A Retrospective Study on Changing Trends of Acquired Immunodeficiency Syndrome related Kaposi's Sarcoma in North-Western Nigeria.

BACKGROUND: The prevalence of AIDS-related Kaposi's sarcoma (KS) has been reducing following the widespread use of highly-active anti-retroviral therapy (HAART). In Nigeria, recent trends in the prevalence of KS in HIV-infected patients has not been described. We determined the prevalence, clinical pattern and treatment outcome of AIDS-related KS in Zaria, Nigeria. METHODS: Over a 5-year period, a retrospective study was conducted at the HIV treatment and care centre of Ahmadu Bello University Teaching Hospital, Zaria and all patients with histologically confirmed AIDS-related KS were included. RESULTS: A total of 4721 patients were enrolled during the period under review, out of which 45 were diagnosed with AIDS related KS, which constituted 0.95% of all patient seen. The male to female ratio was 1:1.5 with a mean age of 35.2 ± 6.5 years. Twenty-six (58%) were on HAART, with median duration of 4 months (IQR: 1-31 months) between HAART commencement and KS diagnosis, while KS was reported as presenting illness in 19 (42%) patients. The lower extremity was the most frequently involved site in 24 (53.3%) patients and disseminated disease was present in 14 (31.1%) patients, commoner in the HAART-naïve group. Following KS treatment, 27 (60%) patients recovered fully, 12 (26.7%) died, while 6 (13.3%) were lost to follow up. Disseminated disease, male gender, and low CD4+ T-cell count was associated with higher mortality. CONCLUSION: Kaposi's sarcoma remains an important AIDS defining illness though with a decreasing prevalence. Early diagnosis and treatment should be prioritized at the time of HAART initiation in HIV service delivery programs in Nigeria.

CONTEXTE: La prévalence du sarcome de Kaposi (KS) lié au SIDA a diminué à la suite de l'utilisation généralisée de la thérapie antirétrovirale hautement active (HAART). Au Nigeria, les tendances récentes de la prévalence du KS chez les patients infectés par le VIH n'ont pas été décrites. Nous avons déterminé la prévalence, le profil clinique et le résultat du traitement du KS lié au SIDA à Zaria, au Nigeria. MÉTHODES: Sur une période de 5 ans, une étude rétrospective a été menée au centre de traitement et de soins du VIH de l'Ahmadu Bello University Teaching Hospital, Zaria, et tous les patients présentant un KS lié au SIDA confirmé histologiquement ont été inclus. RÉSULTATS: Un total de 4721 patients ont été inscrits au cours de la période examinée, dont 45 ont été diagnostiqués avec un KS lié au SIDA, ce qui constituait 0,95% de tous les patients vus. Le rapport hommes/femmes était de 1:1,5 avec un âge moyen de 35,2 ± 6,5 ans. Vingt-six (58%) étaient sous HAART, avec une durée médiane de 4 mois (IQR : 1-31 mois) entre le début de la HAART et le diagnostic de KS, tandis que le KS a été signalé comme la maladie principale chez 19 (42%) patients. Le membre inférieur était le site le plus fréquemment touché chez 24 (53,3 %) patients et une maladie disséminée était présente chez 14 (31,1 %) patients, plus fréquente dans le groupe n'ayant jamais reçu de traitement HAART. Après le traitement par KS, 27 (60%) patients se sont complètement rétablis, 12 (26,7%) sont décédés, tandis que 6 (13,3%) ont été perdus de vue. Maladie disséminée, sexe masculin, et un faible nombre de lymphocytes T CD4+ était associé à une mortalité plus élevée. CONCLUSION: Le sarcome de Kaposi reste une importante maladie définissant le SIDA, bien que sa prévalence soit en baisse. Le diagnostic et le traitement précoces devraient être prioritaires au moment de l'initiation de la thérapie HAART dans les programmes de prestation de services VIH au Nigeria. Mots clés: Sarcome de Kaposi, SIDA, prévalence, HAART.

Early infant diagnosis of HIV infection at the John F. Kennedy Medical Center, Monrovia, Liberia.

