Effect of Obesity on Resistin Concentrations in Normal, Pre-Obese and Obese Apparently Healthy Nigerian-Africans.

BACKGROUND: Among Caucasians, conflicting findings exist on resistin in obesity and its relation to metabolic indices, with scarcity of such in Nigerian-Africans. Therefore, the study assessed plasma resistin and explored its relationship with obesity and selected cardiometabolic risks. METHODS: A cross-sectional comparative-analytical study on 87 randomly-selected non-diabetic Nigerians allocated into three groups by the WHO criteria: 24 normal; 23 pre-obese and 40 obese. Resistin was measured via enzyme-linked immunosorbent assay. One-way Analysis of Variance (ANOVA) and Independent Kruskal-Wallis test determined differences in BMI categories. Spearman's correlation and Multivariate Logistic Regression assessed relationships. A sub-group analysis excluding subjects with first time incidental finding of high blood pressure, determined further associations. RESULTS: Resistin concentrations trended towards higher levels in obese than normal controls {Mean ± SD, 6.72 ± 4.25 ng/mL versus 5.10 ± 2.58 ng/mL}, with significantly (p<0.05) higher obesity indices, fasting insulin (FI) and HOMA-IR in obese than normal controls. Hyperresistinaemia involved 8(9.2%) subjects as against 79(90.8%) with normoresistinaemia, {Mean ± SD, 15.1 ± 2.6 ng/mL versus 5.3 ± 2.8 ng/mL, (p<0.001)}. Log (Ln10) hyperresistinaemia was significantly (p<0.05) positively correlated to obesity indices (BMI, r=0.29, p=0.006; WC, r=0.23, p=0.04) but not to HOMA-IR, FI, FBG, SBP, DBP and age. Ln10 Hyperresistinaemia in females was significantly (p=0.05, OR: 1.12, 95% CI, 1.0-1.25) associated with central obesity by the IDF criteria in both unadjusted and step-wise age, sex, SBP & DBP adjusted models. Similar finding was for generalized obesity, albeit with low odds in all subjects (p=0.009), with persistence in the step-wise age, sex and SBP/DBP adjusted models. In the sub-group analysis, resistin showed similar findings to that of the whole sample population. CONCLUSION: Resistin concentrations trended towards higher levels in obese than normal healthy non-diabetic Nigerian-Africans. Its lack of correlation with HOMA-IR and mild correlations/marginal relations to obesity indices may suggest possible interplay of other proinflammatory cytokines or hormones which may be evaluated in further studies.

CONTEXTE: Chez les Caucasiens, il existe des résultats contradictoires sur la résistine dans l'obésité et sa relation aux indices métaboliques avec la rareté de telles chez les Nigérians-Africains. Par conséquent, l'étude a évalué la résistine plasmatique et a exploré sa relation avec l'obésité et certains risques cardiométaboliques. MÉTHODES: Une étude transversale comparative et analytique a été réalisée sur 87 nigérians non-diabétiques sélectionnés au hasard et répartis en trois groups selon les critères de l'OMS : 24 normaux ; 23 préobèses et 40 obèses. La résistine a été mesurée par dosage immuno-enzymatique. Analyse de variance à sens unique (ANOVA) et test indépendant de Kruskal-Wallis ont déterminé les différences entre les catégories d'IMC. La corrélation de Spearman et la régression logistique multivariée ont évalué les relations. Une analyse de sous-groupe excluant les sujets chez qui une hypertension artérielle avait été découverte par hasard pour la première fois a déterminé d'autres associations. RÉSULTATS: Les concentrations de résistine tendent à être plus élevées chez les sujets obèses que chez les témoins normaux {Moyenne ± SD, 6,72 ± 4,25 ng/mL contre 5,10 ± 2,58 ng/mL}, avec des indices d'obésité significativement (p<0,05) plus élevés, l'insuline à jeun (IF) et l'HOMAIR chez les obèses que chez les témoins normaux. L'hyperrésistinémie concernait 8 (9,2%) sujets contre 79 (90,8%) avec normorésistinémie, {Moyenne ± SD, 15,1 ± 2,6 ng/mL contre 5,3 ± 2,8 ng/mL, (p<0,001)}. L'hyperrésistinémie log (Ln10) était significativement (p<0,05) corrélée positivement aux indices d'obésité (IMC, r=0,29, p=0,006 ; tour de taille, r=0,23, p=0,04) mais pas à HOMA-IR, FI, FBG, SBP, DBP et l'âge. Ln10 L'hyperrésistinémie chez les femmes était significativement (p=0,05, OR : 1,12, IC 95 %, 1,0-1,25) associée à une obésité l'obésité centrale selon les critères de la FID, à la fois de manière non ajustée et par paliers. l'âge, le sexe, la TAS et la TAD. Une constatation similaire a été faite pour l'obésité généralisée, bien qu'avec une faible probabilité chez tous les sujets (p=0,009), avec une persistance dans les modèles ajustés par étape en fonction de l'âge, du sexe et du SBP/DBP. lDans l'analyse de sous-groupe, la résistine a montré des résultats similaires à ceux de l'ensemble de la population de l'échantillon. CONCLUSION: Les concentrations de résistine tendent vers des niveaux plus élevés chez les Nigérians-Africains obèses que chez les Nigérians non-diabétiques en bonne santé. Son manque de corrélation avec HOMA-IR et des corrélations légères/marginales avec les indices d'obésité aux indices d'obésité peut suggérer une interaction possible avec d'autres cytokines ou hormones pro-inflammatoires, ce qui pourrait être évalué dans des études ultérieures. Mots clés: Résistine, obésité, surpoids, non-obésité, non-diabète, Africains Nigérians en bonne santé, risques cardiométaboliques.

