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Background Plasma HIV-RNA viral load (VL) of HIV-infected persons is an important prognostic factor in HIV management. We determined the VL among antiretroviral therapy (ART)-naive patients to identify the association between patients’ demographic, clinical and laboratory characteristics with VL. Method A cross-sectional study of 224 ART-naive HIV-1-infected patients (≥15 years of age) accessing care at the Jos University Teaching Hospital AIDS Prevention Initiative in Nigeria ART treatment centre, from October 2010 to April 2011. A log-linear model was used to determine if VL was related to demographic and clinical variables. Results The patients had a median (interquartile range) age of 34 (28–41) years with females in the majority (59%). Females compared to males and pulmonary tuberculosis (PTB) co-infected compared to not co-infected patients had a significantly higher VL (14.9 loge versus 11.5 logeP=0.003 and 11.31 loge versus 11.89 logeP=0.047, respectively). VL tended to decrease with increasing CD4+ cell count levels in females, but remained relatively unchanged in males across all values of CD4+ cell counts. The difference (β) in the mean change in VL between males and females was loge 0.64 copies/mL, P=0.005. Conclusion In ART-naive HIV-1-infected patients in our setting, females had significantly higher VL and lower CD4+ cell count, at the same VL threshold, compared to males, and hence were more likely to be at a higher risk of rapid progression to AIDS. Therefore, gender-based strategies for early identification and engaging females into care are required in this setting to mitigate against rapid progression to AIDS.

Introduction: Human immunodeficiency virus (HIV) negatively impacts the natural history of hepatitis B virus (HBV) infection, including replication. We determined the prevalence of HBeAg in HIV/HBV co-infected patients compared to HBV mono-infected controls and further investigated the relationship between HBeAg seropositivity and the degree of HIV-induced immunosuppression in co-infected patients. Methodology: The study design was cross-sectional. One hundred HBsAg-positive HIV-infected adults and 100 age and sex matched HBsAg-positive HIV negative controls were consecutively recruited between May and November 2010. Relevant demographic and HBV-related information was obtained. HBeAg was assayed by semi-quantitative third generation ELISA. The HIV/HBV co-infected patients also had CD4+ cell and HIV viral load quantification measured using flow cytometry and polymerase chain reaction techniques respectively. Results: In each group, the mean age was 34 ± 8 years and the majority (61%) was female. The prevalence of HBeAg was significantly higher among co-infected patients (n = 28; 28%) than in the controls (n = 15; 15%; p = 0.03). HBeAg seropositivity was independently associated with age < 40 years (AOR = 2.83, 95% = CI 1.29-6.17) and HIV seropositivity (AOR = 2.44, 95% C.I = 1.17-5.07). The prevalence of HBeAg was significantly higher in co-infected patients with CD4 cell count < 200 cell/µL (41.3%) compared to those with 200-499 cell/µL (18.6%) and ≥500 cell/µL (9.1%), p = 0.006. Conclusion: HIV/HBV co-infected patients have a significantly higher prevalence of HBeAg than HBV mono-infected individuals. HBV-infected patients should be routinely assessed for HBeAg, especially if they are co-infected with HIV.

Background: To determine the level of awareness and knowledge of HIV postexposure prophylaxis (HIV PEP) and determinants of adequate knowledge among Family Physicians in Nigeria. Materials and Methods: This was a cross‑sectional questionnaire‑based survey conducted among 175 Family Physicians at two national conferences. Results: Majority (97.7%) of the respondents was aware of the concept of HIV PEP and 99.4% believed it was effective in preventing HIV transmission. Over two third of our respondents had been exposed to NSI; however, less than 25% of those exposed received PEP. There was high level of knowledge of the various high‑risk body fluids as well as types of high‑risk exposures. 93.9% of our respondents knew that HIV PEP should commence within 1 h of exposure, 83.3% knew the correct duration of HIV PEP, but only 57.0% knew the ideal PEP regimen for high‑risk exposures. The total mean score for our respondents was 17.8±2.9 with 79.4% having an adequate score. Being a junior doctor and male sex were associated with adequate knowledge. Conclusion: This study shows that despite high levels of awareness and knowledge of HIV PEP, access to its use among family physicians in Nigeria is still sub‑optimal.Keywords: Family physicians, HIV PEP, NigeriaNigerian Medical Journal | Vol. 53 | Issue 3 | July-September | 2012

