Olanisun Olufemi Adewole

Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis

Background Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations. Methods We conducted a systematic review and meta-analysis through MEDLINE and EMBASE (up to January 2012), as well as direct author contact. Eligible studies provided summary or individual-level data on one or more of the following traits in HIV+ and HIV-, or ART+ and ART- subgroups in SSA: body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs) and fasting blood glucose (FBG) or glycated hemoglobin (HbA1c). Information was synthesized under a random-effects model and the primary outcomes were the standardized mean differences (SMD) of the specified traits between subgroups of participants. Results Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals. HIV infection was associated with higher TGs [SMD, 0.26; 95% confidence interval (CI), 0.08 to 0.44] and lower HDL (SMD, −0.59; 95% CI, −0.86 to −0.31), BMI (SMD, −0.32; 95% CI, −0.45 to −0.18), SBP (SMD, −0.40; 95% CI, −0.55 to −0.25) and DBP (SMD, −0.34; 95% CI, −0.51 to −0.17). Among HIV+ individuals, ART use was associated with higher LDL (SMD, 0.43; 95% CI, 0.14 to 0.72) and HDL (SMD, 0.39; 95% CI, 0.11 to 0.66), and lower HbA1c (SMD, −0.34; 95% CI, −0.62 to −0.06). Fully adjusted estimates from analyses of individual participant data were consistent with meta-analysis of summary estimates for most traits. Conclusions Broadly consistent with results from populations of European descent, these results suggest differences in cardiometabolic traits between HIV-infected and uninfected individuals in SSA, which might be modified by ART use. In a region with the highest burden of HIV, it will be important to clarify these findings to reliably assess the need for monitoring and managing cardiometabolic risk in HIV-infected populations in SSA.

Obstructive sleep apnea among adults in Nigeria.

INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a common medical condition with significant adverse medical and public health consequences, but OSAS remains undiagnosed in many individuals. The Berlin questionnaire is a validated instrument that is used to identify individuals who are at risk for OSAS. OBJECTIVES To determine the prevalence of high risk of OSAS in an adult population in Nigeria. DESIGN A cross-sectional survey was done of 370 young adults and adults living in Abuja, Nigeria, using the Berlin questionnaire. This instrument includes questions about snoring; witnessed apneas, self-reported hypertension, and daytime sleepiness. Data were collected on sociodemographic characteristics. Excessive daytime sleepiness was determined using Epworth Sleepiness scale. Body mass index (BMI) and blood pressure were calculated and measured, respectively. RESULTS Of the 370 respondents, 218 (59%) were females. The overall prevalence of snoring was 31%. Overall, 19% of participants (22% of men and 16% of women) met the Berlin questionnaire criteria indicating a high risk of OSAS. The highest prevalence of risk of OSAS occurred in ages 50 to 59 years for male. Respondents with a high risk for OSAS were more likely to be obese (BMI >30 kg/m2), have a higher mean ESS score, and a chronic medical condition than those who were at lower risk. CONCLUSIONS OSAS may be more common a medical problem than ever imagined among Nigerians.

Proteomic profiling of Eccrine sweat reveals its potential as a diagnostic biofluid for active tuberculosis

Excessive sweating is a common symptom of the disease and an unexplored biofluid for TB diagnosis; we conducted a proof‐of‐concept study to identify potential diagnostic biomarkers of active TB in eccrine sweat.

Determinants of health related quality of life in a sample of patients with chronic obstructive pulmonary disease in Nigeria using the St. George’s respiratory questionnaire

BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is a multi-systemic and progressive disease. However the determinants of its impact on health related quality of life are not well-studied or understood in Nigeria. OBJECTIVES To assess the determinants of health related quality of life in COPD. METHODS Patients with stable COPD were recruited consecutively from the outpatient clinics of a university hospital. Health Related Quality of Life (HRQL) was assessed using the St. Georges Respiratory Questionnaire (SGRQ) and the Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC) were measured by a vitalograph spirometer. RESULTS Fifty patients were recruited for this study (male = 60%). The mean (SD) age was 69 (9) years. The overall mean (SD) SGRQ scores was 45.9 (26.5), 50.6 (29.2), 29.7 (19.9), 38.8 (22.0) for the symptom, activity, impact and total scores respectively. After adjusting for age, sex and smoking, self-reported breathlessness independently predicted on average 25.2, 36.8, 13.65 and 22.9 points increase in SGRQ symptom, activity, impact and total scores respectively. Self-reported weight loss predicted 12.2 points increase in the impact subscale. CONCLUSIONS Self-reported breathlessness and weight loss are independent predictors of low HRQL score in COPD.

