HIV seroprevalence, clinical profile and surgical outcomes among patients with acquired anorectal conditions in two referral hospitals in Mwanza, Tanzania

Abstract

Background: HIV infection, a major health problem worldwide, has been reported to be prevalent in patients with acquired anorectal conditions. There is a paucity of prospective studies regarding acquired anorectal conditions in Tanzania. This study describes the HIV seroprevalence, clinical profile and surgical outcomes among patients with acquired anorectal conditions at Bugando Medical Centre (BMC) and Sekou-Toure Referral Regional Hospital (SRRH).

Methods: This was a cross-sectional study that was conducted among patients with acquired anorectal conditions as seen at BMC and SRRH from January 2019 to June 2019.

Results:  A total of 389 patients (M: F ratio = 1.5:1) were studied. The median age at diagnosis was 42 years. Out of 389 patients, 101(26.0%) were HIV positive. Of these, 54(53.5%) were males and 47 (46.5%) were females. Haemorrhoids were the most common acquired anorectal disease accounting for 50.9% of cases. The rate of HIV infection in this study was significantly high in patients with hemorrhoids (p< 0.001), perianal ulcers (p< 0.001), anorectal abscess (p = 0.009), perianal warts (p< 0.001) and rectal prolapse (p = 0.023). A total of 173 (44.5%) patients underwent surgical treatment for acquired anorectal conditions. Hemorrhoidectomy was the most commonly performed surgical procedure in 95(54.9%) patients. Out of 171 patients who underwent surgical treatment and outcomes evaluated, 138 were treated successfully giving an overall success rate of 80.7%.  The success rate was significantly influenced by HIV positivity (p = 0.002). Surgical site infection (SSI) was the most common postoperative complication accounting for 25.8% of cases. The rate of SSI was found to be significantly higher in HIV-positive patients than in HIV-negative patients (39.6% vs 18.5%; p-value = 0.001).

Conclusion: HIV infection is prevalent among patients with acquired anorectal conditions in our setting and influences surgical outcomes. We recommend that all patients with acquired anorectal conditions in this region should be screened for HIV infection.