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Item Risk factors for caries and periodontal diseases: a comparative4 study among HIV-positive and HIV-negative adults in nyarugenge5 district, Rwanda(University of the Witwatersrand, Johannesburg, 2024) Murererehe, JulienneDental caries and periodontal diseases are among HIV-positive persons' most frequent oral conditions. These common oral diseases contribute to the impairment of general health and well- being. Dental and periodontal problems among HIV-positive individuals are more severe and difficult to manage than dental and periodontal problems among HIV-negative people. Thus, risk factors for caries and periodontal diseases must be controlled for comprehensive oral health and the general well-being of HIV-positive patients. The burden of oral diseases is reported to be high in Rwanda. Nearly 65% of the oral health survey participants had experienced dental caries and above 54% had untreated cavities. In addition, dental calculus was found among 60% of participants. More than 34% had oral debris. Surprisingly, more than 70% of this population has never visited dentists or dental facilities. This evidence gives impetus to undertake more focused investigations on oral diseases in Rwanda, particularly among HIV-positive people. Therefore, this study sought to assess the risk factors for caries and periodontal diseases among HIV-positive and negative adults in Nyarugenge District, Rwanda Methods This research used a mixed-method approach (qualitative embedded design). For the quantitative part, a comparative cross-sectional study was conducted among 200 HIV-positive and 200 HIV- negative adults aged ≥18 years. Consecutive and purposive sampling method was used to select participants for quantitative and qualitative parts of the study respectively. Caries was assessed using the Decayed (D), Missing (M), and Filled Teeth (F) index (DMFT). Periodontal disease was assessed using the Plaque Index (PI), Community Periodontal Index of Treatment Need (CPITN), and Clinical Attachment Loss (CAL). Oral health Related Quality of Life (OHRQoL) was assessed using the oral health impact profile short version (OHIP-14). Descriptive statistics, Chi-square test, t-test, Cronbach alpha, and multiple logistic regression were applied to analyse quantitative data using Stata version 15. For the qualitative data collection, in-depth interviews (IDIs) were conducted among 10 HIV-positive and 11 HIV-negative adults with caries and periodontal diseases using a semi-structured interview guide. Thematic content analysis using an inductive approach was applied for data analysis of IDIs. NVivo software version 11 was used to code and organize the data. Results A higher proportion (50.5%) of HIV-positive adults had experienced caries (DMFT>0) compared to HIV-negative counterparts (40.5%) and the difference was statisticaly significant (p=0.045). The prevalence of D was higher (23.5%) among HIV-positive compared to HIV-negative adults (13.6%) (p=0.011). The Mean (SD) DMFT score among HIV-positive and HIV-negative participants were 2.28 (3.68) and 1.29 (2.21) respectively (p=0.001). The predictors of caries in HIV-positive persons were being female (OR= 2.33; 95%CI= 1.14-4.75), frequent dental visits (OR= 4.50; 95% CI=1.46-13.86) and detectable RNA viral load (OR= 4.50; 95% CI=1.46-13.86). Among HIV-negative participants, the middle age range (36-45 years) [OR= 6.61; 95%CI=2.14- 20.37], and frequent dental visits were significantly associated with caries (OR=3.42; 95%CI: 1.337-8.760). For periodontal status, having dental calculus was the most prevalent item of the CPITN found among HIV-positive 168 (84%) and 182 (92%) HIV-negative individuals. The mean (SD) score for CAL was higher in HIV-positive persons 1.23 (0.95) compared to HIV-negative counterparties 0.99 (0.75). The difference was statistically significant (p=0.003). Being a male was a predictor of having dental plaque and a need for periodontal treatment for both HIV-positive (PI OR: 2.90 (95%CI=1.26-6.66)); (CPITN OR: 3.33 (95%CI=1.14-9.70)) and HIV-negative respondents (PI OR:3.28 (95%CI=1.48-7.28)); (CPITN: OR: 7.78 (95%CI=1.04-58.07)). A higher percentage of HIV-positive individuals had poorer OHRQL than HIV-negative counterparties in all items of OHIP-14 except for OHIP3 (found it uncomfortable to eat any foods because of problems with teeth or mouth) and OHIP-14 items (being totally unable to function because of problems with teeth or mouth). The findings revealed significant results regarding OHIP1 “trouble pronouncing any word” with a prevalence of 11(2.5%) and 9(2.25%) in HIV-positive and HIV-negative participants, respectively. Also, HIV-positive persons had higher percentage 11(2.75%) for the OHIP 13 item “life not satisfying due to teeth and mouth problems” than HIV-negative counterparties 8(2%) and the difference was statistically significant p≤0.05. Moreover, dental caries was significantly associated with poor OHRQoL among HIV-positive and HIV-negative participants for all 14 items of OHIP-14 tool. There was no association between periodontal disease and OHRQoL in both HIV-positive and HIV-negative adults. Two broad domains and five themes emerged from the interviews. The first broad