Hepatitis B is one of the most common infectious diseases in the world with high prevalence in most of sub-Saharan Africa countries. The complexity in its diagnosis and treatment poses a significant management challenge in the resource-limited settings including Tanzania, where most of the tests and drugs are either unavailable or unaffordable. This mini review aims at demonstrating the current status of the disease in the country and discussing the concomitant challenges in diagnosis, treatment, and prevention.

Introduction. Although ART has improved the outcome of people living with HIV/AIDS, still some patients develop TB while receiving ART. The literature on the magnitude of this problem is still scarce in our setting especially northwestern Tanzania. This study was designed to determine the prevalence of active TB among HIV patients on ART and assess its potential risk factors.Methods. A retrospective cohort study was done among adult HIV-positive patients initiated on ART at Bugando Medical Centre. Patients who were TB positive before ART initiation were excluded. Data regarding demographic, clinical, and laboratory information, TB status on receipt of ART, and time on ART were collected and analyzed using STATA 11 to determine the prevalence of TB and its associated factors.Results. In total, 391 patients were enrolled in this study. The median age was 39 (32–46) years, and a total of 129 (32.99%) participants had CD4 counts <200 cells/µl and 179 (45.78%) had WHO stage 3 and 4 illnesses. A total of 43 (11.0%) participants developed TB while receiving ART which was independently associated with male gender (OR = 2.9;p=0.007), WHO clinical stage 3 and 4 (OR = 1.4;p=0.029), baseline CD4 count <200 cells/µl (OR = 9.1;p<0.001), and having not used IPT (OR = 3.1;p=0.05).Conclusions. Active TB is prevalent among HIV patients while receiving ART in northwestern Tanzania which is independently associated with male gender, advanced HIV disease, and nonuse of IPT. Universal HIV testing could reduce late HIV diagnosis and hence reduce the risk of developing TB while receiving ART in our setting. Also IPT should be widely used for those who are negative for TB on screening.

Schistosomiasis affects about 240 million people worldwide and Schistosoma mansoni alone affects over 54 million people leaving 400 million at-risk especially in Sub Saharan Africa (SSA). About 20 million people are currently suffering from complications of chronic S. mansoni infection and up to 42% of those infected have been found with periportal fibrosis (PPF). About 0.2 million deaths are attributed to chronic S. mansoni every year, which is mainly due to varices. Death occurs in up to 29% of those who present late with bleeding varices even with the best available in-hospital care. The diagnosis of varices before incident bleeding could potentially improve the outcome of this subgroup of patients is SSA. However, there is no prior review which has ever evaluated this issue detailing the magnitude and outcome of varices following available treatment modalities among patients with Schistosoma PPF in SSA. This review summarizes the available literature on this matter and exposes potential practical gaps that could be bridged to maximize the long-term outcome of patients with S. mansoni related PPF in SSA. A total of 22 studies were included in this review. The average prevalence of varices was 82.1% (SD: 29.6; range: 11.1%–100%) among patients with PPF. Late diagnosis of varices was frequent with average bleeding and mortality of 71.2% (SD: 36.5; range: 4.3%–100.0%) and 13.6% (SD: 9.9; range: 3.5%–29%), respectively. Predictors were reported in seven (31.8%) studies including platelet count to splenic diameter ratio (PSDR) for prediction large varices in one study. Active S. mansoni infection was very prevalent, (mean: 69.9%; SD: 24.4; range: 29.2–100.0%). Praziquantel could reverse PPF and use of non-selective B-blockers reduced both rebleeding and mortality. Use of sclerotherapy for secondary prevention of variceal bleeding was associated with high rebleeding and mortality rates. Conclusions: This review shows that varices due to schistosomal PPF are a big problem in SSA. However, patients are often diagnosed late with fatal bleeding varices. No study had reported a clinical tool that could be useful in early diagnosis of patients with varices and no study reported on primary and effective secondary prevention of bleeding and its outcome. Regular screening for S. mansoni and the provision of Praziquantel (PZQ) is suggested in this review. More studies are required to bridge these practical gaps in Sub Saharan Africa.

