Internal Medicine Commons^™

A Prospective Observational Study Of Community Acquired Pneumonia In Kenya: The Role Of Viral Pathogens, Jamila Nambafu, Mary Achakolong, Fridah Mwendwa, Jumaa Bwika, Felix Riunga, Samuel Gitau, Hanika Patel, Rodney Adam

Internal Medicine, East Africa

Background: Lower respiratory tract infections continue to contribute significantly to morbidity and mortality across all age groups globally. In sub-Saharan Africa, many studies of community acquired pneumonia in adults have focused on HIV-infected patients and little attention has been given to risk factors and etiologic agents in an urban area with a more moderate HIV prevalence.

Methods: We prospectively enrolled 77 patients admitted to a 280 bed teaching hospital in Kenya with radiographically confirmed community acquired pneumonia from May 2019 to March 2020. The patients were followed for etiology and clinical outcomes. Viral PCR testing was performed using …

Covid-19 And Mental Well-Being Of Nurses In A Tertiary Facility In Kenya, Sayed Karar, Jasmit Shah, Zohray Talib

Internal Medicine, East Africa

Background: The 2019 coronavirus disease (COVID-19) epidemic is a global health emergency which has been shown to pose a great challenge to mental health, well-being and resilience of healthcare workers, especially nurses. Little is known on the impact of COVID-19 among nurses in sub-Saharan Africa.

Methods: A cross sectional study was carried out between August and November 2020 among nurses recruited from the Aga Khan University Hospital, Nairobi. The survey questionnaire consisted of six components- demographic and work title characteristics, information regarding care of COVID-19 patients, symptoms of depression, anxiety, insomnia, distress and burnout, measured using standardized questionnaires. Multivariable logistic …

Collet-Sicard Syndrome Due To Concurrent Extramedullary Intracranial Plasmacytoma And Jugular Venous Sinus Thrombosis In Multiple Myeloma, Dilraj Sokhi, Caroline Wangui Mithi, Farah Ebrahim, Adil Salyani, Sheila Waa, Riyat Malkit

Internal Medicine, East Africa

In a patient with Collet- Sicard syndrome and multiple myeloma, both extramedullary plasmacytomas and internal jugular vein- sigmoid sinus thrombosis should be consid- ered as they can coexist.

Applying A Mixed-Method Approach To Improve On-The-Job Learning And Job Satisfaction In A Cohort Of Interns At A University Hospital, Amna Subhan Butt, Muhammad Shahzad Shamim, M Asghar Ali, Farah Naz Qamar, Irum Qamar Khan, Swaleha Tariq, Syeda Amrah Hashmi, Quratulain Hafeez, Muhammed Tariq

Section of Gastroenterology

Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern's work-based learning and satisfaction in a university hospital setting.
Methods: Using Kern's six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome …

Frequency And Risk Factors Of Non-Alcoholic Fatty Liver Disease In Helicobacter Pylori-Infected Dyspeptic Patients: A Cross-Sectional Study, Basit Siddiqui, Muhammad Kamran, Shiyam Sunder Tikmani, Rabeea Azmat, Zain Mushtaq, Saad Bin Zafar Mahmood, Muhammad Tahir Khan, Javed Yakoob, Zaigham Abbas

Section of Gastroenterology

Background: In dyspeptic patients with Helicobacter pylori contributes to non-alcoholic fatty liver disease. However, little evidence available from Pakistan.
Objective: The study aims to determine the frequency and risk factors of non-alcoholic fatty liver disease in dyspeptic patients with Helicobacter pylori.
Methods: This cross-sectional study was conducted between 22 November 2016 and 30 June 2018. Adults of age between 18 and 90 years who attended the out-patient department due to abdominal discomfort, pain, fullness, and bloating who underwent upper gastrointestinal tract endoscopy were enrolled after taking informed consent. Patients with celiac disease, inflammatory bowel disease, taking alcohol, pregnant women …

The Discrepancy Between Admission And Discharge Diagnoses: Underlying Factors And Potential Clinical Outcomes In A Low Socioeconomic Country, Samar Fatima, Sara Shamim, Amna Subhan Butt, Safia Awan, Simra Riffat, Muhammed Tariq

