Care of patients with end-stage renal disease in Nigeria: a call for a change in paradigm

The burden of chronic kidney disease (CKD) is increasing in most developing countries such as Nigeria. There are over a million persons with end-stage kidney disease (ESRD) requiring renal replacement therapy (RRT) around the world. The cost of providing care for patients with ESRD is colossal; and data from most renal centres in Nigeria show that majority of patients are unable to afford the cost of care resulting in a high mortality among ESRD patients. Also, there is no organized funding mechanism for RRT in Nigeria. We highlight some of the challenges limiting access to care for ESRD patients in Nigeria and propose some recommendations on how to change this paradigm

Epidemiology of Hepatitis B and Hepatitis C Virus infections among HIV counseling and testing clients in Jos, North central Nigeria

Hepatitis B and hepatitis C virus infection are common in Nigeria; where they are a major cause of both acute and chronic liver disease, as well as hepatocellular cancer. Persons at risk of acquisition of Human Immunodeficiency Virus (HIV) infection are also at risk of acquisition of infection with Hepatitis B virus (HBV) and Hepatitis C virus (HCV). We set out to determine the epidemiology of HBV and HCV infection among HIV Counseling and Testing (HCT) clients at the Jos University Teaching Hospital (JUTH), Nigeria.This was a cross-sectional study conducted at the HCT unit of the AIDS Prevention Initiative in Nigeria (APIN) Jos University Teaching Hospital (JUTH), Jos, Nigeria between November, 2012 and April 2013.Subjects were recruited consecutively at the HCT unit of APIN JUTH. Included were subjects 18 years of age and above, antiretroviral (ARV) drug naive, who accepted and signed the consent form.Clients who declined to sign the consent form were excluded. The study involved collecting demographic data, exposure to risk factors and laboratory determination of HBV and HCV sero-prevalence in the subjects using Enzyme Linked Immunoassay (ELISA) and Polymerase chain reaction (PCR) assay methods.Chi-squared test was used to determine significance of association between categorical variables.One hundred and thirty two (56.9%) were females, 100 (43.1%) were males. Thirty six (15.5%) tested positive for HBsAg by ELISA, 31 (13.4%) were confirmed positive by DNA PCR. Nine (3.9%) tested positive by ELISA to HCV antibody, 7 (3.0%) were confirmed positive by RNA PCR. Co-infection rate of HIV / HBV was 5.2%. Infection was more common among those younger than 36 years in the case of HBV and those older than 36 years in the case of HCV.We concluded the prevalence of HBV infection was high. Study was limited by the cross sectional design

Association of HIV-Induced Immunosuppression and Clinical Malaria in Nigerian Adults

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 HIVinfected adult Nigerians and further investigated the association between their immunological status and the rates of clinical malaria. 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. 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% at <200 cells/μL (χ2 = 18.3, p = 0.0001). This association remained significant after controlling for other factors in a multivariate analysis (AOR=22.98, 95% C.I: 2.62-20.14, p = 0.005). An inverse relationship between CD4 cell count and parasite density was demonstrated (regression co-efficient = -0.001, p = 0.0002). More aggressive malaria control measures are highly needed in severely immunosuppressed HIV-infected patients.Keywords: HIV, Immunosuppression, Clinical malaria, Adult

Human immunodeficiency virus type-1 (HIV-1) genetic diversity and prevalence of antiretroviral drug resistance mutations in treatment-naïve adults in Jos, North Central Nigeria

The presence of human immunodeficiency virus (HIV) type-1 diversity has an impact on vaccine efficacy and drug resistance. It is important to know the circulating genetic variants and associated drug-resistance mutations in the context of scale up of antiretroviral therapy (ART) in Nigeria. The objective of this study was to determine the genetic diversity of HIV-1 and the prevalence of antiretroviral (ARV) drug resistance mutations among antiretroviral treatment-naïve HIV-1 infected patients in Jos, North Central Nigeria. Plasma samples were collected from 105 ARV drug-naïve patients enrolled for HIV care at the Jos University Teaching Hospital (JUTH) HIV Treatment Center between October 2010 and April 2011. One hundred (100) samples were successfully amplified. Viral subtyping was done using REGA subtyping tool and by phylogenetic analysis using PAUP software. The drug resistance mutations were determined using the Stanford University HIVdb sequence interpretation algorithm. HIV-1 subtypes identified were; CRF02_AG (48.0%), G (41.0%), CRF06_cpx (6.0%) and A1 (5.0%). 8% of the patients’ isolates had at least one major resistance mutation in the RT gene: Nucleoside reverse transcriptase inhibitors: M41L (1%), K65KR (1%), M184IM (1%), M184V (2%) and T215ADNT (1%), non-nucleoside reverse transcriptase inhibitors: K103N (2%), K101E (1%), G190A (1%), P225HP (1%), Y181I (1%), Y188L (1%), and Y181C (1%). Among antiretroviral (ARV) naïve patients in Jos, North Central Nigeria, the common HIV-1 subtypes was CRF_02 and G. And the prevalence of drug resistance mutations was found to be high (8%). Further study and national surveillance will be critically important to understand the clinical impact of transmitted resistance mutations on ART naïve individuals in resource limited settings.Keywords: HIV-1 subtypes, antiretroviral (ARV), treatment-naïve, drug-resistance, mutation, accessory and polymorphisms, NigeriaAfrican Journal of Biotechnology Vol. 12(17), pp. 2279-228

