Haruna M. Muktar

Morbidity and Mortality Patterns of Hospitalised Adult HIV/AIDS Patients in the Era of Highly Active Antiretroviral Therapy: A 4-year Retrospective Review from Zaria, Northern Nigeria

Background. This study, undertaken in major tertiary hospital in northern Nigeria, examined the morbidity and mortality patterns of hospitalised adult HIV/AIDS patients in the HAART era. Methods. Between January 2006 and December 2009, admission records and causes of deaths of hospitalised medical HIV-infected patients were retrieved and analysed according to antiretroviral (ART) status. Results. Of the 207 HIV/AIDS patients reviewed, majority were newly diagnosed (73.4%), and most were hospitalised and died from various AIDS-defining illnesses, mainly disseminated tuberculosis and sepsis. Immune-inflammatory-reconstitution-syndrome, ART-toxicity and ART-failure, contributed to morbidity and mortality in patients receiving ART. Sixty six (31.9%) patients died, with higher mortality in males and in those with lower CD4-cell count, lower PCV, and shorter hospital stay. However, hospital stay ≤3 days and severe anaemia (PCV < 24%) were independent predictors of mortality. Conclusion. In the current HAART era, late presentation and tuberculosis continue to fuel the HIV/AIDS pandemic in Africa, with emerging challenges due to ART-related complications.

Prevalence of HIV-Associated Neurocognitive Disorder (HAND) among Patients Attending a Tertiary Health Facility in Northern Nigeria:

Background: HIV-associated neurocognitive disorder (HAND) is a great source of morbidity in sub-Saharan African region. However, the magnitude of this problem remains largely uninvestigated despite having the largest number of population with HIV/AIDS. The aim of this study is to determine the prevalence of HAND among patients attending a tertiary health facility in Nigeria. Method: We conducted a cross-sectional study among HIV-positive patients on antiretroviral therapy (ART) for at least 1 year. They were assessed using the International HIV Dementia Scale, Word Recall Test, Stick Design Test, Subjective Cognitive Complaint Questionnaire, Alcohol Use Disorder Identification Test, Drug Abuse Screening Test, Center for Epidemiological Study–Depression Scale, Instrumental Activity of Daily Living, and neurological examination. The CD4 count and viral load were determined for all the participants. A consensus diagnosis was made on each case based on the Frascati criteria. Data obtained were analyzed using “SPSS” for Windows version 15. Results: A total of 418 HIV-positive patients participated in the study, of which 325 (77.8%) are females. The mean age (standard deviation) of the participants was 37.2 (9.3) years. The prevalence of HAND was 21.5% (95% confidence interval [CI] = 17.6%-25.4%), of which 9.6% were asymptomatic. The significant predictors of HAND in this study are duration of illness (odds ratio [OR] = 1.33 P < .001), detectable viral load (OR = 0.19, P < .001), CD4 count (OR = 0.99, P < .001), education (OR = 0.94, P = .011), stopping medication (OR = 3.55 P = .01), and severity of illness (OR = 1.24, P = .005). Conclusion: One-fifth of the HIV-positive patients in this study had HAND. Various sociodemographic and clinical features were related to the prevalence of HAND.

Epidemiological and clinical features of AIDS-Associated Kaposi's sarcoma in Northern Nigeria

