Olubukola A. Adesina

Asymptomatic bacteriuria among HIV positive pregnant women

The prognostic significance of asymptomatic bacteriuria resides in the observation that the prevalence is, relatively, high in persons with certain medical conditions, such as diabetes mellitus and pregnancy. This prevalence might, even, be higher in patients with human immunodeficiency virus infection. Hence, this study set out to determine the prevalence of asymptomatic bacteriuria among symptom free and newly enrolled HIV infected pregnant women attending PMTCT unit of Antiretroviral clinic of University College Hospital, Ibadan, Nigeria between 1st May and 30th September 2007. Information was obtained on the socio-demographic characteristics of the subjects, CD4 count and viral load. Microbial culture was carried out on aseptically collected urines from the patients. Statistical analysis was done with SPSS 12 package. There were 161analyzable samples from the participants. The mean age and gestational age at presentation of participants was 30.49 ± 4.3 years and 27.3± 3.2 weeks, respectively with modal parity of 2. Twenty-five (15.5%) of the urine samples significantly grew bacteria. The CD4 cells were significantly lower and the viral loads significantly higher (250.52 Vs 355.57 cells/mm3; 88,731 Vs 55,384 copies/ml; p=

Dyslipidemia in ART-Naive HIV-Infected Persons in Nigeria--Implications for Care.

Aims: This study aimed to describe the prevalence and pattern of lipid abnormalities among antiretroviral therapy (ART)-naive HIV patients, understand if there is any relationship to virologic and immunologic status, and discuss the implications for care. Methods: This was a cross-sectional study in which baseline demographic, clinical, and laboratory data of all ART-naive HIV-infected individuals recruited into the adult ARV clinic, University College Hospital, Ibadan, between January and December 2006, were analyzed. Results: In total, 1316 ART-naive HIV-infected persons were recruited in the period. Females subjects and participants aged ≦35 years accounted for 67.1% and 57.7% of all participants, respectively. At least 1 abnormal lipid fraction was seen in 73.3% of participants. It was observed that in 11.5% participants the total cholesterol (TC) was ≧5.2 mmol/L, in 2.7% the low-density lipoprotein cholesterol (LDL)-C was >4.1 mmol/L in 56.5% the high-density lipoprotein cholesterol (HDL)-C was <1.0 mmol/L, and in 27.6% the triglyceride (TG) was >1.7 mmol/L. The TC, LDL-C, and HDL-C were all significantly positively correlated with CD4 counts and negatively correlated with viral load. On the contrary, the TG levels were negatively correlated with CD4 counts and positively correlated with viral load. Multivariate linear analysis showed a significant relationship between all the lipid parameters and viral load. CD4 counts were only significantly associated with TC. Conclusions: A significant burden of dyslipidemia exists among ART-naive HIV-infected persons. Low HDL-C was the most frequently observed abnormality. The abnormalities related more with viral load levels than with CD4 counts. Dyslipidemia screening should be done in ART-naive HIV-infected persons. Simple healthy lifestyle changes should be emphasized, with other care given to those with the disorder.

Demographic and epidemiological characteristics of HIV opportunistic infections among older adults in Nigeria

BACKGROUND In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them. OBJECTIVES To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria. METHODS Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan. RESULTS Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13). CONCLUSION There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa.

P3.55 Pattern of syphilis and hiv co-infections among art treatment naÏve adults in a tertiary institution in ibadan, nigeria

Introduction Syphilis and Human immunodeficiency virus (HIV) infections have been found to be major public health problems in Sub-Saharan Africa. Clinical presentation of syphilis in patients infected with HIV has been described as atypical. This study was aimed to determining the seroprevalence and risk factors of syphilis among HIV infected patients in a tertiary hospital in Nigeria. Methods It is a descriptive cross-sectional survey of 793 HIV- infected patients enrolled at the Anti-Retroviral Treatment (ART) clinic, University College Hospital, Ibadan, Nigeria between July and December 2010. Detailed medical history was obtained from the patients after informed consent. Screening for syphilis using qualitative rapid Plasma Reagin (RPR) was performed on each of the sera/plasma collected from them. Measurement of CD4 + T lymphocyte (CD4) count was carried out by flow cytometry and Roche Ampiclor RNA PCR assay was used for the measurement of plasma HIV RNA (viral load). Data analysis was performed using SPSS version 23. Results A total of 793 participants, 557 females and 236 males were enrolled. The mean age of the patients was 36.99±10.3 years. The overall prevalence of syphilis among this cohort of patients was 1.51% (1.4% in females and 1.7% in males). 30–39 years age groups were mostly affected with 50.0% of the cases of syphilis. The mean age, weight, CD4 count and log viral load for the syphilis co-infected HIV patients were 38.17±8.22 years, 59.8±10.5 Kg, 275.92±282.1 cells/mm3 and 4.35±1.37 copies/ml respectively compared to 36.97±10.3 years, 56.7±15.5 kg, 262.06±256.5 cells/mm3 and 4.62±1.2 copies/ml respectively in the population without syphilis co-infection. Syphilis co-infection occurs more among females (OR 1.1, 95% CI (0.75–1.58), and the married (OR 1.1, 95% CI (0.75–1.58) without significant association. Conclusion Our study had revealed a low prevalence of syphilis in patients living with HIV/AIDS. Routine screening and counselling for syphilis should be considered for patients in AIDS care in Sub-Saharan Africa.

