenza were also observed; and they were associated with patients who cultured polymicrobial organisms. Polymicrobial cultures with Gram-negative and atypical micro-organisms were observed to increase the likelihood for morbidity and mortality. The white cell counts, and erythrocyte sedimentary rate results were tested to be statistically significant with p-value = 0.025 (p < 0.05) and p-value 0.034 (p < 0.05), respectively. However, HIV status was not shown to have an impact on producing a positive or negative culture post arthrotomy. Conclusion: There was no difference in the overall cultured microbiology between HIV positive and HIV negative groups presenting with acute septic arthritis. However, it was noted that polymicrobial cultures were usually a combination of gram-negative and atypical bacteria. The latter was associated with HIV co-infection with CD4+ count of less than 200 cells per millimeter. The predictive power of inflammatory markers in making a diagnosis of septic arthritis was statistically significant in the HIV negative than the HIV positive group. All the studied inflammatory markers were seen to have low likelihood ratios
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    The demographic and clinical profile of HIV infected and non- infected children and adolescents attending two district psychiatric clinics in Sedibeng: a retrospective record review
    (University of the Witwatersrand, Johannesburg, 2024) Makofane, Lerato; Robertson, Lesley
    Background: A limited district-based child and adolescent psychiatric service is provided in Gauteng province. Mental disorders are common in children and adolescents living with HIV and there is a bidirectional relationship between mental health and HIV. Aim: To ascertain the prevalence of HIV among children and adolescents attending two clinics and to compare clinical correlates of those living with and without HIV. Setting: Child and adolescent psychiatric clinics based at two community health centres (Zone 12 Clinic in Sebokeng township and Johan Heyns Clinic in a suburban area of Vanderbijl Park) in the Sedibeng district of Gauteng province. Methods: A retrospective record review was conducted of all active files. Results: 370 records (232 from Johan Heyns and 138 from Zone 12) were retrieved. Only five (1.4%) users were living with HIV, therefore no comparison could be made between users with and without HIV. All five users living with HIV were male and Black African, with an age range of 9-22 years. Of the five, three had one deceased parent and two had lost both parents. Psychiatric diagnoses were intellectual disability (n=3), epilepsy (n=3), ADHD (n=3), depression (n=1), and traumatic brain injury (n=1). Conclusion: Very few children and adolescents living with HIV attended either clinic. The sample reflects different help-seeking priorities and access among different communities regarding mental health. More services and research focusing on community child and adolescent mental health services is required.
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    Conjoint tobacco and alcohol use, and depressive symptoms among hiv positive patients in Sedibeng District, Gauteng
    (2024) Akahilem, Kenneth E.
    Background: Psychosocial challenges among HIV positive patients may promote substance use disorders. In this study, we explored the relationship between conjoint tobacco and alcohol use and depression symptoms among HIV positive patients in Sedibeng district, South Africa. Methods: In a cross-sectional study of 404 participants, a questionnaire collected information on socio-demography, tobacco and alcohol use, and depression symptoms. Outcome measures included the prevalence of conjoint tobacco and alcohol use, and its association with depression. Results: The mean participant age was 43.2 years. Most completed secondary school 62.9% (253/402), were black 99.0% (400/404), female 65.8% (266/404), unemployed 53.6% (216/403) and on ART for >1 year 97.8% (393/402). Current tobacco use was reported by 23.3% (94/404) participants with most smoking cigarette (73.7%) and having low nicotine dependence (75.5%). Current alcohol use was reported by 43.6% (176/404) participants, and 36.9% were categorised as harmful users. Only 7.7% (31/404) participants screened positive for depression; most of these (83.3%) previously undiagnosed. The prevalence of conjoint tobacco and alcohol use was 19.6% (79/404) and this was not associated with depression (p=0.438). Harmful alcohol users were more than five times likely to report conjoint tobacco and alcohol use (p=0.000) but women were less likely to report it (p=0.000).