Section of Internal Medicine

Objective: The discrepancy between admission and discharge diagnosis can lead to possible adverse patient outcomes. There are gaps in integrated studies, and less is understood about its characteristics and effects. Therefore, this study was conducted to determine the frequency, characteristics, and outcomes of diagnostic discrepancies at admission and discharge.
Design and data sources: This retrospective study reviewed the admitting and discharge diagnoses of adult patients admitted at Aga Khan University Hospital (AKUH), Internal Medicine Department between October 2018 and February 2019. The frequency and outcomes of discrepancies in patient diagnoses were noted among Emergency Department (ED) physician versus admitting physician, …

Triggering And Protective Factors Of Burnout In Medical Resident Physicians In A Lower-Middle-Income Country: A Cross-Sectional Study, Saad Bin Zafar Mahmood, Aqusa Zahid, Noreen Nasir, Munaim Tahir, Uzma Ghouri, Aysha Almas

Section of Internal Medicine

Background: Residents and interns are prone to emotional and physical exhaustion, also known as burnout. Burnout has not been studied much in physicians working in lower-middle income countries. We conducted this study to determine the burden of burnout among internal medicine residents and to identify triggering and protective factors associated with burnout.
Materials and methods: A cross-sectional study was conducted at two institutes in Karachi from 2018 to 2019. All residents registered in the internal medicine program for at least 6 months were invited to participate via an online survey. An abbreviated version of the Maslach Burnout scale was used …

Secondary Hyperparathyroidism And Its Clinical And Biochemical Associated Factors In Patients On Maintenance Hemodialysis In Dar Es Salaam, Doris Samwel

Master of Medicine in Internal Medicine

Background: Chronic kidney disease affects 13.6% of adult people in Tanzania. Secondary hyperparathyroidism is associated with an increase in disability-adjusted life years, cardiovascular mortality, and all-cause mortality worldwide especially in patients on maintenance hemodialysis. Justification: In Tanzania, there is a lack of prevalence data of secondary hyperparathyroidism and the factors associated with it. Knowing the factors associated with it will help in the early screening of our patients and intervene early before its complications arise. Objectives: This study aimed to assess the magnitude of secondary hyperparathyroidism and its association with clinical and biochemical variables and further to measure the association …

The Contribution Of Dysphagia To Acute Stroke Morbidity And Mortality In Nigeria: A Prospective Study, O O. Olajide, Philip Adebayo, F T. Taiwo, M O. Owolabi, A Ogunniyi

Internal Medicine, East Africa

Background: The assessment of time-trend morbidity and mortality in acute stroke is critical to clinical policy decisions and resource allocation.

Objectives: To determine the prevalence of dysphagia in acute stroke and the impact of dysphagia on short term stroke outcome (30 days post-stroke).

Methods: This was a prospective longitudinal study. Bedside screening for dysphagia modified Rankin score (MRS) and Barthel Index (BI) were performed on acute stroke patients on day 1, day 7, day 14 and day 30 after stroke to determine the frequency of dysphagia. Patients with dysphagia were then compared with age- and gender-matched controls (stroke patients without …

Morphological Spectrum Of Vesiculobullous Skin Lesions: An Institutional Perspective, Javaria Ali, Sabeeh Islam, Syed Munqaad Ali, Syed Rafay Yaqeen, Anum Aslam, Qurat Ul Ain Khan, Umair Arshad Malik, Muhammad Irfan, Hanna Naqvi, Atif A. Hashmi

Section of Internal Medicine

Introduction: A vesiculobullous lesion of the skin encompasses a group of dermatological disorders with protean clinicopathological features. They usually occur as a part of the spectrum of various infectious, inflammatory, drug-induced, genetic, and autoimmune disorders. Therefore, accurate diagnosis of these lesions is essential for appropriate management and to reduce the associated morbidity and mortality. The conventional skin punch biopsy is the mainstay in the diagnosis of dermatological diseases, especially when combined with confirmatory tests, such as direct immunofluorescence (DIF). Our study evaluated the clinicopathological spectrum of vesiculobullous lesions.
Methods: We studied 150 cases of vesiculobullous lesions at the Department of …

