Limited emergence of resistance to integrase strand transfer inhibitors (INSTIs) in ART-experienced participants failing dolutegravir-based antiretroviral therapy: a cross-sectional analysis of a Northeast Nigerian cohort.

BACKGROUND: Due to the high prevalence of resistance to NNRTI-based ART since 2018, consolidated recommendations from the WHO have indicated dolutegravir as the preferred drug of choice for HIV treatment globally. There is a paucity of resistance outcome data from HIV-1 non-B subtypes circulating across West Africa. AIMS: We characterized the mutational profiles of persons living with HIV from a cross-sectional cohort in North-East Nigeria failing a dolutegravir-based ART regimen. METHODS: WGS of plasma samples collected from 61 HIV-1-infected participants following virological failure of dolutegravir-based ART were sequenced using the Illumina platform. Sequencing was successfully completed for samples from 55 participants. Following quality control, 33 full genomes were analysed from participants with a median age of 40 years and median time on ART of 9 years. HIV-1 subtyping was performed using SNAPPy. RESULTS: Most participants had mutational profiles reflective of exposure to previous first- and second-line ART regimens comprised NRTIs and NNRTIs. More than half of participants had one or more drug resistance-associated mutations (DRMs) affecting susceptibility to NRTIs (17/33; 52%) and NNRTIs (24/33; 73%). Almost a quarter of participants (8/33; 24.4%) had one or more DRMs affecting tenofovir susceptibility. Only one participant, infected with HIV-1 subtype G, had evidence of DRMs affecting dolutegravir susceptibility-this was characterized by the T66A, G118R, E138K and R263K mutations. CONCLUSIONS: This study found a low prevalence of resistance to dolutegravir; the data are therefore supportive of the continual rollout of dolutegravir as the primary first-line regimen for ART-naive participants and the preferred switch to second-line ART across the region. However, population-level, longer-term data collection on dolutegravir outcomes are required to further guide implementation and policy action across the region.

Comparative Evaluation of Prevalence, Risk Factors, and Pathologic Features of Kidney Disease in Highly Active Antiretroviral Therapy-Naive and Highly Active Antiretroviral Therapy-Experienced Patients at a Tertiary Health Facility in Maiduguri, Northeastern Nigeria.

Infection of the kidneys by human immunodeficiency virus (HIV) is known to cause kidney disease. HIV-associated nephropathy occurs with variable prevalence rates in various communities and is found to be higher among sub-Saharan Africans. The disease has not been studied in Northeastern Nigeria. This study was aimed at comparing the prevalence, clinical and histo-pathologic features of kidney disease among highly active antiretroviral therapy (HAART)-experienced and HAART-naive patients in northeastern Nigeria. Four hundred HIV-infected (200 HAART-experienced and 200 HAART-naïve) patients were recruited consecutively from the ART clinic. Their socio-demographic and laboratory data including CD4+ cell counts and viral loads were obtained and documented. Out of the 200 study participants in the HAART-experienced arm, 21 (10.5%) had kidney disease whereas 61 (30.5%) participants in the HAART-naïve group had kidney disease. Their mean ages were 41.43 ± 11.04 years and 37.42 ± 9.96 years in the HAART-experienced and HAART-naïve groups, respectively. The mean serum creatinine (SCr), CD4+ cell counts, and viral load were 185.67 ± 221.80 µmol/L, 493.26 ± 241.97/mm3, and 8,856.79 ± 19,747.11/mL in the HAART-experienced group, respectively. In the HAART-naïve group, the mean SCr, CD4+ cell count, and viral load were 141.88 ± 130.56 µmol/L, 270.00 ± 154.65 cells/mm3, and 139,217.70 ± 12,598.50/mL. Focal segmental glomerulosclerosis (FSGS) was the most common histologic diagnosis in 64.7% of kidney biopsies. Risk factors for chronic kidney disease among the study population included age, low weight and body mass index, high human immunodeficiency virus (HIV)-1 viral load, low CD4+ cell counts, low hemoglobin (Hb), and proteinuria. The prevalence of kidney disease is higher among HAART-naïve HIV-infected patients than in patients who are HAART-experienced patients. Factors associated with development of kidney disease included advanced age, low CD4+ cell counts, high viral load, proteinuria, and HAART-naivety. FSGS is the most common histologic diagnosis in our study population.

Under the counter, underground or unethical medicines? An African perspective.

Discussions about global health issues related to drugs usually concentrate on affordability and availability, with limited consideration of other precipitating factors associated with distribution inequalities and efficacy in low-income countries. Inappropriate prescribing has a significant public health impact ranging from ineffective treatment of disease, drug resistance and potential harm to patients. We report on the problems associated with unsuitable prescribing of medication in an African setting.

Prevalence, Correlates and Under-Diagnosis of Clinical Depression among Adults on Highly Active Antiretroviral Therapy in a Tertiary Health Institution in Northeastern Nigeria.

