Management of HIV infection in Nigeria with zalcitabine in combination with saquinavir mesylate: preliminary findings.

The efficacy and safety of a combination therapy with two anti-retroviral drugs, zalcitabine (ddC) and saquinavir mesylate was evaluated in 24 adult Nigerian patients with HIV infection. The result of an interim analysis after a 6-month course of therapy is presented herein. Patients were given zalcitabine 2.25 mg and saquinavir 1800 mg per day. Efficacy was evaluated by improvement in the CD4 cell count and disappearance and/or resolution of clinical signs and symptoms from the patient baseline condition. Tolerability and safety were assessed by the occurrence of adverse event and monitoring of biochemical parameters such as alanine transaminase, alkaline phosphatase and total bilirubin. The haemogram profile of patients was also monitored. There was clinical improvement in 79.2% of the patients, a minimal increase in the CD4 cell count was observed and the incidence of adverse event was 40%. The haematological and biochemical profile of the patients were not significantly affected by treatment (p > 0.05). We therefore conclude that the drug cocktail comprising zalcitabine and saquinavir does posses good potentials for effective management of Nigerian patients with HIV infection. However, it is imperative and important to continue treatment with the drugs for a longer time in order to demonstrate sustained response.

Serum ferritin and other haematological measurements in apparently healthy children with malaria parasitaemia in Lagos, Nigeria.

One hundred apparently normal nursery and primary school children aged between 2 to 12 years from private schools, in Lagos Nigeria were studied. From this study the mean ferritin levels for children aged 2-5 years, and 6-12 years were 112 +/- 48 micrograms/l, and 119 +/- 38 micrograms/l respectively. Mean haematocrit values were 37.6 +/- 2.2%, and 37.5 +/- 2.6%, while mean haemoglobin levels were 126 +/- 9 g/l 127 +/- 7.9 g/l (2-5 years and 6-12 years respectively). The mean values for MCV, MCH, MCHC were 92 +/- 8.6 fl, 27.6 +/- 3.0 pg, 338.0 +/- 15.0 g/l and 93.5 +/- 9.0 fl, 28.7 +/- 2.5 pg, 332.0 +/- 17.0 g/l (2-5 years and 6-12 years respectively). All haematological parameters measured were similar in both malaria parasitaemia positive and negative subjects, except ferritin level which was significantly higher in subjects with malaria parasitaemia (p < 0.05). There was positive correlation between ferritin concentration and malaria density (r = 0.85, p < 0.05). From the above findings, it would be concluded that, ferritin estimation without examination for malaria parasitaemia in a malarious region like Nigeria is not reliable. It is also concluded that with the high mean ferritin level obtained in this study for normal children on balanced diet, routine iron supplementation may not be necessary for this group of children in Nigeria.

Interferon alfa-2a (Roferon-A) monotherapy in chronic myelogenous leukemia: a pilot study in Nigerian patients in early chronic phase.

The efficacy and safety of interferon alfa-2a monotherapy was evaluated in seventeen Nigeria patients with chronic myelogenous leukaemia (CML). Male and female patients with a mean age of 34.5 +/- 10.6 years were recruited into the study. Interferon therapy was administered at a maintenance dose of 9 MIU daily for 12 months. Efficacy was evaluated by assessing both haematologic and cytogenetic response, tolerability by incidence of adverse events and safety by laboratory haematological and biochemical indices. At the end of 12 months of therapy 6 patients (54.4%) had complete haematologic remission whilst 3 patients (100% of those evaluated) showed partial cytogenetic remission. The incidence of adverse event was 70% and the monitored haematologic and biochemical indices were not adversely affected by treatment. In conclusion, the study clearly demonstrated a significant benefit of interferon alpha-2a in the management of Nigerian patients with CML. The changes in the haematological and cytogenetic profiles between baseline and term were significant (p < 0.05). However, it is imperative and important to encourage and continue monitoring of the responding and stabilized patients beyond 12 months in order to demonstrate sustained response. The drug was reasonably well tolerated, however life threatening pancytopenia may pose a major problem in certain cases.

Otorhinolaryngological manifestations of HIV/AIDS in Lagos.

A prospective study was carried out at the Lagos University Teaching Hospital in Lagos. The aims were to determine the prevalence of otorhinolaryngological disease among patients who were HIV+ and or had clinical AIDS and to correlate the presence of ORL disease with the clinical state of HIV infection. The study was done between October 1998 and September 1999. A total of ninety-eight patients were studied. The age range of the patients was between 15 and 69 years with 83% of them being in the age group of 20-49 years. The results showed that while only 17% of the patients were referred because of ORL diseases, 80% of them actually had O.R.L./head and neck conditions. This difference of proportion is highly significant P = 0.000037. 160.20% of the patients had oral/pharyngeal lesions and 24.5% had identifiable otological disease. Hearing impairment was noted in 30.6% of the patients on pure tone audiometric assessment of which 26.5% were sensorineural. The correlation between O.R.L./head and neck manifestation and the CDC classification of HIV/AIDS infection did not reveal a definite pattern.