Echocardiographic patterns in treatment-naïve HIV-positive patients in Lagos, south-west Nigeria.

INTRODUCTION: Cardiovascular abnormalities are common in HIV-infected patients, although often clinically quiescent. This study sought to identify by echocardiography early abnormalities in treatment-naïve patients. METHODS: One hundred patients and 50 controls with no known traditional risk factors for cardiovascular disease were recruited for the study. The cases and controls were matched for age, gender and body mass index. Both groups had clinical and echocardiographic evaluation for cardiac abnormalities, and CD4 count was measured in all patients. RESULTS: The cases comprised 57 females (57.0%) and 43 males (43.0%), while the controls were 28 females (56.0%) and 22 males (44.0%) (χ(2) = 0.01; p = 0.913). The mean age of the cases was 33.2 ± 7.7, while that of the controls was 31.7 ± 9.7 (t = 1.02; p = 0.31). Echocardiographic abnormalities were significantly more common in the cases than the controls (78 vs 16%; p = 0.000), including systolic dysfunction (30 vs 8%; p = 0.024) and diastolic dysfunction (32 vs 8%; p = 0.002). Other abnormalities noted in the cases were pericardial effusion in 47% (χ(2) = 32.10; p = 0.000) and dilated cardiomyopathy in 5% (five); none of the controls had either complication. One patient each had aortic root dilatation, mitral valve prolapse and isolated right heart dilatation and dysfunction. CONCLUSION: Cardiac abnormalities are more common in HIV-infected people than in normal controls. A careful initial and periodic cardiac evaluation to detect early involvement of the heart in the HIV disease is recommended.

Prevalence of abnormal cervical smears among patients with HIV in Lagos, Nigeria.

BACKGROUND: There are over four million people living with HIV/AIDS in Nigeria. Cervical cancer is the most common genital cancer in Nigeria. There are many reports on the association of HIV with increased risk of cervical dysplasia. OBJECTIVE: To determine the prevalence of abormal cervical smears in Nigerian women who are HIV positive in Lagos. METHODS: Cervical smears were taken from 233 HIV positive women and 235 HIV negative women who attended the HIV clinic and the family planning clinic respectively of the Lagos University Teaching Hospital during the period January-April 2004. Proportions were compared with the X2 test. RESULTS: Data were complete for analysis in 227 of HIV positive and 228 of HIV negative women. Mean (SD) ages of HIV positive and HIV negative patients were respectively 35.2 (9.81) and 34.5 (7.37) years. Prevalence of squamous intraepithelial lesion (SIL) was higher in those who were HIV positive than in those who were HIV negative, 10.9% vs 4.3% (X2, 7.04; p=0.00798). Prevalence of high grade SIL was higher in HIV positive than HIV negative subjects, 7.9% vs 2.6% (X2, 6.38; p=0.0115). There was no significant difference in the prevalence of inflammatory smears, 15.7% in HIV positive vs 16.2% in HIV negative. CONCLUSION: Prevalence of cervical dysplasia is high in women who harbour HIV.

Evaluation of a rapid test kit for detection of HBsAg/eAg in whole blood: a possible method for pre-donation testing.

In many developing countries where hepatitis B is endemic, positivity rate for HBsAg in donor blood is high, and in some places, up to 20% of donated blood has to be discarded for being HBsAg positive. This degree of wastage may be financially crippling for some developing countries. Pre-donation testing may be useful, so that donors who test HBsAg positive are deferred and wastage of costly blood bags is reduced. The study is to evaluate the suitability of the AMRAD kit, for pre-donation testing for HBsAg. One hundred and one (101) healthy blood donors were screened for HBsAg/eAg using the test kit. The same specimens were screened using Monolisa (ELISA) kits for HBsAg and eAg as the standard. True positive (TrP), False negative (FN), True negative (TrN) and, false positive (FP) values were then found, from which, sensitivity and specificity, were derived. The AMRAD test kit detected 93 specimens as negative and 8 specimens as positive for HBsAg as against 94 negatives (TrN) and 7 positives (TrP) by monolisa. Thus, one false positive (FP) result was found in using the kit while no false negative (FN) occurred. The findings in this preliminary study suggest that AMRAD kit may be a useful predonation screening test for HBsAg.

