Normal CD4 T-lymphocyte baseline in healthy HIV-negative pregnant women.

The CD4 count is frequently used as a surrogate marker for immune suppression associated with HIV infection and to monitor antiretroviral treatment. The aim of this study is to establish the normal reference values of CD4 count in healthy pregnant women in our environment. Pregnant women attending the antenatal clinic of the University of Maiduguri Teaching Hospital (UMTH) received voluntary counselling and testing for HIV. Those who tested negative had their CD4 count assessed using the cyflow method. Healthy non-pregnant women attending the family planning clinic of the UMTH as well as healthy men coming to donate blood at the blood bank of the same hospital were recruited as controls. A total of 128 pregnant women, 228 non-pregnant women and 185 men were recruited for the study. The mean CD4 count of the pregnant women was 751.41 cells/microl which was significantly lower than the mean CD4 count of 869 cells/microl for the non-pregnant women. Primigravidas had a lower mean CD4 count than both multiparas and grandmultiparas. Similarly, the mean CD4 count was higher in the first trimester than in the later parts of pregnancy. There was no significant difference in the mean CD4 count across all age groups. There is a slight fall in the mean CD4 count in pregnancy, which is more in the first trimester of pregnancy and in primigravidas. This should not affect the reference values for the initiation of antiretroviral drugs in pregnancy.

The safety of elective caesarean section for the prevention of mother-to-child transmission of HIV-1.

The benefits of elective caesarean section (ELCS) for the prevention of mother-to-child transmission (PMTCT) of HIV are now well known. However, the benefits of such a procedure must be weighed against the risks involved. This study examines the risks of ELCS for PMTCT at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria, from January-December 2006 inclusive. A total of 52 HIV-positive mothers who opted for ELCS for PMTCT were prospectively followed-up for any intra- and postoperative complication. A total of 52 cases of ELCS of HIV-negative mothers during the same period of study were used as controls. The HIV-positive mothers were found to be younger and of lower parity than the uninfected women. Unlike the uninfected mothers, they did not have co-morbid conditions, such as diabetes mellitus and severe pregnancy induced hypertension. There was no significant difference in intra- and postoperative morbidities between the two groups of mothers. The fetal outcome in terms of Apgar scores and birth weight was significantly better among the HIV-infected women. It is recommended that HIV-infected mothers in this environment should be offered the option of ELCS for the purpose of prevention of HIV from mother to child.

Sex and reproduction among HIV-infected people in Maiduguri, Nigeria.

For HIV-infected people, prevention of transmission of the virus to their spouses and other sexual partners can only be achieved through abstinence and safer sex practices using condoms. New drugs and technologies are now available that can prevent vertical transmission of the virus. A total of 262 people living with HIV/AIDS (PLWHA) were interviewed to explore their sexual and reproductive desires and practices. About 75.6% of them were sexually active and 62.2% never used condoms. Although only 26.3% had no living child, the majority of these (71.4%) wanted to have children. Their knowledge of mother-to-child transmission of HIV and how to prevent it was good. PLWHA engage in unprotected sexual intercourse with the desire to have more children. It is expected that more paediatric HIV infections will be seen in the future in a poor-resource setting like ours.