Upper abdominal ultrasonography findings in HIV patients at Kenyatta National Hospital and The Armed Forces Memorial Hospital

Abstract

Background: In the majority of sub-Saharan African countries, the absence of accessible and affordable computerized tomography (CT) facilities makes abdominal ultrasound (US) an alternative imaging tool in the clinical lnvestlqatton of infectious and noninfectious complications of HIV-infected patients. Abdominal ultrasound for diagnostic purposes in HIV-infected individuals is required by clinicians for a range of primary clinical indications. Methods: This was a descriptive cross-sectional study carried out at the Kenyatta National Hospital (K.N.H), Department of Diagnostic Radiology -University of Nairobi (D.D.R-UoN) and the Armed Forces Memorial Hospital (A.F.M.H). The objective of this study was to determine the pattern of upper abdominal abnormalities as detected by sonography in HIV-infected individuals. A sample of 273 HIV¬infected patients and clinical indications were recorded in pre¬designed data collection forms. Systematic sampling procedure was used in selecting patients into the study. Results: In this study right upper quadrant pain accounted for 31.90/0, 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 (66.670/0). Ultrasonography revealed Para-aortic lymphadenopathy in 42.9%, ascites 25.60/0, mesenteric adenopathy in 23.5% and porta hepatis nodes in 13.7%• Solid abdominal masses and abscesses were seen in 2.2% and 3.3% respectively. At sonography various liver pathologies were found in 36.3% of the cases. Different pathC5logical features were seen in the kidneys (44.30%), spleen (20.150/0), gallbladder (22.34%) and pancreas (2.56%).CD4 counts were known in 35.2% of the cases and the mean CD4 count was 212 ceII s/IJI (95%CI 177.05 -246.91)±172.40. The lowest CD4 count was 2.0 cells/ul while the highest was 755 cells/ IJI. There were significant differences in the presence of ascites and CD4 levels (P<0.05), and in increased renal parenchymal change 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). Conclusions: 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 diseases afflicting the HIV-infected patient is usually not readily available and ultrasound is often relied upon as a "diagnostic" investigation by many clinicians.