Efficacy of natural honey in the healing of leg ulcers in sickle cell anaemia.

In order to assess the reported efficacy of natural honey in the healing of chronic ulcers, the efficacy of locally applied natural honey was compared to that of Eusol solution in an open trial involving 20 patients with sickle cell anaemia (SS) who were in steady clinical states and had chronic leg ulceration. All patients were admitted to hospital for the 4 week duration of the trial for bed rest, daily aseptic dressings, and weekly measurement of the size of the ulcer. Fifteen patients with a total of 19 leg ulcers were evaluable at the end of the trial. Eleven ulcers were dressed with honey while 8 were dressed with Eusol. No significant differences were found in rates of healing of the ulcers in either treatment groups. This trial does not support the suggestion that natural honey is superior to Eusol in the healing of chronic sickle cell leg ulceration.

Absolute lymphocyte count as surrogate for CD4+ cell count in monitoring response to antiretroviral therapy.

The objective of the study is to determine whether Absolute Lymphocyte Count (ALC) can serve as a surrogate for CD4 T-lymphocyte Cell Count (CCC) in HIV infected Nigerians on Lamivudine/Zidovudine anti-retroviral therapy. 32 adult Nigerians infected with HIV were recruited into the study. They were assessed clinically and categorised into three clinical stages A, B and C according to CDC criteria. They all received lamivudine 150 mg b.d and Zidovodine 300 mg b.d for six months. Blood specimens were taken on enrollment and at four weekly intervals for paired ALC and CCC determination. ANOVA statistics was used to determine whether ALC and CCC (separately) change significantly with increasing duration of therapy. Paired ALC and CCC values were tested for correlation. Sensitivity and specificity of low ALC values in predicting low CCC values were also calculated. The 32 patients comprised 18 males and 14 females aged between 16 and 49 years. The mean age (SD) was 36.1 (+/-7.85) years. The mean ALC value rose from 2485/l and 2352/microl before commencement of therapy to 3026/microl and 3151/microl four weeks after for males and females respectively. These changes were not significant, P>0.05. No further changes were noted over the next 24 weeks. However, the mean CCC values increased from 233/microl before therapy through 339/microl at four weeks, 362/microl at eight weeks to 398/micro1 at 12 weeks. It then fluctuated between 372/microl and 310/microl for the remaining part of the study. These changes were not significant: F: ratio = 1.28 (df = 6,181), P>0.05. A weak but significant positive correlation was established between ALC and CCC. Correlation coefficient was 0.25, P<0.05. The sensitivity and specificity of ALC 2000/microl as a predictor of CCC 200/microl were 57% and 72% respectively. ALC correlates weakly with CCC in patients undergoing antiretroviral therapy and it may not serve as a perfect surrogate for CCC as a monitor of immunological response to therapy.

Evaluation of saliva-based diagnostic test kit for routine detection of antibodies to HIV.

The study was carried out to determine the reliability of a saliva based test kit for routine detection of HIV antibodies. 150 paired plasma and saliva samples were collected from 50 patients who were known to be positive for HIV-I and 100 others whose HIV serostatus were previously unknown. All the plasma samples were tested for HIV antibodies using Novopath Immunoblot Technique (as the gold standard), Wellcozyme (Murex) ELISA, Latex Agglutination Test (Capillus) and SeroCard Kit. The saliva samples were screened for HIV antibodies using SalivaCard Test Kit. All the 50 known positive patients tested positive when retested with immunoblot and 9 of 100 whose serostatus were unknown also tested positive giving a total of 59 positive results and 91 negative results. Of the 59 positive results, 59, 57, 58 and 47 were correctly identified as true positives by Wellcozyme, Capillus, SeroCard and SalivaCard respectively. Of the 91 negatives, 90, 91, 90 and 85 were correctly identified as true negatives respectively. Sensitivities in the same order were 100%, 97%, 98.3% and 79.7% whilst specificities were 98.9%, 100%, 98.9% and 97.8%. Whereas evaluation parameters for Wellcozyme, Capillus and SeroCard test kits met the criteria for licensure of a test kit as a routine test method for HIV antibody detection, the SalivaCard values fell far short of the stipulated criteria. The Sensitivity, Test Efficiency and Positive Predictive Values of 79.7%, 88% and 67.8% respectively obtained for SalivaCard are too low and the test kit cannot be recommended for routine use as HIV antibody detection kit.