Background: Various preventive strategies have been employed to curb the spread of HIV infection as there is presently no cure. Abstinence, avoidance of multiple sexual partners, condom use, voluntary counselling and testing (VCT) and treatment of HIV-infected individuals form the cornerstone of HIV prevention. This study assessed the acceptability of VCT among medical students in a single institution in Nigeria Methodology: Self-administered questionnaires were distributed to clinical medical students of the University of Jos in a cross-sectional study. Results: Out of a total of 368 students surveyed, 178 (50.7%) have had VCT. There was no significant difference between the proportion of males and females who had had VCT previously (48.9% of males and 56.3% of females; χ2 = 1.65, OR = 0.76 95% CI: 0.46-1.20; p = 0.19). The majority of the respondents (83.1%) would want to have VCT. Fear of a positive test result was the main reason given by those who would be unwilling to be tested. Gender had no effect on the willingness of the subjects to have VCT as 81.8% of males and 87.1% of females were predisposed to it (χ2 = 1.95; OR = 0.63, 95% CI: 0.31-1.26). VCT acceptability was similar among sexually active and inactive respondents (80.2% and 80.2% respectively; χ2 = 0.018, p = 0.99). Conclusion: Awareness of VCT services and acceptability of VCT among medical students is high. These students can be role models for the optimization of VCT services.

Background For regulatory approval, consistency in manufacturing of vaccine lots is expected to be demonstrated in confirmatory immunogenicity studies using two-sided equivalence trials. This randomized, double-blind study ( NCT01323972 ) assessed consistency of three RTS,S/AS01 malaria vaccine batches formulated from commercial-scale purified antigen bulk lots in terms of anti-CS-responses induced. Methods Healthy children aged 5–17 months were randomized (1:1:1:1) to receive RTS,S/AS01 at 0-1-2 months from one of three commercial-scale purified antigen bulk lots (1600 litres-fermentation scale; commercial-scale lots), or a comparator vaccine batch made from pilot-scale purified antigen bulk lot (20 litres-fermentation scale; pilot-scale lot). The co-primary objectives were to first demonstrate consistency of antibody responses against circumsporozoite (CS) protein at one month post-dose 3 for the three commercial-scale lots and second demonstrate non-inferiority of anti-CS antibody responses at one month post-dose 3 for the commercial-scale lots compared to the pilot-scale lot. Safety and reactogenicity were evaluated as secondary endpoints. Results One month post-dose-3, anti-CS antibody geometric mean titres (GMT) for the 3 commercial scale lots were 319.6 EU/ml (95% confidence interval (CI): 268.9–379.8), 241.4 EU/ml (207.6–280.7), and 302.3 EU/ml (259.4–352.3). Consistency for the RTS,S/AS01 commercial-scale lots was demonstrated as the two-sided 95% CI of the anti-CS antibody GMT ratio between each pair of lots was within the range of 0.5–2.0. GMT of the pooled commercial-scale lots (285.8 EU/ml (260.7–313.3)) was non-inferior to the pilot-scale lot (271.7 EU/ml (228.5–323.1)). Each RTS,S/AS01 lot had an acceptable tolerability profile, with infrequent reports of grade 3 solicited symptoms. No safety signals were identified and no serious adverse events were considered related to vaccination. Conclusions RTS,S/AS01 lots formulated from commercial-scale purified antigen bulk batches induced a consistent anti-CS antibody response, and the anti-CS GMT of pooled commercial-scale lots was non-inferior to that of a lot formulated from a pilot-scale antigen bulk batch.

