Demographic and epidemiological characteristics of HIV opportunistic infections among older adults in Nigeria

Background: In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them.Objectives: To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria.Methods: Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan.Results: Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13).Conclusion: There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa.Keywords: HIV/AIDS, older adults, epidemiological characteristics, opportunistic infections, Nigeri

EPIDEMIOLOGY OF BACTERIA COLONIZATION AND ICU-ACQUIRED INFECTION IN A NIGERIAN TERTIARY HOSPITAL

Background: Health care associated infection (HCAI) or Hospital acquired infection is associated with significant morbidity, mortality and cost. The incidence is about 6% and disproportionately higher in critically ill patients who may have been immune-compromised with many invasive procedures already performed. Prevention of HCAI and appropriate management of patients in the intensive care unit (ICU) requires knowledge on the pattern of microbial colonization and infections. The aim of this preliminary study was to provide current data on the pattern of ICU acquired infections in our hospital. Patients and Methods: It was a cross sectional study of patients admitted into the ICU who were expected to stay longer than 48hrs between July 2011 and September 2012. Urine, blood, and tracheal aspirate were collected on days 1, 3 and 5 for microbiological studies. All patients involved in the study had urethral catheter in-situ and received mechanical ventilation in the ICU. Results: Fifty-nine patients were recruited into the study. The mean age of the patients was 30.08 + 19.9yr; while the reasons for admissions were respiratory failure (59.3%), cardiovascular instability, trauma and neurological diseases. About 30% of the samples taken from the study sites on arrival in the ICU had positive culture yields. Organisms cultured included Klebsiella oxytoca, Staphylococcus aureus, and Pseudomonas aeruginosa. The urinary tract had the highest number of isolated organisms- 9(60%), followed by equal number of isolated organisms-3(20%) in the blood and respiratory tract. Eleven (73.3%) of the organisms isolated were Gram-negative bacteria, and 4 (26.7%) were Gram-positive cocci. The commonest bacteria isolates were Staphylococcus aureus (4/26.7%) and Klebsiella oxytoca (4/ 26.7%). A total of 15 ICU- acquired infections were detected in 9 of 59 patients. Conclusion: The HCIA infection rate was 15%, and urinary tract infections (UTI) was the commonest hospital acquired infection in our ICU. Klebsiella oxytoca and Staphylococcus aureus were the commonest organisms

Demographic and epidemiological characteristics of HIV opportunistic infections among older adults in Nigeria.

Background: In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them. Objectives: To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria. Methods: Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan. Results: Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13). Conclusion: There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa

Défis culturels et éthiques des technologies de la reproduction assistées dans le traitement de la stérilité chez les Yoruba du sud-ouest du Nigéria

This paper discusses the cultural and ethical issues arising from the use of Assisted Reproductive Health Technologies. Twenty-five In-depth interviews were conducted with 5 couples of reproductive age who have never conceived or brought pregnancy to term after one year of unprotected intercourse, 4 adult males, 4 adult females, a gyneacologist, a nurse, a herbalist and 2 religious leaders in Ibadan, Nigeria. Content analysis was used for data analysis. Legitimacy of children born through ART, religious obligation, patriarchy, polygamy and value of children are cultural issues surrounding ARTs while decision making about it, discrimination against children born through ART, psychological problems and loss of self esteem, side effects of the technologies and the cost of accessing them are the ethical challenges. The findings have methodological implications for conducting infertility research in non-western societies.Cette étude discute les problèmes culturels qui proviennent de l'emploi des technologies de la santé de la reproduction aussi bien que les défis qui en résultent. Nous avons recueilli vingt – cinq interviews en profondeur au sein de 5 couples en âge d'avoir des enfants mais qui n'ont jamais été enceinte ou dont la grossesse n'est jamais arrivée à terme après une année des rapports sexuels non protégés, 4 mâles adultes, 4 femmes adultes, un gynécologue, une infirmière, un herboriste et deux pasteurs à Ibadan, Nigeria. On s'est servi de l'analyse du contenu pour analyser les données. La légitimité des enfants nés à l'aide des TRAs, les obligations religieuses, le patriarcat, la polygamie et la valeur des enfants, sont des problèmes culturels autour des TRAs alors que la prise de décision à son égard, la discrimination contre les enfants nés à l'aide des TRAs, les problèmes psychologiques et la perte de l'amour–propre, les effets secondaires des technologies et le coût de l'évaluation sont les défis éthiques. Les résultats ont des implications méthodologiques pour la recherche sur la stérilité dans les sociétés non occidentales

Sero-Prevalence of HIV Infection Among Commercial Sex Workers in Ibadan, Nigeria

Context: Commercial sex workers (CSWs) are an important group for the transmission of human immunodeficiency virus (HIV) infection all over the world. In view of the upsurge in the prevalence of HIV in Nigeria, it is desirable to determine the magnitude of their contribution to the problem and how to incorporate them into control efforts. Objective: The main objective of this study was to determine the sero-prevalence of HIV infection among commercial sex workers (CSWs) in Ibadan, Nigeria. Study Design: This was a cross-sectional survey involving 169 CSWs that were randomly selected from 18 brothels in Ibadan and 136 other women without HIV-related symptoms who visited the Special Treatment Clinic, University College Hospital Ibadan who served as the control group. Results: Of the 169 CSWs investigated, 58 (34.3%) had HIV infection whilst only 3 (2.2%) of the control subjects were seropositive for HIV, a highly statistically significant difference (p < 0.000001). Vaginal candidiasis was the most common STD diagnosed in both CSWs and the control subjects. All the 13 CSWs that had scabies, 4 (36.4%) of those with genital warts and 19 (67.9%) of those with genital ulcers had HIV infection. Apart from HIV infection, the only condition that was markedly more prevalent among the CSWs was genital ulcer (16.6% vs 1.5%; p < 0.0001). Conclusion: These findings indicate a high seroprevalence of HIV among CSWs in Ibadan and the need to direct efforts to prevent them from spreading it further in the population. Key Words: HIV, Seroprevalence, Commercial Sex Workers. [Trop J Obstet Gynaecol, 2003, 20: 12-15