Acuity Level Of Care As A Predictor Of Case Fatality And Prolonged Hospital Stay In Patients With Covid-19: A Hospital-Based Observational Follow-Up Study From Pakistan, Aysha Almas, Zain Mushtaq, Jette Moller

Section of Internal Medicine

Objectives: To determine if there is an association between acuity level of care (ALC), case fatality and length of stay in patients admitted to hospital due to COVID-19.
Design: A hospital-based observational follow-up study.
Setting: Internal Medicine Service of the Aga Khan University Hospital, Pakistan, from 26 February 2020 to 30 June 2020.
Participants: Adult patients with confirmed COVID-19, aged ≥18 years.
Methods: ALC was categorised into low, intermediate and high level and patients were triaged using the standard emergency severity illness score. All patients were followed until the end of hospital admission for the outcome of case fatality and …

Predictors Of Iron Consumption For At Least 90 Days During Pregnancy: Findings From National Demographic Health Survey, Pakistan (2017-2018), Sumera Aziz Ali, Savera Aziz Ali, Shama Razzaq, Nayab Khowaja, Sarah Gutkind, Fazal Ur Rehman, Nadir Suhail

Section of Internal Medicine

Background: Iron supplementation is considered an imperative strategy for anemia prevention and control during pregnancy in Pakistan. Although there is some evidence on the predictors of iron deficiency anemia among Pakistani women, there is a very limited understanding of factors associated with iron consumption among Pakistani pregnant women. Thus, this study aimed to investigate the predictors of iron consumption for at least ≥90 days during pregnancy in Pakistan.
Methods: We analyzed dataset from the nationally representative Pakistan Demographic Health Survey 2017-2018. The primary outcome of the current study was the consumption of iron supplementation for ≥90 days during the pregnancy …

The Requirements Of Immunosuppressive Therapy And Clinical Features In Patients With Myasthenia Gravis Who Undergo Thymectomy Versus Non Thymectomy Management In East Africa, Nyawara Anthony Ochola

Master of Medicine in Internal Medicine

Background: Myasthenia gravis is an acquired autoimmune neuromuscular disease leading to fatigability of skeletal muscles. The thymus produces autoantibodies that target receptors to Acetylcholine or Muscle Specific Kinase. The resultant fatigability is generalized or limited to the ocular or bulbar muscles. Therapy has been targeted to reduce the autoimmune process by use of immunosuppressive agents or by thymectomy. In the African population, MG involves younger patients, more ocular involvement, is more aggressive and more resistance to immunosuppressive therapy. Methods: We conducted a retrospective study between January 2009 and December 2019 at Aga Khan University Hospital, Nairobi. Medical records of patients …

Characterization Of Young Hypertensive Patients Aged Between 18 – 40 Years, Kelvin Orare Nyanchoka

Master of Medicine in Internal Medicine

Background: Hypertension is the world’s most significant risk factor for morbidity and mortality. Sub-Saharan Africa has the highest prevalence of hypertension worldwide. In Kenya, the estimated overall prevalence of hypertension is at 24.5%. Young adult hypertensive patients have a lower proportion of controlled blood pressure compared to older adults. Uncontrolled hypertension, irrespective of age, increases cardiovascular risk. Methods: A total of 401 patients aged between 18 and 40 years were identified from the records department based on the ICD-10 codes for hypertension. Using their hospital identification numbers, files were sorted and analyzed including laboratory data on the hospital information management …

Bleeding Complications In Patients On New Oral Anticoagulants For Venous Thromboembolism In Kenya, Antonina Zebby Obayo

Master of Medicine in Internal Medicine

Background: The past five years have seen an increase in the use of new oral anticoagulants (NOACS) for treatment and prophylaxis against venous thromboembolism. These agents are as effective as warfarin, with much fewer bleeding complications. The incidence of bleeding complications in patients with venous thromboembolism on NOACS (New oral anticoagulants) has not been widely studied in Africa's contemporary practice. The purpose of this study is to determine the rates of major bleeding and clinically relevant non-major bleeding (CRNM) associated with new oral anticoagulant use in daily contemporary clinical practice. Methods: A retrospective review of adult patients diagnosed with venous …

Performance In Mortality Prediction Of Saps 3 And Mpm0-Iii Scores Among Adult Patients Admitted To The Icu Of A Private Tertiary Referral Hospital In Tanzania, Nadeem Kassam

