A prospective evaluation of lower extremity ulcers in a Zimbabwean population

Aetiological factors and their frequencies, causes, level and impact of immunosuppression on outcome of lower extremity ulcers were prospectively recorded. A total of 100 patients were evaluated. Consent for HIV testing was given by 68 patients and 31 (46%) of these were HIV infected. Thirty patients were diabetic. CD 4+ T-lymphocyte count was assessed in 41 patients. Eleven were HIV infected with a mean CD 4+ count of 229 +/- 137 cells/microl. Six had non insulin-dependent diabetes mellitus (NIDDM) with a mean CD 4+ count 430 +/- 308 cells/microl. Five had both HIV infection and NIDDM with a mean CD 4+ count of 299 +/- 120 cells/microl. All three groups differed from the normal 707 +/- 285 cells/microl found in 17 non HIV-infected non diabetic patients (P < 0. 05). The main aetiologies were bacterial infection, arterial disease, trauma and neuropathy. Ulcer healing and limb salvage were noted in 71%. Mortality was 10%; seven in HIV-infected and three in non HIV-infected non diabetic patients (P = 0. 06). Amputation rate was 9%. Persisting ulcers were noted in 8% and 2% were lost to follow-up. Our evaluation shows that wound aetiologies in Zimbabwe differ from those in the West. Immunosuppression because of HIV infection and NIDDM was noted in more than half of the patients. HIV infection may increase mortality in this group of patients.