Highly Active Antiretroviral therapy (HAART) reverses the effect of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) by durably suppressing viral replication. This allows CD4 gain to levels that are adequate enough to restore the body’s capability to fight against opportunistic infections (OIs). Patients with poor immune recovery have been shown to have higher risk of developing both AIDS and non AIDS related clinical events. This study aimed at assessing the proportions and risk factors of poor immune recovery in adult HIV-infected patients on 48 months of HAART attending care and treatment center (CTC) in northwestern Tanzania. A retrospective analysis of adult HIV patients’ data attending CTC at Sekou Toure hospital and who initiated HAART between February 2004 and January 2008 was done. Poor immune recovery was defined as a CD4 count less than 350 cells/µl on follow up as used in other studies. A total of 734 patients were included in the study. In this study 50.25% of patients attending CTC at Sekou Toure hospital were found to have poor immune recovery. The risk of developing inadequate immune recovery was independently associated with male gender, age older than 50 years, low baseline CD4 counts, and advanced World Health Organization (WHO) clinical stage. Poor immune recovery is prevalent among adult HIV patients attending CTC at Sekou Toure hospital in Northwestern part of Tanzania and opportunistic infections are common in this sub group of patients. Clinicians in resource limited countries need to identify these patients timely and plan them for targeted viral assessment and close clinical follow up to improve their long term clinical outcome.

Introduction. HIV still causes high mortality despite use of ART. This study was designed to determine the prevalence and risk factors of mortality among HIV patients receiving ART in northwestern rural Tanzania. Methods. A retrospective study of HIV patients on ART was done at Sengerema in Mwanza, Tanzania. The data on demography, date of HIV diagnosis, WHO stage, opportunistic infections, CD4, hemoglobin, ART regimen, and time and outcome on treatment as dead or alive were collected and analyzed using STATA version 11. Results. In total, 740 patients were studied. The median age was 35 (27–42) years with female predominance of 465 (62.8%). Of the participants, 261 (35.3%) had WHO stages 3 and 4 diseases. Most participants, 258 (34.9%), had baseline CD4 counts <200 cells/μl. Deaths occurred in 86 (11.6%) patients which were independently associated with male gender (16.0% versus 9.0%, p=0.015), being divorced (OR = 2.7, p<0.001), WHO stages 3 and 4 (OR = 2.3, p=0.05), CD4 <200 cells/μl (OR = 3.4, p<0.001), and severe anemia (OR = 6.6, p<0.001). Conclusions. The mortality is high among HIV patients receiving ART in northwestern rural Tanzania. Universal testing could increase early diagnosis and treatment. A close follow-up of at-risk patients within the first year of ART could reduce the mortality of this subgroup of patients.

With a growing access to free ART, switching of ART to second line regimen has also become common following failure of first line ART regimens. Patients failing on first line ART regimens have been shown to stand a high risk of failing on subsequent second line ART regimens. The magnitude of those who are failing virologicaly on second line ART is not documented in our setting. This study was designed to assess the magnitude and correlates of second line ART treatment failure. A retrospective analysis of patients on second line ART for at least 1 year was done at Bugando care and treatment center. Information on demographic, clinical and laboratory data were collected and analyzed using STATA 11. The proportion of patients with Virological failure was calculated and potential correlates of virological failure were determined by logistic regression model. In total 197 patients on second line ART were included in this study and 24 (12.18%) of them met criteria for virological failure. The odds of having virological failure on second line ART were independently associated with age of less than 30 years (AOR = 12.5, p = 0.001), being on first line for less than 3 years (AOR = 6.1, p = 0.002) and CD4 at switch to second line ART of less than 200cells/μl (AOR = 16.3, p < 0.001). Virological failure among patients on second line ART is common. Predictors of virological failure in this study could assist in planning for strategies to improve the outcome of this subgroup of patients including close clinical follow up of patients at risk, a continued adherence intensification and a targeted resistance testing before switching to second line ART.