Ca Nwauche

HIV-Positive Nigerian Adults Harbor Significantly Higher Serum Lumefantrine Levels than HIV-Negative Individuals Seven Days after Treatment for Plasmodium falciparum Infection

ABSTRACT Management of coinfection with malaria and HIV is a major challenge to public health in developing countries, and yet potential drug-drug interactions between antimalarial and antiviral regimens have not been adequately investigated in people with both infections. Each of the constituent components of artemether-lumefantrine, the first-line regimen for malaria treatment in Nigeria, and nevirapine, a major component of highly active antiretroviral therapy, are drugs metabolized by the cytochrome P450 3A4 isoenzyme system, which is also known to be induced by nevirapine. We examined potential interactions between lumefantrine and nevirapine in 68 HIV-positive adults, all of whom were diagnosed with asymptomatic Plasmodium falciparum infections by microscopy. Post hoc PCR analysis confirmed the presence of P. falciparum in only a minority of participants. Day 7 capillary blood levels of lumefantrine were significantly higher in HIV-positive participants than in 99 HIV-negative controls (P = 0.0011). Associations between day 7 levels of lumefantrine and risk of persistent parasitemia could not be evaluated due to inadequate power. Further investigations of the impact of nevirapine on in vivo malaria treatment outcomes in HIV-infected patients are thus needed.

Disclosure amongst adult HIV patients on antiretroviral therapy in Port Harcourt, Nigeria.

HIV transmission is still a public health concern in sub-Saharan Africa; disclosure is an effective tool for its prevention, contact tracing and treatment. We aimed to evaluate the disclosure behaviours of adult HIV-positive patients receiving antiretroviral therapy (ART) in University of Port Harcourt Teaching Hospital, and identify major challenges to disclosure in a bid to develop ways to improve this practice in the environment. Patients receiving ART in this centre were interviewed using an interviewer-administered questionnaire. A total of 250 clients were interviewed over three months. A majority of the patients were tested on account of ill health 143 (57.2%). They commenced ART within 8 ± 15.4 SD months of presentation. The mean period before disclosure was 4.75 ± 12.8 SD months of diagnosis. Thirty-six (14.4%) of the respondents had not disclosed their HIV status; the major barrier to disclosure was stigmatisation in 19 (36%).

Antimalarial treatment by health care providers in Port Harcourt, Nigeria

Background In Nigeria, malaria accounts for 60% of outpatient visits, 30% hospitalization, and is estimated to be responsible for about 11% of overall maternal mortality, 25% of infant mortality, and 30% of under-five mortality [1]. The disease is particularly virulent among pregnant women and the under-five years of age, due to their low levels of immunity. It impedes economic growth and keeps households in poverty. Lack of access to diagnostic testing before treatment is one of the weaknesses in the management of malaria in Nigeria [2]. This study examines the treatment practice for malaria among health care providers (HCPs) in Port Harcourt.

Is this Evidence of Success in Malaria Prevention and Control Measures

In Nigeria, mass distribution of Long Lasting Insecticide Treated Nets (LLINs), community awareness programs, increased availability of Artemisinin-based combination therapies (ACTs) and Biolarviciding have been part of strategies employed, with the aim of contributing to the realization of the sixth Millennium Development Goal Combating Malaria. This study investigates malaria prevalence among adult subjects presenting for routine medical examination at the Lulu Briggs Health Centre, University of Port Harcourt. Blood samples of 354 willing subjects were tested for parasitemia using double microscopy and standard Rapid Diagnostic (RDT) Test Kits. Axillary temperature, genotype, blood group and packed cell volume of the subjects were also determined. Questionnaire was used to obtain information regarding their demographics, previous use of antimalarials, and malaria prevention strategies they have adopted. The results obtained on the prevalence of malaria were as follows; RDT, 7.4%, double microscopy 11.0%. Among the parasite-positive samples, 32 (82.1%) were of AA, 6 (15.4%) AS, and 1 (2.5%) SS genotype, while on the other hand, 23 (59%) were of O + , 10 (25%) of A + , 3 (8%) of AB + , and 3(8%) of the B + blood groups. The decline in malaria prevalence rate when compared to other studies, suggests that malaria control measures are having a degree of success and that individuals are making conscious effort to reduce mosquito bites. Also, the study reaffirms that microscopy still remains the gold standard in malaria diagnosis, even though RDTs are invaluable when immediate result is desired and where a laboratory is not in sight.

