Antiretroviral Drug Resistance- implications for HIV/AIDS reduction in Sub-Saharan Africa and other developing countries

Abstract: Background: The introduction of the highly active antiretroviral therapy in the mid-1990s has significantly reduced morbidities and prolonged the lifespan of people living with HIV. However, the emergence of resistance to the antiretroviral drugs is becoming a major cause of treatment failure. While the problem of drug resistance is being tackled in developed countries, not much seem to be done in this regard in developing countries of Africa, Asia and Latin America. This review looked at the regional distribution of HIV groups and subtypes and how this has affected the pattern of antiretroviral resistance.Methods: The review was sourced from papers presented at international conferences on HIV/AIDS and rational drug use, relevant journals and Medline search using the keywords- Antiretroviral drugs, drug resistance, HIV subtypes and resistance testing. Results: The types, groups, subtypes, sub-subtypes and recombinant forms of HIV-1 have been identified according to their geographical distributions. The evolution of HIV viral mutations, process (es) involved in development of primary and secondary antiretroviral drug resistance, including the role of HIV genetic polymorphisms, and transmitted resistance have been discussed. Conclusion: The pitfalls in the current resistance testing based on HIV-1 subtype B have been highlighted. The design of resistance testing algorithm based on HIV-1 subtype non-B has been suggested for the developing world

Prevalence of hypertension and associated factors in a rural community in Bayelsa State

Background: Hypertension is considered among the most common non-communicable diseases globally with significant morbidity and mortality. Closely related to it is pre-hypertension, a category between hypertension and normotension which is believed to be a forerunner to hypertension and cardiovascular disease. Hypertension has been on the increase in recent times, even in rural communities which were previously less affected. The study was carried during the world health day as a screening exercise to determine the prevalence of hypertension and its associated factors in a rural community.Methods: This cross-sectional study was conducted in Ogboloma village, a small rural community in Bayelsa State, Ngeria Consecutive sampling of all eligible participants who presented for the screening exercise was done. Socio-demographic data, clinical history, anthropometry and blood pressure were taken. Data was stored and analyzed using SPSS version 20.0.Results: One hundred and thirty-one participants completed the study. There were 49(37.4%) males. The prevalence of hypertension was 50.4% while pre-hypertension was found in another 41.2%. Factors associated with hypertension on univariate analysis were age (p <0.001) body mass index (p=0.038) waist hip ratio (p=0.008) hyperglycemia (p=0.030) and smoking (p=0.009) However, only age (p=0.004) and smoking (p=0.037) remained significant on multivariate analysis.Conclusions: Hypertension and Pre-hypertension were highly prevalent in this rural community. Age and smoking were significant predictors of hypertension. Hypertension screening and control programmes should therefore target rural communities and smokers

HIV Wasting Syndrome in a Nigerian Failing Antiretroviral Therapy: A Case Report and Review of the Literature

The HIV wasting syndrome represented the face of HIV/AIDS before the advent of highly active antiretroviral therapy (HAART). Although the incidence of wasting has declined since the introduction of HAART, weight loss remains common in patients receiving HAART, especially in the setting of a failing HAART regimen. As we are not aware of any previous reports from Nigeria, we report a case of the classical wasting syndrome in a Nigerian female who had both virological and immunological HAART failure due to poor adherence. The influence of a failing HAART regimen, socioeconomic status, and other clinical variables in the wasting syndrome are discussed

Disseminated infections due to Immune Reconstitution Inflammatory Syndrome after Highly Active Antiretroviral Therapy-Report of 3 cases from Nigeria

Immune Reconstitution Inflammatory Syndromes (IRIS) are exaggerated pathological inflammatory reactions occurring after initiation of highly active antiretroviral therapy (HAART) due to exuberant immune responses to occult or apparent opportunistic infections or cancers. In view of paucity of studies from Nigeria, we report 3 cases of IRIS presenting as disseminated infections in HIV-1 infected patients initiating HAART. The first case was a previously healthy female who developed disseminated tuberculosis after 4 weeks of regular HAART. Her HAART regimen was continued and she improved after commencement of anti-tuberculosis drugs, with evidence of progressive increase in CD4 cell count. The second case was a HAART-experienced female who stopped her drugs for 4months. Two months after recommencement of her previous HAART regimen, she developed features of disseminated herpes zoster infection, despite evidence of decrease in viral load by 95%. HAART was continued and she recovered completely after receiving valaciclovir tablets and antibiotics. The third patient was a female student who was commenced HAART on account of chronic cough and weight loss. Three months after regular HAART, she developed features of disseminated Kaposi's sarcoma involving the skin, oropharynx and lungs, despite evidence of 42% increase in CD4 cell count. Unfortunately, she rapidly deteriorated and died during the course of management. Clinicians should be alert to the possibility of IRIS in HIV-infected patients initiated or re-initiated on HAART. There is need for future prospective studies determining risk factors for IRIS in HIV-infected patients from Nigeria