HCV co-infection is associated with metabolic abnormalities among HAART naive HIV-infected persons

Objectives: To determine the metabolic abnormalities among Hepatitis C Virus (HCV) co infected HAART naïve HIV infected persons within the adult ARV clinic of the University College Hospital/University of Ibadan, Ibadan, Nigeria Methods: This was a retrospective study involving the review of clinical records of newly recruited HIV-infected persons in the adult antiretroviral (ARV) clinic over a 12 month period (January - December 2006). Baseline results for fasting plasma glucose (FPG) and fasting lipid profile were retrieved. Results: Out of the 1,260 HIV infected persons seen during the study period, HCV co-infection was found in 75 (6%) persons. The median values for total cholesterol, LDL-cholesterol and HDL-cholesterol were lower in the HCV co-infected persons. HIV-HCV co–infection was associated with a 0.31 mmol/L depression in Total Cholesterol (TC). The median FPG concentration was significantly higher in HIV-HCV co–infected than HIV only infected persons (5.33mmol/L vs. 5.00mmol/L, p = 0.047). However, regression analysis showed there was no relationship between the HIV-HCV co infected state and fasting glucose levels. Conclusion: HIV-HCV co-infection may be associated with a predictable decline in plasma cholesterol, but FPG may not be sufficient to demonstrate insulin resistance in these persons.

Seroprevalence and factors associated with hepatitis C coinfection among HIV‑positive pregnant women at the University College Hospital, Ibadan, Nigeria

Aim: This study estimated the hepatitis C virus (HCV) prevalence in a population of human immunodeficiency virus (HIV) infected pregnant women, compared women who were positive or negative for HCV and described risk factors associated with HCV infection. Materials and Methods: A retrospective, case control study was conducted at the University College Hospital, Ibadan among 1821 women. Twenty-six (1.65%) women were HCV positive, 139 (8.83%) were HBsAg positive and 1407 (89.33%) were negative for both viruses. Three patients (0.19%) were positive for both viruses. These patients, i.e., the HBsAg positive women and 246 women with no result, for either virus were excluded from analysis. Data from 1433 pregnant women is presented. Chi square test and student′s t-test examined associations, with level of significance set at P < 0.05. Results: Overall, the mean age of the HCV positive women was lower (26.77 ± 6.53 vs. 28. 95 years ± 5.33; P = 0.04), most women had attained primary (28.49%) or secondary (42.44%) education, over 90% were married and heterosexual sex (88.67%) was the most likely risk for HIV. HCV prevalence was higher in the lower age groups (5% in the ≤ 19 years group, P = 0.021). The coinfected had more unmarried women (3.6% vs. 1.7%; P = 0.164) and more likely to indicate blood transfusion as a risk factor for HIV (6.2%; P = 0.34). Conclusion: Only age showed any significant association with HCV infection. Lack of identifiable risk factors sum up challenges for developing screening strategies in sub-Saharan Africa. Further studies will identify factors facilitating HCV transmission in the region.

Temporal distribution of baseline characteristics and association with early mortality among HIV-positive patients at University College Hospital, Ibadan, Nigeria

The first six months of HIV care and treatment are very important for long-term outcome. Early mortality (within 6 months of care initiation) undermines care and treatment goals. This study assessed the temporal distribution in baseline characteristics and early mortality among HIV patients at the University College Hospital, Ibadan, Nigeria from 2006–2013. Factors associated with early mortality were also investigated. This was a retrospective analysis of data from 14 857 patients enrolled for care and treatment at the adult antiretroviral clinic of the University College Hospital, Ibadan, Nigeria. Effects of factors associated with early mortality were summarised using a hazard ratio with a 95% confidence interval obtained from Cox proportional hazard regression models. The mean age of the subjects was 36.4 (SD=10.2) years with females being in the majority (68.1%). While patients’ demographic characteristics remained virtually the same over time, there was significant decline in the prevalence of baseline opportunistic infections (2006–2007=55.2%; 2011–2013=38.0%). Overall, 460 (3.1%) patients were known to have died within 6 months of enrollment in care/treatment. There was no significant trend in incidence of early mortality. Factors associated with early mortality include: male sex, HIV encephalopathy, low CD4 count (< 50 cells), and anaemia. To reduce early mortality, community education should be promoted, timely access to care and treatment should be facilitated and the health system further strengthened to care for high risk patients.