Evaluation of microalbuminuria in relation to asymptomatic bacteruria in Nigerian patients with sickle cell anemia.

Studies have identified microalbuminuria (MA) and asymptomatic bacteruria (ASB) as co-morbid factors in sickle cell anemia (SCA). However, the relationship between these comorbid factors remains unclear and data are lacking for Nigerian patients. This study determined the prevalence of MA and ASB in a cohort of patients with SCA in a steady state, in Lagos, Nigeria. Early morning mid-stream urine samples were collected in sterile bottles from 103 patients comprising 48 males and 55 females with a mean age of 10.4 years. Aerobic culture and colony count of organisms was done using conventional methods. Serum creatinine and hematological indices, including irreversibly sickled cells (ISC), were also assayed. Of the 103 urine samples screened, 23 (22.3%) had albuminuria (ALB), and consisted of nine males and 14 females (P > 0.05); 16.5% of the cases had MA (P <0.05). Age at onset of MA was seven years, and children accounted for 23.5% of all cases with ALB (P >0.05). The prevalence of confirmed ASB was 14.6%, with females accounting for 14 of 19 probable ASB cases (P <0.05). Univariate regression analysis demonstrated a significant (P <0.05) association between age at onset of MA, hemoglobin level, reticulocyte count, ISC and occurrence of ASB, but with only ISC evolving as an independent predictor. Twenty-eight bacterial isolates predominated by Escherichia coli (39.3%; P <0.05), of whom 89.3% were multi-drug resistant, were recovered from the ASB urine samples. In conclusion, both MA and ASB are common in Nigerian SCA patients, with the former occurring from the first decade of life.

Seroprevalence and biochemical features of hepatitis B surface antigenemia in patients with HIV-1 infection in Lagos, Nigeria.

Studies have confirmed HBsAg antigenemia as an important correlate of HIV-1 infections in Nigeria. However, the hepatic pathophysiology and therapeutic implications in antiretroviral regimens are poorly understood. In this study, fifty-four HIV-1 seropositive patients aged 16-47 years (mean age 31.8 years) with CD4 T lymphocyte counts of 148-420 cells/mm3 attending clinics in General Hospital, Ikeja and private medical centres in Lagos Island, Nigeria and forty sex and age-matched apparently healthy controls were serologically examined as carriers of hepatitis B surface antigen (HBsAg) using a particle agglutination assay procedure (Sensitivity 94.5 - 100%, Serodia-HBs.PA, Fujirebio, Inc.). HBsAg was detected in 28 (51.9%) and 5 (12.5%) of the patients and controls respectively ( 2 Mantel-Haenszel = 13.8; P = 0.02). HBV co-infection was found to result in significant (P < 0.05) reduction in total lymphocyte count (1368.6 +/- 53.2 vs. 1590.5 +/- 80.4 cells/ mm3) with 7 of 10 (70%), 18 of 33 (54.5%) and 3 of 6 (50%) HIV-1 patients having < 200, 200 - 350 and > 350 CD4 lymphocyte cells/microl and eliciting HBsAg antigenemia. These patients exhibited 2.9 - 8.6% reduction in CD4 T lymphocyte counts compared to their seronegative counterparts. Although the liver function parameters measured in HIV-1 patients tested were higher than control values, significantly (P < 0.05) elevated liver enzymes: sGOT (44.1 +/- 2.2 vs. 26.2 +/- 2.1 IU/L), sGPT (46.2 +/- 2.4 vs. 23.5 +/- 1.8 IU/ L), and serum bilirubin levels (2.04 +/- 0.18 vs. 1.0 +/- 0.07 mg/ dL) were observed in HBsAg positive HIV-1 patients. sGOT or sGPT activity that was five times greater than the control was observed in 7(25%) and 2 (7.7%) of HbsAg positive and negative HIV-1 patients in whom significant association between decreased total lymphocyte count and measured liver parameters was found. We conclude that hepatitis infection deteriorates liver functions and its investigation in HIV-1 infected patients may be of clino-therapeutic importance prior to antiretroviral therapy administration.