The role of vitamin D status on treatment outcome among HIV- infected children receiving care in Kisumu County, Kenya.

Background: Kenya has a paediatric HIV burden of nearly 140,000 children, of which only 48% of those on antiretroviral therapy (ART) have achieved the desired viral suppression possibly due to vitamin D deficiency. We explored the influence of vitamin D levels on treatment outcome. Method: We performed a cross-sectional study of 196 participants aged 3 - 14 years; among them 98 HIV infected who received treatment between 2019 - 2020 in Jaramogi Oginga Odinga Teaching and Referral Hospital, Kenya. The exposure was vitamin D levels, including deficient (<20 ng/ml), insufficient (≥20 - <30 ng/ml), and sufficient (30 - 50ng/ml). The outcome was optimal immune recovery (CD4 ≥ 500 cells/mm3) and optimal viral suppression (viral load ≤ 200 copies/ml). We compared difference in means for each vitamin D category between HIV infected and uninfected using independent t-test, multiple comparisons of vitamin D levels among age categories using ANOVA and post hoc test and Pearson correlation to correlate vitamin D levels, CD4 and viral load of HIV infected children. Results: Compared with HIV uninfected, HIV infected recorded mean age ± standard deviation of10.65±2.17 years with 39(39.8%) males vs. 6.68±2.81 years with 52(53.1%) males p<0.001; and the difference in vitamin D mean levels was statistically significant [28.21 ± 6.39 infected vs.30.88 ± 6.62 uninfected] t = 2.94, df =194, p = 0.004, 95%CI (0.90 - 4.59). Among age categories, mean vitamin D varied significantly F (2,193) = 10.68, p =0.001; with higher levels observed between 1-4 years category {mean difference 4.64ng/ml, p = 0.02, [95%CI 1.49 - 7.78]} and 5-9 years category {mean difference 4.33ng/ml, p = 0.001, [95%CI 1.89 - 6.38]} as compared to 10 - 14 years respectively.Additionally, children with optimal immune recovery recorded higher proportion of vitamin D deficiency and insufficiency (12.24% and 42.86%) as compared with sub optimally recovered 1.02% and 4.08%); while children with optimal viral suppression recorded higher proportion of vitamin D deficiency and insufficiency (8.16% and 30.61%) as compared with sub optimally suppressed (5.1% and 16.3%). Conclusion: Infections with HIV suppresses levels of vitamin D, but this has no influence on CD4 counts and viral load status in children receiving ART.

Novel biomarkers with promising benefits for diagnosis of cervical neoplasia: a systematic review.

BACKGROUND: Cervical cancer screening is slowly transitioning from Pappanicolaou cytologic screening to primary Visual Inspection with Acetic Acid (VIA) or HPV testing as an effort to enhance early detection and treatment. However, an effective triage tests needed to decide who among the VIA or HPV positive women should receive further diagnostic evaluation to avoid unnecessary colposcopy referrals is still lacking. Evidence from experimental studies have shown potential usefulness of Squamous Cell Carcinoma Antigen (SCC Ag), Macrophage Colony Stimulating Factor (M-CSF), Vascular Endothelial Growth Factor (VEGF), MicroRNA, p16INKa / ki-67, HPV E6/E7/mRNA, and DNA methylation biomarkers in detecting premalignant cervical neoplasia. Given the variation in performance, and scanty review studies in this field, this systematic review described the diagnostic performance of some selected assays to detect high-grade cervical intraepithelial neoplasia (CIN2+) with histology as gold standard. METHODS: We systematically searched articles published in English between 2012 and 2020 using key words from PubMed/Medline and SCOPUS with two reviewers assessing study eligibility, and risk of bias. We performed a descriptive presentation of the performance of each of the selected assays for the detection of CIN2 + . RESULTS: Out of 298 citations retrieved, 58 articles were included. Participants with cervical histology yielded CIN2+ proportion range of 13.7-88.4%. The diagnostic performance of the assays to detect CIN2+ was; 1) SCC-Ag: range sensitivity of 78.6-81.2%, specificity 74-100%. 2) M-CSF: sensitivity of 68-87.7%, specificity 64.7-94% 3) VEGF: sensitivity of 56-83.5%, specificity 74.6-96%. 4) MicroRNA: sensitivity of 52.9-67.3%, specificity 76.4-94.4%. 5) p16INKa / ki-67: sensitivity of 50-100%, specificity 39-90.4%. 6) HPV E6/E7/mRNA: sensitivity of 65-100%, specificity 42.7-90.2%, and 7) DNA methylation: sensitivity of 59.7-92.9%, specificity 67-98%. CONCLUSION: Overall, the reported test performance and the receiving operating characteristics curves implies that implementation of p16ink4a/ki-67 assay as a triage for HPV positive women to be used at one visit with subsequent cryotherapy treatment is feasible. For the rest of assays, more robust clinical translation studies with larger consecutive cohorts of women participants is recommended.

Correction to: Seroprevalence and determinants of transfusion transmissible infections among voluntary blood donors in Homabay, Kisumu and Siaya counties in western Kenya.

Following publication of the original article [1], the authors reported that for two of the authors, Felix Humwa and Vallarie Opollo, an incorrect affiliation has been given. In this Correction the incorrect and correct affiliations are listed.

Seroprevalence and determinants of transfusion transmissible infections among voluntary blood donors in Homabay, Kisumu and Siaya counties in western Kenya.

OBJECTIVE: Since the implementation of a series of blood donation safety improvements in Kenya, information about seroprevalence and determinants of transfusion transmissible infections among voluntary blood donors especially in high HIV burden regions of Homabay, Kisumu and Siaya counties remain scanty. A cross-sectional study examining HIV, syphilis, hepatitis B and C virus sero-markers and associated determinants was conducted among voluntary blood donors. Their demographic characteristics and previous risk exposure were recorded in a pre-donation questionnaire, while blood samples collected were screened for hepatitis B, hepatitis C, human immunodeficiency viruses by ELISA and RPR (syphilis), then confirmed using CMIA. RESULTS: Overall TTIs seroprevalence was 114 (9.4%), distributed among HIV, HBV, HCV and syphilis at 14 (1.15%), 42 (3.46%), 39 (3.21%) and 19 (1.56%), respectively, with co-infections of 3 (0.25%). There were no significant differences in proportions distributions among demographic variables. However, high risk sex was significantly associated with higher odds of HBV infections [> 1 partner vs. 0-1 partner; odd ratio (OR) 2.60; 95% confidence interval (CI) 1.098-6.86; p = 0.046]. In conclusion, a substantial percentage of blood donors still harbor transfusion transmissible infections despite recent safety improvements with greater majority cases caused by HBV infections arising from previous exposure to high risk sex.