The Spectrum of Upper Abdominal Ultrasonography findings in HIV Infected Patients as seen at Kenyatta National Hospital and the Armed Forces Memorial Hospital.
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Objectives

To determine the pattern of upper abdominal abnormalities as detected by sonography in HIV-infected individuals. 

 

Study design

Descriptive cross sectional study.

 

Setting of study

Kenyatta National Hospital (K.N.H), Department of Diagnostic Imaging and Radiation Medicine (DIRM- UoN) and the Armed Forces Memorial Hospital (A.F.M.H). 

 

Subjects studied

A sample of 273 HIV-infected patients and clinical indications were recorded in predesigned data collection forms.  Systematic sampling procedure was used in selecting patients into the study.

 

Results of the study

 

Right upper quadrant pain accounted for 31.9%, pyrexia of unknown origin 30.40%  and general abdominal pain 27.68%.  The main clinical indication for liver sonography was hepatitis (45.8%) whereas for the kidney was renal failure (66.67%).  Ultrasonography revealed para-aortic lymphadenopathy in 42.9%, ascites 25.6%, mesenteric adenopathy in 23.5% and porta hepatic nodes in 13.7%.  Solid abdominal masses and abscess were seen in 2.2% and 3.3% respectively.  At sonography various liver pathologies were found in 36.3% of the cases.  Different pathological features were seen in the kidneys (44.30%), spleen (20.15%), gallbladder (22.34%) and pancreas (2.56%), CD4 counts were known in 35.2% of the cases and the mean CD4 count was 212 cells/µl (95%C1 177.05-246.91) + 172.40.  The lowest CD4 count was 2.0 cells/µl while the highest was 755 cells/ µl.  There were significant differences in the presence of ascites and CD4 levels (P>0.05).  However there were no significant differences in ascites and gender of the patient (P>0.05), ascites and age (P=0.05), para-aortic lymphadenopathy and gender (P>0.05), para-aortic lymphadenopathy and age, (P>0.05), increased renal parenchymal echogenicity and gender (P> 0.05), increased renal parenchymal echogenicity and age (P>0.05), CD4 count levels and gender (P>0.05).

 

Conclusion

This study reveals that renal parenchymal changes, fatty liver, intra-abdominal lymphadenopathy and gallbladder sludge are common intraabdominal findings in HIV infected individuals despite paucity of clinical suspicion.  These findings may have implications for the radiologist especially in our set up, where accurate microbiological or pathologic diagnosis of infectious and noninfectious disease afflicting the HIV-infected patient is usually not readily available and ultrasound is often relied upon as a “diagnostic” investigation by many clinicians.