Gastric mucosa-associated lymphoid tissue: The need for prompt histologic diagnosis

Gastric mucosa-associated lymphoid tissue has a well established pathophysiologic link with Helicobacter pylori infection. Mucosa-associated lymphoid tissue (MALT) is acquired through chronic inflammation/antigenic stimulation in organs which are normally devoid of lymphoid tissue. We report a case of a 65 years old man with a two year history of dyspeptic symptoms associated with gradual weight loss and an epigastric mass. With poor response to anti-ulcer regimens in a peripheral hospital, he was offered a gastrectomy. The histologic report of the mass showed atypical lymphoid cells infiltration of the gastric mucosa up to the muscularis propria. He was promptly commenced on a standard chemotherapeutic regimen for Non Hodgkins lymphoma, but demised before the second course of chemotherapy. This case highlights the need for prompt endoscopy with biopsy and histologic diagnosis of specimen to shorten delays in diagnosis and improve outcome of patients with gastric mucosa-associated lymphoid tissue.

HIV-positive Nigerian adults harbour significantly higher serum lumefantrine levels than HIV negative individuals seven days after treatment for Plasmodium falciparum infection

Ifeyinwa Chijioke-Nwauche, Albert van Wyk, Chijioke Nwauche, Khalid B. Beshir, Harparkash Kaur, Colin J. Sutherland Department of Clinical Pharmacy and Management, Faculty of Pharmaceutical Sciences, University of Port Harcourt, Rivers State, Nigeria; Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, LSHTM, London, United Kingdom; Department of Haematology, Blood Transfusion and Immunology, College of Health Sciences, University of Port Harcourt, Rivers State, Nigeria; Centre for Malaria Research & Phytomedicine, University of Port Harcourt, Rivers State, Nigeria; Department of Disease Control, Faculty of Infectious and Tropical Diseases, LSHTM, London, United Kingdom

The effects of highly active antiretroviral therapy (HAART) of stavudine, lamivudine and nevirapine on the CD4 lymphocyte count of HIV-infected Africans: the Nigerian experience

OBJECTIVES The objective of this study was to investigate the short-term effect of highly active antiretroviral therapy on the CD4 lymphocyte count of HIV-infected Nigerians. DESIGN A case control study of 70 HIV-infected subjects placed on highly active antiretroviral therapy. Thirty HIV-infected yet to start therapy due to unaffordability were observed as controls. SETTING This study was carried out at the Hematology Department of the University of Port Harcourt Teaching Hospital a 500 bed tertiary hospital and one of the designated antiretroviral therapy pilot centers. METHODS CD4 lymphocyte count was determined at baseline for subjects and controls. Subjects were placed on HAART for 12 weeks while controls that were yet to start therapy were monitored as controls. CD4 lymphocyte count was repeated after 12 weeks and the differences compared statistically. RESULTS We observed that subjects and control patients did not differ significantly in their CD4 lymphocyte count at baseline (p>0.05), but after 12 weeks HAART in subjects and untreated control there was a mean increase in CD4 count of (39 cells/microL) in subjects, while untreated controls showed a mean decline of (12 cells/microL) p< 0.05. There was a statistically significant variation in the therapy dependent increases in CD4 count of HAART treated subjects based on pre-therapeutic baseline CD4 count (divide2 = 180.39, p<0.05). The HAART dependent increase in CD4 counts was higher in younger subjects 19-28 years (31 cells/microL) compared to older subjects 49-58 years (21 cells/microL) (p = 0.01). Similarly CD4 response was found higher in females compared to males (p = 0.01). CONCLUSION This study indicates the importance of accessing the CD4 lymphocyte count of HIV infected patients before the initiation of HAART, its use as a prognostic maker in predicting the initial response to HAART and in determining the optimal time to initiate therapy.