ABSTRACT
Abstract@#Introduction: Sustained optimal adherence to antiretroviral therapy (ART) is required for long-term suppression of viral replication. However, adherence level in Jos, Nigeria has been reported to be below optimal adherence, thus this study investigates the predictors of adherence to antiretroviral therapy among Human Immunodeficiency Virus (HIV) patients there. Methods: A validated and pretested questionnaire was used in this cross-sectional study to collect data on sociodemographic characteristics, duration of being on ART, alcohol consumption, presence of symptoms, drug type and disclosure status from 224 randomly selected adult HIV patients. Chi-square and binary logistics regression were used for data analysis. Level of significance was set at 0.05. Results: Only 14.3% of the respondents had optimal adherence. Adherence to ART is significantly associated with gender (p = 0.043), duration of ART use (p = 0.041), alcohol (p = 0.029), drug type (p = 0.001), and disclosure status (p = 0.004). Binary logistics regression reveals that females are 2.4 times more likely to have optimal adherence than males, patients on ART for over 10 years are 2.5 times more likely to have optimal adherence than those less than 10 years, and patients with disclosed HIV status are 3.3 times more likely to have optimal adherence than those who had not. Conclusion: Generally, the patients had suboptimal adherence. Being female, having longer duration on ART and disclosure status are predictors for optimal adherence. Intervention with emphasis on males and new patients on ART is recommended to educate on optimal adherence and motivate patients to disclose their status.
ABSTRACT
Aim: To determine the association between the age at initiation of anti-retroviral therapy (ART) and the 18 month antibody status of human immunodeficiency virus (HIV)-infected children in Jos, Nigeria. Study Design: This was a retrospective cohort study. Place and Duration of Study: AIDS Prevention Initiative in Nigeria (APIN)-supported HIV clinic at Jos University Teaching Hospital, Jos, Nigeria between July 2008 and June 2012. Methods: We reviewed the clinical records of all children confirmed to be HIV-infected with 2 positive HIV deoxyribonucleic acid polymerase chain reaction (DNA PCR) results who were initiated on ART before 12 months of age. We studied the association between the age at initiation of ART and their antibody status at 18months of age. We also studied the association between the viral load and the antibody status. Result: Seventy-three HIV-infected children were initiated on ART at <12 months of age, 66 of these had antibody tests at 18-21 months of age. Nineteen (29%) of the 66 children were negative for rapid antibody test. Those that were initiated on ART at <6 months of age had 5 times the odds ratio of being rapid antibody test negative compared to those who were initiated at ≥6 months of age (AOR=5.23 (1.82-19.66), P=0.002). All the children with negative rapid antibody tests were virally suppressed while all those with detectable viral load were positive for rapid antibody tests. Conclusion: Antibody tests alone cannot be used to determine whether ART should be stopped in children where a definitive diagnosis does not exist. Improved access to affordable, technically simple DNA PCR testing is essential for the appropriate management of HIV-exposed infants in resource limited settings.
ABSTRACT
Aims: To determine the prevalence of HBV co-infection in HIV-infected children and compare the baseline laboratory profile of mono-infected and co-infected patients. Study Design: This was a retrospective cohort study. Place and Duration of Study: AIDS Prevention Initiative in Nigeria (APIN)-supported HIV clinic of Jos University Teaching Hospital, Jos, Nigeria between January 2008 and December 2012. Methodology: We reviewed the clinical records of 452 treatment-naïve children aged 2 months to 15 years confirmed to be HIV positive with Polymerase Chain Reaction (PCR) for children <18 months or Western blot for children ≥18 months. The baseline laboratory tests included: HBsAg, plasma viral load and alanine transaminase (ALT), CD4+T cell count for children ≥5years or CD4+T cell % for children <5years. Results: Three hundred and ninety-four (87.2%) were mono-infected with HIV while 58 (12.8%) were co-infected with HIV and HBV (HIV/HBV). At baseline, the median viral load was 4.6 log copies/mL for mono-infected compared to 4.7 log copies/mL for HIV/HBV (P=.48). The median CD4+T cell count was 366 cells/µL for mono-infected compared to 332 cells/µL for HIV/HBV (P=.64). The median CD4+T cell % was 19% for mono-infected compared to 17% for HIV/HBV (P =.29). The median ALT level for the whole cohort was 23 IU/L for mono-infected compared to 26 IU/L for HIV/HBV (P=.15). However the median ALT level for mono-infected children aged 11-15 years was 28IU/L compared to 43 IU/L for co-infected children of same age (P =.008). Conclusion: A high rate of hepatitis B co-infection was observed in HIV-infected children at our centre; however more severe HIV disease was not observed. Older children co-infected with HBV had significantly higher ALT levels compared to their mono-infected counterparts. Early detection is therefore necessary in order to develop an appropriate treatment plan for children co-infected with HIV and HBV.
ABSTRACT
Background: Reports of adverse drug reactions (ADR) in the era of increasing uptake of antiretroviral drugs particularly in Sub Saharan Africa and especially in Nigeria have been on the rise. Aim: We set out to collate and characterize the pattern of adverse drug reactions in patients on antiretroviral drugs in our treatment centre. Study Design: Retrospective Cross sectional study Place and Duration of Study: The study was carried out at the APIN Centre, Jos University Teaching Hospital, Plateau State, North Central Nigeria from July 2010 to December 2012. Methodology: We reviewed the case files and data base entries of 215 patients attending our treatment centre. These are patients who had reported cases of adverse drug reactions. We took note of demographic profiles of the patients, the medical history as well as the different types of antiretroviral drugs the patients were taking. The types of adverse drug reactions and offending drugs were noted and categorized using descriptive statistics. Results: Out of 215 case files and databases of patients in which there were reports of adverse drug reactions, 80 (37.2%) were male and 135 (62.8%) were female. Almost thirty two percent (31.6%) of the patients were on Zidovudine/Lamivudine/Nevirapine (AZT/3TC/NVP), 14.9%on Zidovudine/Lamivudine/Tenofovir/Lopinavir/ritonavir (AZT/3TC/TDF/LPV/r), 13.5% on Stavudine/Lamivudine/Nevirapine (D4T/3TC/NVP). Anemia was the most common ADR representing 23.4% of all ADRs and 29.3% of all ADRs were associated with Zidovudine. Conclusion: Our study shows that in antiretroviral treatment centre such as our own, healthcare providers/practitioners should take particular note of troubling adverse drug reactions such as anaemia. Healthcare providers/practitioners should particularly have in place alternative treatment regimens as these adverse drug reactions may be potential cause of medication non adherence which in the long run lead to treatment failure.