How accurately do routinely reported HIV viral load suppression proportions reflect progress towards the 90-90-90 target in the population on antiretroviral treatment in Khayelitsha, South Africa?

Background. The Joint United Nations Programme on HIV/AIDS (UNAIDS) third 90-90-90 target requires 90% of patients on antiretroviral treatment (ART) to be virally suppressed (<1 000 copies/mL). In Khayelitsha, Cape Town, South Africa viral load (VL) suppression of <400 copies/mL was reported as 89% in 2016, but only 56% of patients had a result recorded in routine data. We conceived a VL 'cascade' to represent the steps required for an expected VL to be reported as complete in routine data and thus contribute to reported VL suppression: among those for whom a VL is 'expected', a sample must be collected and tested ('done'), a result must be 'filed' in the patient folder, 'noted' by a clinician and electronically 'captured'. The low reported completion suggested gaps along the VL cascade and cast doubt on the validity of reported suppression.Objectives. To assess the validity of routinely reported VL suppression and identify barriers to VL completion. Methods. A retrospective cohort study between 1 July 2015 and 30 June 2016, which included all Khayelitsha patients receiving ART, with a routine VL expected, was conducted. We obtained data routinely captured on site and VL data from the laboratory system. A sample of 1 035 patient folders was reviewed. VL suppression was calculated using laboratory data, including all tests done, and compared with reported suppression based on on-site captured electronic data. Successful progression through each step on the VL cascade was estimated. We used logistic regression to identify factors associated with laboratory data and reported VL testing.Results. Of 22 991 patients for whom a routine VL test was due, 84% were done, 79% filed, 76% noted and 55% captured. Using all laboratory data, VL suppression was estimated as 82%, 87%, 89% and 91% at the 50, 200, 400 and 1 000 copies/mL thresholds, respectively, but reported suppression using captured results was 80%, 86%, 88% and 89% at those thresholds. Routine VL testing is more likely to be done in children <15 years old (adjusted odds ratio (aOR) 1.89, 95% confidence interval (CI) 1.45 - 2.48) and pregnant women (aOR 1.90, 95% CI 1.28 - 2.81) than in men, adjusted for facility. Conclusions. Despite a low reported completion, VL testing completion was high. Reported suppression using captured data was similar to suppression calculated using all laboratory data, which provided an accurate measure of progress towards the 90-90-90 target. More work is needed to reach the 16% of patients missed by routine testing

Clinician Compliance with Laboratory Monitoring and Prescribing Guidelines in HIV-1-Infected Patients Receiving Tenofovir

BACKGROUND:Tenofovir is part of the preferred first-line regimen for HIV-infected patients in South Africa (SA); but is associated with kidney toxicity. SA antiretroviral therapy (ART) guidelines recommend creatinine monitoring at baseline (ART start) and at 3; 6 and 12 months; and substituting tenofovir with zidovudine; stavudine or abacavir should creatinine clearance (CrCl) decrease to etlt;50 mL/min. OBJECTIVE:To assess clinician compliance with tenofovir monitoring and prescribing guidelines.METHODS:We described the proportion of adult patients on tenofovir-based first-line ART who were screened for baseline renal impairment; were monitored according to the SA antiretroviral treatment guidelines; and were switched from tenofovir if renal function declined.RESULTS:We included 13 168 patients who started ART from 2010 to 2012. Creatinine concentrations were recorded in 11 712 (88.9%) patients on tenofovir at baseline; 9 135/11 657 (78.4%) at 3 months; 5 426/10 554 (51.4%) at 6 months; and 5 949/ 8 421 (70.6%) at 12 months. At baseline; 227 (1.9%) started tenofovir despite a CrCl etlt;50 mL/min. While on tenofovir; 525 patients had at least one CrCl of etlt;50 mL/min. Of 382 patients with =3 months' follow-up after a CrCl etlt;50 mL/min; 114 (29.8%) stopped tenofovir within 3 months. Clinicians were more likely to stop tenofovir in patients with lower CrCl and CD4 count. Of 226 patients who continued to receive tenofovir and had further CrCls available; 156 (69.0%) had a CrCl =50 mL/min at their next visit.CONCLUSIONS:Creatinine monitoring is feasible where access to laboratory services is good. Kidney function recovered in most patients who continued to receive tenofovir despite a CrCl etlt;50 mL/min. Further research is needed to determine how best to monitor renal function with tenofovir in resource-limited settings

Oxidative Stress Biomarkers and Their Relationship with Testosterone in Male Auto Mechanics in Ibadan, Nigeria.