Cryptosporidiosis In Hiv Infected Patients With Diarrhoea In Osun State Southwestern Nigeria

Aim: Although cryptosporidiosis is said to be rare among adult HIV patients in certain parts of Nigeria, there are no documented studies on the occurrence of this parasite among HIV patients in Southwestern Nigeria. Methods: We conducted a cross sectional study involving 150 patients (100 HIV infected and 50 HIV negative) with diarrhoea from two tertiary and one secondary health institutions in Southwestern Nigeria. Concentrated stool sample from each patient was screened for cryptosporidium oocysts with the modified cold Ziehl Neelsen method while direct sample was screened for other enteric parasites. Results: The overall parasite prevalence rate in the diarrhoea patients is 79.3% (119/150) with Cryptosporidium parvum 52.7%, Ascaris lumbricoides 11.3%, Hookworm 3.3%, Trichuris trichura 2% and Entamoeba histolytica 10%. The parasite prevalence rate in HIV infected patients is 97% while in HIV-negative patients, the rate is 44%. The rate is significantly higher among HIVinfected patients with diarrhoea than among HIV-negative patients with diarrhoea (OR=41.152, 95%CI=11.467-147.68, P<0.0001). However this difference is attributed to Cryptosporidium which was found exclusively among HIV-infected patients. When Cryptosporidium prevalence was excluded from analysis, the parasite prevalence rates between the two groups was not significantly different (X2=0.8002, df=3, P=0.8494). Conclusion: Contrary to a previous report of apparent rarity of cryptosporidium infections in certain parts of Nigeria, this study revealed a high prevalence of this parasitosis among HIV infected patients in Southwestern Nigeria

Prior subclinical histoplasmosis revealed in Nigeria using histoplasmin skin testing

Disseminated histoplasmosis is an AIDS-defining illness. Histoplasmosis is commonly misdiagnosed as tuberculosis. Nigeria has the second highest number of people living with HIV/AIDS in Africa. The present study was carried out to investigate the prevalence of skin sensitivity amongst Nigerians to histoplasmin.A cross-sectional study was conducted in six centres across five geopolitical zones of Nigeria.We recruited both healthy non-HIV and HIV-positive adults with CD4 count ≥ 350 cells/mm3 regardless of their ART status from March to May 2017. Skin tests were performed intradermally; induration ≥5 mm were considered to be histoplasmin positive.750 participants were recruited from Lagos (n = 52), Yola (n = 156), Ilorin (n = 125), Calabar (n = 120), Ibadan (n = 202) and Benin (n = 95). 467 (62.3%) were HIV negative, 247 (32.9%) were HIV positive and 36 (4.8%) did not know their HIV status. A total of 32/735 (4.4%) participants had a positive skin test. Study centre (p<0.001), education (p = 0.002) and age (p = 0.005) appeared to be significantly associated with positive skin reactivity at the 0.5% significance level, while sex (p = 0.031) and occupation (p = 0.031) would have been significant at the 5% significance level. Males had a higher rate of reactivity than females (p = 0.031, 7% vs 3%). The highest positive rates were recorded from Benin City (13/86 (15%)) and Calabar (7/120 (6%)) and no positives were recorded in Lagos (p<0.001). HIV status was not statistically significant (p = 0.70).Histoplasmosis diagnostics should be included in the Nigerian HIV guidelines. Epidemiological vigilance of progressive disseminated histoplasmosis should be considered by local health authorities

Access to the World Health Organization-recommended essential diagnostics for invasive fungal infections in critical care and cancer patients in Africa: A diagnostic survey

Background: Invasive fungal infections (IFIs) contribute to significant morbidity and mortality among patients with haemato-oncological conditions, seriously ill hospitalised patients and those in intensive care (ICU). We surveyed for the World Health Organization-recommended essential diagnostic tests for IFIs in these risk groups in Africa. Methods: The Global Action For Fungal Infections (GAFFI) evaluated the different levels of access to both diagnostics for IFIs for populations in Africa, with the aim of building a comparative dataset and a publicly available interactive map. Data was collected through a validated questionnaire administered to a country leader in relevant topics (i.e., HIV, laboratory coordination) and/or Ministry of Health representatives and followed up with 2 rounds of validation by video calls, and later confirmation by email of findings. Results: Initial data was collected from 48 African countries covering 99.65 % of the population. Conventional diagnostics such as blood cultures, direct microscopy and histopathology were often used for diagnosis of IFIs in more than half of the facilities. Bronchoscopy was rarely done or not done in 20 countries (population 649 million). In over 40 African countries (population >850 million), Aspergillus antigen testing was never performed in either the public or private sectors. Computed tomography (CT) imaging is routinely used in 27 (56 %) of countries in the public sector and 21 44 %) in the private sector. However, magnetic resonance imaging remains relatively uncommon in most African countries. Conclusions: There are critical gaps in the availability of essential diagnostics for IFIs in Africa, particularly Aspergillus antigen testing and modern medical imaging modalities. Early diagnosis and commencement of targeted therapy of IFIs are critical for optimal outcomes from complex cancer therapies

Final logistic regression model.

<p>Final logistic regression model.</p

Distribution of reported cases of histoplasmosis in Nigeria in relation to vegetation (A) and soil types (B).

<p>Distribution of reported cases of histoplasmosis in Nigeria in relation to vegetation (A) and soil types (B).</p