Lipid profile in HIV/AIDS patients in Nigeria.

INTRODUCTION: Alterations of serum lipid profiles have been reported widely among Human Immuno deficiency Virus (HIV) positive patients on Highly Active Anti Retroviral Therapy (HAART). However, there are few data on serum lipid profile among treatment naïve HIV positive patients in our environment. OBJECTIVES: To describe the pattern of lipid profile among treatment naïve HIV positive patients and changes following HAART initiation. METHODS: One hundred and thirty HIV positive patients seen in HIV center in an urban area in Nigeria and 44 matched individuals were recruited. Data were collected on socio demographic characters, baseline lipid profiles and CD4 count. Values of lipid parameters were retrieved after 12 months on HAART. RESULTS: The mean Low density lipoprotein(LDL) was 2.26+ 0.9 mmol/l among the test group compared with 0.96+0.39 mmol/L among the control, p value=0.000. The mean High density lipoprotein (HDL) was also significantly lower, 0.8+0.6 mmol/L reaching a dyslipidemic level, in the HIV positive group than the control, p value = 0.00. Tuberculosis/HIV co infected patients had a significantly elevated mean LDL, p=0.002. CONCLUSION: Abnormality of serum lipid is common among treatment naïve HIV patients seen in Nigeria. The NNRTI regimen is associated with elevation of HDL and some stabilization of TC and TG.

Lipid profile in HIV/AIDS patients in Nigeria

Introduction: Alterations of serum lipid profiles have been reported widely among Human Immuno deficiency Virus (HIV) positive patients on Highly Active Anti Retroviral Therapy (HAART). However; there are few data on serum lipid profile among treatment na?ve HIV positive patients in our environment. Objectives: To describe the pattern of lipid profile among treatment na?ve HIV positive patients and changes following HAART initiation. Methods: One hundred and thirty HIV positive patients seen in HIV center in an urban area in Nigeria and 44 matched individuals were recruited. Data were collected on socio demographic characters; baseline lipid profiles and CD4 count. Values of lipid parameters were retrieved after 12 months on HAART. Results: The mean Low density lipoprotein(LDL) was 2.26+ 0.9 mmol/l among the test group compared with 0.96+0.39mmol/L among the control ;p value =0.000 .The mean High density lipoprotein (HDL) was also significantly lower;0.8+ 0.6mmol/L reaching a dyslipidemic level; in the HIV positive group than the control; p value = 0.00. Tuberculosis /HIV co infected patients had a significantly elevated mean LDL; p=0.002. Conclusion: Abnormality of serum lipid is common among treatment na?ve HIV patients seen in Nigeria. The NNRTI regimen is associated with elevation of HDL and some stabilization of TC and TG

Arteriovenous fistula for patients on long term haemodialysis in jos, Nigeria.

BACKGROUND: The introduction of haemodialysis has prolonged the lives of patients with end-stage-renal disease (ESRD). To maintain them on long-term dialysis, vascular access procedures are required. OBJECTIVES: To describe the experience with arteriovenous fistula (AVF) from a developing country. METHODS: Eighty-two AVF were created in 74 patients on maintenance haemodialysis. They all had side-to-end AVF using prolene 7/0 monofilament suture for anastomoses. RESULTS: There were 55 males and 19 females with a male: female ratio of 2.9:1. The ages ranged from 18 to 70 years with a mean of 43.4 "12.1 years. Most of the AVF created were on the left upper limbs with the radio-cephalic and brachio-cephalic accounting for more than 70% . Eight patients developed thrombosis of the veins used for the AVF and one developed a pseudo aneurysm. CONCLUSIONS: Arteriovenous fistula makes long-term haemodialysis feasible. It can be created easily and has a low rate of complications.

Renal disease in the acquired immunodeficiency syndrome in north central Nigeria.

BACKGROUND: The brunt of the human immunodeficiency virus infection/the acquired immunodeficiency syndrome is largely borne by communities in sub-Saharan Africa. We describe renal disease in Nigerians with the acquired immunodeficiency syndrome. METHODS: Consecutive patients with the acquired immunodeficiency syndrome (AIDS) seen in the infections unit of the Jos University Teaching Hospital and a similar group of healthy controls were evaluated for renal disease. Subjects with past history of renal disease, hypovolemia, hypertension, diabetes mellitus and/or a documented fever were excluded from the study. RESULTS: Of the 79 patients with the acquired immunodeficiency syndrome and 57 controls studied, renal disease was present in 41 (51.8%) of the patients in the AIDS group and 7 (12.2%) of controls. While 15 (19%) of the AIDS group had azotemia alone and 20 (25.3%) had proteinuria alone, 6 (7.6%) had azotemia and proteinuria. The mean protein excretion/24 hours was significantly higher in the AIDS group compared to controls, (2.99 +/- 54 g and 0.56 +/- 0.12 g respectively, p = 0.001), while the GFR was significantly higher in controls compared to the study group (103.30 +/- 37.78 and 68.03 +/- 37.55 respectively, p = 0.004). Subjects in the AIDS group with renal disease had a significantly longer duration of illness compared to those without (12.33 +/- 8.67 months and 7.28 +/- 7.78 months respectively, p = 0.008). Age and serum CD4+ cell counts were similar in patients with and without renal disease in the AIDS group. CONCLUSION: Renal disease is a common complication of acquired immunodeficiency syndrome, the duration of illness being strongly associated with its presence.