Summary Data on baseline hepatic function of HIV and hepatitis B virus (HBV) co-infected patients are limited in sub-Saharan Africa. We assessed liver function test (LFT) abnormalities in Nigerian patients with HIV/HBV co-infection to highlight the impact of HIV on HBV-related liver disease in sub-Saharan Africa. A cross-sectional study involving 100 HIV/HBV co-infected patients and 100 age- and sex-matched HBV mono-infected controls. Blood testing for HIV antibodies, CD4+ cell count, hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), LFTs, platelet count, fasting blood glucose and lipid profile were carried out. Non-invasive hepatic fibrosis scores (aspartate aminotransferase-platelet ratio index [APRI] and FIB-4) were also calculated. Co-infected patients had deranged liver enzymes more than the controls (77% versus 64%, P = 0.04). The predominant patterns of enzyme derangement in co-infected patients were either predominantly ↑ALP (30% versus 4%, P < 0.0001) or mixed (30% versus 15%, P = 0.01) but predominantly ↑AST/ALT in the controls (25% versus 9%, P = 0.003). Co-infected patients had higher fibrosis scores for both APRI ( P = 0.002) and FIB-4 ( P = 0.0001). On further analysis, LFT abnormalities and fibrosis scores were only significantly higher in co-infected patients in the immune clearance and HBeAg-negative chronic hepatitis phases. LFT abnormalities are common in Nigerians with HBV infection and co-infection with HIV negatively impacts on hepatic function.

Despite the growing body of evidence on the interaction between HIV and malaria in sub-Saharan Africa, there is a dearth of data on clinical malaria in HIV-infected patients in Nigeria. We determined the burden of clinical malaria in HIVinfected adult Nigerians and further investigated the association between their immunological status and the rates of clinical malaria. Ninety seven antiretroviral treatment-naïve HIV-infected adults were enrolled in a cross-sectional study from August to December, 2009. The participants had a complete clinical evaluation, thick and thin blood films for malaria parasites and CD4 cell count quantification. Clinical malaria was defined as having fever (temperature ≥ 37.5oC or history of fever within 48 hours) and a malaria parasite density above the median value obtained for subjects with co-existing fever and parasitaemia. Clinical malaria was diagnosed in 10 out of 97 patients (10.3%). Lower CD4 cell counts were associated with increasing rates of clinical malaria which was 0% at CD4 cell count of ≥ 500, 2.6% at 200-499 and 30% at

Human immunodeficiency virus (HIV) and malaria co-infection has become an important public health problem in sub-Saharan Africa. Data on HIV and malaria interaction in Nigerian adults is scanty. We determined the prevalence of malaria parasitaemia in HIV-infected adults and further investigated the role of immune status in the HIV/malaria association.This was a cross-sectional study involving 100 newly-diagnosed HIV-infected adults and 100 age and sex-matched HIV negative controls. Malaria parasitaemia was diagnosed by blood film microscopy using Giemsa staining technique and was defined as the presence of malaria parasites irrespective of species or parasite density. HIV infection was confirmed by western blot assay and CD4 T-lymphocyte count of the HIV-infected patients was quantified by flow cytometry.The prevalence of malaria parasitaemia was higher in HIV-infected adults (24%) than in the controls (9%) (chi2 = 8.17, p = 0.04). Participants residing in rural areas had higher prevalence of malaria parasitaemia than urban dwellers both for HIV-infected patients (34.1% Vs. 16.1%, chi2 = 4.3, p = 0.04) and controls (18.4%, Vs. 6.5%, chi2 = 3.4, p = 0.04). HIV-infected male patients tended to have malaria parasitemia more than their female counterparts (33.3% Vs. 17.2%, chi2 = 3.4, p = 0.06). Among HIV-infected patients, the prevalence of malaria parasitaemia progressively increased at lower CD4 cell counts, 10.3% for CD4 cell count of = 500, 17.5% for 200-499 and 45.2% for200 cells/microL (chi2 = 11.5, p = 0.003).HIV is likely to fuel malaria infection in tropical countries where both diseases are endemic. Malaria control practices should be further intensified in HIV-infected populations.

