Cord blood full blood count parameters in Lagos, Nigeria

Introduction: Full blood count (FBC), one of the most frequently requested for laboratory investigations, is a simple, fast and cheap test and is a reliable indicator of health. Due to its usefulness in the  assessment of health status of individuals, its parameters in cord blood, a major source of haemopoietic stem cell transplantation and an ideal source for laboratory investigations for newborns were determined to provide a useful guide to local neonatologists and stem cell transplant physicians. Methods: Three millilitres of umbilical cord blood was collected from 130 normal birth weight newborns (69 males and 61 females) whose cord were clamped immediately after delivery, at a teaching hospital in Lagos, Nigeria and full blood count parameters were determined using Sysmex autoanalyzer, model  KX-21N. Consented mothers of the newborns were selected based on, age between 18 and 45 years;  uneventful pregnancy and delivery and haemoglobin (Hb) concentration ≥ 10 g/dL. Results: There were no statistical gender differences in the mean values of Hb concentrations (M=13.27  ±1.60 g/dL; F=13.32±1.61g/dL; p=0.93), total white cell count (M=3.16±5.43 × 109/L; F=13.07±4.98  × 109/L; p= 0.92), platelet count (M= 223.64± 64.21 × 109/L; F=226.69±80.83 × 109/L; p=0.81) and other parameters. Conclusion: Mean values of full blood count parameters obtained in this study are  comparable to reports from other studies in developing countries and could be a useful guide for neonatologists and stem cell transplant physicians in our geographical location.Key words: Haemoglobin, cord blood, stem cell, umbilical cord, neonatologis

Cryptococcal meningitis after ART : Need for proper baseline evaluation in the era of ‘Test & Treat’

Peer reviewedPublisher PD

High levels of resistance to nucleoside/nucleotide reverse transcriptase inhibitors in newly diagnosed antiretroviral treatment-naive children in sub-Saharan Africa.

: Exposure of infants to antiretroviral drugs for prevention of mother-to-child transmission can induce resistance to nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). Data from nine national surveys of pretreatment drug resistance in children newly diagnosed with HIV show high levels of resistance to NRTIs included in first-line antiretroviral treatment (ART) regimens (dual abacavir-lamivudine/emtricitabine resistance). Additional research is needed to determine the impact of NRTI resistance on treatment response and optimize infant ART

Prevalence of HIV-related autoimmune haemolytic anaemia in Lagos, Nigeria

Background: Despite a high frequency of anaemia, a positive direct antiglobulin test (DAT) and bone marrow hyperplasia HIV-infected patients, lack of reticulocytosis may cause underdiagnosis autoimmune haemolytic anaemia (AIHA) in them. This study was carried out to determine the prevalence of autoimmune haemolytic anaemia in HIV-infected patients and to compare the haematological/immunological characteristics of subjects with anaemia and those without. Materials and Methods: A total of 350 HIV-infected subjects attending the Lagos University Teaching Hospital who consented were recruited for the study. This included 250 subjects with anaemia (haemoglobin concentration <10 g/dl) as cases and 100 subjects without anaemia as controls. Five milliliters of venous blood drawn from each subject was used for the full blood count, reticulocyte count and DAT. Results: Subjects with anaemia had lower mean CD4 cell count (284.3 cells/μl) and higher mean reticulocyte per cent (1.5%) than the non-anaemic subjects. The frequency of reticulocytosis was higher in female subjects than in males. Only 0.8% (2 of 250) of the study group screened positive to DAT, p = 0.0339. None of the subjects in control group screened positive to DAT. Conclusion: Autoimmune haemolytic anaemia is a rare complication of HIV infection in our geographical location

Tackling cryptococcal meningitis in Nigeria, one-step at a time; the impact of training.

BACKGROUND:Nigeria is estimated to have 25,000 cases of cryptococcal antigenemia (CrAg) annually. CrAg screening with pre-emptive fluconazole treatment is recommended but not yet implemented in Nigeria. Trainings were conducted to improve health-care provider (HCP) awareness and clinical skills in the management and prevention of cryptococcal meningitis (CM). METHODS:HCPs providing care for people living with HIV were targeted for training at 13 sites from April to November 2018 Course content was adapted from CDC Cryptococcal Screening Program Training Manual and LIFE-website. "Hands-on" training on CrAg testing and lumbar puncture was included. A 14-point pre and post-test assessment instrument was designed to capture the impact of the training and focus group discussions (FGDs) were conducted. RESULTS:A total of 761 HCPs were trained. 519 HCPs completed the pre-test evaluation while 470 (90.6%) took part in the post-test evaluation. Post-training, HCPs were significantly more likely to respond correctly to all 14 assessment items, with the mean percentage score rising to 91.0% from a pre-training value of 60.0%. FGDs revealed that many of the HCPs were not aware of the CrAg screening and pre-emptive treatment recommendations in Nigerian guidelines, and reported not having seen or managed a case of CM. Also, they highlighted challenges with routine CrAg screening due to a lack of access to CD4 testing, CrAg test kits, antifungal drugs, as well as the need for similar trainings across all tiers of care in Nigeria. CONCLUSION:Training significantly improved HCPs' understanding of Nigerian policy on CrAg screening, CM diagnosis and best management practices. This training could be included in routine capacity building efforts for HCPs involved in HIV care in Nigeria

Plasma inflammatory biomarkers predict CD4+ T-cell recovery and viral rebound in HIV-1 infected Africans on suppressive antiretroviral therapy

This multi-country prospective study investigated whether persistent systemic inflammation, measured by eight plasma biomarkers, in HIV-1-infected Africans during suppressive antiretroviral therapy (ART) (viral load&lt;50 copies/mL), was associated with CD4+ T-cell recovery and viral rebound (&gt;1,000 copies/mL) during long-term treatment. On-ART sCD14 and CRP concentrations were inversely associated with subsequent CD4+ T-cell counts. Risk of viral rebound was increased for participants with higher on-ART CXCL10 concentrations, and reduced for those with a greater sCD163 decline during the first year of ART. Persistent systemic inflammation predicted CD4+ T-cell recovery and viral rebound, warranting further mechanistic research in relation to clinical outcomes

Plasma Inflammatory Biomarkers Predict CD4+ T-cell Recovery and Viral Rebound in HIV-1 Infected Africans on Suppressive Antiretroviral Therapy

This multicountry prospective study investigated whether persistent systemic inflammation, measured by 8 plasma biomarkers, in HIV-1-infected Africans during suppressive antiretroviral therapy (ART) (viral load 1000 copies/mL) during long-term treatment. On-ART sCD14 and C-reactive protein concentrations were inversely associated with subsequent CD4+ T-cell counts. Risk of viral rebound was increased for participants with higher on-ART CXCL10 concentrations and reduced for those with a greater sCD163 decline during the first year of ART. Persistent systemic inflammation predicted CD4+ T-cell recovery and viral rebound, warranting further mechanistic research in relation to clinical outcomes