Introduction : The incidence of AIDS-associated Kaposis sarcoma (AAKS) is increasing in the West African sub-region. The objective of this study was to describe the epidemiologic and clinical features of AAKS. Materials and Methods : This study was carried out in a tertiary health center with a federal government supported AIDS treatment program in Zaria, Nigeria. The subjects comprised 137 consecutive patients evaluated for AAKS from 2006 to 2011. Following evaluation appropriate specimens were taken for histologic, virologic, and immunologic assessment. Result : There were 137 patients representing 1.4% of HIV infected patients seen during the study period. The male to female ratio was 1.3:1. Their ages ranged from 2 to 58 years, mean of 32 ± 6 and females were younger than males. Mean duration of symptoms was 4.2 ± 1.5 months. Kaposis sarcoma was the AIDS-defining disease in 95 (69.3%) patients while in 42 (30.7%) it was diagnosed between 1 and 15 months after the diagnosis of HIV infection. The lower limbs were the most frequent sites of lesions. Females had more disseminated lesions involving an increased number of lesions at multiple anatomical sites compared with more localized lesions in the males (OR 2.7, 95% CI 1.5-7.0). The CD4 count ranged from 19 to 798 cells/mm 3 , median 132; interquatile range 102-317 cells/mm 3 while the median HIV RNA copies/ml of plasma was 51,723 (ranged 250-917, 254). Conclusion : The prevalence of AAKS is increasing in our institution. Female patients were younger and had more disseminated disease that progressed faster than in males. Timely identification of HIV-infected patients is essential to avoid the consequences of immunological deterioration associated with delayed anti-retroviral therapy.

Histopathological effects of sub-chronic lamivudine-artesunate co-administration on the liver of diseased adult Wistar rats

Background: Lamivudine and artesunate are sometimes co administered in HIV-malaria co morbidity. Both drugs are used concurrently in presumptive malaria treatment and simultaneous HIV post exposure prophylaxis. Aim: The aim of this study was to investigate the effect of lamivudine-artesunate co administration on the histology of the liver of diseased adult Wistar rats. Materials and Methods: Five groups of rats of both sexes were used for the study and placed on feed and water ad libitum. Disease state consisted of immunosuppression with cyclophosphamide, and infection with Plasmodium berghei. Group 1 animals served as vehicle control, while group 2 were the diseased controls. Group 3 animals received 20 mg/kg lamivudine for three weeks, while group 4 similarly received 20 mg/kg Lamivudine but also received 10 mg/kg artesunate from day 12. Animals in group 5 received 10 mg/kg artesunate from day 12. All drugs were administered intraperitoneally. The animals were treated for twenty-one days, at the end of which they were sacrificed and their livers fixed in 10% formalin for histological studies. Result: Results from the study show the presence of regions of focal necrosis and perivascular cuffing with animals that received artesunate. Hemosiderosis was a common feature in all the parasitized groups, while fatty degeneration was observed in the group that received artesunate alone. Conclusion: Concurrent lamivudine-artesunate administration resulted in some histopathological changes in the liver. This study suggests there may be considerable histological changes with repeated occurrence of malaria and immunosuppression that may warrant intermittent lamivudine-artesunate administration, and may require evaluation as well as monitoring of liver function during such therapeutic interventions.

HIV Wasting Syndrome in a Nigerian Failing Antiretroviral Therapy: A Case Report and Review of the Literature

The HIV wasting syndrome represented the face of HIV/AIDS before the advent of highly active antiretroviral therapy (HAART). Although the incidence of wasting has declined since the introduction of HAART, weight loss remains common in patients receiving HAART, especially in the setting of a failing HAART regimen. As we are not aware of any previous reports from Nigeria, we report a case of the classical wasting syndrome in a Nigerian female who had both virological and immunological HAART failure due to poor adherence. The influence of a failing HAART regimen, socioeconomic status, and other clinical variables in the wasting syndrome are discussed.

Low education and lack of spousal relationship are associated with dementia in older adults with diabetes mellitus in Nigeria: Dementia in diabetes mellitus

The relationship between dementia and type 2 diabetes mellitus (T2DM) in older adults is well established in the literature. However, there have been few studies on this relationship in older adults living in low‐ and middle‐income countries, and most demographic projections predict that older adult population will increase substantially in these regions by 2050.

