The impact of HIV on hepatocellular cancer survival in Nigeria.

BACKGROUND: Hepatocellular carcinoma (HCC) is an increasing cause of mortality in HIV-infected individuals. We compared host and tumour characteristics between HIV-infected and HIV-uninfected Nigerians with HCC and examined the impact of HIV on survival. METHODS: This prospective observational study was conducted at Jos University Teaching Hospital in Jos, Nigeria, among adults (>18 years) with HCC enrolled between September 2015 and September 2017 and followed until April 2019. Demographics, tumour characteristics and survival were compared between HCC subjects with and without HIV. RESULTS: 101 (10 HIV-infected and 91 HIV-uninfected) subjects were enrolled [male 72%; median age 48 (IQR 35-60)]. 60% HIV-infected subjects were receiving ART; 90% had CD4 counts ≥ 200/mm3 at HCC diagnosis, and 20% had HIV RNA levels < 20 copies/mL. 57.4% were infected with chronic HBV (HBsAg+). The duration of symptoms was shorter in HIV-infected vs. HIV-uninfected subjects [93 (IQR 54-132) vs. 155 (93-248] days; p = 0.02]. At the end of follow-up, 99 of 101 (98.0%) subjects were confirmed to have died: 9 of 10 (90.0%) HIV-infected and 90 of 91 (98.9%) HIV-uninfected. The probability of survival at three months was 22% and 47% in HIV-infected and HIV-uninfected subjects, respectively (P = 0.02). Median time to death was significantly shorter in HIV-infected vs. HIV-uninfected subjects [24 days (IQR 16-88) vs. 85 days (IQR 34-178), respectively (P = 0.03)]. CONCLUSIONS: High early mortality was observed in this cohort of Nigerian adults with HCC. HIV infection was associated with a faster clinical presentation and shorter survival. More aggressive HCC surveillance may be warranted in HIV-infected subjects, particularly if they are co-infected with chronic HBV.

CONTEXTE: Le carcinome hépatocellulaire (CHC) est une cause croissante de mortalité chez les personnes infectées par le VIH. Nous avons comparé les caractéristiques de l'hôte et de la tumeur entre les Nigérians avec le CHC infectés par le VIH et non infectés et avons examiné l'impact du VIH sur la survie. MÉTHODES: Cette étude observationnelle prospective a été menée au Jos University Teaching Hospital à Jos, au Nigéria, chez des adultes (>18 ans) avec CHC inscrits entre septembre 2015 et septembre 2017 et suivis jusqu'en avril 2019. Les données démographiques, les caractéristiques tumorales et la survie ont été comparées entre les sujets CHC avec et sans VIH. RÉSULTATS: 101 sujets (10 infectés par le VIH et 91 non infectés par le VIH) ont été recrutés [hommes 72%; âge médian de 48 ans (IQR 35-60)]. 60% des sujets infectés par le VIH recevaient une ART; 90% avaient des taux de CD4 ≥200/mm3 au moment du diagnostic de CHC et 20% avaient des taux d'ARN du VIH <20 copies/ml. 57,4% étaient chroniquement infectés par le VHB (HBsAg +). La durée des symptômes était plus courte chez les sujets infectés par le VIH que ceux non infectés [93 (IQR 54-132) vs 155 (93-248] jours; p = 0,02]. A la fin du suivi, 99/101 (98,0 %) des sujets ont été confirmés décédés: 9/10 (90,0%) sujets infectés par le VIH et 90/91 (98,9%) non infectés par le VIH. La probabilité de survie à trois mois était de 22% et 47% chez les personnes infectées par le VIH et celles non infectées par le VIH, respectivement (p = 0,02). Le délai médian au décès était significativement plus court chez les sujets infectés par le VIH par rapport aux sujets non infectés par le VIH [24 jours (IQR 16-88) contre 85 jours (IQR 34-178), respectivement (p = 0,03)]. CONCLUSIONS: Une mortalité précoce élevée a été observée dans cette cohorte d'adultes nigérians atteints de CHC. L'infection par le VIH était associée à une présentation clinique plus rapide et à une survie plus courte. Une surveillance plus étroite du CHC peut être justifiée chez les sujets infectés par le VIH, particulièrement s'ils sont coinfectés chroniquement par le VHB.

