Page 210 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 4 of 6 Original Research

Chi-square test showed a highly significant correlation Testing and therapy
between HIV status and certain types of histology with a The Zimbabwe Demographic and Health Survey of 2010–
p-value of p < 0.001 and a strong association with a 2011 showed that only 57.0% of women and 36.0% of men
Cramer’s V value of 0.6 (Figure 4). Being HIV-positive was aged 15–49 years had ever been tested for HIV. The follow-
8
associated with a higher likelihood of having cervical cancer up report from 2015 showed an increase in testing from the
or squamous cell carcinoma (3.16- and 2.54-fold greater, previous survey, with 49.0% of women reporting being
respectively; p < 0.001).
tested in the last 12 months compared to 34.0% in 2011.
Among men, this increased from 21.0% in 2011 to 36.0%
In contrast, patients with prostate cancer were 4.9 times less 9
likely to be HIV-positive (p < 0.003). There was a significant in 2015.
difference between the mean age of the prostate cancer group Previous studies have reported very low testing rates among
and the remainder of the patients (71.2 vs. 45.7 years of age, surgical patients, ranging from 10.0% to 50.0%. 3,10 In our
respectively; p < 0.05).
cohort, 80.9% had a valid and documented HIV test. In 2007,
the WHO recommended a PITC approach for all patients
Regarding the other diagnoses, trends but no statistically encountering the health system. Several studies have
11
significant correlations were found.
demonstrated the positive effect of this approach. 12,13,14 The
Zimbabwe Ministry of Health introduced PITC in 2007,
Within the group of patients with malignancies, people living which stated that anyone presenting to any level of healthcare
with HIV were significantly younger than uninfected patients
(mean age 50.5 vs. 64.4 years; p < 0.01). Excluding all patients institution should be offered HIV testing regardless of the
15
with prostate cancer (N = 86), HIV-positive patients were still purpose of their visit. Twenty-one patients were newly
younger (48.8 vs. 52.1), but the difference was not statistically diagnosed with HIV during our study period, eight of whom
significant (p = 0.126). presented with indicator conditions, such as cervical cancer,
anal cancer or vaginal warts and abscesses. Eighteen of these
Discussion patients were started on cotrimoxazole prophylaxis and only
seven began ART. These findings show that PITC for all
Epidemiology patients, even those without an indicator condition, is both
feasible and warranted. With the new test-and-treat approach,
HIV prevalence among the adult surgical patients reviewed
was higher than that in the general population in Zimbabwe where patients start their ART in absence of an opportunistic
in 2016 (23.2% vs. 14.7%). Similar findings have been infection the same day as the test, the numbers of patients
6
reported in studies from South Africa and Malawi. who start ART in hospital will certainly increase.
3,7
Women were over-represented in the HIV-positive adult
group (64.5%). This may be because Karanda Mission Of the HIV patients in our cohort, 88.1% were on ART;
Hospital is well known as a centre for gynaecologic and only 2.8% of these were on second-line treatment. While
obstetric surgery. Distribution of the different age groups this is heartening, to reach the 90-90-90 goal, PITC will
16
was similar to that reported in the UNAIDS Gap report have to be scaled up further. In Zimbabwe, viral load
from 2016. measurements are not routine. Therefore, it remains unclear
if the low number of patients on second-line treatment
was because of the success of first-line ART or the lack of
HIV status virological monitoring.
100.0 Nega ve Posi ve

Interestingly, all the patients on ART were also on
80.0 cotrimoxazole prophylaxis independent of the CD4+
count (mean CD4+ count 413 cells/µL and 73.5% > 200
cells/µL). According to the Zimbabwean guidelines, this
60.0
Percentage is recommended. It appears to be acceptable in an area that
has a high prevalence of malaria and bacterial infections.
40.0
HIV, type of surgery and outcome

20.0 HIV-positive patients in our cohort were significantly more
likely to undergo hysterectomy because of suspected cancer,
plastic surgery and abscess drainage or debridement. These
0.00 findings are not surprising as cervical cancer is an AIDS-
Prostate-Ca Ductal-Ca Cervix-Ca Squamous Adeno-Ca
17
cell Ca defining condition and HIV-positive patients are known to
18
Type of histology have HPV-associated genital warts, which accounted for
most of the plastic surgery in our cohort. The higher
Squamous cell Ca, anal, penile and oesophageal cancer; Adeno-Ca, gastrointestinal; Ca,
cancer. prevalence of abscesses among HIV-positive cohorts has
FIGURE 4: HIV status by histology. been demonstrated in several previous studies. 8,11,19
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