Long Term Exposure to Tenofovir Disoproxil Fumarate-Containing Antiretroviral Therapy Is Associated with Renal Impairment in an African Cohort of HIV-Infected Adults.

OBJECTIVES AND METHOD: There are growing concerns of tenofovir disoproxil fumarate (TDF)-associated renal toxicity. We evaluated the effect of long-term TDF exposure on renal function in a cohort of HIV-1-infected Nigerians between 2006 and 2015. Multivariate logistic regression was used to identify predictors of renal impairment at different time over 144 weeks of antiretroviral therapy (ART). RESULTS: Data of 4897 patients, median age 42 years (interquartile range: 36-49), and 61% females were analyzed. The prevalence of renal impairment increased from 10% at week 24 to 45% at 144 weeks in TDF-exposed participants compared to an increase from 8% at 24 weeks to 14% at 144 weeks in TDF-unexposed participants. Tenofovir disoproxil fumarate exposure predicted the risk of renal impairment at 144 weeks of ART (odds ratio: 2.36; 95% confidence interval: 1.28-4.34). CONCLUSION: Long-term exposure to TDF-based ART significantly increases the likelihood of renal impairment. The continued use of TDF-based regimen in our setting should be reviewed. We recommend the urgent introduction of tenofovir alafenamide-based regimen in the HIV treatment guidelines of Nigeria and other resource-limited countries.

Secondary hyperparathyroidism among Nigerians with chronic kidney disease.

BACKROUND: Secondary hyperparathyroidism (SHPT) is a manifestation of chronic kidney disease mineral bone disorder (CKD-MBD). SHPT is common in patients with chronic kidney disease (CKD) and is associated with significant morbidity and mortality. METHODS: A cross- sectional descriptive study involving 230 patients with CKD. RESULTS: The mean age of the study population was 44.17±15.24 years. The median intact parathyroid hormone and alkaline phosphatase levels were 96pg/ml (range 4-953pg/ml) and 88 iu/l (range 10-800 iu/l) respectively. The mean (with standard deviation) calcium, serum phosphate, calcium phosphate product and haemoglobin levels were 2.22±0.29mmol/l, 1.8±0.62mmol/l, 3.94±1.42mmol2/l2 and 9.90±1.87g/dl respectively. Majority of patients had advanced CKD with 70.3% of patients in stage G5. The prevalence rates of SHPT, hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase and elevated calcium phosphate product were 55.2%, 34.8%, 66.1%, 42.2% and 25.2% respectively.Univariate analysis revealed that SHPT was associated with hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase, proteinuria, anaemia, hypertension, left ventricular hypertrophy and stage of kidney disease; being worse with advancing kidney disease. Independently associated with SHPT were hypocalcaemia (OR=4.84), hyperphosphataemia (OR=3.06), and elevated alkaline phosphatase (OR=2.04). CONCLUSION: The prevalence of SHPT in CKD is high, occurs early and is independently associated with hypocalcaemia, hyperphosphataemia and elevated alkaline phosphatase. The prevalence of SHPT also increases with worsening renal function.

Obesity and obstructive sleep apnea risk among Nigerians.

