Chronic kidney disease screening: Results of the 2013 World Kidney Day activities conducted at the Jos University Teaching Hospital

Background: Chronic kidney disease (CKD) is on the rise globally due to the increase in prevalence of common risk factors. Screening for CKD risk factors is important for early detection and institution of measures to retard its progression. This study aimed to determine the markers of CKD and its risk factors in a selected population.Methods: A cross sectional study of 510 individuals who were recruited during the 2013 world kidney day activities. History, clinical examination as well as the collection of urine and blood samples was performed on each participant to determine the presence of CKD and its risk factors. CKD markers were defined as the presence of proteinuria and or an estimated glomerular filtration rate (eGFR) of < 60ml/min.Results: The mean age of the participants was 39±11 years with majority of them being females (64.7%). Hypertension was present in 256 (50.2%) while diabetes mellitus was seen in 27 (5.29%). Forty three individuals (8.4%) had proteinuria while the prevalence of CKD markers was 10.5%. Only age, (OR =1.03; 95% CI: 1.01-1.06) was found to be a factor independently associated with the development of CKD. Conclusion: Though the prevalence of the traditional risk factors for CKD was high, only age was found to be independently associated with CKD markers.Screening exercise is encouraged for the early detection of CKD markers with a view to mitigating their impact

Factors Associated with a Low CD4 Count among HIV-1 Infected Patients at Enrolment into HAART in Jos, Nigeria.

Aim: To determine the factors associated with a low CD4 count among HIV-1 positive patients. Study Design: Cross-sectional study. Place and Duration of Study: Adult HIV clinic at the Jos University Teaching Hospital, Jos, between October 2010 and April 2011. Methodology: Data on demographic, clinical and laboratory variables for 218 HIV-1 infected patients aged 20 years and older were analysed. A low CD4 cell count was defined as CD4 cell count <200 cells/ml based on the WHO criteria for severe immune suppression. A multivariate logistic regression modeling was fitted to determine the variables that were independently associated with a low CD4 count. Results: Of the 218 HIV-1 infected patients, 119 (54.6%) had a low CD4 count at enrolment. The odds of having a low CD4 count was: 7 times higher in patients with WHO clinical stage 3 or 4 compared to those with stage 1 or 2 (P<.001) and 4 times higher in those with HIV RNA viral load ≥4.6 log10 copies/ml compared to those with less (P<.001); but the odds of having a low CD4 count was reduced by 63% in those patients that were resident in Plateau State compared to those resident outside the state (P=.01). Conclusion: Our study patients were more likely to have a CD4 count <200 cells/ml which would suggest late presentation/ late HIV diagnosis and thus a delayed opportunity for timely access to HIV care and initiation of antiretroviral therapy. There is the need to intensify efforts in early routine HIV counseling and testing not only in health facilities in the cities but also in smaller towns and rural communities, so as to reduce the frequency of late HIV diagnosis with its potential implications.

High Frequency of Non-B Human Immunodeficiency Virus Type 1 (HIV-1) Subtype Specific Mutations at the Protease Gene among Treatment-naive HIV-1 Infected Individuals in Jos, Nigeria.

Aims: To determine the prevalence of non-B HIV-1 subtype specific mutations in the protease gene among antiretroviral drug-naive individuals in Jos, Nigeria. Study Design: This was a cross-sectional study in which randomly selected blood samples of HIV-1 positive anti-retroviral drug-naïve individuals were used for genotyping assay. Place and Duration of Study: The study was conducted at the adult HIV clinic of the AIDS Prevention Initiative in Nigeria (APIN) programme, Jos University Teaching Hospital (JUTH), Jos, Nigeria between October 2010 and April 2011. Methodology: Of the one hundred and five plasma samples, 100 samples were successfully reverse transcribed and amplified by nested PCR. The amplicons were directly sequenced on an automated ABI genetic analyzer using BigDye Terminator Cycle Sequencing Kit. Subtyping and phylogenetic analyses were performed using the REGA subtyping tool version 2.0 and MEGA 5.0 software. Both the Stanford HIV database algorithm and IAS-USA 2013 drug resistance update were used for interpretation of drug sensitivity. Results: The proportion of the non-B HIV-1 subtypes were as follows: CRF02_AG (48%), G (41%), CRF06_cpx (6%), A (5%). Q58E, a major drug resistance mutation to PI, occurred as a low prevalence mutation in subtype G. The most common mutations observed among the subtypes were I13V, K14R, K20I, M36I, R41K, H69K, V82I and L89M. Conclusion: A non-uniform distribution of non-B HIV-1 subtypes were observed in Jos, Nigeria, with CRF02_AG and G predominating among the antiretroviral drug-naive individuals. Among the different subtypes in circulation, there was a high prevalence of minor mutations and natural polymorphisms associated with the protease gene. Such mutations define the subtype diversity which may impact on virulence and drug ‘responses’, thus further studies are needed to evaluate the clinical implications of these mutations.

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