ABSTRACT
Introduction: The prevalence of rifampicin, isoniazid and pyrazinamide induced elevations in serum alanine aminotransferase (ALT) levels were compared in a cohort of Nigerians with and without HIV seropositivity. Methods: Records of all the patients with pulmonary tuberculosis (251 HIV positive and 205 HIV negative), aged above 15 years treated in the TB program of the Federal Medical Centre, Yenagoa from January 2013 to December 2014 were analysed for this study. The WHO 4 grades of hepatotoxicity using ALT were used. ALT of less than 50 U/L was taken as normal. Grade 1 (very mild hepatotoxicity): <2.5 x upper limit of normal (ULN) i.e. ALT 51-125 U/L. Grade 2 (mild): 2.6 – 5 x the ULN (ALT 126-250 U/L). Grade 3 (moderate): 5-10 x the ULN (ALT 251 – 500 U/L). Grade 4 (severe) >10 x the ULN (ALT > 500 U/L). Results: No patient with or without HIV seropositivity had ALT value in the grade 3 and 4 category ≥251 U/L. There was no statistically significant difference in ALT values between cohorts with or without HIV in the 3 ALT categories obtained while on antituberculous drugs (P = 0.761, 0.367 and 0.197). Conclusion: All the observed hepatotoxicity were mild. The average rate of hepatotoxicity in the HIV uninfected pulmonary tuberculosis cohort was 16.6%, 9.8% and 5.4% for ALT1, ALT2 and ALT3 respectively. The rate in the HIV infected cohorts was 15.5%, 8.8% and 16.4% for ALT1, ALT2 and ALT3. It is encouraging to find a low rate of antituberculosis drug induced hepatotoxicity than one would expect based on the high prevalence of risk factors in our environment.
ABSTRACT
Background: In order to advance the extent of self-disclosure of HIV sero-status in Nigeria, we evaluated the prevalence, pattern and determinants of disclosure of HIV status amongst adult patients in a hospital in the Niger Delta. Materials and Methods: In a three month cross sectional study undertaken in March 2012, the demographic and clinical data as well as HIV sero-status disclosure frequency and pattern were obtained using a pre-tested questionnaire from consenting HIV infected adults attending the Anti-Retroviral Therapy Clinic in the Niger Delta. Independent determinants of HIV disclosure to current sexual partner were determined using an unconditional logistic model. P<0.05 was considered statistically significant. Results: A total of 260 patients were studied out of which 184(71%) were females. Disclosure to current sexual partner was found to be 62.0% and students had the least disclosure rate. Majority of study participants preferred to disclose to family members (57%) than past sexual partner (2.5%) or friend (4.9%). Although HIV disclosure was significantly associated with male sex, living with sexual partner, partner being HIV positive; the only independent determinants of HIV disclosure were partner being on ART (OR-12.7,95% CI 1.2-132.7)and being currently married (OR-8.8,95% CI 2.1-36.8). Conclusion: The results of our study suggest low rate of HIV status disclosure among HIV infected patients in the Niger Delta. We found that receiving ART and being currently married promoted disclosure. There is need for clinicians and policy makers to foster disclosure of HIV sero-status in Nigeria especially among HIV infected students and unmarried sexual partners