Occupational exposure to mixed chemicals generates free radicals with inadequate antioxidants resulting in oxidative stress. Recently, hypogonadism in male auto-mechanics was associated with oxidative stress. Studies show that testosterone, a male hormone increases the activities of antioxidant enzymes. This study is aimed at evaluating the oxidative stress biomarkers and their relationship with testosterone in auto mechanics in Ibadan, Nigeria. Eighty-three males participated in this prospective cross sectional study after informed consent. Forty-three were male auto-mechanics, occupationally exposed to mixed chemicals in the mechanic community, Bodija, Ibadan (cases). Their mean (SEM) age and body mass index (BMI) were 42.5 (1.7) years and 23.8 (0.5) Kg/m2 respectively. They were age and BMI matched with 40 unexposed, apparently healthy males from the University College Hospital and environs (controls). Demography, social habits, anthropometry and gonadal status were obtained by standard methods. Serum obtained from blood (10 ml) collected from the participants was used for biochemical analyses. Testosterone levels were determined by enzyme immunoassay method (Immunometrics UK Ltd). Levels of total antioxidant capacity, total plasma peroxide (TPP), malondialdehyde (MDA), hydrogen peroxide (H2O2), glutathione peroxidase (GPX), superoxide dismutase (SOD), glutathione-S-transferase (GST), and reduced glutathione (GSH) were determined using spectrophotometric methods while oxidative stress index (OSI) was calculated. P<0.05 was regarded as significant. TPP, MDA, OSI, H2O2 and GST `levels were significantly higher (P<0.001) in eugonadal cases compared with controls. All these biomarkers levels were similar in hypogonadal compared with eugonadal cases. (P>0.05) Testosterone related negatively with SOD in the controls only but positively with MDA and negatively with GST in cases only (P<0.05). Occupationally exposed auto mechanics appear to have oxidative stress and may benefit improvement in antioxidant status. Testosterone may contribute to and enhance total antioxidant status, which may be important in gonadal function.

Sex Hormones and Their Relationship with Leptin and Cardiovascular Risk Factors in Pre and Post- Menopausal Nigerian Women with Metabolic Syndrome.

Metabolic Syndrome (MS), which affects 33.1% of Nigerians, predisposing them to cardiovascular disease (CVD) risk, has been associated with the female gender. The cardioprotective effect of oestradiol against CVD is now controversial and was investigated in premenopausal with MS (PRMMS) and postmenopausal women with MS (POMMS). A total of 191 women (44 PRMMS, 126 POMMS and 21 premenopausal women without MS (PRM) (controls) with mean (s.d) age of 40.0 (6.9), 57.0 (8.8), 29.0 (6.8) years were participants of this study. Demography, blood pressure (BP), anthropometry, hormones, fasting plasma glucose (FPG) and lipids were obtained by standard methods. Data were significant at (P<.05). Age, parity, all anthropometric measures, FPG, leptin, ET ratio and FSH were significantly higher while HDLC, testosterone and prolactin were significantly lower in PRMMS compared with controls (P<.03). In comparison of POMMS with PRMMS, age, parity, WHR, systolic BP, TG, FSH and LH were significantly higher while body weight, HC, and leptin were lower in POMMS compared with PRMMS (P<.05). DBP positively predicted oestradiol in PRM only (P=.044) while oestradiol positively predicted testosterone in PRMMS only (P<.001). In POMMS only, DBP positively predicted testosterone; testosterone, ET ratio and FSH positively predicted oestradiol while LDLC and oestradiol positively predicted the ET ratio (P<.03). Metabolic syndrome may predispose both pre and postmenopausal women to the risk cardiovascular disease and type 2 diabetes mellitus. Oestradiol may protect against cardiovascular diseases in women without metabolic syndrome only.

Prevalent Components of Metabolic Syndrome and Their Correlates in Apparently Healthy Individuals in Sub-saharan Africa.

