Radiographic chest findings and immunological status in HIV-positive patients with tuberculosis coinfection in a sub-urban Nigerian tertiary hospital.

INTRODUCTION: The study was undertaken to assess chest radiographic features and lymphocyte counts among HIV-positive patients with TB coinfection. MATERIALS AND METHOD: We reviewed the chest radiographs of all newly diagnosed, treatment-naïve HIV-positive patients attending the Treatment Centre at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The radiographs were examined for presence or absence of features of tuberculosis and pneumonia. Those with tuberculosis were further evaluated for presence of cavities and milliary appearance. The demographic characteristics of the patients were recorded. RESULTS: Two hundred and ninety-five radiographs were reviewed, consisting of 192 females, 103 males with mean ages of 33.6±11.65 and 37.85±13.54 years, respectively. Normal radiographs were found in 68.5% patients, features of tuberculosis in 27.8%, and pneumonia in 2.7%. The percentages of males and females with tuberculosis were 35% and 25%, respectively. Patients with milliary TB were from the youngest age group and those with cavities had CD4 cell count below 200cells/mm(3). Cavities occurred most frequently in the lower zones. WBC and counts were highest in patients with pneumonia. CONCLUSION: Normal chest radiographs were associated with mild clinical course. Males were more frequently involved in TB coinfection. Cavities were associated with lowest CD4 cell count and occurred more in lower zones. Patients with HIV/PTB coinfection had the most severe weight loss. There was no statistically significant difference in absolute lymphocyte count between patients with or without tuberculosis. Chest radiograph remains a veritable tool for identifying HIV/AIDS patients with tuberculosis whether sputum is positive or negative.

A Cross-sectional Survey of the Willingness of Tertiary Hospital Staff to Donate Blood in Sagamu, Nigeria

Background: Available donor blood rarely meets the demand in sub-Saharan Africa due to obstacles to blood donation. Willingness to donate blood is adjudged an important step to the actual practice of donating blood.Objective: To assess the willingness of the members of staff of the hospital to donate blood and determine factors affecting their willingness or otherwise.Methods: This was a descriptive cross-sectional study. A proportional allocation of participants was carried out at the various departments in the hospital using self-administered questionnaire. Results: Overall, 183 (73%) of the 246 respondents expressed willingness to donate blood, 111(45%) of whom have been asked to donate blood in the past. Only 91(37%) had donated blood in the past. Significantly higher proportion of health staff showed the willingness to donate blood generally and voluntarily compared to non-health staff. Significantly higher proportion of respondents with tertiary education showed the willingness to donate blood. Two hundred and eighteen (88.8%) were willing to donate blood to help the patient in need while fear of exposure to HIV infection, needle prick and dizziness constituted the major factors discouraging blood donation (19.9%, 18.7% and 18.3% respectively.Conclusion: Willingness to donate blood was mostly based on the primordial motivation of helping the patient in need which does not translate to blood donation. There is a need to improve awareness and advocacy on blood donation among hospital staff and the general population

Effect of highly active antiretroviral therapy on CD4 count and weight in AIDS patients seen at the UITH, Ilorin.

OBJECTIVE: To determine the response on treatment-naïve HIV/AIDS patients to the Highly Active Antiretroviral Therapy (HAART) in terms of CD4 Count and Weight gain over a period of 2 1/2 years. METHODS: Patients with Acquired Immunodeficiency Syndrome (AIDS) were recruited under the Federal Government Highly Active Antiretroviral Therapy (HAART) programme at the University of Ilorin Teaching Hospital. The treatment regimen included Lamivudine, Starvudine and Nevirapine. The patients' responses were evaluated with respect to CD4 count and weight over the period of treatment. The diagnosis of HIV/AIDS was made on the basis of reactivity with two different ELISA reagents, and CD4 count was done with Dynal T4 Quant method. The weights (kg.) of the patients were taken at monthly visit. RESULTS: The duration of treatment for the patients analysed ranged from 1 month to 14 months. Analysis of CD4 count was possible in 105 patients. The mean post treatment CD4 count and weight were significantly higher than the pre-treatment values (p < 0.001 and p < 1.01) respectively. There were significant positive correlations (p < 0.05 and p < 0.001) between increases in CD4 count and weight respectively, and duration of treatment. In eight (8) patients, CD4 Count reduced or remained the same in spite of treatment. CONCLUSION: The HAART regime is associated with increase in CD4 Count and weight gain. While increases in CD4 Count and weight correlated with duration of therapy, there was no correlation between CD4 Count increase and weight gain.

