Association of Bacterial vaginosis and other Sexually Transmitted Infections with HIV among pregnant women in Nigeria.

OBJECTIVES: To determine the association of Bacterial vaginosis (BV) and other sexually transmissible infections (STIs) with HIV prevalence among pregnant women in Jos, Nigeria. METHODS: This was a cross- sectional study of pregnant women who participated in the Prevention of Mother-to-Child Transmission of HIV program of the AIDS Prevention Initiative in Nigeria, between April 2002 and July 2004, at the Jos University Teaching Hospital in Jos, Nigeria. Blood, high vaginal and endocervical samples were obtained for diagnosis of HIV, BV and other STIs. Data were analyzed for prevalence of HIV, BV and other STIs. Univariate and multivariate logistic regression models generated unadjusted and adjusted odds ratios (OR) as well as 95% confidence intervals (CI) of the association of BV and other STIs with HIV prevalence. P value <0.05 was considered statistically significant. RESULTS: A total of 4,046 pregnant women were studied and 97.6% (3,950/4,046) had complete laboratory records for analysis. The prevalence of HIV was 8.2% (CI: 7.4-9.1); BV 11.9% (CI: 10.9-12.9); Candida 10.7% (CI: 9.7-11.7); mixed infection of BV and Candida 2.8% (CI: 2.3-3.4); Trichomonads 0.6% (CI: 0.3-0.8) and syphilis 0.35% (0.16-0.54). BV, Candida, mixed BV and Candida; and Trichomonads were independently associated with HIV infection [adjusted OR (95% CI), 2.9 (CI: 2.2-3.9); 2.0 (CI: 1.5-2.9); 3.4 (CI: 2.0-5.6), and 3.3 (CI: 1.1-9.7) respectively]. CONCLUSION: HIV prevalence is higher among pregnant women who have BV, Candida and Trichomonads vaginal infections compared with women who have no evidence of infection. The practice of routine screening for BV and other STIs among pregnant women as a strategy for identifying women at risk for prevalent HIV infection should be sustained/ encouraged and the syndromic management of STIs should be integrated into all antenatal care management protocols in antenatal clinics in order to curb the epidemic of heterosexual HIV transmission

Treatment Outcomes in a Decentralized Antiretroviral Therapy Program: A Comparison of Two Levels of Care in North Central Nigeria

Background. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment for people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program in Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13 secondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic data on previously antiretroviral drug naïve patients aged ≥15 years that received HAART for at least 6 months and compared treatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites while on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 (P < 0.001) and 24 weeks (P < 0.001) with similar responses at 48 weeks (P = 0.11) and higher rates of viral suppression (<400 c/mL) at 12 (P < 0.001) and 48 weeks (P = 0.03), but similar responses at 24 weeks (P = 0.21). Mortality was 2.3% versus 5.0% (P < 0.001) at prime and satellite sites, while transfer rate was 8.7% versus 5.5% (P = 0.001) at prime and satellites. Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care

Accumulation of Protease Mutations among Patients Failing Second-Line Antiretroviral Therapy and Response to Salvage Therapy in Nigeria

Background: To date, antiretroviral therapy (ART) guidelines and programs in resource-limited settings (RLS) have focused on 1st- and 2nd-line (2 L) therapy. As programs approach a decade of implementation, policy regarding access to 3rd-line (3 L) ART is needed. We aimed to examine the impact of maintaining patients on failing 2 L ART on the accumulation of protease (PR) mutations. Methods and Findings: From 2004–2011, the Harvard/APIN PEPFAR Program provided ART to >100,000 people in Nigeria. Genotypic resistance testing was performed on a subset of patients experiencing 2 L failure, defined as 2 consecutive viral loads (VL)>1000 copies/mL after ≥6 months on 2 L. Of 6714 patients who received protease inhibitor (PI)-based ART, 673 (10.0%) met virologic failure criteria. Genotypes were performed on 61 samples. Patients on non-suppressive 2 L therapy for 24 months. Patients developed a median of 0.6 (IQR: 0–1.4) IAS PR mutations per 6 months on failing 2 L therapy. In 38% of failing patients no PR mutations were present. For patients failing >24 months, high- or intermediate-level resistance to lopinavir and atazanavir was present in 63%, with 5% to darunavir. Conclusions: This is the first report assessing the impact of duration of non-suppressive 2 L therapy on the accumulation of PR resistance in a RLS. This information provides insight into the resistance cost of failing to switch non-suppressive 2 L regimens and highlights the issue of 3 L access

Association of HIV-induced immunosuppression and clinical malaria in Nigerian adults