Knowledge, attitudes and practices towards Covid-19 among Nigerian healthcare workers during the Covid-19 pandemic: A single centre survey.

BACKGROUND: The COVID-19 pandemic has led to hundreds of thousands of deaths worldwide. AIMS: Being a novel viral disease, we sought to evaluate the knowledge and practice of doctors and nurses in a tertiary hospital regarding the disease. SUBJECTS AND METHODS: Using a self-administered questionnaire, respondents were asked questions on the cause, clinical features, and prevention of COVID-19. RESULTS: : We studied 409 respondents (238 doctors and 171 nurses) with a mean age of 34 ± 7 years and a median length of experience of five (IQR 2-9) years. The mean knowledge score was 9.6 ± 1.2 out of a maximum of 12 points with 337 (82.4%) respondents having good knowledge. The majority of respondents (62.8%) had not been trained on infection prevention and control since the outbreak of the pandemic. Only 95 (23.2%) had seen COVID-19 Standard Operating Procedures (SOP) displayed in the hospital. The use of the personal protective equipment (PPE) kit comprising the N-95 mask, face shield, gown, and shoes was seen by 194 (47.4%) respondents in recent times. A total of 397 (97.0%) respondents felt they were at an increased risk of contracting COVID-19 relative to the general populace. Measures taken to prevent COVID-19 included: wearing of face mask (68.7%), hand gloves (78.2%), frequent use of hand sanitizers (84.1%), frequent hand washing (84.8%), the daily wash of uniforms and ward coats (44.5%), daily cleaning of footwear (31.7%), and avoidance of taking home clothing and footwear worn in the hospital (54.2%). CONCLUSION: Despite having good knowledge of transmission and clinical features of SARS-CoV 2, the utilization of protective measures by HCW in this study is unsatisfactory.

Human Immunodeficiency Virus and Risk of Type 2 Diabetes in a Large Adult Cohort in Jos, Nigeria.

BACKGROUND: Human immunodeficiency virus (HIV) infection and the use of antiretroviral therapy (ART) may increase the risk of type 2 diabetes mellitus (T2DM). However, data from regions with a high burden of HIV/AIDS are limited. We determined the prevalence of T2DM at the time of presentation to a large HIV clinic in Nigeria, as well as the incidence of diabetes 12 months following ART initiation. METHODS: Data from patients enrolled for ART from 2011 to 2013 was analyzed, including 2632 patients on enrollment and 2452 reevaluated after 12 months of ART commencement. The presence of diabetes, and demographic, clinical, and biochemical data were retrieved from standardized databases. CD4(+), HIV RNA load, and hepatitis C virus status were noted. Bivariate and logistic regressions were used to identify risk factors for T2DM. RESULTS: Baseline T2DM prevalence was 2.3% (95% confidence interval, 1.8%-2.9%); age, but not body mass index (BMI), was a risk factor for diabetes. After 12 months of ART, an additional 5.3% had developed T2DM. Newly developed diabetes was not associated with age, but was associated with BMI. There were no significant associations between prevalent or incident diabetes and CD4(+), viral load, or type of ART. CONCLUSIONS: Diabetes is not uncommon in HIV-infected individuals at the time of presentation to HIV services. Patients initiating ART have a high risk of developing diabetes in the first year of ART. Excessive weight gain should be avoided, as incident diabetes was associated with a BMI ≥25.0 kg/m(2).

Patients who present late to HIV care and associated risk factors in Nigeria.

