Effect of Dolutegravir regimen against other regimens on some hematological parameters, CD4 count and viral load of people living with HIV infection in South Eastern Nigeria.

BACKGROUND: Appropriate usage of highly active antiretroviral therapy (HAART) suppresses human immunodeficiency virus (HIV) replication. One of such HAART is dolutegravir (DTG) containing regimen which Nigeria included in her national protocol, as the preferred first-line option, with particularly fixed dose combination of tenofovir/lamivudine/dolutegravir (TLD) in 2018. AIM: To access the impact of this regimen as against other regimens on some hematological parameters as well as cluster of differentiation 4 (CD4) count and viral load on people living with HIV infection. METHODS: The study site is a health facility center supported by President Emergency Plan for acquired immunodeficiency syndrome (AIDS) Relief where people living with HIV infection (PLWHIV) visit for their routine management in Abakaliki, Ebonyi State. A hundred and twenty-two (122) subjects participated, 58 PLWHIV and 64 control subjects. CD4 + count by partec cyflow auto analyzer, while the Viral load assay was by Roche COBAS Ampriplep/COBAS TaqMan molecular systems. Full blood count determination was by Sysmex XE-2100 hematology auto analyzer, while the detection of antibody to HAART was by Petz and direct Coombs tests. RESULTS: Mean values of hemoglobin (Hb), Total white cell count, Lymphocytes, Monocytes and CD4 + counts of people living with HIV infection (PLWHIV) were significantly (P = .0001) lower than the control subjects. The Hb level of PLWHIV on Efavirenz combination (TDF/3TC/EFV) are comparable 123 ± 32g/l with those on Ritonavir combination (TDF/3TC/LPV/R) 136 ± 16g/l and Dolutegravir (TLD)134 ± 20.0g/l (P = .307). On the other hand, total white cell count (4.55 ± 1.99 × 109/L) of those on Efavirenz combination (TDF/3TC/EFV) and Dolutegravir (TLD) (4.53 ± 1.31 × 109/L) were significantly higher than those on Ritonavir combination (TDF/3TC/LPV/R) (4.09 ± 1.15 × 109/L). The Viral Load of PLWHIV on Dolutegravir (TLD) was significantly lower 171.57 ± 4.56 copies/mL than those on Efavirenz combination (TDF/3TC/EFV) (86,395.91 ± 27,476.57copies/mL) and Ritonavir combination (TDF/3TC/LPV/R) (81,188.83 ± 13,393.47 copies/mL), respectively. CONCLUSION: Some hematological parameters (such as Hb, total white cell counts and CD4 + count) were lower in people living with HIV than values seen in control group. The 3 regimens used in the management of HIV infection in the locality revealed comparable Packed cell volume and Hemoglobin levels. Total white cell count of those on Efavirenz and DTG is comparable with higher values than those on Ritonavir.

Serum P53 Protein Level and Some Haematologic Parameters among Women of Reproductive Age Living with HIV Infection.

Human immunodeficiency virus (HIV) infection remains a health challenge in Nigeria, and women of reproductive age are disproportionately infected. P53 protein, D-dimer, serum ferritin, CD4 cell count, haemoglobin concentration and haematocrit levels were measured among non-pregnant women of reproductive age living with HIV infection in order to assess the impact of HIV infection on maternal health. A hundred and sixty-two subjects categorised into three groups of 54 persons each involving; newly diagnosed, subjects on highly active antiretroviral therapy (HAART) and apparently healthy control subjects were recruited. Blood samples were analyzed for haemoglobin concentration, haematocrit, CD4 cell count, serum ferritin, D-dimer and p53 protein levels by standard methods. The CD4 cell count, serum p53 protein, and Hb Conc. were significantly lower, while serum ferritin was higher in the newly diagnosed group (p=0.001), followed by the group on HAART (p=0.001) compared to the controls. D-dimer level was significantly lower in the control group (2899.11±670.73pg/ml) than both newly diagnosed (4842.44±489.40pg/ml) and HAART (4660.31±519.83pg/ml) groups, while significant decrease in haematocrit was observed between the newly diagnosed group (0.336±0.07l/l) as against both treated (0.378±0.04l/l) and control (0.362±0.02l/l) groups. D-dimer correlated negatively with serum p53 protein level  among the newly diagnosed subjects  and with Hb Conc. among subjects undergoing treatment.  The study concludes that women of reproductive age living with HIV infection showed higher D-dimer and lower tumour suppression protein levels as well as anaemia and reduced immune response. The newly diagnosed subjects were more affected.