domain was “perceptions on causes of oral diseases” with 2 themes (individuals and external themes). The second broad domain was “perceptions on oral diseases effect” with 3 themes (physical or functional effect, psychological effect and social effect themes). Conclusion and recommendations This research showed a higher prevalence of caries and CAL among HIV-positive adults than HIV- negative counterparts. Also, the mean (SD) PI value was significantly higher in HIV-positive adults compared to the mean PI value in HIV-negative individuals. The reported higher prevalence of caries in HIV-positive persons was associated with being female, detectable viral load, and frequent dental visits. Periodontal disease was associated with older age, being male in HIV-positive and HIV-negative participants. Moreover, HIV-positive adults reported poorer OHRQoL than HIV-negative counterparties. Furthermore, qualitative results revealed individual and external levels factors of oral disease and emphasized the physical/ functional, psychological and social effects of oral diseases on quality of life. Therefore, there is a need for effective oral health interventions specific to HIV-positive persons in Rwanda. The interventions should also raise awareness of the risk of common oral diseases (such as dental caries, and periodontal disease) and provide preventive oral health services among the Rwandan population, especially HIV-positive individuals. There is a need for a collaborative effort to establish programmes for regular and timely screening and management of periodontal disease and dental caries among the general population and specifically, HIV-positive individuals in Rwanda. To ensure timely oral health care among HIV- positive Rwandans, this study provides baseline data to aid policymakers and stakeholders to integrate oral health care services within HIV treatment programmes in RItem A laboratory based retrospective study of plasma cell myeloma in the public sector of South Africa from 2017 to 2019(University of the Witwatersrand, Johannesburg, 2024) Wilding, Bradley Thomas; George, JayaBackground Plasma cell myeloma is a haematological malignancy characterized by clonal proliferation of plasma cells. This malignancy is frequently associated with the production of a monoclonal protein in either serum and / or urine, referred to as an M protein, which is used as a screening test for patients. Patients are then further investigated to assess if they meet the International Myeloma Working Group (IMWG) diagnostic criteria for plasma cell myeloma. There is limited literature describing plasma cell myeloma in South Africa, particularly in people living with HIV. Objective The primary objective of this study was to describe plasma cell myeloma in patients diagnosed in the public sector of South Africa over a three-year period. The secondary objective was to compare demographic features (age, sex) and diagnostic criteria, between the myeloma patients living with HIV and the HIV negative myeloma patients. Methods A retrospective analysis was performed on data from 4518 patients who had a positive immunofixation on serum and / or urine from public sector hospitals, between 2017 and 2019. A total of 718 of the 4518 patients met the laboratory criteria for plasma cell myeloma and were included in the analysis. Demographics (age, sex) and laboratory investigations used in the diagnostic criteria for plasma cell myeloma were analysed and statistically compared across the different HIV status of patients. Results Plasma cell myeloma patients presented at a mean age of 59.46 years with a female to male ratio of 1.2:1. In the patients that met the diagnostic criteria the most common end-organ damage present was anaemia in 77.16% patients and the most common biomarker of malignancy was a bone marrow trephine biopsy plasma cell percentage t60% in 55.71% patients. IgG isotype was the most common paraprotein detected on serum immunofixation in 58.5% of the patients. Kappa was the most common Bence-Jones protein detected in 27.16% of patients which was 1.76 times more common than lambda Bence-Jones protein. People living with HIV were younger 55.11 (±9.79) as compared to their HIV negative counterparts (p value 0.010). No other statistically significant difference was noted when comparing HIV status groups Conclusion In conclusion, this study described the demographics, laboratory investigations and diagnostic features of plasma cell myeloma patients diagnosed in the South African public sector from 2017 to 2019. We found that people living with HIV were diagnosed at younger age when compared to their HIV negative counterpartsItem The relationship between the combined effects of life-course trauma and HIV on cognition in rural South African adults: A secondary data analysis(University of the Witwatersrand, Johannesburg, 2024) Kupa, Nkgodi Obed; Matsena-zingoni, Zvifadzo; Mall, SumayaBackground: Lifecourse traumatic events (TE) refers to both childhood and adult trauma. Childhood TE refers to a spectrum and domains of adverse experiences occurring before the age of 18. Global and South African-based research suggests that life-course TE are associated with both physical and mental disorders including HIV and poor