Master of Medicine in Internal Medicine

Background Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the intensive care unit. They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified acute physiology score (SAPS 3) and Mortality probability models (MPM0-III) in predicting ICU outcome as well as identified disease pattern and clinical factors associated with increased mortality. Methods This was a retrospective cohort study of adult patients admitted to the Intensive Care Unit (ICU) of the Aga Khan …

Correlation Between Disease Severity And Health-Related Quality Of Life Among Patients With Fibromyalgia Syndrome, Janet Chebet Koros

Master of Medicine in Internal Medicine

Background: Fibromyalgia Syndrome is a rheumatic disorder characterized by chronic widespread musculoskeletal pain accompanied by fatigue, sleep, memory problems, and mood disturbances. Little is known about the characteristics of fibromyalgia patients in Kenya. Studies done elsewhere have shown that patients with fibromyalgia syndrome incur more healthcare costs, have a higher prevalence of comorbidities, have more workdays missed, have poor productivity, retire early, have impaired function, and lead a poorer quality of life. Methods: This study was a prospective cross-sectional study that enrolled patients diagnosed with fibromyalgia syndrome attending the rheumatology clinic at the Aga Khan University Hospital Nairobi, Kenya. Those …

Clinical Characteristics And Outcomes Of Covid-19: Experience At A Major Tertiary Care Center In Pakistan, Nosheen Nasir, Kiren Habib, Iffat Khanum, Naveera Khan, Zehra Abdul Muhammad, Syed Faisal Mahmood

Section of Internal Medicine

Introduction: Limited data exist on clinical characteristics and outcomes of hospitalized COVID-19 patients in low-middle income countries. We aimed to describe the clinical spectrum and outcomes of hospitalized COVID-19 patients at a tertiary-care center in Karachi, Pakistan.
Methodology: We conducted an observational study of adult COVID-19 patients hospitalized between February-June 2020. Patients with a discharge diagnosis of COVID-19 and PCR positivity were included. We created logistic regression models to understand association of clinical characteristics with illness severity and in-hospital mortality.
Results: The study population comprised 445 patients [67% males, median age 53 (IQR 40-64) years]. Majority of patients (N = …

Intimate Partner Violence Is A Barrier To Antiretroviral Therapy Adherence Among Hiv - Positive Women: Evidence From Government Facilities In Kenya, Bornice C. Biomndo, Alexander Bergmann, Nils Lahmann, Lukoye Atwoli

Internal Medicine, East Africa

Introduction: Intimate Partner Violence (IPV) is linked to low engagement with HIV management services and adverse clinical outcomes, including poor ART adherence. In sub-Saharan Africa, studies on pregnant/postpartum women and transactional sex workers have produced divergent evidence regarding IPV’s association with poor ART adherence. We investigate this association among a broad group of women.

Methods: We sampled 408 HIV-positive women receiving free ART from different types of HIV clinics at government health facilities, assessing for IPV exposure by a current partner, ART adherence rate, and other factors that affect ART adherence (e.g. education, disclosure). ART adherence rates were measured using …

Hepatic Candidiasis In An Immunocompetent Patient: A Diagnostic Challenge, Zorays Moazzam, Amman Yousaf, Zahid Iqbal, Ahmad Tayyab, Muhammad Hashim Hayat

Medical College Documents

Hepatic candidiasis is a manifestation of disseminated candidiasis, which typically presents in immunocompromised patients. Focal hepatic candidiasis in immunocompetent patients, however, is infrequent/extremely rare. We present the case of an immunocompetent female patient who presented with respiratory distress and right-sided pleural effusion. The pleural fluid tap did not grow anything, and a contrast-enhanced computed tomography (CT) scan revealed a right liver lobe subcapsular collection. CT-guided aspiration and culture resulted in Candida albicans growth. The patient responded to oral fluconazole, and a follow-up CT scan demonstrated resolution of the collection. Although hepatic candidiasis rarely occurs in immunocompetent patients, it should be …

Association Of Vitamin D Deficiency And Disease Activity In Systemic Lupus Erythematosus Patients: Two-Year Follow-Up Study, Ainan Arshad, Saad Bin Zafar Mahmood, Ahmed Ayaz, Adil A. Manji, Akash Kumar Ahuja