Glycated Haemogloin, Fasting Plasma Glucose, Plasminogen Activator Inhibitor Type-1, and Soluble Thrombomodulin Levels in Patients with Type 2 Diabetes Mellitus.

Diabetes mellitus has become increasingly prevalent over the years. The chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunctions, and failure of different organs suggesting that the most effective tool to prevent complications is the effective control of hyperglycaemia itself. The study is set to determine the effect of glycemic control on plasminogen activator inhibitor type 1 (PAI-1), soluble thrombomodulin (STM) alongside fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) among type 2 diabetic subjects. One hundred diabetic subjects accessing care at the University of Calabar Teaching Hospital Calabar and 100 non -diabetics that served as controls were enrolled. Blood samples from participants were analyzed for FPG, HbA1c, PAI-1 and STM by standard methods. The result shows 74% of the diabetic to be females. Half of the diabetics were managed on only oral anti-diabetic drugs while the remaining half were either on insulin injection or a combination of oral and insulin injection.  Poor glycemic control was observed in 56% of the studied subjects. The mean age of 54.69 ± 9.94 years for the diabetics was comparable to the age-matched controls (p=.097). Diabetics showed significantly higher FPG, HbA1c, PAI-1and STM (P=0.001) compared to control values. Correlations between STM, PAI 1 and glycated hemoglobin (figures 2 p=0.001, p =0.001) and STM, PAI-1 and FPG revealed significantly robust association (p=0.001, p=0.001).  The study concludes that there is poor glycemic control among the treated diabetic subjects with PAI-1 and STM showing a very strong positive correlation with HbA1c than FPG.

Demographics of Rhesus Phenotype of Blood Donors in Calabar: A Case Study of University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.

BACKGROUND: Rhesus antigens have been documented to cause haemolytic disease of the newborn as well as acute and delayed transfusion reactions. This study was performed to evaluate the frequency of rhesus antigens (C, c, D, E, and e) in the studied population. METHOD: This study was a cross-sectional study involving 130 prospective blood donors attending University of Calabar Teaching Hospital (UCTH) donor clinic. Donors were grouped for Rh antisera (anti-E, anti-e, anti-C, anti-c, and anti-D) using the standard serologic technique. RESULT: The most prevalent Rh antigen was "c" (98.5%), followed by "D" (97.7%), while the least was "C" (30.7%). The most prevalent phenotype was cDe/cDe (R0R0). CONCLUSION: This work therefore concludes that the most prevalent rhesus antigen and rhesus phenotype was c and cDe/cDe among blood donors in University of Calabar Teaching Hospital.

Haemostatic Indices as Markers for Monitoring Pulmonary Tuberculosis Treatment.

Tuberculosis (TB) is an infectious disease inducing a state of chronic inflammation which could affect thehaemostatic mechanism as part of host defences against infection. Proper diagnosis and monitoring of tuberculosis patientsundergoing therapy is still a challenge especially in a poor resource country such as Nigeria. This study aims to assess somehaemostatic indices of tuberculosis patients and their possible use as markers in monitoring response to anti-tuberculosistreatment. One hundred and twenty TB patients aged 15-60 years and 120 apparently healthy (control) subjects age andgender-matched were studied. Demographic/bio data was compiled by interview and from patients' case notes. Diagnosis ofTB was by sputum smear microscopy, radiography and clinical assessment. Platelet count (PLT), platelet factor 4 (PF4),prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin clotting time (TCT) and fibrinogen (FIB)were determined using standard techniques. The platelet factor 4, prothrombin time, activated partial thromboplastin timeand fibrinogen levels of TB patients were significantly higher while the thrombin clotting time was significantly lower(P<0.05) when compared with healthy subjects. While PF4, TCT and FIB improved significantly (P<0.05) as antituberculosis therapy progressed, PLT, PT and APTT remained the same. It is concluded that abnormal activation ofhaemostasis occurs in TB condition thus pre-disposing TB patients to bleeding complications. Furthermore, platelet factor4, thrombin clotting time and fibrinogen improved as therapy progressed and therefore may be used as markers for monitoringresponse to anti-tuberculosis therapy.