cognition (also referred to as neurocognitive impairment (NCI)). While data suggests that life-course TE, HIV and NCI are highly prevalent in South Africa and risk of NCI has been researched, little is known of the combined effect of life-course TE and HIV on NCI in adulthood. To fill the gap in the literature, I analysed data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), from rural Bushbuckridge (Mpumalanga province). Study Aim To examine the combined (interaction) effect of TE and HIV infection on the cognition of older adults in South Africa. Methods: I analysed (secondary) data from the HAALSI study. The main exposures analysed were: life-course TE and HIV-positive status. A pre-analysis phase consisted of several exploratory steps to define the exposure and outcome: First TE data which had been measured by the English Longitudinal Study of Aging (ELSA) life history questionnaire were examined. The main exposure variable was coded 1 if one experiences a TE and 0 otherwise from seven potential TE. NCI, the main outcome variable was defined based on measuring cognitive domains: orientation and memory. A score≥1.5 standard deviations (SD) below the mean of the baseline cognitive function distribution on the cognitive assessment (managing to know the date, day, month and president) will mean no NCI while a score below the means some degree of NCI). The main outcome variable was cognition measured by the Oxford Cognitive Screener (OCS-plus). Based on the validation of Tablet-Based OCS-plus in HAALSI, OCS-Plus included nine brief tests measuring cognitive ability in nine different domains, including language, memory (intentional and incidental), and executive functioning (task switching-alternating jobs between tasks), attention (auditory), and praxis (doing things). A stand-alone application called OCS- Plus was developed using Matlab and Psychophysics Toolbox for Windows Surface Pro tablets. Further preparatory steps for the analysis included: the exposure variables (HIV status and composite trauma-defined as the presence of at least one trauma item-) were created as follows: 1. HIV status was categorized into HIV positive and negative and coded 1 and 0 respectively. 2. Composite trauma was coded 1 if ever experienced any of the seven trauma items and 0 if none were experienced. Four groups of participants were created by exposure status. These were: 1. HIV positive and also experienced TE. 2. HIV negative but experienced TE. 3. HIV positive but TE negative. 4. HIV negative and trauma negative. Descriptive statistics were calculated for both exposures and outcomes as well as relevant sociodemographic variables. Both unadjusted and adjusted logistic regression techniques were employed to examine the combined effect of life course TE and HIV on NCI in older adults. The adjusted logistic regression models were done: 1) handling HIV and composite trauma separately and 2) considering the interaction term of HIV and composite trauma. Variables such as education, employment status, age, nationality, gender, hypertension, stroke, HIV status, marital status and composite trauma were considered confounders and adjusted accordingly. Results: Of the 5,059 study participants recruited and residing in the Agincourt study area in Bushbuckridge, 65% of the study participants had experienced at least 1 TE, and the most common trauma experienced were “ever experiencing severe financial hardship which was experienced by 58.74% of the participants, 39.73% whom “ever experienced a natural disaster” and 23.30% “ever experienced a death of a relative or friend” and the prevalence of NCI was 7% ( n=352).. The median age of participants was 64 (IQR: 55-74) years; 53.07% of the study participants were females; 44.42% had no formal education, and 72.63% of the study participants were not working. In the multiple logistic regression model with the interaction term, the odds of having NCI decreased by 64% (AOR=0.36; 95%CI: 0.25-0.52) and 59% (AOR=0.41; 95%CI: 0.24-0.75) among those who had some primary school (1-7 years) and some secondary school (8+ years), respectively compared to those with no education. The odds of having NCI decreased by 98% (AOR=1.98; 95%CI: 1.05-3.72) among those who were not working compared to those employed. A one-year increase in age was associated with a 5% increase in the odds of having a cognitive impairment (OR=1.05; 95%CI: 1.04-1.07). Those who were married had 37% (OR=0.63, 95%CI: 0.47-0.84) reduced odds of having NCI compared to those who were married. Those without composite trauma had 90% (AOR=0.10; 95%CI: 0.07-0.15) reduced odds of having NCI compared to those who have composite trauma. Those who were HIV positive and had experienced composite trauma had an increased odds of 1.78 (95% CI: 1.04-3.04) of having NCI compared to those who are HIV negative and had not experienced composite trauma. In the interaction model, we found no association between HIV status, stroke, or hypertension and NCI. However, the results of the interactionmodel suggested a significant association between HIV and the composite trauma score on NCI. Conclusions: The results suggest that lifecourse TE and HIV infection influence NCI. The full HAALSI cohort could be employed to examine the