Pattern, challenges and correlates of condom use among Nigerians living with HIV infection.

OBJECTIVE: To determine the pattern, challenges and correlates of condom use among Nigerians living with HIV Infection. METHODS: A cross sectional questionnaire study among HIV positive adults attending an HIV treatment centre in Lagos, Nigeria. Data entry and analysis were done with Epi-info version 3.5.1. RESULTS: The mean age of respondents was 35 (SD=7.7; range: 17-58 years) and mean age at sexual debut was 20 years old (range: 7-37 years). Majority were women (66.6%), had at least secondary school education(91.1%), married (68.2%)), on ART (50.7%) and knew their partners HIV status(60.9%). The rate of condom use at last sex act was 65.9%, but only 48.8% used condom consistently. Factors associated with condom use were male gender (OR=2.43, CI=1.35-4.33, P=0.002), less than secondary school education (OR=3.12, CI=1.04-9.28, P=0.05) and Not knowing partner's HIV status (OR=1.90, CI=1.04-3.80, P=0.04). Refusal to use condom (28.4%) were as a result of pregnancy intention, undesirability of condom in marriage and decreased sexual pleasure. CONCLUSION: There is low consistent condom use rate of 48.8% among this cohort despite their exposure to behavioural change messages. A review of the present counselling strategy and combination prevention is therefore advocated.

Pattern, challenges and correlates of condom use among Nigerians living with HIV infection

<p><b>OBJECTIVE</b>To determine the pattern, challenges and correlates of condom use among Nigerians living with HIV Infection.</p><p><b>METHODS</b>A cross sectional questionnaire study among HIV positive adults attending an HIV treatment centre in Lagos, Nigeria. Data entry and analysis were done with Epi-info version 3.5.1.</p><p><b>RESULTS</b>The mean age of respondents was 35 (SD=7.7; range: 17-58 years) and mean age at sexual debut was 20 years old (range: 7-37 years). Majority were women (66.6%), had at least secondary school education(91.1%), married (68.2%)), on ART (50.7%) and knew their partners HIV status(60.9%). The rate of condom use at last sex act was 65.9%, but only 48.8% used condom consistently. Factors associated with condom use were male gender (OR=2.43, CI=1.35-4.33, P=0.002), less than secondary school education (OR=3.12, CI=1.04-9.28, P=0.05) and Not knowing partner's HIV status (OR=1.90, CI=1.04-3.80, P=0.04). Refusal to use condom (28.4%) were as a result of pregnancy intention, undesirability of condom in marriage and decreased sexual pleasure.</p><p><b>CONCLUSION</b>There is low consistent condom use rate of 48.8% among this cohort despite their exposure to behavioural change messages. A review of the present counselling strategy and combination prevention is therefore advocated.</p>

Effect of HIV-1 infection and increasing immunosuppression on menstrual function.

AIM: The aim of this study was to determine the prevalence, pattern and determinants of menstrual abnormalities in HIV-positive Nigerian women. METHODS: A cross-sectional study was carried out involving 3473 (2549 HIV-seropositive and 924 seronegative) consecutive and consenting women seen at the HIV treatment centers at the Nigerian Institute of Medical Research, Lagos and the Federal Medical Centre, Markurdi. RESULTS: The sociodemographic characteristics of the two groups were comparable, except for body mass index (BMI): the HIV-negative women (28.1 ± 8.1) had statistically significantly (P < 0.005) higher BMI compared to the HIV-positive women (21.9 ± 7.5). Menstrual abnormalities were significantly more common in women living with HIV/AIDS (29.1%) compared to the HIV-negative (18.9%) women (P < 0.001). The proportions of women in the two groups with intermenstrual bleeding, menorrhagia, hypermenorrhea, and postcoital bleeding were similar (P > 0.005), however amenorrhea, oligomenorrhea, irregular periods and secondary dysmenorrhea were more common in the HIV-positive women (P < 0.02). Primary dysmenorrhea was less common in HIV-positive women (P < 0.03). Among the HIV-positive women, menstrual dysfunction was more common in women living with HIV/AIDS with opportunistic infections, CD4 count < 200, not undertaking therapy, symptomatic disease and BMI < 20. However, after controlling for cofounders, only CD4 < 200 (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.2-9.7), BMI < 20 (OR, 2.4; 95%CI, 1.3-3.5) and not taking antiretroviral drugs (OR, 2.05; CI, 1.7-6.5) were associated with amenorrhea, oligomenorrhea, irregular periods and secondary dysmenorrhea. CONCLUSION: HIV-positive women in this study experienced more menstrual abnormalities of amenorrhea, oligomenorrhea, and irregular periods compared to the HIV-negative controls. HIV-positive women with CD4 count < 200, BMI < 20 and who do not take antiretroviral drugs are at the greatest risk.

