Immunovirological treatment outcomes after 2 years of antiretroviral therapy in children living with the human immune deficiency virus in Lagos Nigeria

Background/objective: The World Health Organization (WHO) recommends routine assessment of antiretroviral treatment outcomes to detect  treatment failure early and prevent the development of drug resistance. The aim of this study was to describe treatment outcomes of antiretroviral therapy (ART) over 2 years in children living with the human immune deficiency virus enrolled in the paediatric HIV clinic at the Lagos UniversityTeaching Hospital (LUTH).Materials and methods: This was a retrospective study of antiretroviral treatment outcomes in 278 children receiving antiretroviral therapy at the paediatric HIV clinic of LUTH. Demographic, clinical and laboratory data were retrospectively collected from clinical records of pediatric patientswho received antiretroviral therapy for 2 years ( from November 2015 to December 2017) . Virological failure was defined as viral load > 400  copies/ml and immunological failure was defined as a CD4 count <100 cells/mm3 or CD4 % <15% after receiving antiretroviral agents for 12 months. Data was analysed using graph pad prism version 5.0.Results: After 12 months on antiretroviral therapy (ART), 101 (36%) had virological failure while 14 (5%) and 36 (13%) failed immunologically [CD4 count <100 cells/mn3 and CD4 <15% respectively]. Virological blips were observed at 24 months in 6.1% of patients while immunovirological discordance occurred in 30% of patients (poor virological clearance despite good immunological recovery) . High baseline viral load (>5000  copies/ml), poor adherence (<95%) and low baseline CD4 counts (101-249 cells/mn3) were significantly associated with virological failure, while low baseline CD4 counts (<350 cells/mn3) and poor adherence (<95%) were significantly associated with immunologic failure.Conclusion: The treatment outcomes observed in this study are similar to those reported in earlier studies. At 1 and 2 years of antiretroviral therapy , there was immune restoration however 101 (36%) and 87 (31%) respectively had virological failure despite good adherence to therapy and good Immunological restoration. This calls for early initiation and switch to second and third line drugs . Key words: Human immunodeficiency virus (HIV), zidovudine, lamivudine, nevirapine, virological blips, immunovirological discordance , children, Nigeria

Adult Squamous Cell Carcinoma of The Scrotum in HIV Positive Patients in Nigeria

Squamous cell carcinoma of the scrotum (SCCS) is rare, particularly in West Africa. It usually affects males older than 60 years. Although it was the first cancer to be linked to environmental factors, the mechanism of action of these risk factors is still not completely understood. We reporton 4 men who presented with SCCS at our centre during a 20-month period. Three patients were relatively younger (mean age 43 years) and tested positive for human immunodeficiency virus (HIV) infection. They had no history of exposure to any known risk factor for SCCS. Thus, it seems that SCCS may occur in younger men who have HIV infection.Key Words:   Squamous cell carcinoma, scrotum, HI

Transfusion of the dangerous universal donor blood leading to maternal mortality: a case report

Background: In a health-care setting in which group-identical donor blood is not always available for transfusion, group O whole blood, in the obsolete concept of its being a universal donor, is sometimes given to group A and B recipients without necessary precautions.Objectives: The objective is to draw attention to the danger of transfusing group A or B recipients with group O blood.Materials and methods: The case is presented of a multiparous blood group A pregnant woman who was transfused with whole blood group O. The woman developed a haemolytic blood transfusion reaction, which led to intravascular haemolysis, disseminated intravascular coagulation, multiple organ failure and death.Conclusion and recommendation: Whenever group-identical compatible blood is not available, and group O blood has to be given to a group A or B recipient, haemolysin test must be included in the pre-transfusion tests, and blood should be given preferably as red cell concentrate.Keywords: Transfusion, maternal, mortality, bloo

Sensitivity and specificity of copper sulphate test in determining fitness of blood donors

Background: The accuracy of the copper sulphate method for the rapidscreening of prospective blood donors has been questioned because this rapid screening method may lead to false deferral of truly eligible prospective blood donors.Objective: This study was aimed at determining the sensitivity and specificity of copper sulphate specific gravity test for haemoglobin estimation as a determinant of fitness for blood donation at Lagos University Teaching Hospital, Lagos, Nigeria (LUTH).Methods: This study was a case control study carried out at LUTH between March and April, 2012. Subjects (n=263) recruited were classified into unfit donors/study group (n=153) and fit donors/control group (n=110). 5ml of venous blood withdrawn from each subject in EDTA bottle were used for full blood count analysis using the Haemoglobin auto-analyzer (Sysmex KX21, USA®) as a reference test for Haemoglobin determination.Results: The mean Haemoglobin, PCV and MCHC of the control group were significantly higher (P<0.05) than that of the study group. MCV and MCH were not significantly different (P>0.05). The sensitivity and specificity of the copper sulphate specific gravity method were found to be 40.52% and 86.4% respectively while the positive and negative predictive values were 80.5% and 50.1% respectively.Conclusion: The sensitivity, specificity, PPV and NPV of Copper sulphate test to determine fitness of donation were too low to recommend it. It is recommended that more sensitive methods such as automated haematology analyzer should be encouraged.Keywords: Copper Sulphate specific gravity method, Blood donors, Haemoglobi

Blood transfusion service in a tertiary hospital in sub- Saharan Africa during the COVID 19 pandemic: Experience from Lagos University Teaching Hospital, Nigeria

