Emeka Ejeliogu

Molecular characterization of cryptosporidium in children aged 0- 5 years with diarrhea in Jos, Nigeria

Introduction Cryptosporidium is an important cause of diarrhea in children and immune-compromised individuals. Recent advances in molecular diagnostics have led to the discovery of subtype families that are thought to be more commonly associated with diarrhea. We aimed to isolate and characterize Cryptosporidium spp among children with diarrhea in Jos, Nigeria. Methods Stool samples were collected from165 children aged 0-5 years with diarrhea. Cryptosporidium oocysts were examined by wet mount preparation, using formalin ether and a modified acid fast staining method. DNA was extracted from positive samples using QIAamp DNA stool mini kit and PCR-RFLP assay was carried out after quantification. Genotyping and phylogenetic analysis were done to determine the subtype families and their relatedness. Results From the 165 children studied, 8 (4.8%) were infected with Cryptosporidium. PCR-RFLP assay and genotype characterization found the following Cryptosporidium species: C. hominis 6 (75%) and C. parvum 2 (25.0%), with family subtypes Id-5, Ie-1 and IIa-1, IId-1 respectively.The most common species was C. hominis and the frequent subtype was C. hominis-Id 5 (62.5%). Conclusion Cryptosporidium is not an uncommon cause of diarrhea in children, with C. hominis being the dominant species. Also C. hominis Id is the commonest sub-family subtype. Put together, zoonotic species may be an important cause of diarrhea in children aged 0-5 years in Jos, Nigeria.

Factors associated with antiretroviral treatment interruption in human immunodeficiency virus (HIV)-1-infected children attending the Jos University Teaching Hospital, Jos, Nigeria

Background: Interrupting anti-retroviral therapy (ART) for any number of reasons is an indication of a compromised adherence to ART. Several factors, including the pill burden from other drugs used in treating co-infections in children with human immunodeficiency virus (HIV), may influence ART adherence. The aim of this study was to identify the factors associated with ART interruption in HIV-1-infected children. Materials and Methods: A retrospective cohort study analysing data on 580 children consecutively enrolled on ART between February 2006 and December 2010 at the paediatric HIV clinic of Jos University Teaching Hospital (JUTH), Jos. Subjects were children aged 2 months - 15 years diagnosed with HIV-1 infection and on first-line ART. Cotrimoxazole prophylaxis was usually commenced at diagnosis while awaiting ART commencement. Children diagnosed with tuberculosis (TB) were also placed on multiple individual anti-TB drugs. Statistical analysis used: A comparison of the data on children with and without ART interruption was made. Variables associated with ART interruption in a univariate analysis were fit in a multivariate logistic model to determine the factors that were associated with ART interruption. Results: Children on anti-TB drugs were twice more likely to interrupt ART compared to those who were not, (adjusted odds ratio, AOR = 1.84 (1.03-3.28); P = 0.04). But children on cotrimoxazole prophylaxis had a 57% reduction in the odds of interrupting ART compared to those who were not, (AOR = 0.43 (0.20-0.93); P = 0.03). Conclusion: Children on ART and also taking multiple individual anti-TB drugs should be monitored closely for ART adherence. Cotrimoxazole prophylaxis should be encouraged in children diagnosed with HIV while awaiting ART commencement as this may prime them for a better ART adherence.

Is Human Immunodeficiency Virus Still Transmissible Through Blood Transfusion in Children with Sickle Cell Anaemia in Jos, Nigeria?

Aims: To compare the prevalence of HIV infection amongst transfused and non-transfused children with sickle cell anaemia (SCA) in Jos, Nigeria and explore the factors affecting it. Study Design: This was a prospective case control study. Place and Duration of Study: Department of Paediatrics (Sickle Cell Clinic), Jos University Teaching Hospital, Jos, Nigeria, between January 2008 and March 2009. Methodology: A total of 200 transfused children with SCA (117 males and 83 females) were recruited consecutively and screened for HIV using rapid test kits. A questionnaire was used to ascertain the details of blood transfusion and other relevant clinical information. Two hundred age and sex matched non-transfused children with SCA attending the same clinic were recruited as controls. Results: The prevalence of HIV infection amongst transfused children with SCA was 2%, compared to 0% in the control group (P=.04). The four HIV positive cases were transfused in private hospitals with blood of unknown screening status. The number of blood transfusions was Original Research Article British Journal of Medicine & Medical Research, 4(21): 3912-3923, 2014 3913 not a significant factor in acquiring HIV infection (P=.78); however remunerative blood donation increased the risk of acquiring HIV through blood transfusion (AOR=6.28; 95% CI (1.82-9.92); P=.01). Conclusion: HIV is still transmissible through blood transfusion and screening of blood before transfusion is still not completely practiced in Jos, Nigeria. Policies on proper screening of blood before transfusion and voluntary blood donation should therefore be enforced at all levels of healthcare.

