T-lymphocyte subsets in apparently healthy nigerian children.

Population studies showed that there are differences in T-lymphocytes subpopulation of normal children in different regions, and reference values in an area might be different from another. This study compared the values in our population with CDC and WHO reference values. Blood samples from 279 healthy, HIV-negative children <12 years of age were analysed for complete blood count, CD3+, CD4+, CD8+ counts and percentages. Except for CD8%, mean values for all parameters measured significantly decreased with age. CD4+ counts were higher in females than males, P < .05. Using the WHO criteria, 15.9% of subjects had low total lymphocyte count and 20.6% had low CD4 count. Children <3 years had median CD4% lower than WHO normal values. Our median CD4+ counts correlated with CDC values. Values used by WHO in infants are higher than ours. We suggest that our children be assessed using CDC reference values which correlate with ours.

Management of HIV-1 infection with a combination of nevirapine, stavudine, and lamivudine: a preliminary report on the Nigerian antiretroviral program.

OBJECTIVE: To evaluate treatment outcome in the first 12 months among HIV-positive patients managed with a combination of nevirapine + stavudine + lamivudine under the current national antiretroviral (ARV) program in Nigeria. DESIGN: This was a prospective observational, cohort study on 50 ARV-naive patients who met the inclusion criteria for the program and had given informed consent. All patients were in stage 2 or stage 3 periods of infection based on World Health Organization clinical classification. The patients were treated with the generic brands of ARVs and treatment consisted of oral nevirapine (Nevimal, Cipla, Mumbai, India), 200 mg daily, lamivudine (Lamivir, Cipla), 150 mg twice daily, and stavudine (Stavir, Cipla), 40 mg twice daily. Prior to initiation of treatment, the clinical history and baseline data for each patient were documented. The levels of plasma HIV-1 RNA, CD4 cell counts, frequency of opportunistic infections, and estimated body mass index were recorded at baseline and subsequently at intervals during treatment. Data obtained at the various sampling times for each parameter were compared against their baseline values. RESULTS: Data on the plasma HIV-1 RNA levels indicated that between baseline and week 24, the median viral load of the patients decreased by 1.79 log(10) copies/mL. Equally between baseline and week 48 the median CD4 cell counts increased by 186 x 10(6) cells/L, the frequency of opportunistic infections decreased by 82%, the median body mass index increased by 4.8 kg/m(2), and 36% experienced side effects, which were minor and transient. The most prevalent side effect recorded was skin rash associated with nevirapine. Good adherence to this triple regimen was recorded in >85% of the patients. CONCLUSIONS: The overall results within the 12-month treatment period indicated an effective suppression of viral replication, the reconstitution of the immune system, and improvement of the physical well-being of the study population. Though there may be differences in global distribution of the infecting HIV-1 subtypes, the clinical and biologic results of this study compared favorably to those documented in cohorts treated with branded and generic ARV drugs in some developed and developing countries. The cumulative data in this study further confirmed that the correct use of generic brands of ARVs is a feasible option in HIV care and support programs in resource-poor countries.

Haematological and biochemical response to treatment of HIV-1 infection with a combination of nevirapine + stavudine + lamivudine in Lagos Nigeria.

To evaluate the effect of a combination of nevirapine + stavudine + lamivudine on Haematological and Biochemical values of HIV-1 positive patients in Lagos. Fifty patients who met the enrollment criteria for accelerated clinical trial were studied. Ten millimeters of blood was taken from each patient at first visit for basic haematological and biochemical values. Viral load and CD4 cell counts were also analyzed. All the values were repeated at 12 weeks, and 24 weeks, after patients were placed on drug treatment regimen. All the data were analyzed using Epi-info version 6.4D. The mean erythrocyte sedimentation rate (ESR) results were 53.3 ± 41.8 mm/1 hr, 48.2 ± 40.6 mm/1 hr and 28.6 ± 20.7 mm/1 hr. Haemoglobin (Hb) 123 ± 15 g/L, 124 ± 21 g/L and 132 ± 14 g/L. Packed cell volume 36.8 ± 4.5%, 37.6 ± 4.8%, and 40.3 ± 3.3%. Total white blood cell (WBC) 4.2 ± 1.0, 5.0 ± 1.5 and 4.6 ± 1.0 (baseline, 12 weeks and 24 weeks respectively). Creatinine, 1.2 ± 0.68 g/L, 1.2 ± 0.7 g/L and 1.04 ± 0.3 g/L at (baseline, 12 weeks and 24 weeks respectively). Serum amylase 37.9 ± 15.1 IU/L, 38 ± 23.9 IU/L and 24.3 ± 11.6 IU/L. Triglyceride 95.2 ± 48.3 IU/L, 92.38 ± 54.3 IU/L, and 78.0 ± 35.6 IU/L. Serum bilirubin 0.18 ± 0.09 µmol/L, 0.29 ± 0.28 µmol/L and 0.33 ± 0.24 µmol/L. Alanine transaminase (ALT) 9.9 ± 3.3 IU/L, 15.1 ± 9.0 IU/L and 14.1 ± 9.3 IU/L. Serum aspartate transaminase (AST) 8.2 ± 6.2 IU/L, 9.4 ± 5.2 IU/L and 9.1 ± 6.0 IU/L. On comparison of the results between baseline and 12th week, all parameter were similar except PCV, Hb, serum bilirubin, serum ALT, and total WBC, which were significantly high at 12th week. (p≤ 0.05). On comparison of results between 12th week and 24th week all parameters were similar except Hb and PCV (which were significantly higher at 24th week) while ESR, was significantly lower at 24th week (p≤ 0.05). It was concluded that nevirapine + stavudine + lamivudine combination results in improved haematological values of HIV/AIDS patients. The effect of the drug combination on biochemical parameter in a short period of 24 weeks may not be much. Clinical response and haematological response alone may be used for patient monitoring in a resource poor setting where CD4 count and viral load analysis is impossible.