Prevalence of lower urinary tract symptoms and associated risk factors among hiv and aids patients attending care and treatment clinic at Muhimbili national hospital from july to december 2007

Abstract

Lower urinary tract symptoms can cause morbidity and hence lowering the quality of life of HIV and AIDS patients, and can also lead to mortality. In most cases, HIV and AIDS patients with lower urinary tract symptoms (LUTS) are regarded as having urinary tract infection and so they end up being treated with antibiotics. It should be remembered that in some cases infection might not be the only cause of the symptoms and hence the importance of looking at the problem in a wider perspective. A cross- sectional study was conducted at MNH CTC to determine the Prevalence of LUTS and associated risk factors in HIV and AIDS patients. Study was conducted for six month, socio-demographic data and their risk factors for LUTS were identified and those patients who had LUTS and UTI were treated and followed up for 2weeks. A total of 260 patients, 116(44.6%) male, and 144 (55.4%) female were recruited during the study period. All patients involved in the study were requested to respond to structured questionnaires on LUTS using standard International Prostate Symptom Score (IPSS) criteria and also urine samples were taken. The majority of patients were in the age group of 27 -46 years. Among 260 patients, 163 patients had no LUTS and 97 patients had LUTS; therefore the prevalence of LUTS was 37.3%. Among 97 patients with LUTS, 77.4% had mild symptoms, 18.6% had moderate symptoms, and 4% had severe symptoms by IPSS. Of 97 patients with LUTS, 55.7% presented with obstructive symptoms, 30.8% had irritative symptoms and 10.3% had others (dysuria and haematuria). Among those presenting with obstructive symptoms, 34.2% had intermittency,14.4% had incomplete emptying, 10.3% had poor stream, while of those with irritative symptoms, 11.3% had increased frequency,11.3% had nocturia ,8.2% had urgency,3.2% had incontinence and 10.3% had dysuria and haematuria . Results from urine culture showed that, the overall prevalence of bacterial growth was 9.6%. In patients with LUTS the prevalence was 9.2% and 10.3% in patients who had no LUTS. E.coli growth was found in 6 patients with LUTS and 8 patients who had no LUTS. S.aureus growth was found in 4 patients, of whom 2 had LUTS and 2 had no LUTS. P. aeruginosa was found in 4 patients of whom one had LUTS and 2 had no LUTS. However, these findings were not statistically significant (p=O.91). Also one patient who had no LUTS had asymptomatic bacteriuria. Most of the bacteria were sensitive to gentamicin, nalidixic acid, clindamycin, ceftriaxone and few were resistant. All bacteria were found to be resistant to Cotrimoxazole. The age of the patient was found to be a risk factor for LUTS (p=O.024). This study also identified sex (male), use of ARVs, Use of prophylactic antibiotics, cigarette smoking, drinking alcohol, neurological symptoms, hypertension and opportunistic infections as risk factors of LUTS. However the findings were not statistically significant (p>O.05).From this study it is evident that LUTS is a problem among HIV and AIDS patients attending CTC, several risk factors have been found. However, more studies need to be conducted in large sample size and in different settings in order to establish the magnitude of the problem in Tanzania and to advice on the standard of care among HIV and AIDS patients who present with LUTS.