Re-evaluation of methaemoglobin reduction as a screening procedure for glucose-6-phosphate dehydrogenase (G6PD).

Methaemoglobin reduction method is considered to be an old method of qualitative analysis of glucose-6-phosphate dehydrogenase with low specificity and sensitivity and as such, many are sceptical about the reliability of the outcome of the result of the methodology.The aims of this study were to determine the sensitivity and specificity of methaemoglobin reduction method and examine its suitability as a routine method for the screening of glucose-6-phosphate dehydrogenase in this environment. One hundred children were recruited into the study which was conducted over a period of one year. The children (males and females) were aged between 1 day and 15 years. G6PD screening by methaemoglobin reduction method was carried out on all the subjects, while G6PD qualitative assay using G6PD assay kits by Biolabo (France), was carried out in the first 15 subjects who were G6PD deficient by the qualitative screening and the first 15 subjects who were G6PD normal. This was to compare the qualitative with the quantitative assay results and thereby determine the sensitivity and specificity of the methaemoglobin reduction method. The sensitivity and specificity of methaemoglobin reduction test was found to be 93.3 percent each. The results of the qualitative methaemoglobin reduction test for the G6PD deficiency compared well with the quantitative enzymatic assay. With sensitivity and specificity each of 93.3%, the simple qualitative test is dependable and therefore suitable for screening for G6PD.

The value of serum albumin in pretreatment assessment and monitoring of therapy in HIV/AIDS patients.

OBJECTIVES: We sought to examine the utility of serum albumin measurement in staging AIDS and monitoring patients' response to therapy. METHODS: The possible importance of serum albumin measurement in assessing AIDS stage and in monitoring the response to highly active antiretroviral therapy using CD4 cell count and body weight as parameters was examined in 185 consecutive HIV-infected, therapy-naïve individuals who were recruited for antiretroviral therapy at the university of Ilorin Teaching Hospital. The regimen included lamivudine, stavudine and nevirapine. The diagnosis of AIDS was established through a combination of clinical features and HIV seropositivity using two different enzyme-linked immunosorbent assay techniques. Serum albumin level was determined by the Bromocresol green method, while the CD4 lymphocyte count was obtained using the Dynal T4 count method. Body weight was measured in kilograms with light clothes on. RESULTS: There were significant positive correlations between pretreatment albumin and both pretreatment CD4 cell count and pretreatment weight, and between post-treatment albumin and both post-treatment weight and post-treatment CD4 cell count up to a count of 700 cells/microL. There were also significant positive correlations between increase in serum albumin and both increase in body weight and duration of treatment. CONCLUSIONS: We conclude that, in developing countries where many patients may not be able to afford to pay for CD4 cell counts and viral load tests, which are the traditional markers for HIV disease, serum albumin would be a very useful surrogate test for predicting severity of HIV infection and for clinical monitoring of response to antiretroviral therapy.

HIV/AIDS in Ilorin: changing trend, emerging risk factors.

OBJECTIVE: We examined HIV seropositivity rates among blood donors, subjects screened for certificate purposes, and four sentinel surveys. Demographic and clinical features were analysed over periods to determine changes in risk factors and groups at risks. METHODOLOGY: Questionnaires and protocols were completed for patients screening or clinically assessed, while HIV positivity was determined on the basis of reactivity with two different ELIZA techniques. RESULTS: The positivity rates were below 2% in blood donors, maximum of 4.3% for sentinel surveys, and 11% among subjects screened for certificate purposes. Results showed decreasing male:female ratio, younger female patients, and preponderance of traders and artisans. Weight loss, fever, and diarrhoea were the commonest presenting features. 41% live away from their spouses. CONCLUSION: The 11% positivity rate among subjects requiring certificates raises questions on the reliability of sentinel survey figures. Campaigns should be targeted at artisans, traders and those living away from their spouses.

Bacterial pneumonia in the AIDS patients.

