Challenges if HIV Treatment in Resource-Poor Countries: A Review

Background: The human immunodeficiency virus/acquired immunodeficiency syndrome pandemic have posed a significant public health challenge to the global community. Massive therapeutic interventions with antiretroviral drugs are being undertaken, yet problems and challenges exist. This review examines these problems and challenges as they affect the treatment of HIV infection in resource-poor countries such as Nigeria.Methods: The information was sourced from relevant literature using human immunodeficiency virus/acquired immunodeficiency syndrome journals, textbooks and Websites on human immunodeficiency virus/acquired immunodeficiency syndrome, highly active antiretroviral therapy, resource-poor countries as key words.Results: Several studies have shown that the advent of highly active antiretroviral therapy in 1996 has significantly reduced morbidity and mortality among people living with HIV/AIDS (PLWHA). But in resourcepoor countries, initiation and maintenance of highly active antiretroviral therapy has been associated with many challenges and problems such as: poor infrastructural base for the control programs; irregular or non availability of drugs; poor drug adherence; co-morbidities and opportunistic infections/malignancies; drug toxicities; drug/food and drug/drug interactions; laboratory monitoring of viral load; CD4 cell counts; full blood counts; electrolytes, kidney and liver functions.Conclusion: The review has shown that the solution to the pandemic lies in a multi-sectoral and holistic approach involving International and local agencies, and communities

Prevalence of hepatitis C Antibody in Human Immunodeficiency Virus infected children

Background: Hepatitis C virus (HCV) is a major public health problem for Human Immunodeficiency virus (HIV) infected population. Both infections share same routes of transmission, and quite often co-exist, with dual infections associated with reciprocal and mutually more rapid progression than either infection alone. Co-infection also adversely impacts on the course and management of both infections. This study was carried out to document the prevalence and determinants of HCV sero-positivity in HIVinfected children.Methodology: A total of 132 HIVinfected children attending the Paediatric Antiretroviral Clinic were recruited as subjects. Another 132 HIV negative children matched for age and sex were recruited as controls. Relevant demographic data was taken from each child. Blood samples were also obtained from each child and from their mothers when available, and assayed for the presence of anti-HCV using a membranebased immune-assay kit.Results: The sero-prevalence of HCV antibodies was 9.8% among HIV-infected children and 3.0% among the controls. This was a statistically significant difference (p = 0.042, Fisher exact). HCV sero-postivity was more frequent in children after 5 years of age in both subjects (92.3%) and controls (100.0%). Injection at patent medicine vendor (PMV) was noted to be the most risky practice leading to HCV in children, with more than thrice the chances of HCV sero-positivity than in those who didn’t receive injections at PMV. Four mothers of the HIV-infected children were co-infected with HCV and none in the control group. All 4 children of these dually infected mothers were also co-infected. Controlling for other factors, children of HIV infected mothers were more than twice as likely to have HCV antibody as children whose mothers were HIV negative (RR = 2.67). Similarly, HCV infected mothers have 12% greater chance of transmitting HCV to their children than noninfected mothers and children delivered vaginally were 1.6 times more likely to have HCV antibody than those delivered via caesarean section.Conclusions: The prevalence of anti-HCV in HIV-infected children is significantly higher than that of HIV uninfected peers. Factors strongly associated with HCV sero -positivity identified are maternal HIV and HCV infections, vaginal delivery and injections at patent medicine vendor.Keywords: HCV; HIV; childre

Safety of blood transfusion: prevalence of hepatitis B surface antigen in blood donors in Zaria, Northern Nigeria

Background: Hepatitis B infection has long been known to be common in the general population and due to its mode of transmission through blood transfusion; it had made provision of safe blood difficult especially in developing countries. Method: A retrospective study aimed at reassessing the current of sero-prevalence of hepatitis B infection in blood donors in a typical developing country was conducted. Results: Six thousand and twenty five regular blood were screened our of which 254 (4.2%) were HBsAg positive with lowest rates being in 2001 (3.5%) and the highest rates occurred in 2002(5.1%).Age of donors ranged from 19-42years with a mean 33 years, 98% were males while only 2% were females. Prevalence of HBsAg was 47.2% in patients' replacement donors, 44.5% in relations of antenatal clinic attendees and 8.3% in voluntary donors. Conclusions: This study has revealed a high prevalence rate of hepatitis B infections in all age groups and categories of blood donors in our setting which makes transfusion of unscreened hazardous. Nigerian Journal of Surgical Research Vol. 7(3&4) 2005: 290-29

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Highlights of the symposium and journal presentation of the National Association of Resident Doctors (NARD), Abuth Zaria branch

 No Abstract

Hepatitis B and C co-infections in HIV/AIDS patients attending ARV center Abuth, Zaria, Nigeria

Background: Co-infections of HIV/AIDS with HBV and HCV are emerging as an added burden to the already chaotic protocols of managing HIV/AIDS mono- infection. Objectives: To determine the prevalence of Hepatitis B and C co infections among HIV/AIDS patients in Zaria. Methods: A cross sectional study by which serum samples of all double ELISA confirmed HIV infected patients referred to the clinic were additionally screened for hepatitis B and C viruses using rapid test ELISA kits. Results: One hundred and thirty seven (17.5%) were HBsAg or anti-HCV positive, 81(10.3%) were HBsAg positive, 41(5.3%) were anti-HCV antibodies positive and 15(1.9%) were positive for the two viruses. Ages of patients ranged from 17 to 58 years with a mean of 34+-5 SD. Eighty-three were females while 51 were males. Forty-two (30.6%) patients had jaundice out of which 23(2.9%) had abnormal liver function tests. Conclusions: There was a high prevalence of hepatitis B and C co infections in patients with HIV/AIDS in Zaria. Recommendations: This calls for the institution of screening measures to detect the presence of hepatitis B and C viruses in HIV infected patients to avert the consequences of their effects. Highland Medical Research Journal Vol. 4(1) 2006: 39-4

The incidence of HIV among blood donors in Kaduna, Nigeria

No Abstract. African Health Science Vol. 8 (1) 2008: pp. 60-6