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Immunovirological and Biochemical Changes in Nigerian Patients with Hepatitis B Coinfection on Antiretroviral Therapy

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World Journal of AIDS 2011年第2期1卷 31-36页

作者： Jesse Abiodun Otegbayo Titilola Stella Akingbola Joshua Odunayo Akinyemi Kayode Solomon Adedapo Georgina Njideka Odaibo Yetunde Adebisi Aken óva David Olufemi Olaleye isaac folorunsho adewole Robert Murphy Phylis Kanki 不详

Hepatitis B virus (HBV) co-infection with HIV is high among Nigerians. Some studies have suggested impaired CD4 recovery among coinfected patients compared to the HIV mono infected. This retrospective study of treatment-na?ve HIV infected patients was aimed at determining the trend of changes in CD4+ counts, HIV-RNA and renal and liver function tests in response to combined antiretroviral therapy (CART). A questionnaire was utilised to extract clinical and laboratory data of HBV co infected HIV/AIDS patients before treatment and at six, twelve and eighteen months of therapy with CART. Findings were compared to those of HIV mono infected. Relevant statistical instruments were used to analyse for comparisons of means of Log10 HIV viral load and CD4 count using SPSS package 15.0. All levels of sig-nificance were at 5 %. Two thousand five hundred and sixty two patients were analysed. Of these, 354(13.8%) were HBsAg positive. Majority (63.1%) were females. Most of the recruited patients were on combivir and nevirapine. The median CD4 count for the HBsAg negative was 104 cells/mm3 (IQR 34 – 171) and it was significantly higher than those of the positive (91 cells/mm3) (p < 0.05). ALT and AST were higher among HBsAg positives, while urea and creatinine levels were similar. The median change in CD4 count from baseline and during the course of therapy were similar in the two groups. Similarly, virological responses were not different in the two groups at the various time points. In con-clusion no significant difference in the rate of CD4 recovery and HIV-RNA decline in among coinfected and monoin-fected HIV patients at different stages of therapy.

关键词： Hepatitis B Coinfection CD4 Viral Load Antiretroviral Nigeria

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Pattern of HIV-1 Drug Resistance among Adults on ART in Nigeria

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World Journal of AIDS 2013年第4期3卷 327-334页

作者： Georgina N.Odaibo Prosper Okonkwo isaac F.adewole David O.Olaleye Department of Virology College of MedicineUniversity of IbadanIbadanNigeria AIDS Prevention Initiative Nigeria Arab Contractor BuildingAbujaNigeria Department of Obstetrics and Gynecology College of MedicineUniversity of IbadanIbadanNigeria.

Background: The development of anitiretroviral drug resistance may limit the benefit of antiretroviral therapy. Therefore the need to closely monitor these mutations, especially the use of ART is increasing. This study was therefore designed to determine the ARV drug resistance pattern among ART na?ve and expose individuals attending a PEPFAR supported by antiretroviral clinic in Nigeria. Methodology: The study participants included patients attending the PEPFAR supported by University College Hospital (UCH), Ibadan ART clinic who have been on HIV treatment for at least one year with consecutive viral load of over 2000 copies/ml as well some ART Na?ve individuals with high (>50,000 copies/ml) baseline viral level attending the hospital for pre-ART assessment. Blood sample was collected from each individual for CD4 enumeration, viral load level determination and DNA sequencing for genotypic typing. Antiretroviral drug resistance mutations (DRM) were determined by using the Viroseq software and drug mutations generated by using a combination of Viroseq and Stanford algorithm. DRM were classified as major or minor mutations based on the June 2013 Stanford DR database. Results: The most common major NRTI, NNRTI and PI mutation were D67N (33.3%), Y181C (16.7%) and M46L/I (55.6%) respectively. Lamivudine (3TC) and emtricitabine (FTC);nevirapine (NVP) and nelfinavir (NFV) were the most common NRTI, NNRTI, and PI drugs to which the virus in the infected individuals developed resistance. Isolates from 4 patients were resistant to triple drug class, including at least one NRTI, NNRTI and a PI. Only one (4.8%) of the isolates from drug Na?ve individuals had major DRM that conferred resistance to any drug. Conclusion: Demonstration of high rates of antiretroviral DRM among patients on 1st and 2nd line ART and the presence of DRM in drug Na?ve individuals in this study show the importance of surveillance for resistance to ARV in line with the magnitude of scaling up of treatment

关键词： Antiretroviral Therapy Drug Resistance Mutation ART Na?ve 1st and 2nd Line ART

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Missed Opportunities for Prevention of Mother-to-Child Transmission of HIV (PMTCT) in Ibadan, Southwest Nigeria

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World Journal of AIDS 2014年第3期4卷 356-364页

作者： Babatunde O. Ogunbosi Regina E. Oladokun Olutosin Awolude Biobele J. Brown Olubukola A. Adeshina Modupe Kuti Babafemi Taiwo Baiba Berzins Demetrious N. Kyriacou Ellen G. Chadwick Kikelomo Osinusi isaac F. adewole Robert L. Murphy Department of Paediatrics College of Medicine University of Ibadan Ibadan Nigeria Department of Paediatrics University College Hospital Ibadan Nigeria Department of Obstetrics and Gynecology College of Medicine University of Ibadan Ibadan Nigeria Department of Obstetrics and Gynecology University College Hospital Ibadan Nigeria Department of Chemical Pathology College of Medicine University of Ibadan Ibadan Nigeria Department of Internal Medicine Feinberg School of Medicine Northwestern University Chicago USA Center for Global Health Institute for Public Health and Medicine Feinberg School of Medicine Northwestern University Chicago USA Department of Emergency Medicine Feinberg School of Medicine Northwestern University Chicago USA Department of Pediatrics Feinberg School of Medicine Northwestern University Chicago USA

Background: Nigeria has the largest paediatric HIV-infected population in the world. Missed opportunities for prevention of mother-to-child transmission of HIV (PMTCT) compromise efforts at eliminating new pediatric HIV infections. Methods: Six hundred children, aged < 15 years, presenting to the pediatric units of the University College Hospital (UCH), Ibadan Southwest Nigeria between June to December 2007 were studied. The demographics, HIV status and socioeconomic status of mothers and their children were studied. A 4-step hierarchy was used to assess the missed opportunities for PMTCT. Step 1: utilization of a health facility for antenatal care and delivery;Step 2: maternal HIV status determination during pregnancy;Step 3: provision of antiretroviral medication to HIV-infected mother and baby;and Step 4: avoidance of mixed feeding in HIV-exposed children. The rates of missed opportunities for PMTCT services at different steps in the PMTCT cascade, perinatal transmission rates, and associated factors were reported. Results: There were 599 mothers and 600 children (one set of twins), 60 (10%) were HIV infected and 56 (93.3%) of these were adjudged perinatally infected. Of 78 HIV-infected women, 7 (9.0%) accessed all interventions in the PMTCT cascade and 71 (91.0%) had missed opportunities for PMTCT. Missed opportunities for PMTCT occurred 42.9% in cascade Step 1, 64.2% in Step 2, 52.6% in step 3 and 73.7% in Step 4. All mother-baby pairs who accessed complete PMTCT interventions received care at a teaching hospital. Among infants with perinatal HIV infection, 53 (94.6%) were born to mothers who had missed opportunities for PMTCT. Most women with missed opportunities attended antenatal care outside the teaching hospital setting and belonged to low socioeconomic status. Conclusion: It is imperative to expand PMTCT access to women who receive antenatal care outside the teaching hospitals and to those of low socioeconomic status.

关键词： HIV Perinatal Prevention PMTCT Missed Opportunities

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