Prevalence of hepatitis B vaccination among health care workers in Nigeria in 2011-12.

BACKGROUND: Hepatitis B virus (HBV) infection is an endemic infection in Nigeria. Health care workers (HCWs) are at risk of occupational exposures to HBV-infected blood and body fluids. OBJECTIVE: To determine the prevalence and determinants of HBV vaccine coverage among HCWs in two teaching hospitals in Nigeria. METHODS: This cross-sectional study was undertaken in 2011 and 2012 in two teaching hospitals in Jos, North-Central Nigeria, and Yenagoa, South-South Nigeria. A self-administered structured questionnaire was administered to HCWs to obtain socio-demographic data and history of HBV vaccination. RESULTS: Out of 290 HCWs who participated in the study, 185 (64.5%) had received at least one dose of HBV vaccine; 105 (36.2%) had full coverage of three doses. Professional category and previous training in infection control were independently associated with HBV vaccination. House officers and laboratory scientists were more likely to be unvaccinated than resident doctors, consultant doctors and nurses. Full vaccine coverage was associated with younger age and shorter years of professional experience. CONCLUSION: We observed a generally low rate of HBV vaccine coverage among HCWs in Nigeria. Establishment of policies on compulsory HBV vaccination of all HCWs in Nigeria is recommended.

Prevalence Pattern and Determinants of Disclosure of HIV Status in an Anti Retroviral Therapy Clinic in the Niger Delta Region of Nigeria.

BACKGROUND: In order to advance the extent of self-disclosure of HIV sero-status in Nigeria, we evaluated the prevalence, pattern and determinants of disclosure of HIV status amongst adult patients in a hospital in the Niger Delta. MATERIALS AND METHODS: In a three month cross sectional study undertaken in March 2012, the demographic and clinical data as well as HIV sero-status disclosure frequency and pattern were obtained using a pre-tested questionnaire from consenting HIV infected adults attending the Anti-Retroviral Therapy Clinic in the Niger Delta. Independent determinants of HIV disclosure to current sexual partner were determined using an unconditional logistic model. P<0.05 was considered statistically significant. RESULTS: A total of 260 patients were studied out of which 184(71%) were females. Disclosure to current sexual partner was found to be 62.0% and students had the least disclosure rate. Majority of study participants preferred to disclose to family members (57%) than past sexual partner (2.5%) or friend (4.9%). Although HIV disclosure was significantly associated with male sex, living with sexual partner, partner being HIV positive; the only independent determinants of HIV disclosure were partner being on ART (OR-12.7, 95% CI 1.2-132.7) and being currently married (OR-8.8, 95% CI 2.1-36.8). CONCLUSION: The results of our study suggest low rate of HIV status disclosure among HIV infected patients in the Niger Delta. We found that receiving ART and being currently married promoted disclosure. There is need for clinicians and policy makers to foster disclosure of HIV sero-status in Nigeria especially among HIV infected students and unmarried sexual partners.

