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

Seroprevalence of parvovirus BI9 antibody in blood donors and sickle cell disease patients at Lagos university teaching hospital (LUTH): a comparative study

Introduction: Parvovirus B19 (PVB19) is a DNA virus transmissible by blood transfusion. It is a major cause of aplastic crisis especially in chronic haemolytic anaemic patients such as sickle cell disease patients.Objective: The study was aimed to determine the seroprevalence of PVB19 in blood donors and sickle cell anaemia (SCA) patients and to evaluate its association with blood transfusion in SCA patients. Methods: This is a cross sectional study conducted at the Lagos University Teaching Hospital; Lagos Nigeria. Three hundred participants; consisting of 150 voluntary blood donors and 150 sickle cell anaemia subjects were enrolled into the study. Seroprevalence of parvovirus was determined using ELISA kits for IgG and IgM anti-PVB19 antibodies by Immuno-Biological Laboratories; (IBL) inc. Minneapolis; USA. Results was analyzed with SPSS 11 software and presented in tables. Fishers Exact test; Chi-square and student T-test were used as appropriate to compare variables between both groups. P-values 0.05 were considered significant. Results: Ninety nine (66 ) blood donors were positive for anti-PVB19 IgG antibody while ninety two (61.3) sickle cell patients were positive. Two (1.3) blood donors were positive anti-PVB19 IgM antibodies while 8 (5.3) blood donors were positive anti-PVB19 IgM antibodies while 8 (5.3) SCD patients were positive for anti-PVB19 IgM antibodies. There was no significant difference in the seroprevalence of IgG and IgM antiPVB19 virus in both groups. There was no association of parvovirus seroprevalence with blood transfusion. Conclusion: The study has shown a high seroprevalence of IgG anti-PVB19 antibodies in both blood donors and SCA patients. Therefore routine screening for parvovirus infection for donor blood is not justified. However seronegative SCA patients who require blood transfusion should have the blood screened for parvovirus to reduce the risk of associated aplastic crisis

Pattern of Demographic Risk Factors in the Seroprevalence of Anti-Toxoplasma Gondii Antibodies in HIV Infected Patients at the Lagos University Teaching Hospital

BACKGROUND:The Apicomplexan protozoan; Toxoplasma gondii; is a human parasite; with an ubiquitous distribution. Prevalence of the infection varies widely; depending on cultural; geographic and climatic factors. More often asymptomatic; T. gondii infection may be a severe and life-threatening disease. OBJECTIVES: This study was conducted to determine the seroprevalence of Toxoplasma gondii IgG antibody (TIgG) among HIV infected persons at the Lagos University Teaching Hospital PEPFAR site; and the demographic characteristics of the study group. METHODS: 460 plasma specimens were tested for TIgG antibodies by enzyme immuno assay technique and close ended questionnaires were applied on all respondents to obtain relevant data on demographics. Plasma was obtained from two study groups comprising of 380 HIV positive patients and 80 HIV negative adults who served as the control group. RESULTS: The overall seroprevalence was 30in the immunocompetent control group (37.5of the males tested and 16.7among the females). The over all seroprevalence of TIgG antibody among the HIV positive respondents was 54(206 Of 380). The study therefore showed statistically significant difference between the seroprevalence of TIgG antibody among the immunocompetent control group and HIV positive study group (p = 0.00356). Seroprevalence of TIgG antibody was lowest among the educated subjects (19of subjects with tertiary education). T. gondii antibody seroprevalence for males; married respondents and rural dwellers were 70.4; 72.3and 69respectively; and were all statistically significant at p 0.000. Moreso; a significant association was observed between the seroprevalence of anti toxoplasma gondii IgG antibody and the consumption of beef among the study groups.(P 0.0001). CONCLUSION: Socio-cultural and nutritional habits;contribute significantly to the prevalence of Toxoplasmosis and thus any effective control must be centred around these issues