HAART \u2013 Dependent CD4+ Lymphocyte Response Based on Pre-Therapeutic CD4 Lymphocyte Count in HIV-Infected Nigerians

Background: Increasing concerns related to cost, drug toxicity, pill burden, tolerability ability of patient to adhere to strict and complicated regimen and emergence of drug resistance has complicated the decision making process of when to start antiretroviral therapy. The present research is aimed at determining if there is any immunological advantage in initiating HAART at a pre-therapeutic CD4 count of > 350cells/\u3bcl rather than at 200-350 or < 200 cells/\u3bcl. Method: One hundred HIV-infected previously antiretroviral- naive individuals grouped under 3 CD4+ lymphocyte count thresholds; < 200, 200 \u2013 350 and > 350 cells/\u3bcl were randomized to take HAART of stavudine (40mg) lamivudine (150mg) and nevirapine (200mg) orally twice daily. CD4 lymphocyte count was determined serially every 8 weeks for an observation period of 48 weeks. CD4 lymphocyte count responses were compared statistically based on pre-therapeutic CD4 lymphocyte counts. Results: The overall increase in CD4 lymphocyte count irrespective of baseline CD4 count was 122 cells/\u3bcl (p < 0.01). CD4 lymphocyte count response to 48 weeks HAART was significantly higher in patients initiating HAART at a pre-therapeutic CD4 count of <200 cells/\u3bcl (163 cells/\u3bcl) compared to 118 and 50 cells/\u3bcl respectively for those initiating at 200 \u2013 350 and > 350 cells/\ub5l respectively (\u3c72 = 1.80, p < 0.05). HIV-related morbidity of 3% was found among subjects who initiated HAART with a pre-therapeutic CD4 count of < 200 cells/\u3bcl. Steven -Johnson syndrome was the commonest adverse clinical event observed occurring in 15% of subjects. Conclusion: Our study indicates that there is no long-term advantage in terms of CD4+ lymphocyte response in initiating HAART at a pre-therapeutic CD4 count of > 350 cells/\u3bcl rather than at 200 \u2013 350 cells/\u3bcl. Our present study appears to support postponing the initiation of therapy in some patients until the CD4+count approaches 200 cells/\u3bcl particularly in sub-Saharan Africa where drug accessibility and affordability constitutes a major challenge.Introduction: Des int\ue9r\ueats progressifs ayant rapport au co\ufbt, toxicit\ue9 des drogues, charge de la pilule, capacit\ue9 tol\ue9rable de patient pour observer les stricts et r\ue9gime compliqu\ue9 et \u3bcmergence de la r\ue9sistante aux drogues ont compliqu\ue9 le processus de la prise de d\ue9cision de quand on doit commencer la th\ue9rapie antir\ue9trovirale. L'objet de cette recherche est de d\ue9cider s'il y a quelque avantage immunilogique dans commencement de HAART dans le compte CD4 pr\ue9th\ue9rapeutique de > 350 cellules/Ul plutot que en 200-350 cellules/Ul \ue9taient randomis\ue9s afin de prendre HAART de stavudine (40mg) lamivudine (150mg) et nevirapine (200mg) par voie orale deux fois par jour. CD4 lymphocyte compte \ue9tait d\ue9cid\ue9 par s\ue9rie chaque 8 semaines pendant une p\ue9riode d'observation de 48 semaines. Compte de CD4 lymphocyte r\ue9ponses ont \ue9t\ue9 compar\ue9s de la base statistique sur CD4 pr\ue9-th\ue9rapeutique compte lymphocyte. R\ue9sultats: Dans l'ensemble, l'augmentation dans le compte lymphocyte CD4 sans tenir compte de ligne de fuite compte CD4 \ue9tait 122 cellules/Ul (P<0,01). Compte lymphocyts CD4 r\ue9ponse aux 48 semaines HAART \ue9tait sensiblement plus \ue9lev\ue9 chez des patients qui commencent l'HAART dans le compte CD4 pr\ue9th\ue9rapeutique de <200 cellules/Ul (163 cellules/Ul) par rapport aux 118 et 50 cellules/Ul respectivement pour ceux qui commencent en 200 \u2013 350 et > 350 cellules/Ul respectivement (X2 = 1,80,P <0,05). Le VIH li\ue9 \ue0 la morbidit\ue9 de 3% \ue9tait trouv\ue9 parmi des sujets qui ont commenc\ue9 le HAART avec le compte CD4 pr\ue9-th\ue9rapeutique de <200 cellules/Ul. Syndrome de Steven-Johnson \ue9tait un \ue9v\ue9nement clinique oppos\ue9 le plus ordinairement observ\ue9 qui arrive chez 15% des sujets. Conclusion: Notre \ue9tude montre qu'il n y a aucun avantage de longue dur\ue9e au terme de la r\ue9ponse CD4+ lymphocyte dans le commencement d'HAART au CD4 pr\u3bc-th\ue9rapeutique compte du > 350 cellules/Ul plut\uf4t que en 200-350 cellule/Ul. Cette \ue9tude semble supporter le ajournement de l'initiation de la th\ue9rapie chez quelques patients jusqu'au moment quand le compte CD4+ approche 200 cellules/Ul particuli\ue8rement en Afrique sud saharien ou accessibilit\ue9 aux drogues et abordabilit\ue9 constituent un d\ue9fi majeur