The frequency and outcome of neuropathies among HIV/AIDS adults treated at a tertiary hospital in Kaduna State, Nigeria.

AIMS AND OBJECTIVES: Highly active antiretroviral therapy (HAART) has been shown to reduce AIDS- defining illnesses, including neuropathies. However, it has been postulated that an increase in age -, HIV- and HAART- related neurological complications will occur as HIV-infected persons live longer. This study investigated the frequency and outcome of neuropathies in relation to CD4+ cell count and HAART status of hospitalised HIV/AIDS patients in Shika. PATIENTS AND METHODS: Consecutive adult (e"15 years) non pregnant HIV- infected patients treated at Ahmadu Bello University Teaching Hospital Shika-Zaria from January 2006 to May 2013 with neuropathies were studied. Non HIV-infected patients with neurological disorders and HIV-infected patients without neuropathies were excluded. RESULTS: Of 5240 HIV/AIDS patients seen , 11% (566) presented with neuropathy at median CD4+ cell counts of 200 cells / ul, with yearly reduction of the frequency of patients with neuropathy from 3.9% in 2006 to 0.06% in 2013. Male: female ratio was 2:1 and respective mean years were 41.9±10.1: 45.3±17.4 (p<0.00). 253 (45%) were on HAART at presentation. 40 patients died and the mortality was associated with recurrent seizures, CD4+ cell counts d" 100 / ul, male sex, HAART-naivety and presence of co-morbidity and complications. CONCLUSIONS: The progressive reduction in the yearly frequency of neuropathy among HIV/AIDS patients suggests a beneficial effect of HAART on neuropathies. However, late presentation, low CD4+ cell counts and failure of patients to start HAART early were responsible for AIDS-related mortality thus highlighting the importance of early HIV screening and treatment.

Prevalence pattern and determinants of disclosure of HIV status in an anti retroviral therapy clinic in the Niger delta region of Nigeria

Background: In order to advance the extent of self-disclosure of HIV sero-status in Nigeria, we evaluated the prevalence, pattern and determinants of disclosure of HIV status amongst adult patients in a hospital in the Niger Delta. Materials and Methods: In a three month cross sectional study undertaken in March 2012, the demographic and clinical data as well as HIV sero-status disclosure frequency and pattern were obtained using a pre-tested questionnaire from consenting HIV infected adults attending the Anti-Retroviral Therapy Clinic in the Niger Delta. Independent determinants of HIV disclosure to current sexual partner were determined using an unconditional logistic model. P<0.05 was considered statistically significant. Results: A total of 260 patients were studied out of which 184(71%) were females. Disclosure to current sexual partner was found to be 62.0% and students had the least disclosure rate. Majority of study participants preferred to disclose to family members (57%) than past sexual partner (2.5%) or friend (4.9%). Although HIV disclosure was significantly associated with male sex, living with sexual partner, partner being HIV positive; the only independent determinants of HIV disclosure were partner being on ART (OR-12.7,95% CI 1.2-132.7)and being currently married (OR-8.8,95% CI 2.1-36.8). Conclusion: The results of our study suggest low rate of HIV status disclosure among HIV infected patients in the Niger Delta. We found that receiving ART and being currently married promoted disclosure. There is need for clinicians and policy makers to foster disclosure of HIV sero-status in Nigeria especially among HIV infected students and unmarried sexual partners

Dermatomyositis associated with HIV-1 infection in a Nigerian adult female: a case report.

Human immunodeficiency virus (HIV) infection has been implicated as a trigger for various autoimmune diseases, one of which is dermatomyositis. This is a very rare autoimmune disease characterised by myopathy, typical cutaneous signs and variable systemic manifestations. To our knowledge, the association of this rare disease with HIV infection has not been previously reported in Nigeria. We therefore decided to report the case of a 40 year old HIV-1 infected Nigerian female who presented to us with muscle, skin, and systemic manifestations of dermatomyositis. Our aim is to show the effect of HIV infection, as well as HAART-induced immune reconstitution on the clinical course of dermatomyositis.