Blood transfusion services are as pivotal to the health system during a pandemic as before the pandemic. The effect of a pandemic ontransfusion services depends on the nature, potential for community spread and risk of transfusion transmissibility. As the total number of cases and deaths from COVID-19 rises, and to prevent the community spread of the SARS‐CoV‐2 virus, governments worldwide, as well as the Nigerian government, announced national lockdowns. Lockdowns have affected blood transfusion services. In Nigeria, blood transfusion services are still decentralized and tertiary health centres run independent transfusion units. The Lagos University Teaching Hospital blood transfusion unit was also impacted by the pandemic and the consequent lockdown. The major challenges experienced are in recruitment of voluntary blood donors, follow‐up of donors and patients with concomitant reduction in blood and blood component  supply derived from family replacement donation, inventory and consumable management, staff safety and adequacy for emergency work. These challenges were compounded by the inadequate infrastructure and policies at the outset of the pandemic. Countries in sub-Saharan Africa should invest in health infrastructure and their transfusion services and encourage local manufacture of basic laboratory reagents and consumables. The blood transfusion services and units should put in place strategic continuity of operations plans (COOP) to respond adequately to challenges generated during a pandemic which should focus on shortage, wastage and supply of blood and components in a cost‐effective manner and human resource management.   French title: Service de transfusion sanguine dans un hôpital tertiaire en Afrique subsaharienne pendant la pandémie COVID 19: Expérience de l'hôpital universitaire de Lagos, Nigéria Les services de transfusion sanguine sont aussi essentiels au système de santé pendant une pandémie qu'avant la pandémie. L'effet d'une pandémie sur les services transfusionnels dépend de la nature, du potentiel de propagation communautaire et du risque de transmissibilité transfusionnelle. Alors que le nombre total de cas et de décès dus au COVID-19 augmente et pour empêcher la propagation communautaire du virus SRAS-CoV-2, les gouvernements du monde entier, ainsi que le gouvernement nigérian, ont annoncé des verrouillages nationaux. Les verrouillages ont affecté les services de transfusion sanguine. Au Nigéria, les services de transfusion sanguine sont encore décentralisés et les centres de santé tertiaires gèrent des unités de transfusion indépendantes. L'unité de transfusion sanguine de l'hôpital universitaire de Lagos a également été touchée par la pandémie et le verrouillage qui en a résulté. Les principaux défis rencontrés concernent le recrutement de donneurs de sang volontaires, le suivi des donneurs et des patients avec une réduction concomitante de l'approvisionnement en sang et en composants sanguins provenant du don de remplacement familial, la gestion des stocks et des consommables, la sécurité du personnel et l'adéquation au travail d'urgence. Ces défis ont été aggravés par des infrastructures et des politiques inadéquates au début de la pandémie. Les pays d'Afrique subsaharienne devraient investir dans les infrastructures de santé et leurs services de transfusion et encourager la fabrication locale de réactifs et de consommables de laboratoire de base. Les services et unités de transfusion sanguine devraient mettre en place des plans stratégiques de continuité des opérations (COOP) pour répondre de manière adéquate aux défis générés pendant une pandémie, qui devraient se concentrer sur la pénurie, le gaspillage et l'approvisionnement en sang et en composants de manière rentable et la gestion des ressources humaines

The relationship between zidovudine, lamivudine and nevirapine plasma drug levels and antiretroviral treatment outcomes in Nigeria children living with HIV

Plasma concentrations of antiretrovirals are significant and important determinants of treatment failure and toxicity. The relationship between antiretroviral pharmacokinetic exposures and immunovirological outcomes has not been extensively studied in our setting. The aim of this study was to investigate the relationship between antiretroviral plasma concentrations and virological and immunological treatment outcomes in children living with human immunodeficiency virus (HIV) A retrospective collection of demographic, clinical , laboratory data and a prospective determination of plasma drug concentrations in 120 children aged 2-14 years after two years of receiving fixed dose zidovudine, lamivudine and nevirapine tablets using a simple, rapid, sensitive and validated method of high performance liquid chromatography with UV detection for simultaneous quantification of zidovudine, lamivudine and nevirapine in human plasma. All analyses were performed using graph pad prism version 5.0. A perfect agreement (p<.001) was found between nevirapine drug levels and prescriptionrefill visit adherence records (Kappa 0.093). Plasma zidovudine, lamivudine and nevirapine concentrations were not statistically associated with virological success (Viral load <400copies/μl ) and immunological success (CD4 cells >100 cells/mm3). At 2 years zidovudine, lamivudine and nevirapine therapeutic levels, zidovudine supra therapeutic levels ,and nevirapine subtherapeutic levels were respectively significantly associated with immunologic success (CD4%>15 %). Low nevirapine levels can be used to identify those that require adherence counseling. Despite good virological and immunological outcomes, plasma concentrations of zidovudine, lamivudine and nevirapine were not significantly associated with virological and immunological outcomes (Absolute CD4 counts) but was significantly associated with immunological outcomes (CD4%). Plasma drug levels may be good surrogates of adherence but not of treatment outcomes. Monitoring CD4% remains important to optimize paediatric HIV treatment.Keywords: Antiretroviral treatment, children, therapeutic drug monitoring, treatment outcomes, immune-virological outcomes, plasma concentrations, zidovudine, lamivudine and nevirapin

Pattern of demographic risk factors in the seroprevalence of Anti-Toxopasma Gondii antibodies in HIV infected patients at the Lagos University Teaching Hospital

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