OBJECTIVE: To determine the incidence, microbiological pattern and prognostic factor of bacterial pneumonia in AIDS patients. STUDY DESIGN: Prospective study of AIDS patients from July 2001 to Dec 2002. METHODOLOGY: Adults AIDS patients on HAART drugs that develop acute fever, cough with bronchial breathing or lung crepitations had diagnostic evaluation that included chest x-ray, paired sputum microscopy, culture and sensitivity, paired blood culture and haematological profiles including CD4' cell count. RESULTS: Twenty-one patients (22.6%), 9 males and 12 females developed community acquired pneumonia during this 16-month period. Pneumonia was confirmed in 9 patients (42.9%), presumed in 4 (19%) and probable in 8 (38%). Streptococcus pneumoniae accounted for 22% of the cases when immunity was less impaired. Staplhylococcus aureus accounted for another 22 % while Klebsiella pneumoniae, Pseudomonas aeraginosa and Escherichial coli were isolated in 11% each when immunity was severely compromised. Fifteen patients (71.4%) were successfully treated with routine antibiotics. Six cases (28.6%) died. All had anaemia, leucopoenia and low CD4 cell count. Four (66.7%) of this had positive bacterial culture with bacteremia in three of them. CONCLUSION: Bacterial pneumonia in HIV-infected patients has similar presentation to that in the general population, Staphylococcus aureus and gram-negative bacilli especially Klebsiella pneumoniae were seen in a good proportion of the cases. Outcome of treatment was poor in the presence of positive bacterial culture, anemia, leucopoenia and very low CD4+ lymphocytes.

Spectrum and prognostic significance of opportunistic diseases in HIV/AIDS patients in Ilorin, Nigeria.

BACKGROUND: Opportunistic diseases (ODs) of varying types and severities have been reported amongst HIV infected patients around the world, this made us to define the incidence, spectrum and effects of ODs on HIV infected Nigerians' CD4+cells count and survival rate. DESIGN: Retrospective analyses of HIV register from February 2002 to July 2004. RESULTS: ODs developed in 201 (68.6%) patients, 107 (53.2%) were AIDS-defining viz; TB, HIV-encephalopathy, scopulariopsis meningitis, cutaneous kaposis sarcoma and pulmonary candidiasis. Mean CD4+ count was lower with ODs compared to the controls, 138/ul vs 211/ul, p < -0.0006. It was low with non-AIDS-defining infection, 221.6/ul, lower with non-infectious AIDS-defining diseases, 192.4/ul and lowest with AIDS-defining infections, 117.7/ul. Mortality rate was 29.4%; 51 infectious and 8 non-infectious ODs against 19 (18.4%) from the controls. Risk of death was four folds higher with ODs over the controls, 59 vs 19, OR=3.98, 95%CI= 2.20- 7.27, X=24.2, p-<0.0001. This risk was also higher with infectious AIDS-defining illnesses compared to non-infectious ones, 48 vs 8, RR=4.83, 95 %CI=2.80- 8.34, X= 51.7, p-<0.0001. Death from TB was over 2(1/2) times higher than deaths from other AIDS-defining diseases, 45 vs 14, RR=2.7,95%CI=2.01-3.73,x=37.3, p-<0.0001. Average survival was shorter with ODs; 12.3weeks compared to controls, 37.8weeks, p-< -0.039. Mean survival was longest with EPTB, 29.8weeks and shortest with fungal meningitis, 1.9weeks. CONCLUSION: incidence of ODs was high, 68.6%; it was associated with lower CD4+ count and shorter patient's survival especially when it was infectious and AIDS defining.

Role of hepatic enzymes in the biochemical assessment of the severity of sickle cell anemia.