OBJECTIVES: Our objectives were to assess trends in late presentation and advanced HIV disease (AHD) and determine associated risk factors. METHODS: We conducted a retrospective cohort analysis of patients who had received care and treatment at the AIDS Prevention Initiative Nigeria Plus (APIN)/Harvard School of Public Health-President's Emergency Plan for AIDS Relief (PEPFAR) programme at the Jos University Teaching Hospital, Jos, Nigeria from 2005 to 2010. We used the European Consensus Definition to assess trends in late presentation (CD4 count < 350 cells/µL or AIDS-defining illness) and AHD (CD4 count < 200 cells/µL or AIDS-defining illness) and evaluated associated risk factors using logistic regression methods. RESULTS: Among 14,487 eligible patients, 12,401 (85.6%) were late presenters and 9127 (63.0%) presented with AHD. Late presentation decreased from 88.9% in 2005 to 80.1% in 2010 (P < 0.001). Similarly, AHD decreased from 67.8% in 2005 to 53.6% in 2010 (P < 0.001). In logistic regression models adjusting for sociodemographic and biological variables, male sex [adjusted odds ratio (aOR) = 1.80; 95% confidence interval (CI) 1.60-2.04], older age (aOR = 1.37; 95% CI 1.22-1.54), civil service employment (aOR = 1.48; 95% CI 1.00-2.21), referral from out-patient (aOR = 2.18; 95% CI 1.53-3.08) and in-patient (aOR = 1.55; 95% CI 1.11-2.17) services, and hepatitis B virus (aOR = 1.43; 95% CI 1.26-1.63) and hepatitis C virus (aOR = 1.18; 95% CI 1.02-1.37) coinfections were associated with late presentation. Predictors of AHD were male sex (aOR = 1.67; 95% CI 1.54-1.82), older age (aOR = 1.26; 95% CI 1.16-1.36), unemployment (aOR = 1.34; 95% CI 1.00-1.79), referral from out-patient (aOR = 2.40; 95% CI 1.84-3.14) and in-patient (aOR = 1.97; 95% CI 1.51-2.57) services and hepatitis B virus coinfection (aOR = 1.30; 95% CI 1.19-1.42). CONCLUSIONS: Efforts to reduce the proportion of patients who first seek care at late stages of disease are needed. The identified risk factors should be utilized in formulating targeted public health interventions to improve early diagnosis and presentation for HIV care.

Sonographic characterization of renal pathologies in HIV/AIDS in Plateau State, Nigeria.

BACKGROUND: The prevalence of HIV/AIDS in Jos is about 7% according to Idoko et al. Many deaths from infection occur from the complications involving vital organs. The effects of this complication on the kidneys being one of the vital organs are yet to be determined in the locality. The kidneys are prone to impairment due to direct viral attack, opportunistic infections and nephrotoxic drugs. Though renal sonographic features are well characterized in literature, there is no documentation of correlation between renal sonographic features in HIV/AIDS and healthy population in Nigeria. The objectives of the study are to determine the commonly occurring renal sonographic features in HIV/AIDS in terms of echogenicity and size, and correlate these features with measured CD4 cell count. METHODS: 302 subjects were studied prospectively over a period of twenty two months. In order to determine renal sizes, several bilateral longitudinal and transverse scans of the subjects' kidneys in a supine position were done. In order to clarify renal echogenicity, a-four point scoring method was devised to measure the severity of sonographic changes in the kidneys. Subjects' CD4 cell counts were collected from the APIN laboratory and Faith Alive Foundation both in Jos. Pearson's correlation and regression were used for correlation between CD4 cell count and renal length, and between renal length and age, and Z-test was used to compare mean renal dimension of male and female of subjects and HIV sero negative subjects. RESULTS: The subjects consisted of 123 males and 179 females with a mean age of 34.4 years, between the ages of 4 and 80 years. Results indicated that 77.7% of subjects had increased renal echogenicity reflecting the prevalence of renal disease in HIV/AIDS in the locality, 76.7% of the subjects were in their reproductive and sexually active ages (21-40 years). There was significant negative correlation between renal length and measured CD4 cell count (p < 0.01) and also between renal length and age of subjects (p < 0.05). No significant correlation between renal echogenicity and CD4 cell count was noted. Result also indicate that renal length is related to CD4 cell count by the equation = 0.0029CD4+11.1423. CONCLUSION: It is concluded that sonographic features of the kidneys in HIV infection in this locality is characterized by increased renal length with decreasing CD4 cell count amongst sexually active age group. And also a generally high incidence of renal involvement (disease) in HIV/AIDS is seen, similar to those reported in literatures.