Neurobrucellosis- A Case Report and Review of Literature

Neurobrucellosis is a rare form of systemic brucellosis, a disease acquired through ingestion of unpasteurized dairy products, which may manifest as stroke, encephalitis, meningitis, or psychiatric disorders. Presently there is no known report of neurobrucellosis in Nigeria, although consumption of unpasteurized dairy products is not uncommon in this country. In this report we present a 28 year old spinster with history of significant ingestion of unpasteurized cow milk and brucellosis of the brain diagnosed in our centre through brain magnetic resonance imagining (MRI) and brucella antigen agglutination test. Because of the indolent nature of brucellosis infection, it should be suspected in individuals with pyrexia of unknown origin so that early detection and treatment could prevent long-term sequelae such as focal neurologic deficits, hydrocephalus and psychiatric illness.Key Words: Antigen agglutination test, Brucella, neurobrucellosis, unpasteurized dairy product

Effect of dietary inclusion of Pleurotus tuber-regium on performance and intestinal morphology of growing rabbits

The Pleuroteus mushroom has immense growth and health promoting potentials. However, reports on its utilization in the diet of the rabbit is sparse. Therefore, a 56-day feeding trial was conducted to investigate the effects of dietary inclusion of Pleurotus tuber-regium sclerotium powder (PTRSP) in growing rabbits. Forty–eight crossbred rabbits aged between 7 and 9 weeks with average initial weight of 700±25 g were used for the study. The rabbits were allotted to 4 experimental diets containing 0.0, 25.0, 50.0 and 75.0 g/kg PTRSP, respectively. Each treatment had 4 replicates with three rabbits each in a completely randomised design. Growth performance, serum biochemistry and intestinal morphology were determined. The weight gain and feed conversion ratio were better (P&lt;0.05) in rabbits fed diet containing 50.0g/kg PTRSP. Rabbits fed diet containing 75.0 g/kg PTRSP had lower (P&lt;0.05) serum cholesterol, creatinine and alanine transaminase and higher (P&lt;0.05) total glucose concentration compared to those receiving other experimental diets. Rabbits fed diet with 50.0g/kg PTRSP had higher (P&lt;0.05) caecal apical width than those fed diet containing 0.0 g/kg. Inclusion of 50.0 g/kg of PTRSP in the diets of rabbits is beneficial for improved growth, cholesterol metabolism and intestinal morphology without any adverse effects

PREVALENCE AND DETERMINANTS OF OCCUPATIONAL EXPOSURES TO BLOOD AND BODY FLUIDS AMONG HEALTH WORKERS IN TWO TERTIARY HOSPITALS IN NIGERIA

Background: Healthcare associated infections among health workers commonly follow occupational exposures to pathogens infecting blood or body fluids of patients. We evaluated the prevalence and determinants of occupational exposures to blood/body fluids among health workers in two tertiary hospitals in Nigeria. Methods: In a cross section study undertaken in two tertiary hospitals in North-central and South-south Nigeria in 2011, a structured self-administered questionnaire was used to obtain demographic data and occupational exposures to blood/body fluids in the previous year from doctors, nurses and laboratory scientists. Independent predictors of occupational exposures were determined in an unconditional logistic regression model. Results: Out of 290 health workers studied, 75.8%, 44.7%, 32.9%, 33.9% and 84.4% had skin contact with patient’s blood, needle stick injuries, cut by sharps, blood/body fluid splashes to mucous membranes and one or more type of exposures respectively. Ninety one percent, 86%, 71.1%, 87.6%, 81.3%, and 84.4% of house officers, resident doctors, consultant doctors, staff nurses, principal/chief nursing officers and laboratory scientists, respectively had one or more type of exposures in the previous year (P>0.05). Professional group was found to be the only independent predictor of cut by sharps. House officers and nurses had higher and more frequent occupational exposures than other professional groups. Conclusion: Our results suggest high rates of occupational exposures to blood/body fluid among health workers in Nigeria, especially among newly qualified medical doctors and nurses. Health facilities in Nigeria ought to strengthen infection prevention and control practices while targeting high risk health workers such as house officers and nurses