BACKGROUND: The contribution of obesity to obstructive sleep apnea (OSA) is poorly described in Nigeria. We aimed to compare OSA risk between obese and nonobese adults in urban Nigeria. MATERIALS AND METHODS: An analytic cross-sectional study was conducted. Participants were interviewed using the World Health Organization Non-Communicable Disease questionnaire. OSA risk assessment was performed using the STOP-BANG questionnaire. A total score of ≥3 on the STOP-BANG questionnaire indicated OSA risk, whereas a score ≥5 indicated high OSA risk. Obesity was defined as body mass index (BMI) >30 kg/m2. Relationship between obesity and OSA was tested using chi-square and logistic regression models used to control for confounding factors. RESULTS: There were 744 respondents, with a mean age of 44 (standard deviation 10) years. A total of 206 [27.7%, 95% confidence interval (CI) 24.46-30.9] respondents were obese (BMI ≥30 kg/m2). A total of 307 (41.3%, 95% CI 37.7-44.9) respondents scored ≥3 on the STOP-BANG questionnaire, whereas 37 (4.9%, 95% CI 3.6-6.7) scored ≥5. More number of obese than nonobese [57.8% (119/206) versus 34.9% (188/538)] respondents met the criteria for OSA risk (P < 0.001). Similarly, more obese persons [10.3% (21/206)] met the criteria for high-risk OSA compared to the nonobese [3% (16/538)]; P < 0.001. In logistic regression models adjusted for cigarette smoking and alcohol consumption, the odds for OSA risk was 15.76 (95% CI 7.44-33.9) in persons with BMI >35 kg/m2 compared to those with a BMI range of 18.5-24.99. CONCLUSION: Obesity and OSA may be more prevalent in Nigeria than previously predicted. Obesity independently increased OSA risk in this population.

A survey of non-communicable diseases and their risk factors among university employees: a single institutional study.

BACKGROUND: The incidence of non-communicable diseases (NCDs) is rising globally, with its attendant morbidity and mortality, especially in developing countries. This study evaluated the prevalence of NCDs and their risk factors among members of a university community. METHODS: All employees of the university were invited to the University health clinic for screening, using the World Health Organisation's STEPwise approach to NCDs. RESULTS: A total of 883 (521; 59.0% males) employees with a mean age of 44 ± 10 years were studied. The median (IQR) number of NCD risk factors was three (two to three) per participant. The most common NCD risk factors were inadequate intake of fruit and vegetables (94.6%; 95% CI: 92.8-95.9), physical inactivity (77.8%; 95% CI: 74.9-80.5%) and dyslipidaemia (51.8%; 95% CI: 48.4-51.6%). Others included obesity (26.7%; 95% CI: 23.9-29.8%), alcohol use (24.0%; 95% CI: 21.3-27.0%) and cigarette smoking (2.9%; 95% CI: 2.0-4.3). Hypertension was the most common NCD (48.5%; 95% CI: 45.1-51.8%), followed by chronic kidney disease (13.6%; 95% CI: 11.4-16.1) and diabetes mellitus (8.0%; 95% CI: 6.4-10.1). There was no gender-specific difference in the prevalence of NCDs. CONCLUSION: This study identified that NCDs and their modifiable risk factors are highly prevalent in this community. Workplace policy to support the adoption of healthy living is needed.

Sexual Functioning and Health-related Quality of Life in Men.

BACKGROUND: Although erectile dysfunction (ED) is common, little is known about the impact of ED on the quality of life (QoL) among African men. MATERIALS AND METHODS: We used the International Index of Erectile Function (IIEF) to evaluate ED and the WONCA charts to assess QoL among employees of a university. RESULTS: A total of 508 men with a mean age of 43 ± 10 years were studied. IIEF5 scores of <22 were present in 406 participants (77.9%). Mild ED, mild-to-moderate ED, moderate ED, and severe ED were present in 34.6%, 26.6%, 10.4%, and 5.7%, respectively. Systolic and diastolic blood pressure were significantly lower in those with ED. Marital status, alcohol, cigarette, physical inactivity, obesity, hypertension, diabetes mellitus, and antihypertensive drug use were not associated with ED. ED was associated with poor QoL in the domains of social activities (odds ratio [OR] = 4.35; 95% confidence interval [CI]: 1.01-18.7), and overall health (OR = 2.27; 95% CI: 1.07-4.82). However, there was no association of ED with poor QoL in the domains of physical fitness (OR = 1.46; 95% CI: 0.82-2.59), feelings (OR = 1.43; 95% CI: 0.75-2.72), daily activities (OR = 4.72; 95% CI: 0.61-36.4), and change in health (OR = 1.75; 95% CI: 0.58-5.26). CONCLUSION: ED negatively impacts QoL in men.