Background: Despite the growing body of evidence on the interaction between HIV and malaria in sub-Saharan Africa, there is a dearth of data on clinical malaria in HIV-infected patients in Nigeria. We determined the burden of clinical malaria in HIV-infected adult Nigerians and further investigated the association between their immunological status and the rates of clinical malaria. Methods: Ninety seven antiretroviral treatment-naïve HIV-infected adults were enrolled in a cross-sectional study from August to December, 2009. The participants had a complete clinical evaluation, thick and thin blood films for malaria parasites and CD4 cell count quantification. Clinical malaria was defined as having fever (temperature ≥ 37.5oC or history of fever within 48 hours) and a malaria parasite density above the median value obtained for subjects with co-existing fever and parasitaemia. Results: Clinical malaria was diagnosed in 10 out of 97 patients (10.3%). Lower CD4 cell counts were associated with increasing rates of clinical malaria which was 0% at CD4 cell count of ≥ 500, 2.6% at 200-499 and 30% a

Cytokine-associated neutrophil extracellular traps and antinuclear antibodies in Plasmodium falciparum infected children under six years of age

<p>Abstract</p> <p>Background</p> <p>In <it>Plasmodium falciparum</it>-infected children, the relationships between blood cell histopathology, blood plasma components, development of immunocompetence and disease severity remain poorly understood. Blood from Nigerian children with uncomplicated malaria was analysed to gain insight into these relationships. This investigation presents evidence for circulating neutrophil extracellular traps (NETs) and antinuclear IgG antibodies (ANA). The presence of NETs and ANA to double-stranded DNA along with the cytokine profiles found suggests autoimmune mechanisms that could produce pathogenesis in children, but immunoprotection in adults.</p> <p>Methods</p> <p>Peripheral blood smear slides and blood samples obtained from 21 Nigerian children under six years of age, presenting with uncomplicated malaria before and seven days after initiation of sulphadoxine-pyrimethamine (SP) treatment were analysed. The slides were stained with Giemsa and with DAPI. Levels of the pro-inflammatory cytokines IFN-γ, IL-2, TNF, CRP, and IL-6, select anti-inflammatory cytokines TGF-β and IL-10, and ANA were determined by immunoassay.</p> <p>Results</p> <p>The children exhibited circulating NETs with adherent parasites and erythrocytes, elevated ANA levels, a Th2 dominated cytokine profile, and left-shifted leukocyte differential counts. Nonspecific ANA levels were significant in 86% of the children pretreatment and in 100% of the children seven days after SP treatment, but in only 33% of age-matched control samples collected during the season of low parasite transmission. Levels of ANA specific for dsDNA were significant in 81% of the children both pre-treatment and post treatment.</p> <p>Conclusion</p> <p>The results of this investigation suggest that NET formation and ANA to dsDNA may induce pathology in falciparum-infected children, but activate a protective mechanism against falciparum malaria in adults. The significance of in vivo circulating chromatin in NETs and dsDNA ANA as a causative factor in the hyporesponsiveness of CpG oligonucleotide-based malaria vaccines is discussed.</p

Safety, Efficacy and Acceptabilty of NorplantR Implants in Jos, Northern Nigeria

Context: NorplantR is a long acting reversible progestogen method suitable for women of all ages. It is however not without side effects that may affect its continuous usage. Documentation of such changes is important for counselling acceptors to achieve user\'s satisfaction. Objective: To evaluate the safety, efficacy and acceptability of NorplantR amongst its acceptors. Study Design, Setting and Subjects: This study was part of ongoing prospective longitudinal studies that involved 23 women who had complete records at three years out of the 37 healthy non breast feeding informed volunteers recruited from our family planning clinic in August 1997. Data on socio-demographic characteristics, menstrual pattern, packed cell volume, weights, blood pressure, side effects and user\'s satisfaction were analysed. Results: The mean age and parity of the acceptors were 31.7 ± 3.4 years and 4.7 ± 1.0 respectively. Even though the mean weight at 12months (63.2 ± 11.7kg was not statistically different (p 0.5) from the mean weight at pre-insertion (62.5 + 11.2kg), there were statistical significant increases in weights at 2years (66.9 ± 12.1kg; p= 0.001) and at 3years (65.9 ± 11.6kg; p 0.01). Apart from the slight statistically significant increase (p 0.02) in systolic blood pressure at 2years, the blood pressure changes at 1year and 3years did not show significant changes. Main side effects were menstrual abnormalities, weight changes, headache, abdominal pain and dizziness. The packed cell volume significantly increased. Continuation rate was 100% and there was no pregnancy recorded. Users were satisfied with the method because of its convenience, low risk of pregnancy and long duration of action. Conclusion: NorplantR subdermal implant was an effective safe and acceptable method of contraception amongst the acceptors, despite its minimal side effects. Key Words: NorplantR Implants, Safety, Efficacy and Acceptability NorplantR is a registered trademark of The Population Council for levonorgestrel subdermal implants [ Trop J Obstet Gynaecol, 2004;21:95-99

Prevalence and spectrum of cervical cytological abnormalities among brothel based sex workers in Jos, Nigeria

