Immunovirological treatment outcomes after 2 years of antiretroviral therapy in children living with the human immune deficiency virus in Lagos Nigeria

Background/objective: The World Health Organization (WHO) recommends routine assessment of antiretroviral treatment outcomes to detect treatment failure early and prevent the development of drug resistance. The aim of this study was to describe treatment outcomes of antiretroviral therapy (ART) over 2 years in children living with the human immune deficiency virus enrolled in the paediatric HIV clinic at the Lagos UniversityTeaching Hospital (LUTH). Materials and methods: This was a retrospective study of antiretroviral treatment outcomes in 278 children receiving antiretroviral therapy at the paediatric HIV clinic of LUTH. Demographic, clinical and laboratory data were retrospectively collected from clinical records of pediatric patients who received antiretroviral therapy for 2 years ( from November 2015 to December 2017) . Virological failure was defined as viral load > 400 copies/ml and immunological failure was defined as a CD4 count <100 cells/mm3 or CD4 % <15% after receiving antiretroviral agents for 12 months. Data was analysed using graph pad prism version 5.0.Results: After 12 months on antiretroviral therapy (ART), 101 (36%) had virological failure while 14 (5%) and 36 (13%) failed immunologically [CD4 count <100 cells/mn3 and CD4 <15% respectively]. Virological blips were observed at 24 months in 6.1% of patients while immunovirological discordance occurred in 30% of patients (poor virological clearance despite good immunological recovery) . High baseline viral load (>5000 copies/ml), poor adherence (<95%) and low baseline CD4 counts (101-249 cells/mn3) were significantly associated with virological failure, while low baseline CD4 counts (<350 cells/mn3) and poor adherence (<95%) were significantly associated with immunologic failure.Conclusion: The treatment outcomes observed in this study are similar to those reported in earlier studies. At 1 and 2 years of antiretroviral therapy , there was immune restoration however 101 (36%) and 87 (31%) respectively had virological failure despite good adherence to therapy and good Immunological restoration. This calls for early initiation and switch to second and third line drugs

The relationship between zidovudine, lamivudine and nevirapine plasma drug levels and antiretroviral treatment outcomes in Nigeria children living with HIV

Plasma concentrations of antiretrovirals are significant and important determinants of treatment failure and toxicity. The relationship between antiretroviral pharmacokinetic exposures and immunovirological outcomes has not been extensively studied in our setting. The aim of this study was to investigate the relationship between antiretroviral plasma concentrations and virological and immunological treatment outcomes in children living with human immunodeficiency virus (HIV) A retrospective collection of demographic, clinical , laboratory data and a prospective determination of plasma drug concentrations in 120 children aged 2-14 years after two years of receiving fixed dose zidovudine, lamivudine and nevirapine tablets using a simple, rapid, sensitive and validated method of high performance liquid chromatography with UV detection for simultaneous quantification of zidovudine, lamivudine and nevirapine in human plasma. All analyses were performed using graph pad prism version 5.0. A perfect agreement (p<.001) was found between nevirapine drug levels and prescriptionrefill visit adherence records (Kappa 0.093). Plasma zidovudine, lamivudine and nevirapine concentrations were not statistically associated with virological success (Viral load <400copies/µl ) and immunological success (CD4 cells >100 cells/mm3). At 2 years zidovudine, lamivudine and nevirapine therapeutic levels, zidovudine supra therapeutic levels ,and nevirapine subtherapeutic levels were respectively significantly associated with immunologic success (CD4%>15 %). Low nevirapine levels can be used to identify those that require adherence counseling. Despite good virological and immunological outcomes, plasma concentrations of zidovudine, lamivudine and nevirapine were not significantly associated with virological and immunological outcomes (Absolute CD4 counts) but was significantly associated with immunological outcomes (CD4%). Plasma drug levels may be good surrogates of adherence but not of treatment outcomes. Monitoring CD4% remains important to optimize paediatric HIV treatment

Prescribing Pattern of Non-Steroidal Anti-inflammatory Drugs at the Outpatient Pharmacy Department of Lagos University Teaching Hospital; Nigeria

Background: Non-steroidal Anti- inflammatory Drugs (NSAID); are among the most widely used and misused of all drugs. Though they provide symptomatic relief from pain and swelling in chronic joint diseases; they may cause renal impairment; especially in combination with other nephrotoxic agents.Objectives: This study aimed to investigate the prescription pattern of NSAID in the Out-patient Pharmacy Department of Lagos University Teaching Hospital (LUTH); Nigeria.Design: A total of 3800 prescriptions containing NSAIDs were analyzed for information on drug name; the number of NSAIDs per prescription; the presence of ACE inhibitors and diuretics alongside NSAIDs and NSAIDs prescribed in generic or brand names. Results: The results showed that Aspirin was the most frequently prescribed NSAID (62.2) and 68.4 of the NSAIDs prescriptions studied were written in generic names. The total number of drugs per prescription was in most cases 3 or greater (84.6). There were statistically significant (p ? 0.05) associations between the individual NSAID prescribed and whether they were prescribed in generics or brand names; individual NSAID prescribed and the frequency of co-prescription with an ACE inhibitor and a diuretic; types of NSAID prescribed and the cost in Naira. Conclusion: Though most of the prescribers complied with WHO standard in their prescriptions vis a vis generic prescription; avoidance of polypharmacy and avoidance of drug interactions and contraindications; there is obvious need for interventional measures or strategies to improve rational prescribing for some of the prescribers tailored towards rational prescription and use of drugs

Analgesic activity of the aqueous leaf extract of Byrsocarpus Coccineus

Byrsocarpus coccineus (Schum. and Thonn.) is used as an herbal remedy for earache; muscular and rheumatic pains in West Africa. To validate the claim of the users; the analgesic effect of the aqueous leaf extract of the plant was studied in mice and rats using acetic acid-induced writhing; formalin; tail immersion; and cold-water tail flick pain tests. The extract (50 - 400mg/kg; p.o) showed a dose dependent and significant (p0.05) inhibition of pain in the acetic acid-induced writhing; tail immersion; tail flick and the formalin (second phase) tests. The extract (400mg/kg) gave a significantly (p0.05) higher inhibition than acetylsalicylic acid; ASA; (100mg/kg; p.o) in the acetic acid-induced writhing test. Its effect on the second phase of the formalin test was comparable to that of ASA. The elevation of pain threshold at 60 minutes post-treatment produced by 400mg/kg of the extract in the tail immersion and tail flick tests were slightly lower than that of morphine (2mg/kg; s.c). The results suggest that the aqueous leaf extract of Byrsocarpus coccineus possesses effective analgesic activity mediated via peripheral and central mechanisms