Review of Human Immunodeficiency Virus Type 1–Related Opportunistic Infections in Sub‐Saharan Africa

Abstract

Understanding the natural history of human immunodeficiency virus type 1 (HIV-1) and opportunistic infections in sub-Saharan Africa is necessary to optimize strategies for the prophylaxis and treatment of opportunistic infections and to understand the likely impact of antiretroviral therapy. We undertook a systematic review of the literature on HIV-1 infection in sub-Saharan Africa to assess data from recent cohorts and selected cross-sectional studies to delineate rates of opportunistic infections, associated CD4 cell counts, and associated mortality. We searched the MEDLINE database and the Cochrane Database of Systematic Reviews and Cochrane Clinical Trials Register for English-language literature published from 1990 through April 2002. Tuberculosis, bacterial infections, and malaria were identified as the leading causes of HIV-related morbidity across sub-Saharan Africa. Of the few studies that reported CD4 cell counts, the range of cell counts at the time of diagnosis of opportunistic infections was wide. Policies regarding the type and timing of opportunistic infection prophylaxis may be region specific and urgently require further study.

A re-examination of the potential impact of preventive therapy on the public health problem of tuberculosis in contemporary sub-Saharan Africa

“…We were not able to include this intervention in our analysis because risk ratio estimates of the effect of HAART on the incidence of active tuberculosis are not yet available. HAART significantly enhances host immunity in HIV-infected persons, thereby reducing the risk of opportunistic infections in these individuals, including reactivation of LTBI [31]. Since most of the increase in tuberculosis cases in sub-Saharan Africa is attributed to reactivation of LTBI in HIV-positive persons, as access to HAART continues to improve in the coming years, it should significantly contribute toward the reduction of HIV-infection-associated tuberculosis morbidity and mortality.…”

A case of pulmonary tuberculosis in a HIV-positive patient

“…Olgumuz, HIV pozitif hastalarda TB'un, hızlı progresyonunu göstermesi ve uygun tanı ve tedaviyle hızlı klinik yanıt alındığını gös-termesi nedeniyle sunuldu. TB ve HIV birlikteliği açısından baktığımızda ise bazı Afrika ülkeleri ve Hindistan gibi tüberküloz prevalansının yüksek olduğu bölgelerde tüberkülozun HIV pozitif hastalarda en sık görülen fırsatçı infeksiyonlardan biri olduğu bildirilmektedir 6,7 . HIV negatiflerde TB riski, yaşam boyu %10 iken, HIV pozitiflerde yıllık TB riski %9 olduğu gösterilmiştir .…”

Malaria - The Formidable Enemy of Humanity

“…It is intriguing to note that malaria was recognized as the third reason of HIV-related morbidity in Africa [12]. Any kind of interaction between HIV infection and malaria may have potentially important public health implications [13].…”