Seroprevalence of hepatitis B virus co-infection among HIV-1-positive patients in North-Central Nigeria: The urgent need for surveillance.

We report the seroprevalence of hepatitis B surface antigen among HIV-positive patients at a clinic in North-Central Nigeria. Screening for hepatitis B virus was based on serological markers. Alanine aminotransferase levels and CD4+ T-lymphocyte counts were compared between patients. The study showed that 9.2% were positive for hepatitis B surface antigen with significant differences between alanine aminotransferase levels of patients with and without hepatitis B virus. We recommend a national surveillance system to monitor control efforts.

Changes in the haematological parameters of HIV-1 infected children at 6 and 12 months of antiretroviral therapy in a large clinic cohort, North-Central Nigeria.

BACKGROUND: Prior to commencing antiretroviral therapy (ART), haematological abnormalities are a common occurrence in individuals diagnosed with human immunodeficiency virus (HIV). In the course of receiving ART, these abnormalities usually improve. We determined the prevalence of haematological abnormalities in children diagnosed with HIV-1 and the changes in haematological parameters that occur after 6 and 12 months of being on ART. METHODS: A cross-sectional study of HIV-1 infected children aged 2 months to 15 years, between July 2005 and March 2013, at the paediatric HIV clinic of the Jos University Teaching Hospital, Jos. Median values of repeated measures were compared using the Wilcoxon signed-rank sum test. RESULTS: The prevalence of anaemia, thrombocytopenia and leukopenia among the 941 children studied, prior to ART was 6.4%, 7.0% and 8.6%. Median (IQR) haemoglobin (Hb) levels increased from 10 g/dL (9-11 g/dL) at baseline to 11 g/dL (10-12 g/dL) and 11 g/dL (10-12 g/dL) at 6 and 12 months of ART (P<0.001 and P<0.001), respectively, a 10% increase in both cases. Also, platelet count increased from a median of 327×103/µL (243-426×103/µL) at baseline to 333×103/µL (266-408×103/µL) at 6 months and 339×103/µL (267-420×103/µL) at 12 months, representing a 1.8% and 3.7% increase, respectively. The median total white blood cell count decreased from 7.4×103/µL (5.3-9.9×103/µL) at baseline to 5.9×103/µL (4.6-8.0×103/µL) and 5.8×103/µL (4.5-7.5×103/µL) at 6 and 12 months of ART (P<0.001 and P<0.001), a 20.3% and 21.6% decrease, respectively. CONCLUSION: During the 12 months of ART, children in our cohort had significant improvements in haematological parameters such as haemoglobin levels and platelet counts, which would suggest an early positive response to ART.

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).

Antituberculosis drugs and hepatotoxicity among hospitalized patients in Jos, Nigeria.

BACKGROUND: Tuberculosis (TB) could be fatal if left untreated, however, adverse effects of anti-TB medications (anti-TBs) themselves may limit treatment. We determined the incidence and clinical characteristics of hepatotoxicity in hospitalized patients receiving first-line anti-TB treatment. METHODS: A retrospective cohort study of patients aged ⩾18years seen at the medical wards of the Jos University Teaching Hospital from January 2013 to June 2013 was carried out. Data were retrieved for 110 patients who were prescribed anti-TBs. Their demographic and clinical characteristics were described, and the incidence of symptomatic hepatotoxicity determined. The incidence of hepatotoxicity by strict American Thoracic Society criteria (symptomatic hepatotoxicity plus alanine transaminase in IU/L levels >3×upper limit of normal) was also determined. RESULTS: Twenty patients developed symptomatic hepatotoxicity, giving an incidence of 18.2%. Furthermore, 18 (16.4%) patients had hepatotoxicity according to the American Thoracic Society criteria. Those with symptomatic hepatotoxicity unexpectedly had lower baseline alanine transaminase interquartile range (IQR) (35 [16-63] vs. 67 [4-226]; p=.04) and bilirubin (µmol/L): total IQR (15.3 [10.2-74.8] vs. 20.4 [20.4-20.4]; p=.01) and conjugated IQR (7.6 [5.1-34.8] vs. 10.2 [10.2-10.2]; p=.004). However, there were no significant differences in age, sex, body mass index, and duration of anti-TB treatment, human immunodeficiency virus infection status, antiretroviral therapy status, alcohol consumption, and the presence of hepatitis B surface antigen or hepatitis C virus antibody. CONCLUSION: Hepatotoxicity due to first-line anti-TBs, whether based on clinical features alone or backed by liver chemistry, is common among hospitalized patients in our environment. Studies to determine the predictors of hepatotoxicity to guide clinical interventions aimed at the prevention or timely identification of cases are needed.

Nonadherence to First-Line Antiretroviral Therapy among Human Immunodeficiency Virus-1 Infected Children at the Jos University Teaching Hospital; Jos; Nigeria

Background: Nonadherence to antiretroviral therapy (ART) may encourage the development of resistance to antiretroviral drugs (ARVs). Poor adherence is known to be associated with ART failure which could compromise the benefits of ART in children. Therefore; it is important to identify the reasons why children on ART may fail to take their ARVs. In this study; we described the characteristics of human immunodeficiency virus-1 (HIV-1) infected children with ART nonadherence as well as the reasons for their nonadherence. Methodology: A retrospective cohort study in which data on 580 HIV-1 infected children enrolled on ART between February 2006 and December 2010 at the pediatric HIV clinic of the Jos University Teaching Hospital; Jos; was analyzed. Subjects were aged 2 months to 15 years. Information on adherence was obtained by child or caregiver self-report. They also had repeated adherence counseling during each clinic follow-up visit and were taught the use of alarm clocks daily for reminding them of when the next ARV dose will be due. Results: There were 30 (5.2) children with non-adherence to ART. Among children with nonadherence; majority were: Children aged 1-10 years (76.7); males (53.3) and did not know their diagnosis of HIV (90.9). The odds of nonadherence was two times higher among children who failed first-line ART compared with those who did not (odds ratio [95 confidence interval]; 2.28 [1.03-5.02]; P = 0.04). The most common reason for nonadherence was: Forgot to take medications (46.7). Conclusion: The low rate of nonadherence to ART in this study could be attributed to repeated adherence counseling during each clinic follow-up visit and the use of alarm clocks daily for reminders on when the next ARV dose will be due