Temporal changes in renal glomerular function associated with the use of Tenofovir Disoproxil Fumarate in HIV-infected Nigerians.

BACKGROUND: Reports of renal dysfunction in Tenofovir Disoproxil Fumarate (TDF)-treated HIV-1 infected patients have raised concerns about potential nephrotoxicity. OBJECTIVE: To compare the effects on renal function of TDF-containing highly active anti-retroviral therapy (HAART) with a non-TDF-containing HAART. METHODS: This was an observational study.Clinical and laboratory data of 186 HIV-1 infected adult Nigerians on first-line HAART for at least 48 weeks were reviewed. Eighty-four patients whose nucleos(t)ide reverse transcriptase inhibitor (NRTI) backbone included TDF were compared to 102 patients on other NRTI backbones. Creatinine clearance (CLcr) was estimated using the Cockcroft-Gault equation. Changes in serum creatinine and CLcr from the baseline for each patient were compared between the TDF-treated and the TDF-free patients. We also assessed the associations of other variables with change in CLcr... RESULTS: Baseline median serum creatinine (mmol/L) was 77 and 84 in the TDF-treated and TDF-free groups, respectively (p=0.59). Baseline median CLcr (mls/min) was 83 in the TDF-treated patients vs 78 in the TDF-free group. At 48 weeks, serum creatinine increased by 18.1% and 1.2% in the TDF-treated and TDF-free arms, respectively. There was a decrease of 4.8% in GFR in the TDF arm compared to a gain 5.1% in the TDF-free arm. CONCLUSION: Tenofovir Disoproxil Fumarate-containing HAART is associated with a slight decline in the medium term in CLcr compared with HAART regimens containing alternative Nucleosid(t) Reverse Transcriptase Inhibitors.

Frequency of cryptococcal meningitis in HIV-1 infected patients in north central Nigeria.

BACKGROUND: Cryptococcal meningitis (CM) is the most common severe life threatening fungal infection in AIDS patients. It is an important cause of morbidity and mortality There is paucity of data on the prevalence of CM in Nigeria. We aimed to determine the frequency of CM, the clinical presentation and immunological profile. METHODS: A cross sectional study was carried out at the Jos University Teaching Hospital (JUTH). A total of 100 HIV-1 infected patients suspected of having meningitis or meningoencephalitis were subjected to cerebrospinal fluid (CSF) analysis (including Indian ink preparation and fungal culture by conventional methods) and CD4 count was determined using flow cytometry (count bit Y-R 1004 Partec Muster Germany). RESULTS: The freguency of CM was 36% in our cohort. The commonest clinical presentation included headache (100.0%), neck stiffness (77.8%), fever (72.0%), vomiting 55.6%), personality changes (55.6%), photophobia (27.8%) and convulsions (27.8%). The mean duration of symptoms was 24 +/- 22 days with a median of 17 days. The mean CD4 count was 89 +/- 60 cells/mm3 with a median of 82 cells/mm3. CONCLUSION: The high prevalence of CM and the associated severe immunosuppression underscores the importance of early diagnosis of HIV infection which may reduce the incidence of CM. There is the urgent need for access to Amphotericin B and fluconazole in resource constrained settings in addition to a wide access to HAART.

Presentation and survival of patients with AIDS-related Kaposi's sarcoma in Jos, Nigeria.

AIDS-related Kaposi's sarcoma (AIDS-KS) remains a significant cause of morbidity and mortality. We describe the pattern of presentation and survival in Jos, Nigeria. We identified 48 HIV-positive patients with AIDS-KS and matched them for age and sex with an equal number of HIV-positive patients without AIDS-KS. We compared their clinical, immunological, virological characteristics and survival. They were similar in age and body mass index profile but patients with AIDS-KS had more tuberculosis co-infection (P, 0.02), lower median CD4 count (P, 0.003) and higher mortality (P, 0.002). Surprisingly, patients with AIDS-KS had lower levels of median viral load (29,347 copies/mL) compared with controls (80,533 copies/mL). We recommend specific AIDS-KS therapy in addition to highly active antiretroviral therapy in order to improve survival.