Aim: To assess the prevalent components of metabolic syndrome (MSC) and their related determinants of lipid metabolism in the Nigerian for early diagnosis, prevention and management of the metabolic syndrome (MS) and its associated diseases. Study Design: Cohort study. Place and Duration of Study: Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan between March and August 2010. Methodology: 534 apparently healthy Nigerian traders aged 18–105 years were participants of a cohort study. The IDF (2005) criteria was used for MS diagnosis. Anthropometric indices and blood pressure (BP) were obtained by standard methods. Fasting plasma glucose, total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDLC) were determined by enzymatic methods while low density lipoprotein cholesterol (LDLC) was calculated. Data analysed were statistically significant at P<0.05. Results: 60.1% of traders had 2 and 3MSC. 0.6%, 1.1% and 9.6% of traders had all 5MSC, ≥3MSC without elevated waist circumference (WC) and zero MSC respectively. Elevated WC, reduced HDLC and high BP were more frequent MSC representing 70.2%, 63.1% and 47.9% while FPG and TG were less frequent representing 11.2% and 2.2% of traders respectively. This pattern was similar in MS and non-MS groups. 25.3% of males and only 2.2% of females had no MSC. Reduced HDLC and elevated WC were the most frequent MSC in males and females respectively. All metabolic risk factors (MRF) except TC were significantly different in comparison between MS and non-MS groups as well as among traders with 0-5 MSC. WHR was the only parameter that correlated significantly with all MRF. Conclusion: Elevated waist circumference, reduced high density lipoprotein cholesterol, and high blood pressure may be prevalent metabolic syndrome components and important in managing metabolic syndrome in Nigeria. Regional specific cut-offs for these components for the African population is needed.

Environmental Influences in Normal Weight Women with History of Recurrent Pregnancy Loss.

Aim: The study investigated the possible relationship of luteal phase progesterone, toxic heavy metals and nutrients in normal-weight women with history of recurrent pregnancy loss for adequate management. Study Design: Cross sectional study. Place and Duration of Study: The Obstetrics and Gynaecology Clinic, University College Hospital, Ibadan, Olabisi Onabanjo University Teaching Hospital, Shagamu and State Hospital, Ijebu-Ode; the University of Ibadan and environs between April and September, 2009. Methodology: 90 apparently healthy women with normal weight aged 18-45years with regular and ovulatory cycles of 26-30 days were enrolled. They were 60 women with history of recurrent pregnancy loss (cases) age-matched with 30 women without history of recurrent pregnancy loss (controls). Demographic and anthropometric measurements were done by standard methods. Progesterone was determined by enzyme immunoassay (Immunometrics UK Ltd). Total cholesterol, triglyceride and high density lipoprotein were performed by enzymatic methods (Randox laboratories, USA) while low density lipoprotein was calculated using Friedwald’s formula. Zinc, selenium, chromium, manganese, iron, magnesium, copper, lead, and cadmium were estimated by atomic absorption spectrophotometry while Vitamin E was measured by high performance liquid chromatography. Statistical analysis was done using SPSS version 16.0. Results: Results showed significantly higher levels of triglycerides, cadmium and lead, and significantly lower levels of progesterone, iron, copper, magnesium, chromium, selenium and vitamin E in cases compared with controls (p<0.013). Conclusion: Oxidative stress mechanisms in normal-weight women with history of recurrent pregnancy loss were implicated. Healthcare policies should focus on pollution reduction and increase awareness on healthy diet for optimal periconceptional micronutrient requirements.

Chlamydia Infection; Plasma Peroxidation and Obesity in Tubal Infertility

Background: Genital tract infections and obesity are both sources of oxidative stress. Alterations in immune and antioxidant parameters may arise from this or from an indeterminate autoimmune mechanism. Objective: This study aimed to investigate the association of Chlamydial infection; obesity and oxidative response with tubal infertility in Nigerian women. Methods: It was a case-control study of 40 women with tubal infertility and 32 fertile women; respectively; recruited from the Infertility and Family Planning Clinics respectively; of the University College Hospital; Ibadan; Nigeria. Anthropometric indices were measured in each subject and endocervical swabs were taken to screen for current genital tract infection. Antioxidant; hormonal and immunologic analysis were performed on serum. Results: None of the subjects had current genital tract infections. Chlamydia trachomatis IgG positivity was significantly higher in infertile than in fertile subjects [OR 4.33; 95CI (0.078-0.681)]. No significant variations were observed in the anthropometric indices; antioxidant parameters and hormones between infertile and the fertile women. Body mass index correlated positively with oxidative stress in infertile subjects. Waist and hip circumferences correlated negatively with oestradiol in women with tubal infertility. Conclusion: Chlamydial infection is associated with tubal factor infertility; however; obesity seems to increase oxidative stress and reduce fertility potential in women with tubal factor infertility