Seroprevalence and determinants of human herpes virus 8 infection in adult Nigerians with and without HIV-1 infection.

BACKGROUND: There is a dearth of studies on HHV8-HIV co-infections from Nigeria, even as both infections have been shown to be endemic in Africa. This study examined the seroprevalence and determinants of HHV8 infections in adult Nigerians with and without HIV-infection. METHODS: In 2007, a cross sectional study undertaken in a tertiary hospital in Zaria, northern Nigeria enrolled 71 HIV-1 positive adults without Kaposi's sarcoma and 85 apparently healthy HIV-negative adult volunteers of the general population. Anti-lytic antibodies to HHV8 infection was determined by ELISA. A univariate analysis including age, sex, marital status, past sexually transmitted disease (STD), past blood transfusion, HIV/AIDS staging and CD4 count was used to determine variables associated with HHV8 seropositivity. Significant variables were adjusted in a logistic regression model expressed in odds ratio (OR) with 95% confidence interval (CI). P<0.05 was considered significant RESULTS: The seroprevalence of HHV8 infection was 62% in HIV-1 positive patients and 25.9% in HIV negative adults (p<0.001). A past history of STD [OR= 2.88, 95% CI= 1.0 - 8.2] and advanced HIV/AIDS (WHO stage 3 and 4) [OR=3.5, 95% CI= 1.21-10.1] were the only variables independently associated with HHV8 seropositivity in HIV-infected patients. In HIV-negative adults, none of the variables was significantly associated with HHV8 seropositivity. CONCLUSION: The study findings suggest an adverse interaction between HHV8 and HIV-1. The higher prevalence of HHV8 infection in HIV-infected patients and its association with STD support a predominant sexual route of HHV8 transmission among adult Nigerians.

Seroprevalence and Determinants of Human Herpes Virus 8 Infection in Adult Nigerians with and without HIV-1 Infection

Background: There is a dearth of studies on HHV8-HIV co-infections from Nigeria; even as both infections have been shown to be endemic in Africa. This study examined the seroprevalence and determinants of HHV8 infections in adult Nigerians with and without HIV-infection. Methods: In 2007; a cross sectional study undertaken in a tertiary hospital in Zaria; northern Nigeria enrolled 71 HIV-1 positive adults without Kaposi's sarcoma and 85 apparently healthy HIV-negative adult volunteers of the general population. Anti-lytic antibodies to HHV8 infection was determined by ELISA. A univariate analysis including age; sex; marital status; past sexually transmitted disease (STD); past blood transfusion; HIV/AIDS staging and CD4 count was used to determine variables associated with HHV8 seropositivity. Significant variables were adjusted in a logistic regression model expressed in odds ratio (OR) with 95confidence interval (CI). P0.05 was considered significant Results: The seroprevalence of HHV8 infection was 62in HIV-1 positive patients and 25.9in HIV negative adults (p0.001). A past history of STD [ORCI= 1.0 - 8.2] and advanced HIV/AIDS (WHO stage 3 and 4) [OR=3.5; 95CI= 1.21-10.1] were the only variables independently associated with HHV8 seropositivity in HIV-infected patients. In HIV-negative adults; none of the variables was significantly associated with HHV8 seropositivity. Conclusion: The study findings suggest an adverse interaction between HHV8 and HIV-1. The higher prevalence of HHV8 infection in HIV-infected patients and its association with STD support a predominant sexual route of HHV8 transmission among adult Nigerians

Neurobrucellosis--a case report and review of literature.

Neurobrucellosis is a rare form of systemic brucellosis, a disease acquired through ingestion of unpasteurized dairy products, which may manifest as stroke, encephalitis, meningitis, or psychiatric disorders. Presently there is no known report ofneurobrucellosis in Nigeria, although consumption of unpasteurized dairy products is not uncommon in this country. In this report we present a 28 year old spinster with history of significant ingestion of unpasteurized cow milk and brucellosis of the brain diagnosed in our centre through brain magnetic resonance imagining (MRI) and brucella antigen agglutination test. Because of the indolent nature of brucellosis infection, it should be suspected in individuals with pyrexia of unknown origin so that early detection and treatment could prevent long-term sequelae such as focal neurologic deficits, hydrocephalus and psychiatric illness.