Hypofibronectinaemia and severity of sickle cell anaemia in Nigeria.

Plasma fibronectin levels in sickle cell anaemia and apparently healthy Nigerians were investigated to determine any correlation with disease severity. A cheaper in-house plasma fibronectin assay was also developed that could be adapted for use in Africa and elsewhere. Plasma fibronectin assay was concurrently carried out using the newly developed inhibition enzyme-linked immunosorbent assay (ELISA) and a commercial competitive binding ELISA. The in-house assay compared favourably with that of the commercial kit. The mean plasma fibronectin levels in sickle cell anaemia subjects were significantly lower than that of control subjects (P < 0.001). Plasma fibronectin concentration could therefore be useful in assessing the severity of sickle cell anaemia.

Seroprevalence study of HTLV-1 and HIV infection in blood donors and patients with lymphoid malignancies in Lagos, Nigeria.

OBJECTIVE: To document the seroprevalence of HTLV-1 and HIV in blood donors and in patients with lymphoma and leukaemia in Lagos metropolis. DESIGN: Cross sectional. SETTING: The Lagos University Teaching Hospital (LUTH) and General Hospital, Lagos (GH). SUBJECTS: 406 apparently healthy voluntary blood donors from the LUTH and GH and 30 patients [20 patients with histological diagnosis of Non-Hodgkin's Lymphoma (NHL) and 10 patients with diagnosis of Chronic Lymphocytic Leukaemia (CLL)] were recruited at LUTH. MAIN OUTCOME MEASURES: HTLV-1 and HIV-1 seroprevalence. RESULTS: Out of 406 donors, three (0.7%) were positive for HTLV-1 and 20 (4.9%) were positive for HIV-1. None of the 30 patients with NHL or CLL were positive for HTLV-1. Five of NHL patients were positive for HIV-1. CONCLUSION: HTLV-1 seroprevalence is low among Lagos donors. Routine screening of donors for this virus will not be cost effective. NHL is one of the AIDS related malignancies which has been documented in this study.

Spectrum of clinical diseases in HIV-infected adults at the Lagos University Teaching Hospital: a five-year experience [1992-1996].

The study was conducted to document the spectrum of clinical diseases in HIV infected patients at the Lagos University Teaching Hospital (LUTH) over a period of five years: 1992-1996. Patients with symptoms suggestive of HIV infection in both in and out-patients at LUTH were studied. Their blood specimens were screened for HIV infection using enzyme immunosorbent assay (EIA) technique and positive results were confirmed by western blotting techniques. The following were documented: risk factors, clinical history and physical findings. Of the 5,010 patients screened in a five-year period, 759 (15.15%) were found to be HIV positive. Of these 759 patients, 406 (53.5%) were young adults in their third decade (20-30 years). Heterosexual intercourse was the major risk factor in these patients (76%). Progressive loss of weight occurred in 77.8%, prolonged fever in 73%, chronic cough in 50%, painless lymphadenopathy in 40%, chronic diarrhoea in 35%, Kaposi's sarcoma in 0.52% and non-Hodgkin's lymphoma in 0.65%. It appears the scourge of AIDS has eventually hit Nigeria. There is the need for reinvigoration of preventive efforts but some energy has to be channeled towards patient care.

The influence of socio-economic status on the severity of sickle cell disease.