Background: The use of urethral catheter is common in medical practice with up to 25% of hospitalized adults having an indwelling Foley catheter at some point during hospital stay. Its use however, is not without complications. We sought to find out the knowledge and practice patterns of physicians regarding urethral catheterization. Methodology: Self-administered questionnaires aimed at elucidating knowledge of the indications of urethral catheterization and precautionary measures effective against catheter-associated urinary tract infection (CAUTI) were distributed to physicians in a teaching hospital. Results: The majority of respondents correctly identified hemodynamic instability necessitating fluid administration (94.9%), lower urinary tract obstruction (92.1%), and assisting the healing of perineal wounds (84.3%) as appropriate indications for urethral catheter use. Incontinence (89.1%), preoperative use (88.3%), and epidural anesthesia (66.9%) were also identified as indications for catheterization. Early catheter removal (94.9%), use of condom catheter (91%), use of antibiotic coated Foley catheter (79.6%), intermittent catheterization (76.2%) and the use of automated reminders (67.6%) were correctly identified as measures that can prevent CAUTI by the majority of the respondents. Routine change of catheter was identified as an effective measure by 84% of the respondents. Conclusion: Physicians in a teaching hospital in Jos, Nigeria have adequate knowledge of indications for urethral catheter use and effective measures aimed at preventing CAUTI. More surgeons identified epidural anesthesia as an appropriate indication for urethral catheter use when compared to those of the medical specialties. Key Words Foley Catheter, Indications, Physicians, Urethral catheterization

Background: The introduction of highly active antiretroviral therapy (HAART) has significantly reduced the morbidity and mortality associated with HIV/AIDS. This benefit that HAART confers can only be maximized if patients present early. This study was embarked upon to describe the characteristics of patients presenting late at a teaching hospital in north central Nigeria. Methodology: This was a cross sectional study of patients who presented late with HIV/AIDS admitted into the medical wards of the Jos University Teaching Hospital over a one year period. Late presentation was defined as patients presenting in CDC class B or C Results: 56.7% of patients who were admitted with HIV /AIDS presented late with the majority (79%) being in CDC class C. The median CD4+ cell count was 88 cells/mm3 with a range of 12 -552 cells/mm3. Reasons for late presentation included fear of stigma 35 (46.7%), financial constraints 23 (30.7%), faith in herbal / spiritual healing 8 (10.7%) and not believing in HIV treatment 5 (6.7%). No one came to hospital in late stage because of distance from hospital. Similarly HCT services were not accessed early because of fear of stigma 37 (50.7 %), not wanting to know about status 29 (39.2 %), absence of symptoms 51(68%) and seeing partner as faithful 28 (38.9%). Tuberculosis was the commonest reason for hospitalization Conclusions: Stigma was the major reason for delayed HIV testing and late presentation.. Public education and enlightenment on the need for routine HCT and early presentation for care and treatment is advocated.Key Words HIV/AIDS, Late presentation, Stigma, Tuberculosis

Background : Chronic hepatitis B virus (HBV) infection affects 350 million persons worldwide with its attendant consequences of liver cirrhosis and liver cancer. The degree of liver damage in asymptomatic hepatitis B surface antigen positive native Africans is unknown. We report hepatic histological findings in apparently healthy Nigerians infected with HBV. Methods : This was a retrospective study of apparently healthy Nigerians (61 males and 30 females) chronically infected with HBV aged 33±10 years who had liver biopsies done at the Jos University Teaching Hospital. Results : A lanine transferase (ALT) was elevated in 36.5% and serum albumin was low in 9.9% of the subjects respectively. Fifty nine subjects (64.8%) had evidence of chronic hepatitis, with 29 (49.2%) having histologic activity index (HAI) > 7. Normal histology was present in 27 (29.6%) subjects, three (4.6%) had frank cirrhosis and two (2.3%) had hepatocellular carcinoma with one on the background of cirrhosis. Similar proportions of subjects with 2 normal and elevated ALT levels (50% vs. 51% respectively) had HAI scores > 7; X = 0.1, p =0.92. Conclusion : Our study shows that the vast majority of incidentally detected asymptomatic individuals infected with HBV have significant liver disease. Policies aimed at screening, evaluation, treatment and prevention is mandatory in our communities.

