CD4-T Cells as a Predictor of Immune Status and Its Outcomes Following Second-Line Combination Antiretroviral Therapy in Adult HIV-1 Infected Patients Attending Apin/Juth HIV Clinic in Jos, Plateau State, Nigeria

Deficiency in immune cell number or activity is a cardinal feature of HIV.  Second line antiretroviral therapy is geared towards improving immune cell activity and improving treatment outcomes. More people are now accessing free combination antiretroviral therapy through public health programmes in resource limited settings. There is currently no third line therapy for patients failing second line therapy in most of these programmes and data on effectiveness of second line antiretroviral therapy are limited. To adequately address and prepare for this scenario, critical assessments of the outcomes of second-line cART are needed. This is a retrospective cohort study of patients accessing second line cART at the APIN/ JUTH, Jos adult HIV clinic from 2004 to 2018, to determine the proportion of patients failing second line cART, to evaluate time to immunologic failure, time to lost to follow up and time to death using Kaplan Meier estimates. Immunological failure occurs when there is a fall of CD4 counts to pre-therapy baseline (or below) or 50% fall from the on-treatment peak value (if known) or persistent CD4 levels below 100 cells/mm3 6 months after ART initiation. A total of 285 patients were included in the study, with a mean age of 45±9.5 years. Females where 194 (68.1%) All the patients were on boosted protease inhibitor, the predominant combination antiretroviral therapy for second line regimen was Lopinavir boosted with ritonavir in combination with Tenofovir, Lamivudine and Zidovudine (43.9%). The baseline CD4 count was 134 (IQR 54-272). The CD4 count increased to 339 (IQR213-498) at 72 weeks.   In conclusion, Second line cART immunologic failure rates are low in our cohort and patient stay longer on cART before failure. Keywords: CD4 cells, Immunologic failure, Antiretroviral therapy DOI: 10.7176/JHMN/107-02 Publication date: April 30th 202

Ascending aortic dissection in the developing world; case report

Aortic dissection is frequently a life threatening condition and is the most common emergency of the acute aortic syndromes. Left untreated or poorly treated; the mortality rate has been reported to increase by 1-3% per hour after presentation and is approximately 36-72% within an hour of diagnosis and 62-91% within one week. Various contributory factors related to human resources, technical resources, socio-economic constraints and other utilities in poor income countries with poor health indices also worsen the prognosis of acute aortic dissection. We have made an attempt to remind ourselves of the continued existence and challenges in managing this disease.Keywords: Aortic Dissection, Mortality, Outcome, Underdevelope

Frequency of Cryptococcal Meningitis in HIV-1 Infected Patients in North Central Nigeria

Background: Cryptococcal meningitis (CM) is the most common severe life threatening fungal infection in AIDS patients. It is an important cause of morbidity and mortality. There is paucity of data on the prevalence of CM in Nigeria. We aimed to determine the frequency of CM, the clinical presentation and immunological profile.Methods: A cross sectional study was carried out at the Jos University Teaching Hospital (JUTH), A total of 100 HIV-1 infected patients suspected of having meningitis or meningoencephalitis were subjected to cerebrospinal fluid (CSF) analysis (including Indian ink preparation and fungal culture by conventional methods) and CD4 count was determined using flow cytometry (count bit Y-R 1004 Partec Muster Germany).Results: The freguency of CM was 36% in our cohort. The commonest clinical presentation included headache (100.0%), neck stiffness (77.8%), fever (72.0%), vomiting (55.6%), personality changes (55.6%), photophobia (27.8%) and convulsions (27.8%). The mean duration of symptoms was 24 ±22 days with a median of 17 days. The mean CD4 count was 89±60 cells/mm3 with a median of 82 cells/mm3.Conclusion: The high prevalence of CM and the associated severe immunosuppression underscores the importance of early diagnosis of HIV infection which may reduce the incidence of CM. There is the urgent need for access to Amphotericin B and fluconazole in resource constrained settings in addition to a wide access to HAART.Key words: Cryptococcal meningitis, HIV, North central Nigeri