BACKGROUND AND OBJECTIVES: Various clinical and hematological indices have been used to assess the severity of Sickle Cell Anemia (SCA), however biochemical indices are lacking. Hepatomegaly has been a frequent finding in SCA and its persistence has been associated with increased disease severity. The association between hepatic enzymes and disease severity in SCA is undefined. This study was therefore designed to look at the association between clinical severity and hepatic enzymes in SCA subjects with persistent hepatomegaly (that is, lasting more than six months) in order to determine a possible role for hepatic enzymes as a biochemical index of severity. MATERIALS AND METHODS: Serum levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (SAP) and gamma-glutamyl-transferase (GGT) were determined in two groups of SCA subjects and in hemoglobin genotype AA (HbAA) controls. SCA group comprised of 37 subjects with persistent hepatomegaly equal to or greater than 10 cm (below right coastal margin) while the second group comprised another 38 SCA subjects without palpable hepatomegaly. 40 individuals with hemoglobin genotype AA served as control for both groups. Clinical and hematological parameters of severity which included steady state haematocrit, number of transfusions per year, number of crises per year and percentage HbF level were determined and scored in a manner similar to the Glasgow coma scale. Results obtained were analyzed with the aid of statistical package on EPI-INFO version 6.02. RESULTS: There was a significant increase in serum ALT, ALP and GGT levels in SCA with persistent hepatomegaly over those without hepatomegaly (p < 0.05, p < 0.05 and p < 0.01 respectively). All the index scores and the final aggregate severity scores were also significantly higher in SCA subjects with persistent hepatomegaly. Only GGT demonstrated a fairly positive and significant correlation (r = 0.46, P < 0.05) with increased clinical severity among the hepatic enzymes. CONCLUSION: Elevated serum level of GGT in SCA during steady state is suggestive of increased disease severity.

Short-term effect of oral contraceptive pills on some haemostatic parameters in healthy Nigerian women.

The objective of this study was to determine the effect of low-dose combined oral contraceptive pill, Lo-femenal, on the following haemostatic parameters: platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen, of apparently healthy Nigerian women over a period of three months. A total of sixty-seven women were recruited for the study consisting of forty-seven subjects and twenty age-matched controls, who were aged between 17 and 37 years. All haemostatic parameters were determined using standard haematological techniques described by Dacie and Lewis, before, and three months after continuous use of oral contraceptive pills in the subjects. The same parameters were determined three months apart in control subjects who were on oral contraceptive pills. Statistical analysis of data was done using the chi-squared test and statistical significance was based on p value < 0.05. The mean values of platelet count and fibrinogen were significantly increased (p=0.0000 and 0.0003 respectively), while the PT and TT reduced significantly (p=0.007 and 0.0000 respectively) after three months of contraceptive use. There was no significant difference in the value of APTT (p=0.17) before and after oral contraceptive use. No differences were observed in the values in the controls. The findings in this study indicate some degree of pro-coagulant activity in the subjects, and the need to properly assess and monitor haemostatic parameters in pills users before commencement and while on them.

Sludge, stones and sickle cell anaemia.

A total of ninety-seven paediatric and adult patients with sickle cell anaemia and fourty-eight control subjects were investigated with the aim of determining the content of the gallbladder. The patients and control subjects were categorised according to the presence or otherwise of gallbladder stones, and, or sludge. The age last birthday, PCV and number of crises per year were recorded in order to determine their influence on the development of gallbladder stones and sludge. The gallbladder contents were examined using ultrasonographic technique. The age and number of crises per year was determined from the clinical record files and direct questioning of patients. Seventy patients had normal gallbladder content while eighteen had sludge, six had stones, and three had a combination of sludge and stones. None of the control subjects had sludge or stone. The age of patients increased from progressively from those with normal content through those with sludge to those with stones. The PCV and number of crises per year only differentiated between normal and abnormal gallbladder contents. While the prevalence of gallbladder stones in this study falls within the range in previous studies, a high prevalence of sludge was observed. The association between the occurrence of sludge and stones with age, PVC and number of crises per year suggests the need for a larger series and that they may identify a group of patients requiring closer monitoring.

Trends in haemoglobin S, F, and A2 levels in West African and Caribbean sickle cell anaemia patients.

The levels of Haemoglobins S, F and A2, as well as Haemoglobin concentration, age, and average admissions per year (AVEADM) were compared in sickle cell anaemia patients of West African and Caribbean origins. Correlations of the haemoglobin levels with age, and the trends were also determined. The West African patients who comprised of 42 Nigerians, 23 Ghanaians and 13 Sierra Leoneans were compared to determine any differences in trend within them. One hundred and thirty-four patients, made up of 78 West Africans and 56 Caribbeans were analysed. The Caribbean patients were significantly older than the West African patients (P = 0.023). Haemoglobins S and F showed positive and negative significant correlations, respectively, with age in West African patients whereas there was no significant correlation in the Caribbean patients. Scatter charts and trendlines show that Haemoglobin S continued to increase while Haemoglobin F declined with age up to the age of 30 years in West Africans, Nigerians showing the steepest slope, while it remained stable with increasing age in the Caribbean patients. These findings may be due to the fact that the Caribbeans are genetic and socio-cultural mixtures of the different West African peoples, and the absence of indigenous malaria pressure.