Background : Liver cirrhosis is a chronic inflammatory condition associated lipid abnormalities. There are no studies documenting lipid levels among patients with liver cirrhosis in northern Nigeria. Methodology : Seventy four consecutive patients with liver cirrhosis seen at the Jos University Teaching Hospital and 88 apparently healthy controls had lipid levels estimated in the fasting state. Results : The median serum triglyceride levels were similar in both patients and controls (2.6 mmol/L versus 2.6 mmol/L, ÷2 0.09, P=0.7). The median LDL were also similar being 2.3 mmol/L and 1.9 mmol/L respectively, ÷2 =2.75 p= 0.09. However, the median total cholesterol and HDL cholesterol levels were significantly higher in the controls compared to the 2 study subjects (4.2 mmol/L vs. 3.6 mmol/L; X = 10.1; P=0.0001, and 1.1 mmol/L vs. 0.9 mmol/L; ÷2 = 21.7l, P Conclusion : Lipid abnormalities exist in patients with liver cirrhosis. HDL-C levels are significantly reduced in these subjects. Patients with liver cirrhosis thus, should be routinely screened for such abnormalities.

Introduction Parkinsonism puts a high direct cost burden on both patient and caregiver. Several reports of drug-induced parkinsonism have been published, but to the best of our knowledge, there has not been any report of quinine or halothane inducing parkinsonism. Case presentation We describe two cases of parkinsonism possibly caused by adverse drug reaction to quinine in a 29-year-old black Nigerian woman and to halothane in a 36-year-old black Hausa (Nigerian) man who received it as general anaesthesia for appendicectomy in our teaching hospital. Conclusion These are two unusual cases of parkinsonism caused by adverse drug reactions to high-dose quinine and to halothane as general anaesthesia. We consider that these two cases are important in bringing this potential side-effect to the attention of both pharmacologists and primary care physicians as these are two of the most commonly used medications in our clinics. We conclude that parkinsonism should be included among the adverse drug reactions to high-dose quinine and halothane general anaesthetic.

Various preventive strategies have been employed to curb the spread of HIV infection as there is presently no cure. Abstinence, avoidance of multiple sexual partners, condom use, voluntary counselling and testing (VCT) and treatment of HIV-infected individuals form the cornerstone of HIV prevention. This study assessed the acceptability of VCT among medical students in a single institution in NigeriaSelf-administered questionnaires were distributed to clinical medical students of the University of Jos in a cross-sectional study.Out of a total of 368 students surveyed, 178 (50.7%) have had VCT. There was no significant difference between the proportion of males and females who had had VCT previously (48.9% of males and 56.3% of females; chi(2) = 1.65, OR = 0.76 95% CI: 0.46-1.20; p = 0.19). The majority of the respondents (83.1%) would want to have VCT. Fear of a positive test result was the main reason given by those who would be unwilling to be tested. Gender had no effect on the willingness of the subjects to have VCT as 81.8% of males and 87.1% of females were predisposed to it (chi(2) = 1.95; OR = 0.63, 95% CI: 0.31-1.26). VCT acceptability was similar among sexually active and inactive respondents (80.2% and 80.2% respectively; chi(2) = 0.018, p = 0.99).Awareness of VCT services and acceptability of VCT among medical students is high. These students can be role models for the optimization of VCT services.

