BackgroundThere are conflicting reports on the impact of highly active antiretroviral therapy (HAART) in resolving hematological complications. Whereas some studies have reported improvements in hemoglobin and other hematological parameters resulting in reduction in morbidity and mortality of HIV patients, others have reported no improvement in hematocrit values of HAART-treated HIV patients compared with HAART-naïve patients.ObjectiveThis current study was designed to assess the impact of HAART in resolving immunological and hematological complications in HIV patients by comparatively analyzing the results (immunological and hematological) of HAART-naive patients and those on HAART in our environment.MethodsA total of 500 patients participated, consisting of 315 HAART-naive (119 males and 196 females) patients and 185 HAART-experienced (67 males and 118 females) patients. Hemoglobin (Hb), CD4+ T-cell count, total white blood count (WBC), lymphocyte percentage, plateletes, and plasma HIV RNA were determined.ResultsHAART-experienced patients were older than their HAART-naive counterparts. In HAART-naive patients, the incidence of anemia (packed cell volume [PCV] <30%) was 57.5%, leukopenia (WBC < 2.5), 6.1%, and thrombocytopenia < 150, 9.6%; it was, significantly higher compared with their counterparts on HAART (24.3%, 1.7%, and 1.2%, respectively). The use of HAART was not associated with severe anemia. Of HAART-naive patients, 57.5% had a CD4 count < 200 cells/μL in comparison with 20.4% of HAART-experienced patients (P < 0.001). The mean viral load log10 was significantly higher in HAART-naive than in HAART-experienced patients (P < 0.001). Total lymphocyte count < 1.0 was a significant predictor of

This cross-sectional study at a teaching hospital in north-eastern Nigeria estimated the prevalence of anaemia, leukopenia and thrombocytopenia in treatment-naïve HIV-infected patients (177 males and 316 females), and the associations with virological and immunological markers. The overall prevalences of anaemia, leukopenia and thrombocytopenia were 49.5%, 5.5% and 4.5% respectively. The prevalence of anaemia was significantly higher in males than females (61.6% versus 42.7%), while the rates of leukopenia (5.1% versus 5.7%) and thrombocytopenia (5.7% versus 3.8%) were similar. Almost two-thirds of the HIV treatment-naïve studied patients, 293/493 (59.4%), had cytopenia and would require antiretroviral drugs. AIDS was diagnosed by clinical or immunological criteria in 70% of patients. The degree of cytopenia was directly related to the degree of immunosuppression and clinical AIDS status. No relationship was observed between cytopenia and viral load.

Abnormalities of lipid metabolism are common in human immunodeficiency virus (HIV)-infected patients and tend to be accentuated in those receiving antiretroviral therapy, particularly with protease inhibitors (PIs). However, there is a dearth of information on serum lipid profiles and biochemical parameters among treatment-naive HIV-positive patients in our environment. We found that after 24 months of highly active antiretroviral therapy (HAART), there was a significant increase in serum lipids. After 24 months of HAART, renal impairment was associated with a low increase in mean HDL and a high increase in triglycerides (TG). In conclusion, abnormality of serum lipid is common and showed female preponderance among treatment-naive HIV patients in our environment. Patients with HIV infection on HAART should be screened for lipid disorders given their high prevalence as observed in this study, because of its potential for morbidity and mortality in patients on HAART.

Background: Cholera is endemic in sub-Saharan Africa, especially in areas affected by natural disaster and human conflict. Northeastern Nigeria is experiencing a health crisis due to the destruction of essential amenities such as health infrastructure, sanitation facilities, water supplies, and human resources by Boko Haram insurgents. In 2017, a cholera outbreak occurred in five local government areas (LGAs) hosting internally displaced persons. The Nigeria Center for Disease Control, World Health Organization, Mĕdecins Sans Frontiĕres International, and several other organizations supported disease containment. An emergency operating center (EOC) established by the State Ministry of Health (SMoH) then coordinated the outbreak response. Methods: We conducted a retrospective analysis of data extracted from the line list utilized by the SMoH to investigate outbreaks. We evaluated the outbreak by time, place, and person. Attack rate by LGA and age-specific case fatality rate (CFR) was calculated based on cases with complete records for age, sex, place of residence, date of symptom onset, and disease outcome. Results: A total of 5889 cholera cases were reported from five LGAs with an overall attack rate of 395.3/100,000 population. Among 4956 cases with documented outcome, the overall CFR was 0.87%, with CFR ranging from 0% to 6.98% by LGA. The age-specific CFR was highest among those aged ≥60 years (1.92%) and least among those aged 20–29 years at 0.3%. The epidemiological curve revealed two peaks that coincided with periods of heavy rain and flooding. Conclusion: This study reports on the largest ever documented cholera outbreak in five LGAs in Borno State. The outbreak was focused in LGA hit hardest by the destructive activities of insurgents and then spread to neighboring LGAs. The low CFR recorded in this cholera outbreak was achieved through timely detection, reporting, and response by the coordinated efforts of the EOC established by the SMoH that harmonized the outbreak response.

