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

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<0.05) in rabbits fed diet containing 50.0g/kg PTRSP. Rabbits fed diet containing 75.0 g/kg PTRSP had lower (P<0.05) serum cholesterol, creatinine and alanine transaminase and higher (P<0.05) total glucose concentration compared to those receiving other experimental diets. Rabbits fed diet with 50.0g/kg PTRSP had higher (P<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

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

Dermatomyositis associated with HIV-1 infection in a Nigerian adult female: a case report

Human immunodeficiency virus (HIV) infection has been implicated as a trigger for various autoimmune diseases, one of which is dermatomyositis. This is a very rare autoimmune disease characterised by myopathy, typical cutaneous signs and variable systemic manifestations. To our knowledge, the association of this rare disease with HIV infection has not been previously reported in Nigeria. We therefore decided to report the case of a 40 year old HIV-1 infected Nigerian female who presented to us with muscle, skin, and systemic manifestations of dermatomyositis. Our aim is to show the effect of HIV infection, as well as HAART-induced immune reconstitution on the clinical course of dermatomyositis

Aflatoxins In Body Fluids And Food Of Nigerian Children With Protein- Energy Malnutrition

Aflatoxins are natural contaminants of food crops implicated in the pathogenesis of various human diseases. This study aimed to determine the associations between aflatoxins and protein- energy malnutrition (PEM) by measurements of aflatoxins in serum, urine and food on plate of Nigerian children with PEM. A cross- sectional study was undertaken in 3 agro- ecological regions of Nigeria (Guinea savannah, Sudan savannah and Rain forest), where aflatoxins B1, B2, G1, G2, M1, and M2 were measured in sera, urine and food on plate of 79 children with PEM (kwashiorkor n=36, marasmic kwashiorkor n=29 and marasmus n=13) and 33 healthy controls, matched for age and sex. Among healthy controls, aflatoxin detection rates were higher in the Guinea Savannah (72.2%) than in the Sudan Savannah (53.8%), albeit statistically insignificant. In relation to nutritional groups, the rates of detection of aflatoxins were higher in marasmic kwashiorkor (93.1%) and kwashiorkor patients (88.9%), compared to marasmus (76.9%) and controls (63.6%, p=0.013). The rates of detection of B1 aflatoxin followed a similar trend viz. marasmic kwashiorkor (82.4%), kwashiorkor (69.4%), marasmus (53.8%) and controls (42.4%, p=0.007). Of all types of aflatoxins detected in serum, M2 had the highest rates of detection in all patient groups and controls. The median concentrations of aflatoxins detected in sera of each PEM group were significantly higher than those of controls, but comparisons between PEM groups were not statistically significant. The frequency and concentration of aflatoxins detected in urine and food of PEM groups and controls were not statistically different. However, controls had the lowest serum /urine aflatoxin ratio as well as lowest median aflatoxins concentrations in their food as compared to PEM patients. In conclusion, aflatoxins are commonly detected in the body fluids and food of Nigerian children, but more frequently and at higher concentrations in children with PEM, possibly due to decreased excretion or increased exposure. Future prospective studies are desirable to determine if aflatoxins contribute to the pathogenesis of all types of PEM and not necessarily kwashiorkor alone

A Multi-Site Knowledge Attitude and Practice Survey of Ebola Virus Disease in Nigeria

Background The 2014 Ebola Virus Disease (EVD) outbreak was characterised by fear, misconceptions and irrational behaviours. We conducted a knowledge attitude and practice survey of EVD in Nigeria to inform implementation of effective control measures. Methods Between July 30th and September 30th 2014, we undertook a cross sectional study on knowledge, attitude and practice (KAP) of Ebola Virus Disease (EVD) among adults of the general population and healthcare workers (HCW) in three states of Nigeria, namely Bayelsa, Cross River and Kano states. Demographic information and data on KAP were obtained using a self-administered standardized questionnaire. The percentage KAP scores were categorised as good and poor. Independent predictors of good knowledge of EVD were ascertained using a binary logistic regression model. Results Out of 1035 study participants with median age of 32 years, 648 (62.6%) were males, 846 (81.7%) had tertiary education and 441 (42.6%) were HCW. There were 218, 239 and 578 respondents from Bayelsa, Cross River and Kano states respectively. The overall median percentage KAP scores and interquartile ranges (IQR) were 79.46% (15.07%), 95.0% (33.33%) and 49.95% (37.50%) respectively. Out of the 1035 respondents, 470 (45.4%), 544(52.56%) and 252 (24.35%) had good KAP of EVD defined using 80%, 90% and 70% score cut-offs respectively. Independent predictors of good knowledge of EVD were being a HCW (Odds Ratio-OR-2.89, 95% Confidence interval-CI of 1.41–5.90), reporting ‘moderate to high fear of EVD’ (OR-2.15, 95% CI-(1.47–3.13) and ‘willingness to modify habit’ (OR-1.68, 95% CI-1.23–2.30). Conclusion Our results reveal suboptimal EVD-related knowledge, attitude and practice among adults in Nigeria. To effectively control future outbreaks of EVD in Nigeria, there is a need to implement public sensitization programmes that improve understanding of EVD and address EVD-related myths and misconceptions, especially among the general population

Seroprevalence and determinants of human herpes virus 8 infection in adult Nigerians with and without HIV-1 infection

Background: There is a dearth of studies on HHV8-HIV co-infections from Nigeria, even as both infections have been shown to be endemic in Africa. This study examined the seroprevalence and determinants of HHV8 infections in adult Nigerians with and without HIV-infection. Methods: In 2007, a cross sectional study undertaken in a tertiary hospital in Zaria, northern Nigeria enrolled 71 HIV-1 positive adults without Kaposi&apos;s sarcoma and 85 apparently healthy HIV-negative adult volunteers of the general population. Anti-lytic antibodies to HHV8 infection was determined by ELISA. A univariate analysis including age, sex, marital status, past sexually transmitted disease (STD), past blood transfusion, HIV/AIDS staging and CD4 count was used to determine variables associated with HHV8 seropositivity. Significant variables were adjusted in a logistic regression model expressed in odds ratio (OR) with 95% confidence interval (CI). P<0.05 was considered significant Results: The seroprevalence of HHV8 infection was 62% in HIV-1 positive patients and 25.9% in HIV negative adults (p<0.001). A past history of STD [OR= 2.88, 95% CI= 1.0 - 8.2] and advanced HIV/AIDS (WHO stage 3 and 4) [OR=3.5, 95% CI= 1.21-10.1] were the only variables independently associated with HHV8 seropositivity in HIV-infected patients. In HIV-negative adults, none of the variables was significantly associated with HHV8 seropositivity. Conclusion: The study findings suggest an adverse interaction between HHV8 and HIV-1. The higher prevalence of HHV8 infection in HIV-infected patients and its association with STD support a predominant sexual route of HHV8 transmission among adult Nigerians