Metabolic syndrome and its components among HIV/AIDS patients on Antiretroviral Therapy and ART-Naïve Patients at the University of Calabar Teaching Hospital, Calabar, Nigeria

Background: Although an increasing access to ART in sub-Saharan Africa has made it possible for HIV/AIDS patients to live longer, clinicians managing such patients are faced with the challenge of drug-related metabolic complications. Methods: A cross -sectional study was carried out at the University of Calabar Teaching Hospital, Nigeria, on three groups of participants; namely HIV patients on ART, ART-naïve patients and HIV negative subjects (n =75). Demographic and anthropometric data were collected using a well-structured questionnaire while biochemical parameters were measured using colorimetric methods. Results: The highest prevalence of MS was associated with the HIV/AIDS patients on ART (i.e. 32.0 %, and 50.3% for NCEP-ATP III and IDF criteria respectively). Patients on ART had significant increases (p< 0.05) in waist to hip ratio, FPG, serum TG and LDL-c; and a significantly higher (p< 0.05) prevalence of hypertension, diabetes, low HDL-c and hypertriglyceridemia compared to the ART-naïve patients. Low serum HDL-c was the most prevalent form of dyslipidemia in all three groups and the most prevalent component of MS in HIV patients. Conclusion: ART increases the risk of MS and CVD. HIV/AIDS patients on ART should be advised on lifestyle modifications and undertake regular assessment of their cardiovascular risk factors

Pregnancy Outcome of ART-experienced and ART-naïve HIV-infected Mothers at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Background:Untreated maternal Human Immunodeficiency Virus (HIV) infection is associated with adverse pregnancy outcome including preterm birth, low birth weight, and mother-to-child transmission of the virus. This study aimed to compare the pregnancy outcome between HIV infected mothers who received ART in pregnancy and those who were ART-naïve. Methods:A cross-sectional study of HIV-infected mothers who brought their infants for follow up between November 2007 and May 2017 at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.Relevant information obtained include: time of diagnosis, antiretroviral therapy (ART) regimen and when it was commenced, gestational age at delivery and birthweight of child, mode of delivery, infant feeding option and ARV prophylaxis. Infection status of the infant was determined by DNA PCR at 6weeks of age. Based on when ART was commenced, mothers were grouped into three [(HAART experienced (HE) if ART was started before pregnancy, HAART in pregnancy (HIP) and HAART naive (NH) if no HAART was taken in pregnancy].Main outcome measures were rates of prematurity, low birth weight, mean birth weight, birth defects and mother-to-child transmission Result:A total of 1,640 HIV-exposed infants were seen (716(43.6%) in HE, 360(22.0%) in HIPand 564(34.4%) in NH groups). There were 825(50.3%) males and 815(49.7%) females. Zidovudine/Lamivudine and Nevirapine/Efavirenz was the most frequently used combined ART in 724 (67.3%) mothers. The mean birthweight was 3.12±0.38Kg; range 1.2 –5.7Kg (3.11±0.58Kg in HE; 3.13±0.53Kg in HIP; 3.18±0.74Kg in NH) Table 3. A hundred and eighty (11.0%) babies were preterm [76(42.2%) in HE; 26(14.4%) in HIP; 78(43.3%) in NH](p=0.007), while 159(9.7%) were LBW [74(46.5%) in HE; 22(13.8%) in HIP; 63(39.6%) in NH](p=0.03). Fourteen (0.9%) babies had birth defects [5(35.7%) in HE; 9(64.3%) in HIP] (p=0.01). The commonest birth defects were neural tube defect 7(50%) and congenital heart defect 4(28.8%). Overall transmission rate was 21.4% [8% in the HE, 4.5% in HIP and 87.5% in NH groups] (p=0.001). The mean birth weights of uninfected babies were higher than their infected counterparts but was not significant (p>0.05).Conclusion:The benefits of early HAART in reducing mother-to-child transmissionmust be weighed against the risks of lower birthweight and potential teratogenic effects of drug exposure on the foetus

Correlation between CD4 Count and HIV-1 Viral Load among ART Naive Patients Attending ICTC, SMS Medical College, Jaipur