Direct observation therapy-highly active antiretroviral therapy in a resource-limited setting: the use of community treatment support can be effective.

This study examines the use of various direct observation therapy-HAART treatment support modalities in Jos, Nigeria. A 12-month observational study enrolling 175 antiretroviral naïve patients into four arms of direct observation therapy-HAART (highly active antiretroviral therapy); daily observed therapy (DOT), twice weekly observed therapy (TWOT), weekly observed therapy (WOT) and self-administered therapy (SAT), examined community treatment support using family and community members. Treatment outcomes were much better in the treatment-supported groups compared with the control self-therapy group. CD4 cell increases were 218/microL (DOT), 267/microL (TWOT), 205/microL (WOT) versus 224/microL (SAT), whereas plasma HIV-1 RNA reached undetectable levels (<400 copies/mL) in 91%, 88%, 84% versus 79% of patients in the DOT, TWOT, WOT versus SAT groups, respectively, at 48 weeks. We, therefore, strongly support the use of treatment support in our settings.

Does immunological status affect the prevalence of Hepatitis C virus infection among HIV/AIDS patients?

BACKGROUND: Even though HIV-HCV co-infection rates vary widely according to western reports, not so much has been documented about the situation in our environment. We determined the prevalence of HCV among our HIV cohort as well as described the relationship between the immune and virological status of the patients in this report. METHODS: Data of 1044 consenting HIV infected patients (confirmed by Western blot assay) receiving treatment at our centre between Sep 2002 and Feb 2005 were analyzed using EpiInfo 2004 retrospectively. The sera of the patients were used to determine their anti-HCVstatus by third generation ELISA (DIA.PRO Diagnostic, Bioprobes srl, Italy). HIV RNA levels and CD4 cell counts were also determined at recruitment by Roche Amplicor 1.5 and Flow Cytometry (Partec, Germany). RESULTS: Ninety out of 1044 patients (8.6%) were positive for anti-HCV The rate of co-infection was highest among the divorced (10.3%), followed by widows (9.9%) though this did not reach statistical significance. The odds of finding anti-HCV was more than twice with CD4 cell counts >600 cells/microlitre compared to below 200 cells/microlitre (p=0.026). The median HIV RNA levels of HCV co-infected individuals was 514 copies/ml, while it was 200 copies/ml for HIV monoinfected persons (p>0.05). CONCLUSION: The prevalence of HCV among this HIV cohort is high. There is also an associated higher chance of detecting anti-HCV in sera of the HIV patients whose immunological status is better than severely immunocompromised individuals.

Prevalence of musculoskeletal diseases in a semi-urban Nigerian community: results of a cross-sectional survey using COPCORD methodology.

The International League of Associations for Rheumatology (ILAR) in collaboration with the World Health Organization (WHO) initiated the Community Oriented Program for the Control of Rheumatic diseases (COPCORD) to promote the growth of rheumatology in developing countries. This is the first COPCORD-type survey carried out in a West African community. The objective of this study was to determine the prevalence of musculoskeletal diseases in a semi-urban Nigerian community, using the COPCORD methodology. This is a cross-sectional total population survey, carried out in Katon Rikkos, Jos, Nigeria, from June 2015 to November 2016. All inhabitants of the community who are 15 years and older were included in the study, except those who were not available or refused to participate. Trained health workers from the community carried out a house-to-house survey, to administer the COPCORD questionnaire. People reporting musculoskeletal symptoms were examined and investigated at the teaching hospital, to determine the specific type of musculoskeletal diseases. Data was analyzed using Epi-info version 7.1.5 and P values of <0.05 were considered statistically significant. The median age of the study population was 33 (IQR 24-46) years, with a male to female ratio of 1:1.1. The prevalence of musculoskeletal disease was 33%. Females (57.0%) were more affected than males (43.0%); the most common form of musculoskeletal diseases diagnosed was osteoarthritis (22.0%). Male sex and a family history of musculoskeletal diseases were independent predictors of musculoskeletal diseases. A Health Assessment Questionnaire Disability Index (HAQ-DI) ≥1 was recorded in 14% of subjects with musculoskeletal diseases. The prevalence of musculoskeletal diseases in this community is high with significant disability; therefore, there is urgent need for increased access to rheumatology care in the community.

