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

Traditional Herbal Medicines used in Neonates and Infants less than Six Months Old in Lagos Nigeria

Background: Herbal medicine use in children; adults and other groups have been documented but little information is known about the use herbal medicine mixtures in neonates and infants less than six months old. This is important because pharmacokinetics and pharmacodynamics changes between infants and adults may result in age-related differences in drug metabolism. This study was carried out to document the herbal medicines used for common ailments in neonates and infants less than six months in Lagos; Nigeria.Methods: With the aid of questionnaires and personal interviews during field trips to herbal medicine markets and infant welfare clinics a survey was undertaken to collect information on herbal medicine use by neonates and infants less than six months from traditional healers and nursing mothers during July and September 2014. Demographic Information and types of herbal medicines used by the respondents; indications for their use and adverse effects of the herbal medicines they used were obtained.Results: Medicinal plant species used for the treatment of common ailments including diarrhea ; abdominal cramps ; skin rashes; Fever (malaria) ; jaundice; convulsions; Insomnia and weight loss in neonates and infants less than 6months were documented. A high percentage of the mothers (72%) agreed they used herbal medicines in neonates and infants; although 96% of them did not notice any adverse effect while 100% of the mothers perceived the herbs to be efficacious. Herbal medicines are administered as a polyherbal compound; containing 4-6 plants Conclusion: The use of herbal medicines is common amongst neonates and infants less than six months old . Further studies on the efficacy and safety of these medicines which are administered as polyherbal mixtures is recommended