Clinical depression is a highly debilitating illness, which is often under-diagnosed and negatively impacts on the quality of life of its sufferers. When it co-exists with other medical conditions, its effect is even more incapacitating. Undiagnosed depression in the context of HIV infection leads to accelerated decline in CD4+ cell counts with concomitant increase in the viral load and poor adherence to the antiretroviral medications which lead to viral mutation and the evolution of resistant strains. This study examined the prevalence of depression, its correlates and the frequency of the diagnosis of the condition among HIV+ subjects on highly active antiretroviral therapy (HAART) by the internists and general physicians at the University of Maiduguri Teaching Hospital in Northeastern Nigeria. Three hundred and fifty representative samples of HIV+ adults on HAART were drawn from the Antiretroviral Therapy Clinic of the Institution. Diagnosis of depression was made using the International Classification of Diseases-10 criteria based on Composite International Diagnostic Interview generated data. Socio-demographic and clinical variables were also analyzed for their correlation with depression in the subjects. About 20% of the respondents were diagnosed with clinical depression and no diagnosis of the condition was hitherto entertained in all the respondents. The independent determinants of depression in the participants were: female gender [odds ratio (OR)=3.87 (95% confidence interval, CI: 2.089-7.183)], past history of psychiatric illness [OR=43.81 (95% CI: 9.731-197.30)] and family history of psychiatric illness in first-degree relatives of the subjects [OR=14.364 (95% CI=5.327-38.729)]. Depression is a relatively common psychiatric condition among adults on HAART, there is therefore the need for routine screening of this condition among HIV+ subjects in order to optimize patient care and improve clinical outcomes.

Using the effects of maternal nutritional indicators (hemoglobin and total protein) on baby's birth weight outcome to forecast a paradigm shift toward increased levels of non-communicable diseases in children.

BACKGROUND: Maternal malnutrition can lead to low birth weight in babies, which puts them at risk of developing non-communicable diseases later in life. Evidence from developed countries has shown that low birth weight is associated with a predisposition to higher rates of non-communicable diseases later in life. However, information on this is lacking in developing countries. Thus, this work studied the effects of maternal nutritional indicators (hemoglobin and total protein) on birth weight outcome of babies to forecast a paradigm shift toward increased levels of non-communicable diseases in children. MATERIALS AND METHODS: Mother-baby pairs were enrolled in this study using systematic random sampling. Maternal haemogblobin and total proteins were measured using micro-hematocrit and biuret methods, and birth weights of their babies were estimated using the bassinet weighing scale. RESULTS: Of the 168 (100%) babies that participated in this study, 122 (72.6%) were delivered at term and 142 (84.5%) had normal birth weights. Mean comparison of baby's birth weight and maternal hemoglobin was not significant (P = 0.483), that for maternal total protein was also not significant (P = 0.411). Even though positive correlation coefficients were observed between birth weight of babies, maternal hemoglobin and total proteins, these were however not significant. CONCLUSION: Maternal nutrition did not contribute significantly to low birth weight in our babies. Therefore, association between maternal nutrition and low birth weight to predict future development of non-communicable diseases in our study group is highly unlikely. However, we recommend further work.

Peak expiratory flow in normal medical students in Maiduguri, Borno state, Nigeria.

BACKGROUND: The assessment of lung function is of considerable importance in the diagnosis of respiratory diseases, normal reference values need to be determined. The peak expiratory flow (PEF) is a simple, reproducible and easily affordable test of lung function which has been used in resource poor countries like Nigeria. A study PEF was carried out in medical students of the University of Maiduguri and the result was compared with various prediction equations calculated in other parts of Nigeria. METHODS: It was a cross-sectional study involving 255 medical students. Data was collected between March and June 2010 using MicroPeak™ peak flow meter (Micromedical MEI 2A2 Kent) as the instrument. RESULTS: There was a statistically significant difference between the measured PEF and the predicted values based on different formulae derived from the different parts of Nigeria. However, the values in females in this study was consistent with the one obtained by one investigator in the north western part of the country. PEF positively correlated with the measured anthropometric parameters and age. CONCLUSION: The result of the study showed that the prediction formulae of Njoku et al and Salisu et al may be used in the assessment of PEF of individuals in this environment; however, further studies with larger sample size may be needed.

C-reactive protein in healthy adult Nigerians.

BACKGROUND: C-reactive protein (CRP) is an acute phase reactant produced in the liver in response to tissue injury or systemic inflammation, its release is stimulated by cytokines (interleukin-6 and tumour necrosis factor-alpha). Elevated CRP levels have been linked to an increased risk of later development of diabetes mellitus and systemic hypertension. Baseline level of C-reactive protein in apparently healthy men and women predict long-term risk of a first myocardial infarction. METHOD: The study design was cross-sectional conducted among apparently healthy adult relative of patients and hospital staff of the Obafemi Awolowo University Teaching Hospitals complex (OAUTHC) Ile Ife, Osun State south western Nigeria. Serum lipids and fasting blood glucose were measured, while C-reactive protein measurement was based on the principle of solid phase enzyme-linked immunosorbent assay (ELISA). RESULTS: Atotal of 50 apparently healthy consecutive adult subjects were recruited into the study comprising 19 male and 31 female. There was no significant difference in mean Fasting blood glucose and serum lipids between the male and female study subjects. However, C-reactive protein was found to be higher in female compared to male, but the difference was not statistically significant. CONCLUSION: This study showed that apparently healthy adult female Nigerians have higher level of C-reactive protein compared to male, but with no significant difference.