Splenic size determination in sickle cell anaemia: an ultrasonographic study.

OBJECTIVES: To examine the generally accepted concept of autosplenectomy in patients with sickle cell anaemia, and determine the relationship between age, the steady state PCV and splenic size. DESIGN: Case-control study. SETTING: Sickle Cell Clinic, University of Ilorin Teaching Hospital, Ilorin, Nigeria. SUBJECTS: Sickle cell anaemia patients aged three to 47 years, while the controls included age and sex matched patients attending the General Outpatient Department for minor ailments. INTERVENTIONS: Longitudinal and coronal sizes of the spleen were measured antemortem, by ultrasonographic method, in 98 adult sickle cell anaemia patients and 48 control subjects and compared. The splenic size was correlated with age and PCV among sickle cell anaemia patients. MAIN OUTCOME MEASURES: Determination of longitudinal and coronal sizes of the spleen, comparison of mean splenic sizes of patients with those of controls by Student's t test, and correlation of age and PCV with splenic sizes. RESULTS: Both mean longitudinal and coronal diameters, and surface area were found to be higher in the sickle cell anaemia patients compared to the controls. While the longitudinal diameter increased with age continuously, the coronal diameter decreased after the age of 30 years. There were no significant correlations between the splenic sizes and PCV and number of crises per year. CONCLUSION: The general belief that sickle cell anaemia patients suffer anatomical autosplenectomy was not confirmed. This could be due to the effect of malaria and improved clinical care.

Prevalence and titre of alpha and beta haemolysins in blood group 'O' donors in Ilorin.

Sera from 250 selected group 'O' donors were screened for anti A and anti B haemolysins. Those that were positive were titrated for haemolytic antibodies and the result read both visually and spectrophotometrically. The visual and spectrophotometric titres were then compared. The prevalence of alpha and beta haemolysin was 23.2%. Haemolytic anti B occurred twice as frequent as haemolytic anti A but the titre of haemolytic anti-A was higher than haemolytic anti-B. There was no relationship between sex and age and the prevalence of haemolysins. Significant visual titre of 8 and above was found in 18.5% of lytic anti-A and 13.2% of lytic anti-B, but the proportion of the whole study population with significant visual titre of 8 and above was low, i.e., 2.0% for anti-A and 2.8% for anti-B. On the average the spectrophotometric titres were consistently one fold higher than the visual titres.

Distribution of ABO and RH genes in Nigeria.

Phenotype and gene frequencies of ABO and RH (D) systems were studied in 37,846 random blood donors in five zone of Nigeria (South West) (Yoruba)--Zone A, North West (Hausa-Fulani)--Zone B, Plateau (Birom)--Zone C, South East (Igbo)--Zone D and North East (Kanuri)--Zone E). We assessed the micro differences of genetic markers of ABO and RH blood groups between the ethnic groups in the ABO and RH blood group systems. Gene frequencies were ABO *O = 0.7068, ABO *A = 0.1490, ABO *B = 0.1443, RH *D = 0.8150 and results are similar to those earlier reported. Phenotype frequencies of the blood groups were in agreement with Hardy-Weinberg equilibrium expectations, except in two zones B and C where deviation was thought to be due to a high frequency of blood group AB.

The predictive value of white cell count in assessing clinical severity of sickle cell anaemia in Afro-Caribbeans patients.

The relationship between each of haemoglobin concentration (Hb), red cell count (RCC), white cell count (WBC), platelet count (PLT), mean corpuscular volume (MCV), red cell width difference (RWD), and average number of acute admissions per year (AVEADM), were determined in a cross-sectional study of 128 Afro-Caribbean sickle cell anaemia patients attending the Sickle Cell Disease Clinic of Central Middlesex Hospital in London for a mean of 7.6 patient-years. The diagnosis of sickle cell anaemia was made by both haematological and DNA analyses. The haematological parameters were determined using Coulter S automated counter during the steady state periods while the AVEADM was computed from all admissions for painful crisis, acute anaemia and acute chest syndrome, priapism, and acute stroke. Haemoglobin F level was determined by HPLC. Analysis was done in the paediatric and adult patients separately. There were no significant correlations between any of the parameters and AVEADM in the paediatric group. In adult patients, there was significant positive correlation (P < 0.05) between WBC and AVEADM. WBC has a negative correlation with Hb concentration and HbF level. WBC 10 x 10(9)/L and above is associated with Hb and HbF level below the mean for the group. WBC is lower but not significantly, in patients with single alpha-gene deletion than in those without deletion (P = 0.06). This study suggests that higher WBC count may suggest possible increased hospital admission, lower Hb concentration, and lower HbF level, in adult patients, and that, as a single parameter it can be of value in the assessment of patients with sickle cell anaemia. Possible mechanisms for these findings are also suggested.

