Adherence to Immunosuppressive Medications in Kidney Transplant Patients at Three Centers in Khartoum State, Sudan: A Cross-sectional Hospital Study

Background: Graft survival post-kidney transplantation is of paramount importance to patients and nephrologists. Nonadherence to immunosuppressive therapy can be associated with deterioration of renal function and graft rejection. This study aimed to evaluate the adherence to immunosuppressive medications in kidney transplant patients at three centers in Khartoum, Sudan. Methods: In this descriptive cross-sectional hospital-based survey, 277 post-kidneytransplant patients were recruited. Data were collected using a questionnaire and analyzed using the SPSS v.23. Our scoring method was calculated based on Morisky Medication Adherence Scale (MMAS-8) related to immunosuppressive medications and was expressed as questions in the questionnaire; every correct answer was given one mark, then the marks were gathered and their summation was expressed. Results: Overall, 33% ,45%, and 22% of the studied participants reported high, medium, and low adherence, respectively. The major factor for nonadherence was forgetfulness affecting 36.1% of those who did not adhere. The cost of the immunosuppressive medications did not negatively affect any of the participants' adherence (100%). However, a significant association was seen between adherence and occupational status, duration of transplantation, shortage of immunosuppressants, recognizing the name of immunosuppressant, side effect, and forgetfulness (P-values = 0.002, 0.01, 0.006 , 0.000, 0.022, and 0.000, respectively). Logistic regression analysis showed a significant association with occupational status, side effects, and forgetfulness.

CD4+ cells recovery in HIV positive patients with severe immunosuppression at HAART initiation at Centre Medico-Social Cor-Unum, Kigali

Introduction: up to 30% of HIV infected patients who are receiving HAART do not exhibit a marked increase in the CD4+ T cell count. There is still a concern that immune recovery may not be complete once CD4+ T cells have decreased below 200 cells/µl. The objective is to assess CD4+ cell recovery in HIV+ patients with CD4 count below 200 cells/µl) at HAART initiation.Methods: this was a retrospective cohort study among 110 HIV+ patients with initial CD4 count < 200 cells/µl. Baseline Age, sex, CD4 count and viral load were extracted from the patient's database. After12 months of HAART; CD4 count was done using flow cytometry and viremia by COBAS AmpliPrep/COBAS TaqMan HIV-1 test v 2.0 technology.Results: the mean age of the respondents was 35 years; males being 57% and females were 43%. The mean CD4 count before HAART was 110.18 cells/µl whereas at 12 months of HAART; this was 305.01 cells/µl. Though some patients did not achieve a CD4 count of more than 200 cells/µl or a drop in viral load; there was a significant recovery of CD4+ cells (P value=0.000) and viremia following HAART (P value=0.001). Participants aged 18-30 years were likely to have less than 200 cells/µl CD4 count (46.4%) [OR=4.33; 95%CI: 1.29-14.59; P=0.018] than participants aged above 40 years (16.7%).Conclusion: HAART was associated with viremia suppression but many patients failed to achieve a CD4 count >200 cells/µl. HAART before severe immunosuppression is a key factor for immune restoration among HIV+ patients

Association of HIV-induced immunosuppression and clinical malaria in Nigerian adults

Abstract Despite the growing body of evidence on the interaction between HIV and malaria in sub-Saharan Africa, there is a dearth of data on clinical malaria in HIV-infected patients in Nigeria. We determined the burden of clinical malaria in HIVinfected adult Nigerians and further investigated the association between their immunological status and the rates of clinical malaria. Ninety seven antiretroviral treatment-naïve HIV-infected adults were enrolled in a cross-sectional study from August to December, 2009. The participants had a complete clinical evaluation, thick and thin blood films for malaria parasites and CD4 cell count quantification. Clinical malaria was defined as having fever (temperature ≥ 37.5oC or history of fever within 48 hours) and a malaria parasite density above the median value obtained for subjects with co-existing fever and parasitaemia. Clinical malaria was diagnosed in 10 out of 97 patients (10.3%). Lower CD4 cell counts were associated with increasing rates of clinical malaria which was 0% at CD4 cell count of ≥ 500, 2.6% at 200-499 and 30% at <200 cells/µL (χ2 = 18.3, p = 0.0001). This association remained significant after controlling for other factors in a multivariate analysis (AOR=22.98, 95% C.I: 2.62-20.14, p= 0.005). An inverse relationship between CD4 cell count and parasite density was demonstrated (regression co-efficient = -0.001, p = 0.0002). More aggressive malaria control measures are highly needed in severely immunosuppressed HIV-infected patients