The influence of socio-economic status on morbidity was studied in 122 unselected consecutive patients with homozygous sickle cell disease in steady state. They included 65 females and 57 males, divided into three social classes (I, II and III, from highest to lowest). The morbidity indices used were, frequency of bone pain crisis, leg ulceration, growth index and the degree of anaemia as denoted by the mean steady haemoglobin level. It was found that the frequency of bone pain crisis was significantly higher in social class III patients than in social class I and social class II (P < 0.01). Leg ulceration was significantly more common in patients of social class III than in patients of social class I (P < 0.05). There was no correlation between the growth index and social class (r = 0.067, P > 0.05). The mean haemoglobin level was found to fall slightly from the highest to the lowest social class although the differences were not statistically significant. Our findings suggest that socio-economic status has some modifying influence on morbidity in sickle cell disease.

Pernicious anaemia in Africans.

Ten cases of pernicious anaemia seen over a 15-year period (1973-1988) in a Lagos hospital are presented. Their ages ranged from 34 to 67 with a mean of 53.6 years. Females outnumbered males 6 to 4. Complications seen include gastric carcinoma, myelopathy, peripheral neuropathy, skin hyperpigmentation, hair depigmentation and diarrhoea. Reluctance to consider the diagnosis owing to firmly held notions of its rarity and a penchant for empirically treating chronic anaemias with all available haematinics and blood transfusion are probably contributory to its underdiagnosis. The fact that seven of the patients presented were seen in the last three years and three of them in the last one year raises the possibility of an increasing incidence of pernicious anaemia in Africans. The disease may be much less rare in Africans than once believed, and medical education should emphasize its existence and advocate greater care in the management of chronic anaemias.

Submandibular chronic sialadenitis presenting with alcohol-induced pain.

A 32 year old man with alcohol-induced pain over a right submandibular swelling is described. Excision biopsy of this swelling revealed chronic sialadenitis and the symptoms promptly ceased following this excision. We speculate on the possible pathophysiological mechanism.

Chronic leukaemia: an African experience.

One hundred and eighteen patients with chronic leukaemias were seen at the Lagos University Teaching Hospital, Nigeria, between 1964 and 1982. There were 75 patients with chronic granulocytic leukaemia (CGL) and 43 patients with chronic lymphocytic leukaemia (CLL). Although most of them presented with the familiar features of chronic leukaemias, a few features were remarkably different from those reported in some of the Caucasian series. CLL is less common than CGL in contrast to their relative incidence in Caucasians. Our patients generally presented with more massive splenomegaly and more severe anaemia, which could be attributed to late presentation, endemic malaria and possibly increased hypersplenism. The peak-age incidence in our patients with CGL was found in a younger age group (20-40 yr) than in the Caucasian series. When compared with a Caucasian series, our CGL patients on presentation had a significantly higher proportion of immature cells (blasts and promyelocytes) (P less than 0.05), probably reflecting their more delayed presentation. Follow up was generally poor as a result of a high default rate. Survival duration of both leukaemias was generally lower than in Caucasian series and for CGL patients there was a significant negative correlation between survival and spleen size at presentation, while for CLL patients there was a significant association between poor survival duration and high white cell count at presentation.

Effects of ethanol on cell volume and protein synthesis in a human lymphoblastoid cell line (Raji).

A human lymphoblastoid cell line (Raji) developed macrocytosis after 5-7 days when cultured in the presence of 100, 250 and 500 mg ethanol/dl. The degree of macrocytosis was least with 100 mg/dl and greatest with 500 mg/dl. The macrocytosis was associated with a proportionate increase in the total protein content per cell, was reversed after culture in the absence of ethanol and was uninfluenced by the supplementation of the culture medium with 50 micrograms folic or folinic acids per millilitre. Ethanol also caused a substantial prolongation of the cell doubling time at concentrations of 250 and 500 mg/dl (but not 100 mg/dl) and this was associated with some increase in the proportion of non-viable cells in the cultures. Furthermore, ethanol increased the incorporation of 3H-leucine into protein per femtolitre of cell volume. It is proposed that the ethanol-induced macrocytosis may have developed as a consequence of the stimulation of the rate of protein synthesis within a normal or prolonged cell cycle.