No abstract

Objective: To assess the pattern of condom use among HAART naive and experienced patients in north eastern Nigeria. Methods: An interviewer-administered questionnaire was used to assess the pattern of condom use among 201 HIV clients. Participants included for this comparative cross sectional study were divided into two group: HAART experienced participants that had been on therapy for at least 12 months and HAART naive participants that had been registered at least 3 months before the beginning of the study. Results: Almost half of the HAART naive and substantial proportion of HAART experienced couples never used condom. Few (13.4%) HAART experienced and 16.5% naive participants always used condom. Inconsistent condom use among HAART naive and experienced partners was 38.8% and 41.8% respectively. Spouse notification of HIV was significantly associated with the use of condoms (p = 0.02; OR 1.32, 95% CI: 1.06 -1.64). The stepwise logistic regression indicated that female (OR 2.40; CI: 1.09 -3.82), partner notification of HIV seropositive status (OR 1.32; CI: 1.06 -1.64, yes versus none), occupation as a civil servant (OR 1.40; CI: 0.15 -1.05), are factors independently associated with condom use in our studied participants. Conclusion: We report that condom use is uncommon among HIV clients in our environment. Condom is significantly influenced by partner notification of HIV seropositive status, occupation as a civil servant and female gender. This study supports an absence of association between condom B. A. Denue et al.170 uptake and HAART use. Intensive and regular condom counselling for every HIV-positive outpatient who attends the clinic in our environment is expedient. We recommend interventions directed at increasing condom use among HIV clients in our environment.

This study was designed to validate or refute the reliability of total lymphocyte count (TLC) and other hematological parameters as a substitute for CD4 cell counts. Participants consisted of two groups, including 416 antiretroviral naive (G1) and 328 antiretroviral experienced (G2) patients. CD4+ T cell counts were performed using a Cyflow machine. Hematological parameters were analyzed using a hematology analyzer. The median ± SEM CD4 count (range) of participants in G1 was 199 ± 10.9 (5-1840 cells/µL) and the median ± SEM TLC (range) was 1. 61 ± 0.05 (0.07-6.63 × 10 3 /µL). The corresponding values among G2 were 421 ± 15.8 (13-1801) and 2.13 ± 0.04 (0.06-5.58), respectively. Using a threshold value of 1.2 × 10 3 /µL for TLC alone, the sensitivity of G1 was 88.4% (specificity (SP) 67.4%, the positive predictive value (PPV) 53.5% and negative predictive value (NPV) of 93.2% for CD4 , 200 cells/µL, the sensitivity for G2 was 83.3%, SP 85.3%, PPV 23.8%, and NPV of 93.2%. Using multiple parameters, including TLC , 1.2 × 10 3 /µL, hemoglobin , 10 g/dL, and platelets , 150 × 10 3 /L, the sensitivity increased to 96.0% (SP, 82.7%; PPV, 80%; NPV, 96.7%) among G1, while no change was observed in the G2 cohort. TLC , 1.2 × 10 3 /µL alone is an insensitive predictor of CD4 count of , 200 cells/µL. Incorporating hemoglobin , 10 g/dL, and platelets , 150 × 10 3 /L enhances the ability of TLC , 1.2 × 10 3 /µL to predict CD4 count , 200 cells/µL among the antiretroviral-naïve cohort. We recommend the use of multiple, inexpensively measured hematological parameters in the form of an algorithm for predicting CD4 count level.

No abstract