effect of TE data collected at baseline and incident NCI at later wavesItem Risk factors for recurrent tuberculosis among HIV patients who are on anti-retroviral treatment in rural northeast, South Africa(University of the Witwatersrand, Johannesburg, 2024) Kanzoole, Kingsley; Ibisomi , Latifat; Kabudula, ChodziwadziwaBackground: Tuberculosis (TB) is a major public health concern, and according to the World Health Organization (WHO), is one of the top 10 causes of death worldwide. Recurrent TB is a significant contributor to the overall TB burden worldwide, particularly in areas where TB prevalence is high (4–6), and among HIV infected people. Aim: In this study, we investigated the risk-factors that are associated with the recurrence of TB among HIV infected people in rural northeast, South Africa. Methods: The study employed a retrospective cohort study design and used data from Agincourt health socio-demographic surveillance system spanning from 1st January 2014 to 31st December 2022. Data analysis was conducted using STATA 17 SE as the analytical tool. Cox regression was used to determine risk factors for recurrent TB among HIV patients on ART in rural northeast, South Africa. Results: The study included 4,803 participants with 1,326 (27.6%) males and 3,477 females (72.4%). The participants were predominantly of HIV WHO Stage 1 (84.7%), followed by Stage 2 (7.6%), then Stage 3 (7.0%) and Stage 4 (0.7). The age distribution had 24.8% aged 18-29, 34.5% aged 30-39, 23.1% aged 40-49, 11.0% aged 50-59 and 6.6% aged 60 and above. The study population had a CD4 count median of 229 cells/mm3 with an IQR of 112-390 cells/mm3 and a median duration of previous TB treatment of 31 weeks with an IQR of 16-49 weeks. Out of the 4,803 patients, 396 (8.2%) experienced recurrent TB. This translated to a recurrence rate of 3.0 per 100 person years. The median time to TB recurrence was 1.93 years, with approximately 50% experiencing the recurrence within this period. The significant risk factors associated with recurrent TB were being male (AHR=1.48, CI: 1.11 – 1.96), WHO HIV stage (AHR=2.53, CI: 1.81 – 3.54), baseline CD4 count (AHR=0.98, CI: 0.98 – 0.99), and duration of previous TB treatment (AHR=0.96, CI: 0.93 – 0.98). Conclusion: This study has identified significant risk factors for recurrent TB among HIV patients in rural northeast South Africa. Male patients have a higher risk, necessitating targeted interventions. Advanced HIV stages increase recurrence risk, emphasizing early diagnosis and management. Maintaining higher CD4 counts and continuous monitoring during and after TB treatment are vital to reducing recurrence. These findings inform strategies to improve health outcomes and control recurrent TB among HIV patients receiving ART in the regionItem 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, KarlIntroduction: 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 viraemiaItem 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, DeepakBackground 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.Item 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, NazeerBackground 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.Item 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 ratiosItem 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, LesleyBackground: 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.Item Comparison between lupus nephritis in HIV positive patients and HIV associated immune complex glomerulonephritis with “lupus–like” features: a clinicopathologic study(2024) Mathaba, Margaret MasalaBackground: Systemic lupus erythematosus (SLE) is an autoimmune disease seen commonly in black females of childbearing age. More than half of the patients present with renal disease or lupus nephritis complications. Coinfection with HIV in patients with lupus nephritis is rare. Despite Africa having the highest rate of HIV infection in the world, and there is no available data on the coexistence of HIV and Lupus nephritis. HIV is associated with a wide spectrum of renal diseases, including “lupus-like” HIV-Associated Immune Complex Kidney Disease (HIVICK). The most prevalent renal lesions in “lupus-like” HIVICK is diffuse proliferative lupus nephritis Objectives: This study aimed to compare and correlate the demographics, epidemiology, pathological and clinical findings of HIV positive patients with lupus nephritis and those with “lupus-like” HIVICK. Methods: This retrospective chart review study was conducted at the Charlotte Maxeke Johannesburg Academic Hospital in 5 years (2014-2018). We reviewed case reports that met our criteria for cases with lupus nephritis and cases with “lupus-like” HIVICK and allocated a lupus class according to the report findings. Results: Out of 2174 renal reports, 25(1.14%) patients were diagnosed with lupus nephritis and nine (0.41%) with “lupus-like” HIVICK. There were significant differences in age, serology (urea and creatinine), clinical presentation and lupus class. Conclusion: The occurrence of both HIV associated lupus nephritis and ‘lupus like’ HIVICK is rare. In our setting, the former is more common than the latter. We observed clinical and pathological differences which may be used to diagnose these disease entities.