Spectrum of infections and outcome among hospitalized South Africans with systemic lupus erythematosus

Clinical Rheumatology - Our aim was to determine reasons for admission, the prevalence and spectrum of infections, and the outcomes in a multiethnic cohort of hospitalized systemic lupus...     

Concomitant systemic lupus erythematosus and HIV: Case series and literature review

Objectives

To determine the effect of systemic lupus erythematosus (SLE) and human immunodeficiency virus (HIV) infection on the course of each other and to review the published reports on concomitant SLE and HIV infection.

Methods

We performed a retrospective review of the records of patients with SLE and HIV seen in the Department of Rheumatology at the Inkosi Albert Luthuli Central Hospital, Durban, South Africa. We used the terms “systemic lupus erythematosus” and “HIV” or “AIDS” to identify patients with SLE and HIV infection reported in the English medical literature.

Results

We identified 13 patients with SLE and HIV infection. All the patients were females and there were 11 African blacks and 2 Indians. SLE and HIV infection were diagnosed together in 6 patients. In this group, there were 5 lupus flares in 4 patients, and 2 of the flares followed highly active anti-retroviral treatment (HAART). Five patients developed HIV after the diagnosis of SLE. The 3 patients in whom follow-up data was available had inactive SLE, one of whom was on HAART. Two HIV-positive patients developed SLE after receiving HAART for 30 and 35 mo. Seven of our patients also had tuberculosis. Our literature search identified 58 previously reported patients with HIV and SLE.

Conclusion

Our case series and review of the literature show that there is a reduction in SLE disease activity in patients with concomitant SLE and HIV. However, when lupus flares occur in HIV-positive patients, they are unrelated to the use of HAART.     

Association of waist and hip circumferences with the presence of hypertension and pre-hypertension in young South African adults

BackgroundObesity is one of the most important risk factors for cardiovascular diseases (CVDs) including hypertension (HT) which is itself a risk factor for CVDs. Recent studies suggest that waist circumference (WC) may be more sensitive than Body Mass Index (BMI) in determining individual risk scores for CVDs.ObjectivesThe current study aimed at investigating the influence of various anthropometric variables on blood pressure status in a group of students from Walter Sisulu University.MethodsInformed consent was obtained from 216 male and female students from Walter Sisulu University with a mean age of 22.1±0.2 years. Anthropometric measurements were performed for each participant. Blood pressure was measured in triplicates after 10 minutes of rest and the average computed.ResultsJust over 46% of the subjects were diagnosed with hypertension (HT) and pre-HT. The gender specific prevalence of HT/pre-HT was higher in the male (76.7%) compared to the female (30.5%) group. Waist circumference (WC) and total body fat (TBF) correlated significantly with blood pressure and HT/pre-HT in females but not males. ROC analysis showed that with the exception of waist-to-hip (WHR), all other anthropometric measurements and ratios studied can be used to discriminate blood pressure in young adult females not males.ConclusionIncreased WC and HC were associated with HT and pre-HT in young adult females in the Walter Sisulu University.     

Predictive performance of eGFR equations in South Africans of African and Indian ancestry compared with 99mTc-DTPA imaging

Background

South African guidelines for early detection and management of chronic kidney disease (CKD) recommend using the Cockcroft?CGault (CG) or Modification of Diet in Renal Disease (MDRD) equations for calculating estimated glomerular filtration rate (eGFR) with the correction factor, 1.212, included for MDRD-eGFR in black patients. We compared eGFR against technetium-99m-diethylenetriaminepentaacetic acid (^99mTc-DTPA) imaging.

Methods

Using clinical records, we retrospectively recorded demographic, clinical, and laboratory data as well as ^99mTc-DTPA-measured GFR (mGFR) results obtained from routine visits. Data from 148 patients of African (n?=?91) and Indian (n?=?57) ancestry were analyzed.

Results

Median (IQR) mGFR was 38.5 (44) ml/min/1.73?m², with no statistical difference between African and Indian patients (P?=?0. 573). In African patients with stage 3 CKD, MDRD-eGFR (unadjusted for black ethnicity) overestimated mGFR by 5.3% [2.0 (16.0) ml/min/1.73?m²] compared to CG-eGFR and MDRD-eGFR (corrected for black ethnicity) that overestimated mGFR by 17.7% [6.0 (15.0) ml/min/1.73?m²] and 17.1% [6.0 (17.5) ml/min/1.73?m²], respectively. In stage 1?C2, CKD eGFR overestimated mGFR by 52.5, 38.0, and 19.3% for CG, MDRD (ethnicity-corrected), and MDRD (without correction), respectively. In Indian stage 3 CKD patients, MDRD-eGFR underestimated mGFR by 35.6% [?21.0 (6.5) ml/min/1.73?m²] and CG-eGFR by 4.4% [?2.0 (27.0) ml/min/1.73?m²], while in stage 1?C2 CKD, CG-eGFR and MDRD-eGFR overestimated mGFR by 13.8 and 6.3%, respectively.

Conclusion

MDRD-eGFR calculated without the African-American correction factor improved GFR prediction in African CKD patients and using the MDRD correction factor of 1.0 in Indian patients as in Caucasians may be inappropriate.