Sputum Cytological Findings Comparison in Hiv Positive and Hiv Negative Patients With Productive Cough at the Kenyatta National Hospital

Abstract

HIV patients are vulnerable and are therefore predisposed to opportunistic cancers and opportunistic infections (OIs). With respect to cancers in HIV patients, lung cancer takes the lead as a non-AIDS defining cancer that is the most common cause of cancer deaths in HIV-infected patients. In terms of OIs, Mycobacterium tuberculosis, Aspergillus fumigatus, Pneumocystis jirovecii, Pneumococcal pneumonia are some of the most common bacterial and fungal microorganisms responsible for the secondary respiratory infections associated with HIV infection. Sputum examination, a minimally invasive, inexpensive and a simple method to obtain specimen can effectively be used for the rapid screening of respiratory disease. Broad objective: To describe cytomorphological changes and opportunistic infection patterns in HIV positive patients being compared with HIV negative patients with a productive cough in KNH Chest Clinic and CCC. Study design and site: A cross-sectional study conducted at the KNH CCC and Chest Clinic. Study population: HIV positive and HIV negative patients with productive cough. The estimated sample size was 106 patients: 53 HIV +ve and 53 HIV -ve sampling both males and females with productive cough. Methodology: Participants were recruited as they visited the clinics by convenient sampling. A consent form and questionnaire was administered as part of the recruitment protocol. Socio-demographic data, Clinical data and respiratory symptoms were recorded. Sputum was then collected, processed, and stained using various stains before microscopic examination. Results: Four of the 106 participants in this study had atypical squamous cells of undetermined significance (ASCUS) (3.7%). There were no obvert cases of lung cancer detected. For ZN staining, about 8.5% of patients sampled tested positive for AFB, 6.6% tested positive for Candida Spp. on PAS staining. For Gram stain, 19.8% of the patients had only Gram positive cocci in clusters, 18.9% had only Gram positive cocci in chains and 7.5% of the patients had Gram positive diplococci. Conclusion: Of the positive findings in this study, AFB and inflammatory changes were the commonest findings at 8.5% each and this concurs with previous studies. Of the 4 ASCUS findings, only one was an HIV positive patient. Lung cancers were therefore uncommon in this study population of HIV positive and HIV negative patients with productive cough. xix Recommendation: Sputum cytology should continue to be the standard of care for patients with productive cough, both HIV positive and HIV negative. Careful evaluation of sputum for epithelial lesions, although rare, is recommended. However, routine screening for intraepithelial lesions is not recommended.