Hypertension in treated and untreated patients with HIV: a study from 2011 to 2013 at the Jos University Teaching Hospital, Nigeria.

Background: Individuals with HIV, especially those on antiretroviral therapy (ART), may have increased risk of hypertension. We investigated the prevalence of hypertension at enrolment and 12 months after commencing ART in a Nigerian HIV clinic. Methods: Data from patients enrolled for ART from 2011 to 2013 were analysed, including 2310 patients at enrolment and 1524 re-evaluated after 12 months of ART. The presence of hypertension, demographic, clinical and biochemical data were retrieved from standardized databases. Bivariate and logistic regressions were used to identify baseline risk factors for hypertension. Results: Prevalence of hypertension at enrolment was 19.3% (95% CI 17.6-20.9%), and age (p<0.001), male sex (p=0.004) and body mass index (BMI) (p<0.001) were independent risk factors for hypertension. Twelve months after initiating ART, a further 31% (95% CI 17.6-20.9%) had developed hypertension. Total prevalence at that point was 50.2%. Hypertension among those on ART was associated with age (p=0.009) and BMI (p=0.008), but not with sex. There were no independently significant associations between hypertension and CD4+ counts, viral load or type of ART. Conclusions: Hypertension is common in HIV infected individuals attending the HIV clinic. Patients initiating ART have a high risk of developing hypertension in the first year of ART. Since BMI is modifiable, life-style advice aimed at weight reduction is strongly advisable.

Arteriovenous fistula for patients on long term haemodialysis in jos, Nigeria.

BACKGROUND: The introduction of haemodialysis has prolonged the lives of patients with end-stage-renal disease (ESRD). To maintain them on long-term dialysis, vascular access procedures are required. OBJECTIVES: To describe the experience with arteriovenous fistula (AVF) from a developing country. METHODS: Eighty-two AVF were created in 74 patients on maintenance haemodialysis. They all had side-to-end AVF using prolene 7/0 monofilament suture for anastomoses. RESULTS: There were 55 males and 19 females with a male: female ratio of 2.9:1. The ages ranged from 18 to 70 years with a mean of 43.4 "12.1 years. Most of the AVF created were on the left upper limbs with the radio-cephalic and brachio-cephalic accounting for more than 70% . Eight patients developed thrombosis of the veins used for the AVF and one developed a pseudo aneurysm. CONCLUSIONS: Arteriovenous fistula makes long-term haemodialysis feasible. It can be created easily and has a low rate of complications.

Treatment Discontinuation in Adult HIV-Infected Patients on First-Line Antiretroviral Therapy in Nigeria.

BACKGROUND: Retention in care and treatment services is critical to health outcomes of individuals diagnosed and living with HIV. We evaluated the incidence of and risk factors for treatment discontinuation (TD) in a large adult HIV population on ART in Nigeria. METHOD: A retrospective cohort study of adult HIV patients initiated on first-line ART between 2004 and 2011 at the Jos University Teaching Hospital (JUTH) in Nigeria. Follow up information of participants was retrieved from various sources (patient visit database, pharmacy data and patients charts) up to the end of 2012. The primary study endpoint was TD, defined as discontinuation of ART for any reason, including death or loss to follow-up (lack of pharmacy pick-up for periods≥12 months). The Incidence and hazard for TD were estimated by Kaplan-Meier and Cox proportional regression analysis, respectively. RESULT: Overall, 3,362 (28%) patients discontinued treatment during 49,436 person-years (py) of follow-up (incidence rate (IR) 6.8 TD per 100 py). The hazard of treatment discontinuation decreased with increasing age (adjusted hazard ratio (aHR 0.99; 95% CI 0.98-0.99). Other independent risk factors for treatment discontinuation were: being unmarried (aHR 1.24; 95% CI: 1.12-1.38), having primary or secondary level of education as compared to tertiary level education (aHR 1.24; 95% CI: 1.12-1.40) and average percent adherence to drug refill visits<95% (adjusted hazard ratio (aHR) 2.13; 95% CI: 1.9-2.40). Compared to tenofovir, greater hazard of TD was noted in patients initiated on ART containing didanosine (aHR) 1.73; 95% CI: 1.03-2.91), but lower in those initiated on zidovudine containing regimen (aHR 0.77; 95% CI: 0.69-0.86). CONCLUSION: Long-term treatment discontinuation rate in this study was comparable to estimates in resource-rich countries. Younger patients, as well as patients with lower educational levels and those with poor adherence had significant hazards for treatment discontinuation and should be the target of interventions to reduce treatment discontinuation and improve retention, especially within the first year of ART.