Malaria prophylaxis in post renal transplant recipients in the tropics: is it necessary?

OBJECTIVES: Malaria prophylaxis is usually not provided routinely for most post renal transplant recipients in malaria endemic zones. Therefore, very little information is known about the incidence and severity of this disease among the post-transplant recipients in our environment. Hence a prospective, non-randomized open label clinical trial to determine the incidence of malaria and the beneficial effect of malaria prophylaxis among renal transplant recipients in Nigeria was carried out. SUBJECTS: All seven consecutive patients who had renal transplants and returned to the unit not more than four weeks later were seen and followed up. This consisted of an initial four week period of no prophylaxis and another four weeks of prophylaxis with proguanil hydrochloride 200 mg daily. Weekly thin and thick blood films by Giemsa stain were examined and other routine investigations of liver function tests, full blood count, urea, creatinine, electrolytes and urinalysis were done. RESULTS: Only three out of the seven patients (42.8%) had positive smears for malaria parasites in the initial no prophylaxis phase. No malaria parasites were detected at the prophylactic phase. There was no significant difference in the results of other investigations including the renal function between the two phases. CONCLUSION: This study has shown the benefit of short term routine malaria prophylaxis among renal transplant recipients in malaria endemic zones.

The impact of renal impairment on the management of patients with lower urinary tract obstruction.

One hundred patients with lower urinary tract obstruction (LUTO) seen over a 10-month period were prospectively studied. Nineteen (19%) had an elevated serum creatinine (> 125 mumol/l); 13% had benign prostatic hyperplasia (BPH); 4% had urethral strictures; and two had congenital anomalies. Though urethral strictures are more common than BPH they cause less renal impairment, probably because the patients are younger and also because a urinary fistula may form proximal to the stricture when the intravesical pressure rises very high. Eighty per cent of the patients with renal impairment had a urinary tract infection (UTI), and in these the reduction in serum creatinine following relief of obstruction was slow and erratic. In three patients who did not have UTI the serum creatinine dropped steadily at a rate which varied from 6.8-845 mumol/l/week following continuous bladder drainage and appropriate supportive management. All patients with elevated serum creatinine had delayed surgery and required prolonged preoperative hospitalization, with a resultant sharp increase in the cost of their treatment.

Clinical pattern of human immunodeficiency virus infection (HIV) in pulmonary tuberculosis patients in Jos, Nigeria.

A study of determine the seroprevalence rate and clinical presentation of HIV-associated pulmonary tuberculosis was carried out in Jos between October 1990 and September 1991. Out of the 180 newly diagnosed pulmonary tuberculosis patients, 11(6.1%) were confirmed seropositive for HIV-1 and 2. The peak age range for both tuberculosis and HIV infection in both sexes is 20-40 years. The risk of HIV infection was associated with multiple sex partners and blood transfusion. There was no significant difference in the clinical presentation of pulmonary tuberculosis between HIV-seropositive and seronegative patients (P > 0.1). However, diarrhoea, lymphadenopathy and marked weight loss were found to be significantly associated with HIV infection (P < 0.05). The mean lymphocyte count of HIV seropositives was significantly lower than seronegatives (P < 0.01).

PIP: While tuberculosis (TB) is already a highly common disease in developing countries, the advent and spread of HIV/AIDS has further increased the incidence of TB worldwide, especially in Africa. Findings are presented from a study conducted to determine the seroprevalence rate and clinical presentation of HIV-associated pulmonary TB among 180 newly diagnosed pulmonary TB patients at Jos University Teaching Hospital, Nigeria, between October 1990 and September 1991. 11 (6.1%) patients were confirmed seropositive for HIV-1 and HIV-2 infection, with the peak age range for both TB and HIV infection in both sexes being 20-40 years. The risk of HIV infection was associated with multiple sex partners and blood transfusion. No significant difference was observed in the clinical presentation of pulmonary TB between HIV-seropositive and seronegative patients. However, diarrhea, marked weight loss, and lymphadenopathy were significantly associated with HIV infection. The mean lymphocyte count of HIV seropositive individuals was significantly lower than among seronegative individuals.

Open clinical trial of roxithromycin amongst patients of Jos University Teaching Hospital with lower and upper respiratory tract infections.

An open non-comparative clinical study to determine the efficacy and tolerance of Roxithromycin 150 mg twice daily was carried out amongst Nigerian patients with acute upper and lower respiratory tract infections. Twenty-four (24) patients (mean age 21.6 years, male 13; females 11 who completed the study presented with acute tonsillitis (33.3%, acute bronchitis (12.5%), lober pneumonia (12.5%), Otitis media (8%), acute pharyngitis (4%) and acute sinusitis (4%). Most of the patients had normal bacterial flora isolated (50.3%). Pathogens isolated included streptococcus pyogenes (21%), moraxella catarhalis (8.3%), streptococcus pneumonia (8.3%) and Klebsiella pneumonia (4%). The quick clinical response, lack of major adverse drug reactions and susceptibility of the bacterial isolates to Roxithromycin were very significant attributes of the drug. In addition, there was complete recovery in 95.8% of the patients. Roxithromycin is therefore a well tolerated and effective drug for the treatment of acute respiratory tract infections in Nigerian patients.