Objectives: To determine whether family structure (polygamous or monogamous) is associated with sexual activity among school students in Nigeria. Design: Cross sectional school survey with a two stage, clustered sampling design. Participants: 4218 students aged 12–21 years attending 39 schools in Plateau state, Nigeria. Responses from 2705 students were included in the analysis. Main outcome measure: Report of ever having had sexual intercourse. Variables of interest included sexual history, age, sex, religion, family polygamy, educational level of parents, having a dead parent, and sense of connectedness to parents and school. Results: Overall 909 students (34%) reported ever having had sexual intercourse, and 1119 (41%) reported a polygamous family structure. Sexual activity was more common among students from polygamous families (42% of students) than monogamous families (28%) (χ2=64.23; P Conclusions: Secondary school students in Nigeria from a polygamous family structure are more likely to have engaged in sexual activity than students from a monogamous family structure. This effect is partly explained by a higher likelihood of marriage during adolescence and forced sex. Students9 sense of connectedness to their parents and school, regardless of family structure, decreases the likelihood of sexual activity, and fostering this sense may help reduce risky sexual behaviour among Nigerian youth. What is already known on this topic In 2000 Nigeria developed a national health policy aimed at preventing behaviour among adolescents leading to sexually transmitted infections (including HIV), pregnancy, and dropout from school Effective interventions in Nigeria have been hampered by inadequate information on contextual factors associated with sexual behaviour of adolescents In Western countries adolescents9 sense of connectedness to their parents and to school is inversely associated with risky sexual behaviour, but these effects may differ in countries where polygamy is prevalent and where school attendance is low What this paper adds A polygamous family structure is associated with early sexual activity among adolescents, an effect partly explained by a higher likelihood of marriage and history of forced sexual intercourse A greater sense of connectedness to parents and school decreases the likelihood of sexual activity, regardless of family structure

Background : Human immunodeficiency virus (HIV) infection and its treatment are associated with lipid abnormalities. Data on lipid profile of treatment-naοve HIV-infected patients in Nigeria are limited, and available studies did not exclude the role of major host-related risk factors for dyslipidemia. Aim: We assessed the lipid profile of normotensive, non-diabetic, and non-obese treatment-naοve HIV-infected patients to identify their abnormalities in comparison with age- and sex-matched HIV-negative control. Subjects and Methods : One hundred and six normotensive, non-diabetic, and non-obese HIV positive patients and 98 age-and sex-matched HIV-negative controls had lipid profile estimation in the fasting state. The CD4+ cell count of the HIV-infected patients was also quantified. Results : The median (IQR) triglyceride was significantly higher in HIV-positive patients than in the controls [1.75 (1.30-2.40) mmol/L vs. 1.55 (1.30-1.90) mmol/L, P = 0.01]. HIV-positive patients also had significantly lower mean total cholesterol, TC [4.18 (1.04) mmol/L vs. 4.64 (1.01) mmol/L, P = 0.001] and HDL-C [1.17 (0.35) mmol/L vs. 1.29 (0.43) mmol/L, P = 0.03]. The mean LDL-C [2.20 (0.87) mmol/L vs. 2.19 (0.75) mmol/L, P = 0.97] and TC/HDL-C ratio [3.95 (1.42) vs. 3.84 (1.14) mmol/L, P = 0.52] were similar between the HIV-positive patients and controls. The HIV-infected patients had a significantly higher proportion of subjects with low HDL-C [36.8% (39/106) vs. 23.5% (23/98), P = 0.04] and hypertriglyceridemia [31.1% (33/106) vs. 11.2% (11/98), P = 0.001] while the controls had significantly higher proportion of subjects with hypercholesterolemia [22.4% (22/98) vs. 10.4% (11/106), P = 0.02]. Lower HDL-C was associated with CD4+ cell count P = 0.02). Conclusion : Lipid abnormalities are common in treatment-naοve HIV-infected patients even in the absence of major host-related risk factors for dyslipidemia. HIV-infected patients should, therefore, be routinely screened for lipid disorders before commencement of anti-retroviral therapy.