Trend of Antiretroviral therapy interruption in a clinic cohort of HIV-infected children in Jos, Nigeria

Background: In the early years of introducing antiretroviral therapy (ART), compromised adherence to ART in children, from treatment interruptions, was a challenge partly due to lack of trained or experienced personnel with expertise in adherence counselling. Over subsequent years with increasing expertise coupled with more patient education and public awareness it is expected that these interruptions would decline. We therefore determined the trend in ART interruptions in a clinic cohort of HIV-1 infected children attending the Jos University Teaching Hospital (JUTH).Methods: This was a retrospective analysis of data on 580 children, aged 2 months – 15 years, who were enrolled on ART between February 2006 and December 2010 at JUTH. Children who had ART interruptions were compared with those who did not. The odds of ART interruption versus no ART interruption, across the categories of year enrolled on ART were examined using the test of homogeneity of odds. The trend in ART interruptions over a period of 5 years was examined using score test for trend of odds.Results: The overall frequency of ART interruptions per child among the 580 study subjects over a period of 5 years was 20.2%, that is, 4.04% per year. The odds of ART interruptions was different across the years from 2006 to 2010 (p= <0.0001). There was also evidence for a trend in the decreasing odds of ART interruptions over the years (p= <0.0001).Conclusion: ART interruptions declined over the years in children attending the HIV clinic and this may have been due to enhanced ART adherence as a result of repeated health education and decreasing HIV stigmatization.Keywords: Antiretroviral therapy interruptions, Trend, HIV- 1, Adherence, Health educatio

Serum Lipids In Pre Dialysis Chronic Renal Failure Patients In Jos University Teaching Hospital, Nigeria

A prospective study of serum lipids in pre dialysis chronic renal failure (CRF) patients in the Jos university teaching hospital over a twelve month period undertaken to determine the pattern of lipid abnormalities associated with this disease. Lipids were measured in the fasting state using standard methods in 67 patients with CRF and 50 healthy controls. The means of total cholesterol and triglyceride were similar in both groups. The mean HDL cholesterol was significantly lower in the study group compared to controls; being 1.72+ 1.34 mmol/L and 4.21+ 1.89 mmol/L respectively (df= 1, F= 83.78, p < 0.001), while LDL cholesterol was significantly higher in the study group compared to controls (2.90+ 1.56 mmol/L vs. 1.87+ 1.00 mmol/L; df= 1, F= 16.99,

The prevalence of and risk factors for chronic kidney disease in spouses of patients with advanced chronic kidney disease

Background: Clustering of chronic non-communicable diseases has been described in the western world. We embarked on this study to determine spousal concordance of chronic kidney disease (CKD).Methods: A hospital based descriptive cross sectional study of spouses of patients with advanced CKD (stage 4 and 5).Results: A significantly higher prevalence of CKD was detected among spouses of patients with advanced CKD (21%) compared with (6%) in spouses of patients without CKD. Variables associated with CKD included age, hypertension, diabetes mellitus, chronic use of nonsteroidal antiinflammatory drugs and use of herbal medication (p&lt;0.05).Conclusion: This study has shown that spouses of patients with advanced CKD are at increased risk of developing CKD.Keywords: Chronic Kidney Disease, Concordance, Diabetes Mellitus, Hypertension, Spous

High-Risk Behaviour among Hepatitis B Virus-Infected Patients in a Nigerian Tertiary Hospital