Acceptability of prenatal diagnosis of sickle cell anaemia by a sample of the Nigerian population.

The acceptability of prenatal diagnosis (PND) as a means of controlling sickle cell anaemia (SCA) in Nigeria was examined using a semi-structured questionnaire. The aim of the study was to examine the attitudes of well-informed, educated Nigerians to the use of PND and abortion of confirmed HbSS pregnancies in the control of SCA. There were 433 respondents comprising 204 males and 210 females (gender was not recorded for 19 respondents). They were aged 15-50 (31 +/- 18) years. Forty percent had HbAA, 15% HbAS, 1.6% HbAC, 2% HbSS, and 0.2% HbSC; 153 (35%) had no knowledge of their haemoglobin electrophoretic patterns "genotypes". The majority of the respondents (69.5%) appreciated the role of both parents in the transmission of the disease. Only 45 (18%) of the respondents heard of SCA for the first time through sickle cell counsellors, 23% through newsmedia, 29% through friends and relations, 21% obtained the information through health workers, while 5% had never heard of sickle cell disease before the interview. As many as 192 (44%) of the respondents were aware that SCA could be diagnosed in pregnancy; 45% would opt for termination of the affected pregnancies. Avoidance of the problems associated with managing SCA children was the most important reason for approving pregnancy termination, whereas 73% of those rejecting pregnancy termination did so for religious and moral reasons. Seventy-eight percent of those interviewed would want PND started in Nigeria. The two approved control measure for SCA by most of the respondents were genetic counselling and PND; both should, therefore, be considered in implementing control measures for SCA in this country.

Splenic regrowth in sickle cell anaemia following hypertransfusion.

We describe five adult patients with sickle cell anaemia (SS) who developed clinical, radiological and histological evidence of splenic regrowth while receiving regular blood transfusions. Five patients, all homozygous SS, range 23-34 years, were commenced on hypertransfusion therapy. Three patients were transfused because of severe recurrent vaso-occlusive crises, one for chronic sickle lung and one in an attempt to prevent deterioration of renal function. The mean duration of hypertransfusion prior to documentation of splenic regrowth was 52 months (range 12-97 months). Two patients developed significant hypersplenism. One patient had clinically-apparent splenomegaly and four patients had splenomegaly documented on ultrasound. Splenic regrowth in hypertransfused adults with sickle cell anaemia is not infrequent and may have important clinical implications.

Hepatitis B surface antigenaemia in Ilorin, Kwara State, Nigeria.

OBJECTIVE: To determine the prevalence of HBsAg among blood donors in Ilorin, in the middle belt area of Nigeria. DESIGN: Cross sectional. SETTING: University of Ilorin Teaching Hospital. SUBJECTS: 100 patients from antenatal clinic, 100 patients from STD clinic and 295 healthy blood donors from UITH. MAIN OUTCOME MEASURES: Prevalence of HBsAg. RESULTS: One hundred and sixteen (23.4pc) of the subjects were positive for HBsAg. These included 16pc of ANC patients, 36pc of STD patients and 21.7pc of blood donors. The positivity rate among STD patients was significantly higher than among ANC patients (p < 0.01) and blood donors (p < 0.01). The positivity rate among patients above 34 years of age was higher than in those of 15 to 34 years. CONCLUSION: The above positivity rates are higher than those previously reported in Nigeria and may indicate increasing prevalence. The highest rate found among STD clinic patients may have identified them as a reservoir group to which control programmes need to be targeted.

Blood transfusion in sickle cell disease.

Blood transfusion is used as a life-saving and prophylactic treatment in sickle cell disease. Despite the many complications associated with its use, few randomised controlled trials and careful research studies have been performed to fully define its role. This subjects is, therefore, discussed in the context of the current literature and authors' experience.