CLINICAL PROFILE AND WOUND-HEALING OUTCOMES OF ANORECTAL DISEASES AMONG PEOPLE LIVING WITH HIV IN EASTERN SUDAN: A PROSPECTIVE OBSERVATIONAL STUDY
DOI:
https://doi.org/10.37268/mjphm/vol.25/no.3/art.3742Keywords:
Keywords: HIV, AIDS, anorectal disease, hemorrhoids, fistula-in-ano, HPV, wound healing, Eastern SudanAbstract
Anorectal disorders are a common association of HIV/AIDS infection. Sociocultural factors, immune status, and co-infection influence the patient profile. Data from Eastern Sudan remains scarce. This study aims to describe the clinical profile and wound-healing outcomes of anorectal diseases among people living with HIV and to identify predictors of delayed wound healing. This prospective observational study included all adult patients presenting with anorectal disease with confirmed HIV/AIDS infection at Kassala Police Hospital, Eastern Sudan, from June 2013 to June 2023. The prolonged study duration reflects the low regional prevalence of HIV and the referral-based nature of case accrual. Structured forms were used for data collection, including demographic, socioeconomic, and HIV-related variables. Standardised diagnostic criteria were followed. Healing outcomes were defined using objective clinical criteria and categorised as good, fair, or poor. A predefined subgroup of 120 patients with complete follow-up of more than 24 months was used for detailed outcome analysis. A total of 412 people living with HIV with anorectal disease were enrolled. Median age was32 years (interquartile range 26–40), 61.4% were male, and 68.2% lived in rural areas. Median CD4 count was288 cells/µL (interquartile range 168–412). Good adherence to antiretroviral therapy was 58.8%. Independent predictors of delayed healing included CD4 count less than 200 cells/µL (adjusted odds ratio 3.12, 95% confidence interval 1.62–6.01), rural residence (adjusted odds ratio 2.47, 95% confidence interval 1.18–4.91), low income (adjusted odds ratio 2.89, 95% confidence interval 1.41–5.22), human papillomavirus co-infection (adjusted odds ratio 2.41, 95% confidence interval 1.21–4.81), and delayed presentation. Good adherence to antiretroviral therapy was protective (adjusted odds ratio 0.42, 95% confidence interval 0.21–0.83). HIV infection among patients presenting with anorectal diseases in Eastern Sudan predominantly affects young, rural residents and socioeconomically disadvantaged populations. Poor outcomes are linked to immunosuppression, human papillomavirus co-infection, and late presentation. Better outcomes are achieved with good adherence to antiretroviral therapy.
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