Unmet needs in asthma treatment in a resource-limited setting: findings from the survey of adult asthma patients and their physicians in Nigeria

Introduction The prevalence of asthma in our society is rising and there is need for better understanding of the asthma patients’ perception and treatment practice of physicians. The study was aimed at determining asthma attitudes and treatment practices among adult physicians and patients in Nigeria, with the goal of identifying barriers to optimal management. Methods To assess asthma attitudes, treatment practices and limitations among adult physicians and patients in Nigeria, a questionnaire survey was conducted among 150 patients and 70 physicians. Results Majority (66.7%) of the patients reported their asthma as moderate to severe, 42.7% had emergency room visit and 32% had admission due to asthma in the previous 12 months. Physicians and patients perceptions significantly differed in the time devoted to educational issues (31.4% vs.18.7%) and its contents: individual management plan (64.3% vs.33.3%), correct inhaler technique (84.0% vs.71.0%), medication side effects (80.0% vs.60.0%) and compliance 100% of time (5.7% vs. 18.7%). Patients reported that non-compliance with medication causes increased symptoms (67.0%), exacerbations (60.0%), bronchodilator use (56.0%), urgent physician visit (52.0%) and hospitalizations /ER visits (38.7%). Asthma medication in patients caused short term (10.7%) and long term side effects (20.0%). Due to side effects, 28.0% skipped and stopped their medications. Most physicians (85.7%) and patients (56.0%) agreed on the need for new medication options. The need for new medication in patients was strongly related to asthma severity, limitation of activities, side effects, cost and lack of satisfaction with current medication. With the exception of pulmonologists, physicians did not readily prescribe ICS and their prescriptions were not in line with treatment guidelines. Conclusion This study has highlighted the gaps and barriers to asthma treatment which need to be addressed to improve the quality of care in Nigeria.

Interferon-gamma treatment kinetics among patients with active pulmonary tuberculosis

Introduction: Interferon-γ (IFN-γ) is essential for defence against Mycobacterium tuberculosis; however, levels in patients with active tuberculosis (TB) and changes during treatment have not been documented in our tuberculosis patients in Nigeria, hence this study has been carried out. Objective: To determine variations, treatment kinetics, and predictive value of IFN-γ levels during treatment of active tuberculosis. Design: Patients with pulmonary tuberculosis were recruited and subsequently followed up for 3 months during treatment with anti-TB. Peripheral blood was collected for IFN-γ assays, C-reactive protein and others followed by a Mantoux test. IFN-γ levels produced by stimulation with TB antigens were determined by ELISA and repeated measurement of IFN-γ were done at 1 and 3 months of anti-TB therapy. Chi Associations and correlations between IFN-γ were determined. Regression analysis was done to determine association between serial IFN-γ and treatment outcome. Results: We recruited 47 patients with active tuberculosis with a mean age of 34.8 ± 3.6 years and M:F ratio of 1.12:1. Six (11%) were HIV positive. The mean level of IFN-γ induced by TB antigens was 629 ± 114.1 pg/ml, higher for HIV-negative PTB patients compared with HIV-positive PTB patients, 609.78 ± 723.9 pg/ml and 87.88 ± 130.0 pg/ml, respectively, P-value = 0.000. The mean level of IFN-γ induced by TB antigen increased significantly from 629 ± 114.1 pg/ml to 1023.46 + 222.8 pg/ml, P-value = 0.03 and reduced to 272.3 ± 87.7 pg/ml by the third month on anti-TB drugs, P-value = 0.001. Negative correlation was observed between the mean of baseline and chest X-ray involvement, P = 0.03. There was no significant correlation between sputum smear grade with baseline and follow-up IFN-γ levels. Three-month IFN-γ level among cured patients were higher than those with treatment failure, regression analysis showed that it does not predict outcome. Conclusion: IFN-γ may be useful in early detection and monitoring response; however, large scale studies are needed.

HIV treatment is associated with a twofold higher probability of raised triglycerides: Pooled analyses in 21 023 individuals in sub-Saharan Africa

Background Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TGs) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations. Methods Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models. Findings Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51–2.77, I2 = 45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies. Interpretation Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.

Comparison of Asthma Control Test (ACT) and Global Initiative for Asthma (GINA) in the Assessment of Asthma Control and Usefulness of Act in a Resource Poor Setting

Background: The gold standard in assessing asthma control is the Global Initiative for Asthma (GINA) criteria. It is difficult to follow GINA criteria in assessing asthma control in resource poor settings because of the lack of access to pulmonary functions tests. The Asthma Control Test (ACT) questionnaire is a simple, self-administered, accessible and validated tool that is used in assessing control among asthmatics. The ACT has the added advantage that it does not require lung function assessment. However, its relationship with GINA guideline-defined asthma control has not been clarified in our setting. Aim: The aim of this study is to assess asthma control through ACT and GINA, and to determine if the ACT can be as useful as the GINA-guidelines criteria in assessing asthma control in our setting. Methodology: It was a cross-sectional analytical study. Asthma control was assessed by the ACT and GINA criteria questionnaires. Pulmonary function tests were performed on the subjects according to American Thoracic Society (ATS) guidelines. The sensitivity, specificity, negative and positive predictive values of ACT were determined. Results: A total of 65 asthmatics participated in this study. The level of asthma control among the subjects was poor, 37% and 23% by ACT and GINA criteria respectively. There was a significant and positive correlation between the ACT and GINA. The Kappa score for the entire subjects was 0.66 representing a substantial agreement between the ACT and GINA. Conclusion: Asthma control was poor among the subjects. The fact that ACT can predict GINA guidelines-based level of control further gives credence to its usefulness in a resource-poor clinical setting.