Section of Internal Medicine

Objectives: This study aims to determine the prevalence of vitamin D deficiency in Pakistani systemic lupus erythematosus (SLE) patients and the effect of vitamin D deficiency on the severity and outcomes of SLE.
Patients and methods: This retrospective study evaluated SLE patients presenting to our hospital between January 2009 and December 2018. A total of 98 patients (13 males, 85 females; mean age 39.8±14.9 years; range, 16 to 73 years) with vitamin D levels available at the time of diagnosis were included in the study. Disease activity was measured using SLE disease activity score at the time of diagnosis and …

Knowledge And Attitude Towards Identification And Management Of Sepsis Among Resident Physicians In A Tertiary Care Teaching Hospital In Pakistan, Ainan Arshad, Abdul Aziz, Ahmed Ayaz, Syed Maaz Salahuddin, Bushra Jamil

Section of Internal Medicine

This study was conducted to determine the compliance and knowledge of sepsis guidelines among resident physicians in a tertiary care hospital of a developing country. A self-structured validated questionnaire was prepared to evaluate compliance and knowledge of the Surviving Sepsis Campaign (SSC) guidelines. A total of 76 resident physicians completed the questionnaire; out of these, 51 (67%) were from Internal Medicine department and 25 (33%) were from Emergency Medicine department of the Aga Khan University Hospital, Karachi. A total of 71 (93%) participants claimed to be aware of the SSC guidelines but only 20 (26%) considered themselves very knowledgeable on …

Bilateral Systematised Epidermolytic Epidermal Nevus: A Case Report, Sabeika R. Kerawala, Najam-Us-Saher Rizvi, Saadia Tabassum

Section of Internal Medicine

Verrucous epidermal nevi (VEN) are benign congenital hamartomas consisting of keratinocytes. Histological examination mostly exhibits hyperkeratosis, acanthosis, papillomatosis and, rarely, the features of epidermolytic hyperkeratosis (EHK). We report a case of a 6-year-old boy who presented at Aga Khan University Hospital, Karachi, Pakistan with bilaterally symmetrical linear epidermal nevi following Blaschko's lines and showing epidermolytic hyperkeratosis on histology. The patient was treated with topical keratolytics and emolients which led to considerable improvement. To the best of the authors' knowledge, this is the first report of VEN from Pakistan.

Heidenhain Variant Of Sporadic Creutzfeldt-Jakob Disease: First Reported Case From East Africa, Dilraj Sokhi, Fazal Yakub, Karishma Sharma, Sheila Was, Peter Mativo

Internal Medicine, East Africa

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare prion disease that causes rapidly progressive fatal neurodegeneration. The rarer Heidenhain variant of sCJD presents with visual symptoms and is rarely reported in the literature from sub-Saharan Africa. We report the case of a 57-year-old male with a three-week history of losing direction when driving home and visual hallucinations described as seeing rainbows. Magnetic resonance imaging (MRI) of the brain revealed unilateral parieto-occipital sulcal hyperintensities with restriction on diffusion-weighted imaging (DWI), and electroencephalography (EEG) showed right para-central slowing leading to an initial diagnosis of non-convulsive status epilepticus. He was treated with anti-epileptic medication …

Subcutaneous Emphysema And Pneumomediastinum In Patients With Covid-19 Disease; Case Series From A Tertiary Care Hospital In Pakistan, Sher Sethi, Amber Sabeen Ahmed, Sadaf Hanif, Masooma Aqeel, Ali Bin Sarwar Zubairi

Section of Internal Medicine

Since December 2019, the clinical symptoms of coronavirus disease 2019 (COVID-19) and its complications are evolving. As the number of COVID patients requiring positive pressure ventilation is increasing, so is the incidence of subcutaneous emphysema (SE). We report 10 patients of COVID-19, with SE and pneumomediastinum. The mean age of the patients was 59 ± 8 years (range, 23-75). Majority of them were men (80%), and common symptoms were dyspnoea (100%), fever (80%) and cough (80%). None of them had any underlying lung disorder. All patients had acute respiratory distress syndrome on admission, with a median PaO2/FiO2 ratio of 122.5. …

