Browsing by Author "Kyeyune, R."

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    Clinical Significance Of Normal Chest Radiographs Among HIV-infected TB Suspects In Uganda
    (American Thoracic Society, 2010) Yoo, S. D.; Worodria, W.; Kisembo, H.; Kyeyune, R.; Kalema, N.; Kampiire, L.
    Algorithms for management of HIV-infected pulmonary tuberculosis suspects typically include a chest radiograph with further work-up and/or empiric treatment recommended for patients with abnormal radiographs. The clinical implications of a normal chest radiograph in this population are not well-described. Our objectives were to describe the frequency, predictors, disease etiology, and outcomes of HIV-infected tuberculosis suspects with a normal chest radiograph. Consecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between September 2007 and July 2008 with cough ≥2 weeks were enrolled. Chest radiographs were obtained within 24 hours of admission and were interpreted independently by two radiologists blinded to clinical data. CD4+ T-lymphocyte counts were obtained at enrollment. Patients submitted two sputum specimens for acid-fast bacilli (AFB) smear and culture on Lowenstein-Jensen media. Patients with negative sputum AFB smears were referred for bronchoscopy with bronchoalveolar lavage (BAL). Bronchoscopy included inspection for endobronchial Kaposi sarcoma (KS). BAL fluid was examined for mycobacteria, Pneumocystis jirovecii, and other fungi. Patients were followed for 2 months after hospital discharge. Diagnostic criteria: (1) Tuberculosis: positive sputum/BAL mycobacterial culture; (2) Fungal pneumonia: positive BAL fungal culture; (3) PCP: positive BAL Giemsa stain; and (4) Kaposi Sarcoma: KS lesions seen during airway examination. We assigned patients a clinical diagnosis of bacterial pneumonia or culture-negative tuberculosis if they improved with empiric treatment for those pneumonias. 52 (16%) of 323 patients had a normal chest radiograph. Patients with a normal chest radiograph were younger (median age 30 vs. 34 years, p=0.003), more often female (73% vs. 51%, p=0.004), and had lower CD4+ T-lymphocyte counts (median 13 vs. 56 cells/ul, p<0.001) than those with an abnormal radiograph. Pulmonary tuberculosis was the most common diagnosis (42%), followed by bacterial pneumonia, pulmonary aspergillosis, and pulmonary cryptococcosis among those with a normal chest radiograph. Four (8%) patients with a normal radiograph had two respiratory processes at the same time. The frequency of a normal chest radiograph was 8% among patients diagnosed with culture-positive tuberculosis patients and 20% among patients diagnosed with culture-negative tuberculosis (p=0.02). Two-month mortality was not significantly different between patients with a normal chest radiograph (37%) and patients with an abnormal radiograph (29%, p=0.25). A normal chest radiograph is common among HIV-infected pulmonary tuberculosis suspects, especially among those who are young, female, or have very low CD4+ T-lymphocyte counts. This finding should not preclude further diagnostic evaluation, as pulmonary tuberculosis is common and mortality is high.
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    Vitamin-D deficiency impairs CD4þT-cell count recovery rate in HIV-positive adults on highly active antiretroviral therapy: Q9 A longitudinal study
    (Clinical Nutrition, 2015) Ezeamama, A.E.; Guwatudde, D.; Wang, M.; Bagenda, D.; Kyeyune, R.; Sudfeld, C.; Manabe, Y.C.; Fawzi, W.W.
    We implemented a prospective study among human immunodeficiency virus (HIV)- positive adults to examine the association between vitamin-D deficiency (VDD) and insufficiency (VDI) vs sufficiency (VDS) and CD4þT-cell improvement over 18 months of highly active antiretroviral therapy (HAART). Methods: We used data from a randomized placebo-controlled micronutrient trial with 25-hydroxy vitamin-D (25(OH)D) measured at enrollment in 398 adults. CD4þT-cell count was measured repeatedly at months 0, 3, 6, 12 and 18. Linear mixed models quantified the vitamin-D-related differences in CD4þT-cell count and associated 99% confidence intervals at baseline and respective follow-up intervals. Results: At baseline 23%, 60% and 17% of participants were VDS, VDI and VDD, respectively. Absolute CD4þT- cell counts recovered during follow-up were persistently lower for baseline VDD and VDI relative to VDS participants. The greatest deficit in absolute CD4þT-cells recovered occurred in VDD vs VDS participants with estimates ranging from a minimum deficit of 26 cells/ml (99% CI: 77, 26) to a maximum deficit of 65 cells/ml (99% CI: 125, 5.5) during follow-up. This VDD-associated lower absolute CD4þT-cell gain was strongest among patients 35 years old or younger and among participants with a baseline body mass index of less than 25 kg/m2. Conclusions: VDD is associated with lower absolute CD4þT-cell count recovery in HIV-positive patients on HAART. Vitamin-D supplementation may improve CD4þT-cell recovery during HAART. However, future intervention studies are needed to definitively evaluate the effectiveness of this vitamin as an adjunct therapy during HAART.