Liver function test abnormalities in Nigerian patients with human immunodeficiency virus and hepatitis B virus co-infection.

Data on baseline hepatic function of HIV and hepatitis B virus (HBV) co-infected patients are limited in sub-Saharan Africa. We assessed liver function test (LFT) abnormalities in Nigerian patients with HIV/HBV co-infection to highlight the impact of HIV on HBV-related liver disease in sub-Saharan Africa. A cross-sectional study involving 100 HIV/HBV co-infected patients and 100 age- and sex-matched HBV mono-infected controls. Blood testing for HIV antibodies, CD4+ cell count, hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), LFTs, platelet count, fasting blood glucose and lipid profile were carried out. Non-invasive hepatic fibrosis scores (aspartate aminotransferase-platelet ratio index [APRI] and FIB-4) were also calculated. Co-infected patients had deranged liver enzymes more than the controls (77% versus 64%, P = 0.04). The predominant patterns of enzyme derangement in co-infected patients were either predominantly ↑ALP (30% versus 4%, P < 0.0001) or mixed (30% versus 15%, P = 0.01) but predominantly ↑AST/ALT in the controls (25% versus 9%, P = 0.003). Co-infected patients had higher fibrosis scores for both APRI (P = 0.002) and FIB-4 (P = 0.0001). On further analysis, LFT abnormalities and fibrosis scores were only significantly higher in co-infected patients in the immune clearance and HBeAg-negative chronic hepatitis phases. LFT abnormalities are common in Nigerians with HBV infection and co-infection with HIV negatively impacts on hepatic function.

Drug susceptibility test of Mycobacterium tuberculosis by nitrate reductase assay.

BACKGROUND: Drug susceptibility testing for Mycobacterium tuberculosis (M. tuberculosis) is especially required in difficult cases of tuberculosis (TB) chemotherapy and in cases of multidrug resistance (MDR-TB; combined resistance to isonizid and rifampicin with or without resistance to any other drug). The methods for in vitro cultivation and drug susceptibility testing (DST) of M. tuberculosis are cumbersome and not readily adaptable in most routine laboratories, particularly those in the developing world due to limited resources and lack of political will in those countries. A simple and cost effective method, the nitrate reductase assay (NRA), was compared with the gold standard proportion (egg bases Lowenstein Jensen's [LJ]) method for DST of M. tuberculosis in order to substantiate its suitability for routine use in Nigeria and in other countries of the developing world with high TB endemicity. METHOD: Drug susceptibility test was performed for 70 pulmonary isolates of M. tuberculosis (Indirect DST) and 20 sputum (10 acid fast bacilli [AFB] positive and 10 AFB negative) specimens (direct DST) by the NRA and the proportion method using 0.2microg isoniazid (INH), 2microg ethambutol (EMB), 40 microg rifampicin (RIF) and 4 microg streptomycin STR). RESULTS: The indirect NRA showed sensitivity and specificity for INH: 100% and 100%, EMB: 75% and 100% RIF: 90% and 96.6%, STR: 66.6% and 91.8%. The results of direct NRA and proportion method for INH, EMB RIF and STR agreed 10/10 (100%) for AFB negative specimens and 9/10 (90%) with AFB positive specimens. CONCLUSION: Drug susceptibility test of M. tuberculosis by the NRA is simple and sensitive with shorter turn around time of 10 to 1 4 days compared to 42 days by the LJ proportion method. The direct use of AFB positive sputum specimens is likewise reproducible and excludes about 3 - 8 weeks period required for isolation of M. tuberculosis .