Erythropoietic response to anaemia of dialysis naïve patients with chronic kidney disease in Zaria, north west Nigeria

Introduction: Chronic kidney disease (CKD) is a global health problem with an increasing prevalence worldwide. Anemia is one of its consistent and severe hematological complications although its mechanism is not fully elucidated. The primary defect could manifest as serum erythropoietin (sEPO) deficiency or EPO resistance. We set out to determine the erythropoietic response to anemia of patients with CKD and its relationship with their iron status in a cross-sectional descriptive study of 91 patients in various stages of CKD. Materials and Methods: Soluble transferrin receptor (sTfR), sEpo, and serum ferritin levels were determined using ELISA method (Diagnostic Automation Inc and WKEA med supplies corp.). Data generated were analyzed using Epi Info version 3.5.3 and level of statistical significance was set at ≤0.05. Results: Participants comprised of 50 females (54.9%) and 41 (45.1%) males with an overall mean age of 47 ± 15 years. The major causes of CKD were hypertension (HTN) (50.54%), diabetes mellitus (DM) (6.59%), and HTN + DM (19.78%). The mean hemoglobin (Hb) concentration of the participants was 10.97 ± 2.28 g/dl; the red cell indices were within normal ranges except for Red cell distribution width-Coefficient of variation (%) which was elevated (16.29%). The mean serum ferritin, sTfR, and sEpo were 70.58 ± 46.44 ng/ml (interquartile range [IQR] 82.00), 22.9 ± 49.7 ng/ml (IQR 15.00), and 12.49 ± 33.47 IU/L (IQR 6.00), respectively, with a high variance. Serum ferritin and sTfR are consistently low across the stages of CKD (range between 54.54 ng/ml and 88.64 ng/ml), but sEPO for stage 3 and 4 showed a 2-fold increase when compared to normal level at Hb 10.97 g/dl (29.54 IU/L and 38.83 IU/L, respectively). Correlation between sTfR and sEpo (r2 = 0.96, P = 0.001), while between sEpo and serum ferritin (r2 = 0.02, P = 0.185), and between Hb and stage of CKD undulating (r2 = 0.41, P = 0.001). Conclusion: In contrast to some existing literature, this study has demonstrated that EPO resistance and iron deficiency contributes to anemia in CKD and serum ferritin can be used to assess the iron level of dialysis naïve CKD patients at every stage of the disease.

Protein C and antithrombin levels in patients with sickle cell anemia in Ahmadu Bello University Teaching Hospital Zaria, Nigeria

Background: Alterations in the components of hemostasis, namely platelet function, the procoagulant, anticoagulant, and the fibrinolytic systems, are observed in sickle cell anemia (SCA) and are in favor of a procoagulant phenotype. Therefore, study of protein C and antithrombin (AT) levels in patients with SCA in steady state may be used in the treatment and/or prevention of SCA-related thrombotic complications. We studied the changes of these naturally occurring anticoagulants in patients with SCA attending the sickle cell clinic in Ahmadu Bello University Teaching Hospital, Zaria. Methods: We conducted a case–control study involving 50 SCA (HbSS) patients in the steady state as cases and 25 healthy volunteers with normal hemoglobin (HbAA) as controls. Protein C and AT levels were estimated by semi-automation using Diagnostica Stago hematology coagulation analyzer. Frequencies, proportions, and independent t test were performed using SPSS version 20. Results: The mean ages of both the patients and controls were 23.80 ± 7.46 and 24.28 ± 3.48 years, respectively, and study participants comprised 40 (53.0%) women between the ages of 15–50 years and 15–34 years (P = 0.76). The mean values of protein C and AT levels in patients with SCA in the steady state and the control group were 60.26 ± 20.58% versus 81.30 ± 19.74%, 95% CI 11.13–30.96, and 42.11 ± 5.01% versus 61.88 ± 11.27%, 95% CI 16.03–23.51 with P values (P < 0.001), respectively. Conclusions: This study showed that there was a significant decrease in the levels of protein C and AT between the SCA patients in the steady state and the controls. We recommend baseline investigations of these naturally occurring anticoagulants in patients with SCA, especially in those with frequent vaso-occlusive crises. This will give us an insight into the additional pathophysiologic mechanism in SCA-related thrombotic complications for better patient management and outcome.

