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 compare the prevalence of HIV infection amongst transfused and non-transfused children with sickle cell anaemia (SCA) in Jos, Nigeria and explore the factors affecting it. Study Design: This was a prospective case control study. Place and Duration of Study: Department of Paediatrics (Sickle Cell Clinic), Jos University Teaching Hospital, Jos, Nigeria, between January 2008 and March 2009. Methodology: A total of 200 transfused children with SCA (117 males and 83 females) were recruited consecutively and screened for HIV using rapid test kits. A questionnaire was used to ascertain the details of blood transfusion and other relevant clinical information. Two hundred age and sex matched non-transfused children with SCA attending the same clinic were recruited as controls. Results: The prevalence of HIV infection amongst transfused children with SCA was 2%, compared to 0% in the control group (P=.04). The four HIV positive cases were transfused in private hospitals with blood of unknown screening status. The number of blood transfusions was not a significant factor in acquiring HIV infection (P=.78); however remunerative blood donation increased the risk of acquiring HIV through blood transfusion (AOR=6.28; 95% CI (1.82-9.92); P=.01). Conclusion: HIV is still transmissible through blood transfusion and screening of blood before transfusion is still not completely practiced in Jos, Nigeria. Policies on proper screening of blood before transfusion and voluntary blood donation should therefore be enforced at all levels of healthcare.