WHICH BABIES GET BLOOD IN JOS-NIGERIA?

Documentation of the transfusion needs of neonatal units is required to guide blood banks in meeting demands. A prospective observational study of newborn transfusions over 35 weeks was conducted. Eighty-four transfusions were conducted in 62 of 377 (16.45%) admitted infants in 35 weeks. Neonatal jaundice (57.2%) and anemia (38.1%) were main indications. In 85.7% cases, blood transfused was <3 days old. Weight of infants at transfusion was <2500 g in 51.6% cases. Infants were first transfused at <7 days in 59.7% cases. Whole blood was used in 64.3% of all cases. Overall transfusion rate was 2.4/week. Neonatal jaundice is the commonest indication for transfusion and whole blood is in greater demand.

Risk Factors for First-line Antiretroviral Treatment Failure in HIV-1 Infected Children Attending Jos University Teaching Hospital, Jos, North Central Nigeria

Aim: To determine risk factors for first-line antiretroviral treatment failure in HIV-1 infected children attending Jos University Teaching Hospital, Jos. Study Design: Retrospective cohort study. Place and Duration of Study: Paediatric HIV clinic at the Jos University Teaching Original Research Article British Journal of Medicine & Medical Research, 4(15): 2983-2994, 2014 2984 Hospital, Jos, between February 2006 and December 2010. Methodology: Data on demographic, clinical and laboratory variables for 580 HIV-1 infected children aged 2 months to 15 years on antiretroviral therapy (ART) were analysed. A comparison of the data on children with and without treatment failure was made. Variables associated with treatment failure in a univariate analysis were then fit in a multivariate logistic model to determine the factors that were associated with treatment failure. Results: The rate of treatment failure among the children was 18.8%. Previous antiretroviral drugs (ARV) exposure for treatment, not receiving cotrimoxazole prophylaxis before commencement of ART and having severe immune suppression at HIV diagnosis were the factors independently associated with treatment failure. Children with previous ARV exposure for treatment were 4 times more likely to fail treatment compared to those without previous exposure (AOR=4.20 (1.93-9.15); p <0.001). Children who did not receive cotrimoxazole prophylaxis were twice more likely to develop treatment failure compared to those who did (AOR=2.26 (1.06-4.79); p=0.03) and children with severe immune suppression at HIV diagnosis were twice more likely to develop treatment failure compared to those without severe immune suppression (AOR=2.34 (1.47-3.72); p<0.001). Conclusion: HIV-infected children with previous ARV exposure for treatment and severe immune suppression should be monitored closely and given frequent adherence counseling to minimize the risk of treatment failure. Cotrimoxazole prophylaxis should be encouraged in HIV-infected children while they await commencement of ART, which may improve ART adherence and thus reduce the risk of treatment failure.

Prevalence of and risk factors for pulmonary tuberculosis among newly diagnosed HIV-1 infected Nigerian children

INTRODUCTION Studies on the prevalence of and risk factors for tuberculosis (TB) among newly diagnosed human immunodeficiency virus (HIV)-infected children in sub-Saharan Africa are scarce and in Nigeria there is paucity of reported data. We determined the prevalence of and risk factors for pulmonary TB (PTB) in newly diagnosed (treatment-naïve) HIV-1 infected children at the pediatric HIV clinic of the Jos University Teaching Hospital (JUTH) in Nigeria. METHODS We performed a retrospective analysis of 876 children, aged 2 months - 13 years, diagnosed with HIV-1 infection between July 2005 and December 2012, of which 286 were diagnosed with PTB at presentation after TB screening. The study site was the AIDS Prevention Initiative in Nigeria (APIN)-supported Pediatric HIV clinic at JUTH, Jos. A multivariate forward logistic regression modelling was used to identify risk factors for PTB-HIV co-infection. RESULTS The prevalence of PTB-HIV co-infection was 32% (286/876). Severe immunosuppression (SI) and World Health Organization (WHO) HIV clinical stage 3/4 were identified as independent risk factors for PTB-HIV co-infection in HIV infected children. The odds of PTB-HIV co-infection was increased two-fold in HIV-infected children with WHO clinical stage 3/4 compared to those with stage 1/2 (adjusted odds ratio (AOR) 1.76 [1.31-2.37], p<0.001) and 1.5-fold in children with SI compared to those without SI (AOR 1.52 [1.12-2.06], p=0.007). CONCLUSION In our setting, the burden of PTB was high among newly diagnosed HIV-infected children, and late WHO HIV clinical stage and severe immunosuppression were associated with PTB-HIV co-infection. Therefore there is a clear need to improve strategies for early diagnosis of both HIV and PTB to optimize clinical outcomes.