Seroepidemiology of cytomegalovirus antibodies in Hiv-positive and Hiv-negative adults in Nigeria

Introduction: Cytomegalovirus (CMV) is the most common viral opportunistic infection in HIV/AIDS reported in the Western literature. There is a paucity of reports on the seroprevalence of CMV antibodies in Nigeria despite the high HIV burden. Few studies were carried out in pregnant women and healthy blood donors. This analytical cross-sectional study was conducted to describe the seroepidemiology of CMV antibodies in HIV-positive and healthy adults in Nigeria. Materials and Methods: Between August 2012 and March 2013, a structured questionnaire was administered to 250 HIV-positive patients attending the HIV clinic and 250 HIV-negative controls matched for age and gender. Participants were screened for quantitative CMV immunoglobulin G (IgG) and qualitative CMV immunoglobulin M (IgM) antibodies by enzyme-linked immunosorbent assay. Information was collected on sociodemographic characteristics, risk for HIV infection, and anthropometric measurements. Data were analyzed with SPSS Version 17. Results: A total of 500 participants were recruited. Females comprised 54%. Median age for males was 39 years (range 17-65 years), whereas for females, it was 35 years (range 16-62 years) (P = 0.002). In HIV-positive patients, CMV IgG and IgM antibodies were detected in 215 (86%) and 33 (13.2%), respectively, but in HIV-negative controls, it was 182 (72.8%) and 7 (2.8%), respectively (P = 0.001). In HIV-positive patients, CMV IgG age-specific seroprevalence was highest in the 16-25 years age group (93.5%), whereas CMV IgM, it was highest in the 26-35 years age group (16.1%). Mean quantitative CMV IgG antibody titer was higher in HIV-positive patients (P = 0.001). There was no gender difference between groups. Conclusion: Seroprevalence of CMV antibodies is high in Nigeria. HIV preventive strategies and routine screening of HIV patients and blood donors for CMV antibodies before blood transfusion are recommended to minimize the potential risk of transfusion transmitted CMV infection.

An evaluation of the gallbladder in adult sickle cell anemia patients in Zaria North-West Nigeria

Background: Sickle cell anemia (SCA) is characterized by a constant state of hemolysis which leads to hyperbilirubinemia. Hyperbilirubinemia may predispose to development of pigment gallstones in these patients. Gallstones in SCA patients increase morbidity and mortality and poses diagnostic dilemma as most patients are asymptomatic. The objective of this study was to evaluate the gallbladder using ultrasonography, biochemical, and hematological parameters among adult SCA patients in steady state at the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Patients and Method: We conducted a case-control cross-sectional study of adult SCA patients attending the hematology clinic of ABUTH, Zaria, Nigeria and HbAA controls. Sixty-seven consenting adult SCA patients in steady state and twenty HbAA controls had abdominal ultrasonography, biochemical, and hematological tests on blood samples. Information obtained was entered and analyzed using Statistical Package for the Social Sciences (SPSS) 17.0. Statistical evaluation consisted of descriptive analysis and comparison of means using student′s t-test. Level of significance was set at P < 0.05. Results: Of the 67 SCA patients, 19 (28.4%) had gallstones, and the prevalence increased with increasing age of the patients. There were significant differences in all laboratory parameters between SCA patients and the HbAA controls except alkaline phosphatase levels. While there were no significant differences in these parameters between SCA patients with gallstone and those without gallstone except the gallbladder volume. All the SCA patients with gallbladder stones were asymptomatic. Conclusion: There is a high prevalence of gallbladder stone in SCA patients, especially after the age of 20 years. Thus, abdominal ultrasonography should be part of the routine care of SCA patients, especially after the second decade of life.