Genomic characterisation of human monkeypox virus in Nigeria

Monkeypox virus (MPXV) is a large, double-stranded DNA virus belonging to the Orthopox genus in the family Poxviridae. First identified in 1958, MPXV has caused sporadic human outbreaks in central and west Africa, with a mortality rate between 1% and 10%.1 Viral genomes from west Africa and the Congo Basin separate into two clades, the latter being more virulent.2 Recently, MPXV outbreaks have occurred in Sudan (2005), the Republic of the Congo and Democratic Republic of the Congo (2009), and the Central African Republic (2016).3 A suspected outbreak of human MPXV was reported to WHO on Sept 26, 2017, by the Nigeria Centre for Disease Control (NCDC) after a cluster of suspected cases had occurred in Yenagoa Local Government Area, Bayelsa State, Nigeria.4 Since the onset of the outbreak, 155 cases have been reported by the NCDC, of which 56 were confirmed.4 A subset of these samples was sent to the WHO Collaborating Center at the Institut Pasteur de Dakar (IPD) in Senegal for confirmation by PCR

Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: a global case series.

BACKGROUND: Between May and November, 2022, global outbreaks of human monkeypox virus infection have been reported in more than 78 000 people worldwide, predominantly in men who have sex with men. We describe the epidemiological and clinical characteristics of monkeypox virus infection in cisgender (cis) and transgender (trans) women and non-binary individuals assigned female sex at birth to improve identification and understanding of risk factors. METHODS: International collaborators in geographical locations with high numbers of diagnoses of monkeypox virus infection were approached and invited to contribute data on women and non-binary individuals with confirmed monkeypox virus infection. Contributing centres completed deidentified structured case-report spreadsheets, adapted and developed by participating clinicians, to include variables of interest relevant to women and non-binary individuals assigned female at birth. We describe the epidemiology and clinical course observed in the reported infections. FINDINGS: Collaborators reported data for a total of 136 individuals with monkeypox virus infection who presented between May 11 and Oct 4, 2022, across 15 countries. Overall median age was 34 years (IQR 28-40; range 19-84). The cohort comprised 62 trans women, 69 cis women, and five non-binary individuals (who were, because of small numbers, grouped with cis women to form a category of people assigned female at birth for the purpose of comparison). 121 (89%) of 136 individuals reported sex with men. 37 (27%) of all individuals were living with HIV, with a higher proportion among trans women (31 [50%] of 62) than among cis women and non-binary individuals (six [8%] of 74). Sexual transmission was suspected in 55 (89%) trans women (with the remainder having an unknown route of transmission) and 45 (61%) cis women and non-binary individuals; non-sexual routes of transmission (including household and occupational exposures) were reported only in cis women and non-binary individuals. 25 (34%) of 74 cis women and non-binary individuals submitted to the case series were initially misdiagnosed. Overall, among individuals with available data, rash was described in 124 (93%) of 134 individuals and described as anogenital in 95 (74%) of 129 and as vesiculopustular in 105 (87%) of 121. Median number of lesions was ten (IQR 5-24; range 1-200). Mucosal lesions involving the vagina, anus, or oropharynx or eye occurred in 65 (55%) of 119 individuals with available data. Vaginal and anal sex were associated with lesions at those sites. Monkeypox virus DNA was detected by PCR from vaginal swab samples in all 14 samples tested. 17 (13%) individuals were hospitalised, predominantly for bacterial superinfection of lesions and pain management. 33 (24%) individuals were treated with tecovirimat and six (4%) received post-exposure vaccinations. No deaths were reported. INTERPRETATION: The clinical features of monkeypox in women and non-binary individuals were similar to those described in men, including the presence of anal and genital lesions with prominent mucosal involvement. Anatomically, anogenital lesions were reflective of sexual practices: vulvovaginal lesions predominated in cis women and non-binary individuals and anorectal features predominated in trans women. The prevalence of HIV co-infection in the cohort was high. FUNDING: None