The Association Of Chest Radiographic Findings And Severity Scoring With Clinical Outcomes In Patients With Covid-19 Presenting To The Emergency Department Of A Tertiary Care Hospital In Pakistan, Raima Kaleemi, Kiran Hilal, Ainan Arshad, Russell S. Martins, Avinash Nankani, Tanveer Ul Haq, Sundas Basharat, Zeeshan Ansar

Department of Radiology

Introduction: While chest x-rays (CXRs) represent a cost-effective imaging modality for developing countries like Pakistan, their utility for the prognostication of COVID-19 has been minimally explored. Thus, we describe the frequency and distribution of CXR findings, and their association with clinical outcomes of patients with COVID-19.
Methods: All adult (≥ 18 years) patients presenting between 28th February-31st May to the emergency department of a tertiary care hospital in Pakistan, who were COVID-19 positive on RT-PCR with CXR done on presentation, were included. A CXR Severity Score (CXR-SS) of 0-8 was used to quantify the extent of pulmonary infection on CXR, …

Assessment Of Palliative Care Needs In A Kenyan Intensive Care Unit Based On A Trigger-Based Model., Linda Atero Barasa

Master of Medicine in Internal Medicine

Background: Palliative care triggers have been used in the Intensive Care Unit (ICU) setting, usually in high-income countries, to identify patients who may benefit from palliative care consults. The utility and benefits of palliative care triggers in the ICU have not been previously studied in sub-Saharan Africa. Objectives: The primary objective of this study was to estimate the prevalence of ICU admissions who meet the criteria for one or more palliative care triggers. The secondary objectives were to determine an association between palliative care consults and length of ICU stay, mortality, and time to formal change of goals of care …

Compliance Of Checking Hba1c In A Tertiary Care Hospital Of Pakistan, Abdul Aziz, Syed Ahsan Ali

Section of Diabetes, Endocrinology and Metabolism

Background and objectives: The prevalence of diabetes mellitus worldwide was 171 million one and half decade ago, while the prediction is 366 million patients by 2030 and more than 640 million people by 2040. HbA1c value represents average blood glucose over the past 2-3 months and accounts for both pre-prandial and post-prandial blood glucose levels. A link between HbA1c and diabetic complications has been confirmed. In general, patients with controlled diabetes mellitus should have at least biannual testing, while patients with uncontrolled diabetes mellitus or unmet glycemic targets should be tested every three months. The objective was to see compliance …

Prevalence And Severity Of Malnutrition In People Living With Hiv On Chronic Haemodialysis In Dar Es Salaam., Hanifa Mbithe

Master of Medicine in Internal Medicine

BACKGROUND: Human immunodeficiency virus is still a global burden more so in sub-Saharan Africa. Chronic kidney disease and end-stage renal disease are important comorbid conditions that are prevalent in HIV-infected individuals. Patients who are HIV positive and on hemodialysis have triple risk factors for development of malnutrition (i.e. Human immunodeficiency virus, chronic kidney disease, and haemodialysis). Malnutrition greatly impacts these patient’s morbidity and mortality and thus the great need to address this gap which will improve their prognosis. OBJECTIVE: The objective of the study was to assess the prevalence and severity of malnutrition in people living with HIV on chronic …

Occult Hepatitis B Virus Infection In A Kenyan Cohort Of Hiv Infected Anti-Retroviral Therapy Naïve Adults, Adil Salyani, Jasmit Shah, Rodney Adam, George Otieno, Evelyn Mbugua, Reena Shah

Internal Medicine, East Africa

Background: Occult hepatitis B virus (HBV) infection (OBI) is a phase of HBV infection characterised by the presence of HBV DNA in the absence of detectable hepatitis B surface antigen (HBsAg). OBI is of concern in the HIV-infected due to high prevalence and risk of HBV reactivation. The prevalence and clinico-demographic characteristics of OBI in anti-retroviral therapy (ART) naïve HIV infected adults in Kenya is unknown.

Methods: A cross sectional study carried was out at three sites in Kenya. HIV infected ART naïve adults were enrolled and demographic data collected. Blood samples were assayed for HBsAg, HBV DNA, alanine aminotransferase, …