Immunosuppression reversible; marqueurs du foie; des reins et metabolisme phosphocalcique chez le lapin sain

But : Le but de cette etude a ete de determiner la ou les doses de Methylprednisolone qui induit une immunodepression reversible dans un temps long sans perturber les marqueurs du foie; des reins et du metabolisme phosphocalcique chez le lapin sain. Materiel et methodes : Cette etude a ete effectuee chez quinze lapins. Ils ont constitue cinq lots selon l'administration de Nacl et du Methylpredmisolone. Lot control (Nacl 0; 9); Lot I (2;5mg/kg MP); Lot II (5mg/kg MP); Lot III (10mg/kg MP) et Lot IV (15 mg/kg MP). Les marqueurs biochimiques ont ete doses par des methodes chimique et enzymatique. Resultats : Les resultats ont montre une immunodepression pendant 7 jours avec les doses de 10 et 15 mg/kg de MP (P0;05). Les perturbations biochimiques ont ete observees avec 15 mg/kg ou le calcium a ete abaisse a J15 et la TGO augmentee a J3 par rapport a J0 (P0;05). Conclusion : Cette etude a montre que les doses qui induisent une longue immunodepression (7 jours) sont 10 et 15 mg/kg de MP. Elle suggere que la dose qui ne perturbe pas les parametres biochimiques induisant une immunodepression longue reversible est 10 mg /kg de MP

Congenital Toxoplasmosis: a Review of its Pathology; Immune Response and Current Treatment Options

Toxoplasmosis; caused by the protozoan parasite Toxoplasma gondii; is one of the most common parasites of man and other warm-blooded animals. Humans are infected through contaminated food; water; and blood transfusion; organ transplantation or from mother to foetus through the placenta. Severe congenital infections occur as a result of primary T. gondii infection in early pregnancy. Transmission of T.gondii to the foetus can result in serious health problems; including mental retardation; seizures; blindness and death. Frequency of foetal infection is higher when maternal infection occurs later in pregnancy and sequelae are more severe when maternal infections occur early in the first trimester of pregnancy. The ability of the parasite to survive intracellularly largely depends on the blocking of different proapoptotic signaling cascades of the host cells. During pregnancy; however; alterations in the incidence of apoptosis are associated with abnormal placental morphology and function. Both cellular and humoral immune responses control T.gondii infection. Toxoplasma is asymptomatic; infected women can only be detected by serological testing. In many instances; congenital toxoplasmosis can be prevented by educating pregnant women and women of childbearing age about the route of transmission. The need for screening suspected cases of T. gondii will help reduce transmission to the foetus

Invasive Salmonellosis in Malawi

The incidence of invasive salmonellosis has increased among children and HIV-infected adults in Malawi. This has been associated with the emergence of drug resistance in the non-typhoidal Salmonella serovars Enteritidis and Typhimurium. In contrast; S. Typhi isolates have remained fully sensitive to commonly used antibiotics and the estimated incidence of typhoid fever; although still present; has fallen slightly among both adults and children. Infection with S. Typhi is not closely associated with underlying immuno- suppression but it is possible that the non-typhoidal Salmonellae have adapted to the person-person human transmission niche in this frequently immunosuppressed population. The huge burden of invasive salmonellosis in Malawi; the high associated mortality; and the recent emergence of drug resistance emphasise the need for a better understanding of the epidemiology and the need for vaccine development

Marqueurs biologiques d'immunopression chez les malades tuberculeux seropositifs

La double infection du VIH et de la tuberculose en Afrique de l'Ouest connait aujourd'hui une augmentation considerable. Ainsi une etude a ete menee en vue d'evaluer le degre d'atteinte immunitaire des patients seropositifs lors du diagnostic de la tuberculose ; d'ameliorer la definition du SIDA chez les patients et de proposer les marqueurs alternatifs aux marqueurs classiques d'immunodepression. Lors du diagnostic de la tuberculose seuls 33 pour cent des patients presentaient biologiquement du SIDA