Background: Vertical transmission accounts for majority of new HIV infections among children worldwide. Ninety percent of HIV-positive children reside in Sub- Saharan Africa with their infection predominantly acquired via vertical transmission. In 2004, the vertical transmission rate of HIV in Africa was estimated at 25 - 40% but, remarkably, the rate has significantly decreased to less than 5% in most African countries following implementation and expansion of prevention of MTCT (PMTCT) programs.Objective: To determine the rate of and factors associated with vertical transmission of HIV among attendees of early infant diagnosis (EID) program of an academic and community-based tertiary facility in Liberia.Design: A retrospective cross-sectional analysis.Methods: A retrospective review of medical records of babies seen at Pediatric Unit of Infectious Disease Clinic of John F Kennedy Medical Center (JFKMC) in Monrovia, Liberia between January 1, 2016 and December 31, 2020. All subjects were children born to HIV-positive mothers and who had HIV DNA PCR testing performed between the ages of 6 weeks and 6 months. Children who suffered early neonatal death and those who did not undergo PCR testing were excluded. Demographics of mother to child pairs as well as factors known to influence vertical transmission of HIV such as partial (15.8%) or full (84.2%) participation in prevention of MTCT (PMTCT) programs, mode of delivery, breastfeeding and utilization of post-exposure prophylaxis were collected and assessed. Binomial logistic regression analyses were used to assess factors associated with vertical transmission.Results: During the study timeframe, 284 children had a HIV DNA PCR test with a male:female ratio - 1.3:1. Sixteen tested positive (conducted at a mean of 155 days post birth) giving a vertical transmission rate of 5.6%. For 239 mothers (84.2%) who had full PMTCT, 1.3% of their children tested positive, while for 45 mothers (15.8%) who had partial PMTCT, 28.8% of their children being positive. Two hundred and seventy six children (97%) had exclusive breastfeeding, 13 of whom tested positive while 2 children who were mixed fed tested positive. Children who had Nevirapine vs no prophylaxis (OR = 1.89[95% CI 1.16 - 2.96]), were delivered via caesarian section vs vaginal delivery (OR= 2.26[95% CI 1.92 - 4.12].) and full versus partial participation in PMTCT programs (OR = 4.02[95% CI 2.06 - 4.13] were more likely to have negative HIV test.Conclusion: Vertical transmission rate was found to be high in Liberia and may be driven by suboptimal PMTCT program participation including post-exposure prophylaxis for infants. Therefore, strategies to scale up and improve uptake of PMTCT services are needed to mitigate the burden of HIV among children.

A cross-sectional study of cytomegalovirus retinitis in HIV-1 infected adults in Nigeria.

BACKGROUND: Cytomegalovirus (CMV) retinitis is one of the most important opportunistic infections in HIV-infected patients in developing countries before the introduction of highly active antiretroviral therapy. In Nigerian and African HIV populations, CMV retinitis is under-reported. PATIENTS AND METHODS: In a cross-sectional study, 250 HIV-infected adults ≥18 years were recruited by systematic random sampling from March to August 2013. Using a structured questionnaire, information was obtained on socio-demographic characteristics and symptoms of visual impairment. HIV disease was staged according to the WHO clinical staging, and CD4+ T-lymphocyte count was measured. Participants with symptoms of impaired vision and/or CD4+ T-lymphocyte count <50 cells/µL had indirect ophthalmoscopic examination of the retina to detect CMV related eye lesions. RESULTS: Two hundred and fifty adults were HIV-infected, out of which 114 (46%) were males and 136 (54%) were females. The mean age of study participants was 35 years. History of impaired vision was reported by 21 (8.4%) of participants. The right eye was involved in 7 (33%), the left eye in 4 (19%), and both eyes in 10 (48%) of participants. The predominant symptoms were blurred vision 9 (43%), floaters 9 (43%), and blindness 3 (14%). Among participants who had indirect ophthalmoscopy, 3 (1.2%) had characteristic retinal changes suggestive of CMV retinitis. Two (67%) of patients with CMV retinitis were females and 1 (33%) was male. Mean CD4+ count was 25.33 ± 14.19 and all were WHO HIV clinical stage 4 with death occurring within 6 months of diagnosis. CONCLUSION: CMV retinitis though rare is associated with advanced HIV disease and attendant morbidity and mortality. We recommend integration of CMV diagnostic services and ophthalmological services as routine in HIV care and treatment programs in Nigeria targeted toward high-risk patients.

Tuberculosis of the Breast: An Initial Presentation of the Metabolic Syndrome with Type 2 Diabetes Mellitus in a Young Nigerian Woman.

Breast tuberculosis is an uncommon presentation of extra pulmonary tuberculosis. A 40-year-old obese woman presented with a right breast abscess which had failed to heal after surgical drainage. There was no family history of breast disease. Biopsy and histology of the lesion showed chronic granulomatous inflammation with positive stains for acid fast bacilli compatible with tuberculosis. Further evaluation confirmed metabolic syndrome with type 2 diabetes mellitus. She was placed on antituberculosis chemotherapy and appropriate therapy for diabetes mellitus with complete resolution of the lesion. We report this case because of its rarity and to highlight the association between tuberculosis an infectious disease and overnutrition in diabetes mellitus, a noncommunicable disease.