The Seroprevalence of Herpes Simplex Virus Type-1 Among Children in Jos, Nigeria

This study was to determine the prevalence rate of Herpes Simplex Virus Type-1 (HSV-1) among children in Jos metropolis. Herpes simplex virus type-1 is mostly acquired in childhood and is responsible for orolabial ulcers or lesions. Prevalence of oro-facial herpes simplex virus type-1 infection is a common worldwide problem. There is little or no public awareness of herpes simplex virus in Jos, plateau state, Nigeria. A total of 188 samples were collected and analyzed using Enzyme Linked Immunosorbent Assay (ELISA) kit by GeneFront Inc. CA. USA to test for HSV-1 specific glycoprotein IgG. Out of the 188 samples tested, 157 (83.5%) were seropositive. The seroprevalence among male was 86.8%, and female 78.4%. The Age group 6-10 years had the highest prevalence of 88.8% while 0-5yrs had 75.0% which had significant association (P <0.05). This study showed high prevalence of HSV-1, with the highest prevalence in aged 6-10 years which suggests that, HSV-1 is common among school-aged children. HSV-1 infection is acquired during early childhood and therefore age is an important factor in the epidemiology of HSV-1 infection. Further larger studies are needed in North Central Nigeria.

Nonadherence to first‑line antiretroviral therapy among human immunodeficiency virus‑1 infected children at the Jos University Teaching Hospital, Jos, Nigeria

Background: Nonadherence to antiretroviral therapy (ART) may encourage the development of resistance to antiretroviral drugs (ARVs). Poor adherence is known to be associated with ART failure which could compromise the benefits of ART in children. Therefore, it is important to identify the reasons why children on ART may fail to take their ARVs. In this study, we described the characteristics of human immunodeficiency virus-1 (HIV-1) infected children with ART nonadherence as well as the reasons for their nonadherence. Methodology: A retrospective cohort study in which data on 580 HIV-1 infected children enrolled on ART between February 2006 and December 2010 at the pediatric HIV clinic of the Jos University Teaching Hospital, Jos, was analyzed. Subjects were aged 2 months to 15 years. Information on adherence was obtained by child or caregiver self-report. They also had repeated adherence counseling during each clinic follow-up visit and were taught the use of alarm clocks daily for reminding them of when the next ARV dose will be due. Results: There were 30 (5.2%) children with non-adherence to ART. Among children with nonadherence, majority were: Children aged 1-10 years (76.7%), males (53.3%) and did not know their diagnosis of HIV (90.9%). The odds of nonadherence was two times higher among children who failed first-line ART compared with those who did not (odds ratio [95% confidence interval], 2.28 [1.03-5.02], P = 0.04). The most common reason for nonadherence was: Forgot to take medications (46.7%). Conclusion: The low rate of nonadherence to ART in this study could be attributed to repeated adherence counseling during each clinic follow-up visit and the use of alarm clocks daily for reminders on when the next ARV dose will be due.

Zidovudine-Induced Anaemia in Human Immunodeficiency Virus Infected Children on Highly Active Anti-Retroviral Therapy in Jos, Nigeria

Aims: To determine the incidence and severity of zidovudine -induced anaemia in HIVinfected children initiated on anti -retroviral therapy in Jos, Nigeria. Study Design: This was an observational cohort study. OriginalResearch Article

Intestinal parasites and human immunodeficiency virus (HIV) status of children in Jos, Nigeria

Intestinal parasitic infestations (IPI) are not uncommon in immunocompetent individuals. However, human immunodeficiency virus (HIV)-infected individuals with depleted immunity have an abnormally high susceptibility to infections. This study therefore, examines children with intestinal parasites according to HIV status and degree of immunosuppression. Consecutively consenting patients aged 1 to 15 years attending the Paediatric Clinic of acquired immune deficiency syndrome (AIDS) Prevention Initiative, Nigeria, were recruited as cases, while age and sex matched HIV negative controls were recruited from Out Patient Department of Jos University Teaching Hospital. Stool samples were examined for parasites by direct wet mount, formol-ether and modified Ziehl-Neelsen technique. Levels of immunosuppression were assessed amongst HIV-positive subjects. Five hundred and ten children aged 1 to 15 years equally divided between the two cohorts were enrolled for the study. Seventy-nine had IPI, giving a prevalence rate of 15.5%; 44 (8.6%) HIV positive and 35 (6.9%) HIV-negative children. The most prevalent extracellular parasite was Giardia lamblia, however HIV positives had significantly higher rate of G. lamblia infestation. Among the intracellular parasites, the infection rate in HIV-positive subjects (5.9%) was three times that in HIV-negative subjects (2.0%). HIV positive children with advanced and severe immunosuppression had significantly higher intracellular parasites. HIV status did not significantly predict the overall risk of having extracellular intestinal parasites however, it was noted that G. lamblia infection was significantly higher in HIV positive children. HIV positive children had higher risk of having intracellular parasites especially if they have advanced or severe immunosuppression. Therefore, the policy of screening children for intestinal parasites should continue irrespective of their HIV status. Those that are HIV positive children should specifically be screened for intracellular parasites.