Antiretroviral drug resistance--implications for HIV/AIDS reduction in sub-Saharan Africa and other developing countries.

BACKGROUND: The introduction of the highly active antiretroviral therapy in the mid-1990s has significantly reduced morbidities and prolonged the lifespan of people living with HIV However, the emergence of resistance to the antiretroviral drugs is becoming a major cause of treatment failure. While the problem of drug resistance is being tackled in developed countries, not much seem to be done in this regard in developing countries of Africa, Asia and Latin America. This review looked at the regional distribution of HIV groups and subtypes and how this has affected the pattern of antiretroviral resistance. METHODS: The review was sourced from papers presented at international conferences on HIV/AIDS and rational drug use, relevant journals and Medline search using the keywords-Antiretroviral drugs, drug resistance, HIV subtypes and resistance testing. RESULTS: The types, groups, subtypes, sub-subtypes and recombinant forms of HIV-1 have been identified according to their geographical distributions. The evolution of HIV viral mutations, process (es) involved in development of primary and secondary antiretroviral drug resistance, including the role of HIV genetic polymorphisms, and transmitted resistance have been discussed. CONCLUSION: The pitfalls in the current resistance testing based on HIV-1 subtype B have been highlighted. The design of resistance testing algorithm based on HIV-1 subtype non-B has been suggested for the developing world.

Antiretroviral drug resistance--implications for HIV/AIDS reduction in sub-Saharan Africa and other developing countries.

BACKGROUND: The introduction of the highly active antiretroviral therapy in the mid-1990s has significantly reduced morbidities and prolonged the lifespan of people living with HIV. However, the emergence of resistance to the antiretroviral drugs is becoming a major cause of treatment failure. While the problem of drug resistance is being tackled in developed countries, not much seem to be done in this regard in developing countries of Africa, Asia and Latin America. This review looked at the regional distribution of HIV groups and subtypes and how this has affected the pattern of antiretroviral resistance. METHODS: The review was sourced from papers presented at international conferences on HIV/AIDS and rational drug use, relevant journals and Medline search using the keywords--Antiretroviral drugs, drug resistance, HIV subtypes and resistance testing. RESULTS: The types, groups, subtypes, sub-subtypes and recombinant forms of HIV-1 have been identified according to their geographical distributions. The evolution of HIV viral mutations, process (es) involved in development of primary and secondary antiretroviral drug resistance, including the role of HIV genetic polymorphisms, and transmitted resistance have been discussed. CONCLUSION: The pitfalls in the current resistance testing based on HIV-1 subtype B have been highlighted. The design of resistance testing algorithm based on HIV-1 subtype non-B has been suggested for the developing world.

Antiretroviral Drug Resistance- Implications for HIV/AIDS Reduction in Sub-Saharan Africa

Background:The introduction of the highly active antiretroviral therapy in the mid-1990s has significantly reduced morbidities and prolonged the lifespan of people living with HIV. However; the emergence of resistance to the antiretroviral drugs is becoming a major cause of treatment failure. While the problem of drug resistance is being tackled in developed countries; not much seem to be done in this regard in developing countries of Africa; Asia and Latin America. This review looked at the regional distribution of HIV groups and subtypes and how this has affected the pattern of antiretroviral resistance. Methods: The review was sourced from papers presented at international conferences on HIV/AIDS and rational drug use; relevant journals and Medline search using the keywords- Antiretroviral drugs; drug resistance; HIV subtypes and resistance testing. Results: The types; groups; subtypes; sub-subtypes and recombinant forms of HIV-1 have been identified according to their geographical distributions. The evolution of HIV viral mutations; process (es) involved in development of primary and secondary antiretroviral drug resistance; including the role of HIV genetic polymorphisms; and transmitted resistance have been discussed. Conclusion: The pitfalls in the current resistance testing based on HIV-1 subtype B have been highlighted. The design of resistance testing algorithm based on HIV-1 subtype non-B has been suggested for the developing world