Objectives: To study the correlation between CD4 count &HIV-1 viral load among ART Naive patients attending ICTCSMS Medical College, Jaipur.Material and Methods: This study was conducted on 250 HIVserologically confirmed, ART Naive cases from ICTC, SMSJaipur. RNA extraction was done from plasma samples byQiagen Viral RNA Mini Kit then HIV-1 Viral load wasdetermined by Qiagen HIV-1 viral load kit on ABI 7500 Fast dxReal Time PCR, while CD4 count was done on FACSCALIBUR flowcytometer (BD Biosciences). SPSS ver. 21.0was used to determine correlation between CD4 count & HIV-1viral load.Results: Out of 250, 216 (86.4%) cases were found in whichviral RNA was detected. These samples were correlated withtheir CD4 Count. The mean of viral load was 194746.2791 ±550442.61805 IU/ml while CD4 count was 282.7674 ±217.56456 cells/ul. Females were having Avg. Viral load228506.7273 & CD4 count 337.21 and males were found tohave Avg. Viral load 179791.9866 & CD4 count 258.65Conclusion: This study concluded a negativecorrelation between HIV-1 RNA viral load and CD4 count inHIV-seropositive ART naïve patients of this part of the country.Our study confirmed that HIV-1 RNA viral load levels aresignificantly higher in women than in men, but no suchsignificant gender difference in the CD4 count was found.

Iron intake is positively associated with viral load in antiretroviral naïve Brazilian men living with HIV

BACKGROUND Iron homeostasis contribute for the human immunodeficiency virus (HIV) pathogenesis. OBJECTIVES We assessed the iron intake pattern in antiretroviral naïve Brazilian men living with HIV correlating with clinical and nutritional parameters. METHODS The iron consumption mean was estimated according to a food frequency questionnaire (FFQ), and a 3-day food record (3dFR) submitted to the patients. HIV viral load, CD4+ T cell counts, serum iron, haematological and anthropometrics parameters were recorded. FINDINGS Fifty-one HIV-infected adult men naïve for antiretroviral therapy (ART) were enrolled. The mean age of participants was 35 (SEM ± 1.28) years old, with mean time of HIV-1 infection of 1.78 (0-16.36, min-max) years. Majority (41.18%) had complete secondary, and 21.57% had tertiary educational level. The income was around 1x (54.90%) to 2x (41.18%) minimum wage. Fifty-four percent showed normal weight, while 40% were overweight. The patients showed normal mean values of haematological parameters, and mean serum iron was 14.40 µM (SEM ± 0.83). The FFQ showed moderate correlation with the 3dFR (ρ = 0.5436, p = 0.0009), and the mean values of iron intake were 10.55(± 0.92) mg/day, recorded by FFQ, and 15.75(± 1.51) mg/day, recorded by 3dFR. The iron intake, recorded by FFQ, negatively correlated with serum iron (ρ = -0.3448, p = 0.0132), and did not have influence in the CD4+ T cell counts [e.B 0.99 (0.97-1.01, 95% confidence interval (CI), p = 0.2]. However, the iron intake showed a positive effect in HIV viral load [e.B 1.12 (1.02-1.25, 95%CI), p < 0.01]. MAIN CONCLUSIONS This study draws attention for the importance of iron intake nutritional counseling in people living with HIV. However, more studies are required to clarify the association between high iron intake and HIV infection and outcome.

Mitochondrial DNA content of peripheral blood mononuclear cells in ART untreated & stavudine/zidovudine treated HIV-1-infected patients

Background & objectives: Nucleoside reverse transcriptase inhibitors (NRTIs) are known to cause mitochondrial toxicity. This study was done to estimate mitochondrial DNA (mtDNA) content of peripheral blood mononuclear cells (PBMCs) among human immunodeficiency virus (HIV) infected, NRTI treated and antiretroviral therapy (ART)-naïve patients and evaluate the utility of mtDNA content as a biomarker of mitochondrial toxicity. Methods: mtDNA content in PBMCs of 57 HIV-infected ART untreated and 30 ART treated with stavudine (d4T) or zidovudine (AZT) containing regimen were compared against 24 low-risk healthy controls (LoRHC). Results: There was a significant (P=0.01) reduction in mtDNA content among HIV-infected (104; 80-135) compared to LoRHC (127; 110-167), and it was the same in both the treated (104.8; 88-130) and untreated patients (104.7; 78-142). mtDNA significantly (P=0.014) declined in ART treated patients symptomatic for toxicity (97; 74-111) than the asymptomatic patients (128; 103- 153). Interpretation & conclusions: mtDNA depletion in PBMCs was evident among HIV-infected individuals on ART. Moreover, as mtDNA content was reduced among the patients symptomatic for toxicity than the asymptomatic in both the HIV-infected groups, the current study supports mtDNA content of PBMCs to serve as a biomarker of mitochondrial dysfunction induced by NRTI and HIV. Longitudinal studies with a large sample need to be done to confirm these findings.