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.

Prevalence of HIV among women with vaginal discharge in a gynecological clinic.

OBJECTIVE: Vaginal discharge is a common complaint among women with sexually transmitted diseases (STDs) in Nigeria. Given the association between STDs and HIV and the alarming rise in the prevalence of HIV in Nigeria, we performed this study to determine the prevalence of HIV in patients with vaginal discharge. STUDY DESIGN: Between April 2000 and August 2000, women who attended the Lagos University Teaching Hospital and complained of vaginal discharge were adequately counseled for HIV serotest. High vaginal/endocervical swabs and venous blood were taken for microbiological studies and HIV serotest, respectively. RESULTS: Out of the 230 women counseled for HIV serotest 140 (60.9%) consented. The mean age of the 140 was 31.1+/-6.9 years (range 18-50 years). In 31 (22.1%), Candida albicans was isolated, in 26 Gardnerella vaginalis (18.8%), in 17 Staphylococcal spp. (12.1%); and E. coli, Trichomonas vaginalis, and Neisseria gonococcus in 7.9%, 4.3%, and 1.4%, respectively. Four (2.9%) of the 140 patients were HIV seropositive, and all had Candida albicans isolated. The prevalence of HIV among patients with Candida albicans was 12.9%. Association between HIV seropositivity and Candida albicans infection is significant (X2=14.48; p=0.002). CONCLUSION: Candida albicans is a common cause of vaginal discharge among HIV-seropositive women in Lagos.

Ferritin and haematological values in healthy elderly Nigerians.

Two-hundred Nigerians (65 years and above) were studied and compared with control (18-50 years). Haematocrit, haemoglobin, mean corpuscular haemoglobin concentration, mean corpuscular haemoglobin, mean corpuscular volume, platelets and ferritin were analyzed. Mean ferritin levels were 105 ± 30 µg/L and 72 ± 10 µg/L (males and females respectively). Mean MCV, MCH and MCHC were 94.6 ± 9.0 fl, 93.6 ± 9.0 fl, 31.5 ± 3.0 pg, 31.4 ± 4.4 pg, 348 ± 30 g/L, and 347 ± 42 g/L. Mean haematocrits were 37 ± 4%, 36 ± 4%, while mean haemoglobins levels were 132 ± 24 g/L and 129 ± 1 g/L. RBC counts were 4.1 ± 0.8 x 1012/L, and 4.0 ± 0.5 x 1012/L. Mean total WBC counts were 6.4 ± 1.5 x 109/L and 6.3 ± 0.7 x 109/L; mean platelets were 170 ± 60 x 109/L, 184 ± 5 x 109/L. All haematological parameters were similar in both aged males and females, except ferritin, haematocrit, RBC and haemoglobin, which were significantly higher in males (p< 0.05). Significant sex differences exist in all the parameters, of control except MCV and total WBC count. There were significant differences in all the haematological parameters between the controls and the aged (p< 0.05), and between the aged (65-84 years) and the very aged (85-105 years) (p< 0.05). Reference haematological range needs to be established for the elderly Nigerians.