Background: We evaluated the pattern and socio-demographic predictors of high-risk behaviour for hepatitis B virus (HBV) transmission among HBV-infected Nigerian adults in order to provide clues for intensifying HBV prevention and control.Methodology: 200 hepatitis B surface antigen (HBsAg) positive patients attending the Jos University Teaching Hospital were enrolled in a cross-sectional study from June to November, 2010. A structured interviewer-administered questionnaire was used to obtain information from the participants regarding their socio-demographic characteristics, and history of HBV-related risk factors in the 12 months preceding the study.Results: The mean age of the participants was 34 &#177; 8 years, females (61.0%) were in the majority and only 2 subjects (1.0%) reported previous HBV vaccination. One hundred and fifty one subjects (75.5%) reported at least one risk factor for HBV transmission. The commonest risky practices were sharing of unsterilized sharp instruments for various purposes reported by 141 subjects (70.5 %) and having multiple sex partners (46.5%). Sharing of sharps was significantly associated with male sex (79.5% vs. 62.7%, &#967;2=4.97, p=0.03) and low educational status (81.1% vs. 64.3%, &#967;2=6.32, p=0.01). Male subjects (70.3% vs. 35.0%, &#967;2=22.52, p&lt;0.0001) and those with high educational status (54.0% vs. 33.8%, &#967;2=7.64, p=0.006) were significantly more likely to have multiple sex partners.Conclusion: There is a high rate of risky practices for HBV transmission among HBV-infected patients and such practices have important socio-demographic predictors. This justifies a call for urgent and targeted steps to intensify HBV prevention and control in our environment

Pattern of opportunistic infections in HIV Patients who fail first line antiretroviral therapy in Jos, Nigeria

Background: Opportunistic infections (OIs) are an important cause of morbidity and mortality in persons living with human immuno-deficiency virus (HIV) infection and may be an indication of failure of antiretroviral therapy (ART).Methods: This descriptive cross-sectional study was carried out at a large HIV clinic of the Jos University Teaching Hospital (JUTH), North-central Nigeria. Hundred patients were randomly selected from a sample frame of 320 patients on antiretroviral therapy of at least 6 months who failed ART.Results: Fifty-nine (59%) were females. The mean age of the patients was 41 ± 9 years. The median duration on ART was 7.5months IQR (6-17) and the median CD4 cell count was 139 3 cell/ml IQR (69-245). The prevalence of OIs was 26% with the following frequencies: oral/ vaginal candidiasis 39%, chronic diarrhoea 26%, dermatitis 23% and pulmonary tuberculosis 13%. Neither age, sex, ART default, hepatitis co-infection, baseline CD4 count, nor CD4 count at the time of virological failure was associated with OIs.Conclusion: Oral/vaginal candidiasis, diarrhoeal diseases, and tuberculosis are common opportunistic infections in HIV patients who fail first line antiretroviral therapy. No risk factor was associated with virological failure in this cohort of patients.Keywords: Opportunistic infections, HIV, antiretroviral therapy

Hepatitis B Co-Infection is Associated with Poorer Survival of HIV-Infected Patients on Highly Active Antiretroviral Therapy in West Africa.

Hepatitis B has been reported to be high in HIV-infected African populations. However, the impact of this co-infection on the survival of HIV-infected Africans on long-term highly active antiretroviral therapy (HAART) remains poorly characterised. We investigated the impact of HBV/HIV co-infection on survival of HIV infected patients undergoing antiretroviral therapy in a West African population.This was a clinic-based cohort study of HIV-infected adults enrolled in Nigeria, West Africa. Study subjects (9,758) were screened for hepatitis B and hepatitis C at HAART initiation. Kaplan-Meier survival and Cox proportional hazards models were used to estimate probability of survival and to identify predictors of mortality respectively, based on hepatitis B surface antigen status. All patients had signed an informed written consent before enrolment into the study; and we additionally obtained permission for secondary use of data from the Harvard institutional review board.Patients were followed up for a median of 41 months (interquartile range: 30-62 months) during which, 181 (1.9%) patients died. Most of the deaths; 143 (79.0%) occurred prior to availability of Tenofovir. Among those that were on antiretroviral therapy, hepatitis B co-infected patients experienced a significantly lower survival than HIV mono-infected patients at 74 months of follow up (94% vs. 97%; p=0.0097). Generally, hepatitis B co-infection: HBsAg-positive/HIV-positive (Hazards Rate [HR]; 1.5: 95% CI 1.09-2.11), co-morbid tuberculosis (HR; 2.2: 95% CI 1.57-2.96) and male gender (HR; 1.5: 95% CI 1.08-2.00) were significantly predictive of mortality. Categorising the patients based on use of Tenofovir, HBV infection failed to become a predictor of mortality among those on Tenofovir-containing HAART.HBsAg-positive status was associated with reduced survival and was an independent predictor of mortality in this African HIV cohort on HAART. However, Tenofovir annulled the impact of HBV on mortality of HIV patients in the present study cohort