Visual and Auditory Complications of Chronic Myeloid Leukemia: A Case Report

Hearing loss and visual impairment are not common presentations of Chronic Myeloid Leukemia (CML). We report such a case who presented in the chronic phase with profound hearing loss, visual impairment, progressively enlarging spleen, anaemia, and weight loss. Laboratory evaluation showed Packed Cell Volume – 10%, Total White Cell Count – 1,343 x 109/ L, Platelets – 589 x 109/ L. Blood chemistry showed Uric Acid level of 530mmol/L. Karyotyping showed the Philadelphia chromosome. Chemotherapy was instituted and she improved remarkably with minimal improvement in perception of sound

High prevalence of hepatitis B virus among female sex workers in Nigeria Alta prevalência de hepatite pelo vírus B entre trabalhadoras do sexo feminino na Nigéria

Hepatitis B virus (HBV) infection is endemic in Nigeria and constitutes a public health menace. The prevalence of HBV infection in many professional groups has been described in Nigeria. However, literature on HBV infection among female sex workers (FSW) in Nigeria is scanty. FSW in Nigeria are not subjected to a preventive control of HBV infection. This study assesses the extent of spread of HBV among FSW in Nigeria. Seven hundred and twenty (n = 720) FSW (mean age = 26.7 years) were tested for hepatitis B surface antigen (HBsAg) by a double antibody sandwich ELISA method. The overall HBV prevalence among the FSW was 17.1%. FSWs between the ages of 31-35 year (20.5%) and those with 'age-at-first-sex' below 10 years of age (28%) were most affected. This high prevalence of a vaccine preventable disease is unacceptable, therefore, vaccination of this high risk HBV reservoir group should be considered worthwhile.<br>A hepatite pelo vírus B (HBV) é infecção endêmica na Nigéria e constitui problema de saúde pública. A prevalência da infecção HBV em muitos grupos profissionais foi descrito na Nigéria. No entanto, a literatura da infecção HBV entre trabalhadoras do sexo feminino (FSW) na Nigéria é escasso. FSW na Nigéria não são submetidas a um controle preventivo de infecção de HBV. Este estudo avalia a extensão da disseminação de HBV entre FSW na Nigéria. Setecentos e vinte (n = 720) FSW (média de idade = 26,7 anos) foram testadas para antígeno de superfície da hepatite B (HBsAg) pelo método ELISA usando sandwich de duplos anticorpos. A prevalência total de HBV entre o FSW foi 17,1%. FSWs entre as idades de 31-35 anos (20,5%) e abaixo de 10 anos de idade (28%) foram mais afetadas. Esta alta prevalência de doença evitável pela vacinação é inaceitável, portanto, vacinação deste grupo de alto risco de HBV deve ser considerada fundamental

Seroprevalence of hepatitis B e antigen (HBe antigen) and B core antibodies (IgG anti-HBcore and IgM anti-HBcore) among hepatitis B surface antigen positive blood donors at a Tertiary Centre in Nigeria

<p>Abstract</p> <p>Background</p> <p>Hepatitis B virus (HBV) is a common cause of liver disease throughout the world. HBV is transmitted through blood and other body fluids, including semen and saliva. Chronic replication of HBV virons is characterized by persistence circulation of HBsAg, HBeAg and HBV DNA; usually with anti-HBc and occasionally with anti-HBs. Aim: To determine the prevalence of HBeAg, IgG anti-HBcore and IgM anti-HBcore amongst HBsAg positive blood donors. These parameters are reflective of transmissibility and active hepatitis B infection. A cross sectional study was carried out at the blood donor clinics of Lagos State University Teaching Hospital Ikeja and Lagos University Teaching Hospital Idiaraba. A total of 267 donors were recruited to determine HBe antigen, IgG and IgM anti-HBcore antibodies amongst hepatitis BsAg positive donors. Five milliliters of blood was collected from those who tested positive to HBsAg screen during donation. The sera were subjected to enzyme linked immunosorbent assay (ELISA). Pearson chi-squared test was used for the analytical assessment.</p> <p>Findings</p> <p>A total number of 267 HBsAg positive blood donors were studied. A seroprevalence of 8.2% (22 of 267) HBeAg was obtained, 4 of 267 (1.5%) were indeterminate while 241 (90.3%) tested negative. Only 27 out of 267 donors (10.1%) tested positive to IgM anti-HBcore, 234(87.6%) tested negative, while 6(2.2%) were indeterminate. A higher percentage of 60.7% (162 of 267) tested positive to IgG anti-HBcore, while 39.3% (105 of 267) tested negative.</p> <p>Conclusion</p> <p>There is a low seroprevalence rate of HBeAg-positive chronic hepatitis and relatively high IgG anti-HBcore and IgM anti-HBcore rates in South West Nigeria.</p