Background: Cervical cancer is the second most common cause of cancer-related death among women in sub-Saharan Africa. Female sex workers being high-risk group are more susceptible to infections with the Human Papillomavirus and thus, the development of the premalignant and malignant disease of the cervix. We therefore sought to determine the prevalence and spectrum of cervical cytological abnormalities among female sex workers in Jos, Nigeria. Methods: A cross-sectional study was conducted among Brothel based sex workers (BBSW) aged 18years and above in Jos, Nigeria between March 2018-February 2019. Papanicolaou test technique was the screening method used to detect premalignant lesions. Data were entered and analyzed using STATA version 15.1 software. Results: A total of 201 participants were recruited for the study. One hundred and ninety-four (194) had adequate smears and were included in the analysis. Of this 80.4% were negative for intraepithelial malignancy, while 19.6% were positive for intraepithelial malignancy and this included ASCUS (10.3%), LSIL (4.6%), HSIL (3.6%), AGUS (0.5%) and ASC-H (0.5%). Abnormal cervical cytology was seen more in participants that were single, between the ages of 24-34years, multiparous, with a previous history of sexually transmitted disease, and have greater than 2 clients/day, but all these were not statistically significant. Conclusion: Due to the high prevalence of abnormal cervical cytology among BBSW, there is a need for them to have regular screening, follow-up, and treatment of premalignant lesions to prevent progression to frank cervical cancer

Calcaneal ultrasound analysis of Nigerian adults with type 2 diabetes

Objective: Type 2 diabetes is a major chronic disease in northern Nigeria. Although type 2diabetes is usually associated with increased bone mineral density, we were interested in estimating the bone mineral density of patients with type 2 diabetes in a region of the world where the usual calcium intake is well below the recommended dietary recommendations. Research Design and Methods: A total of 50 patients (25M/25F) with type 2 diabetes and 50 healthy controls (20M/30F) were recruited at the Jos University Teaching hospital in Jos, Nigeria. Information regarding age, weight, height, medication use and duration of disease were obtained. Body composition analysis to determine lean body mass and body fat was performed using bioelectrical impedance analysis. Bone quality was assessed using quantitative ultrasound of the calcaneus. Glucose control was monitored using fasting glucose concentrations. Results: Both male and females subjects with type 2 diabetes had superior ultrasound parameters including broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI) relative to controls. However, there were no significant differences in these parameters between the subjects with diabetes and the controls. No associations between ultrasound parameters and body mass index or body composition were found for either the diabetic subjects or controls. A non-significant trend was observed between glucose control and SI for the female diabetic subjects. A statistically 2 significant correlation was obtained between SI and duration of disease but only for the female diabetic subjects. Conclusions: Calcaneal ultrasound is a relatively inexpensive means for monitoring bone quality in patients with type 2 diabetes. The more favorable bone ultrasound parameters observed for patients with type 2 diabetes may be the result of the bonepromoting effects of hyperinsulinemia. Keywords: type 2 diabetes, bone density, calcaneal ultrasound, stiffness index, hyperglycemia, Nigeria Highland Medical Research Journal Vol. 3(2) 2005: 1-1

Meals and dephytinization affect calcium and zinc absorption in Nigerian children with rickets

Nutritional rickets resulting from calcium insufficiency is common in Nigeria and high dietary phytate is thought to inhibit calcium and zinc absorption. We compared the effects of a high-phytate meal and enzymatic dephytinization on calcium and zinc absorption in Nigerian children with and without rickets. Nineteen children with rickets and 15 age-matched control children, aged 2-10 gamma, were given calcium (600 mg/d) and ergocalciferol (1250 mu g/wk). After 6 wk, calcium and zinc absorption were measured in both groups with and without maize porridge using stable isotopes. One week later, absorption measurements were repeated to assess the effects of enzymatic dephytinization and fermentation of the maize porridge. The phytate concentration of maize porridge (3.87 +/- 0.38 g/kg wet weight) was reduced by enzymatic dephytinization (2.83 +/- 0.41 g/kg; P < 0.001) but not by fermentation (3.35 +/- 0.27 g/kg; P = 0.08). Calcium and zinc absorption were unaffected by the presence of rickets or by fermentation of maize porridge. Calcium absorption was greater with a meal (61.3 +/- 25.1%) than without (27.8 +/- 14.6%; P < 0.001). Zinc absorption was lower with a meal (16.2 +/- 8.0%) than without (63.4 +/- 23.9%; P < 0.001). Enzymatic dephytinization increased relative zinc absorption from a meal by 101 +/- 81% (P < 0.001) but did not affect calcium absorption. Rickets was not associated with impaired calcium or zinc absorption. Calcium absorption was enhanced by maize porridge, but zinc absorption was reduced. Enzymatic dephytinization increased zinc absorption. Multiple strategies may be required to optimize calcium and zinc absorption in deficient populations. J. Nutr. 139: 926-932, 2009