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HIV-1 compartmentalization in the central nervous system (CNS) and its contribution to neurological disease have been well documented. Previous studies were conducted among people infected with subtypes B or C where CNS compartmentalization has been observed when comparing viral sequences in the blood to virus in cerebrospinal fluid (CSF). However, little is known about CNS compartmentalization in other HIV-1 subtypes. Using a deep sequencing approach with Primer ID, we conducted a cross-sectional study among Nigerian and Malawian HIV-1 cohorts with or without fungal Cryptococcus infection diagnosed as cryptococcal meningitis (CM) to determine the extent of CSF/CNS compartmentalization with CM. Paired plasma and CSF samples from 45 participants were also analyzed for cytokine/chemokine levels. Viral populations comparing virus in the blood and the CSF ranged from compartmentalized to equilibrated, including minor or partial compartmentalization or clonal amplification of a single viral sequence. The frequency of compartmentalized viral populations in the blood and CSF was similar between the CM− and CM+ participants. We confirmed the potential to see compartmentalization with subtype C infection and have also documented CNS compartmentalization of an HIV-1 subtype G infection. Cytokine profiles indicated a proinflammatory environment, especially within the CSF/CNS. However, sCD163 was suppressed in the CSF in the presence of CM, perhaps due to elevated levels of IL-4, which were also a feature of the cytokine profile, showing a distinct cytokine profile with CM.

Background The incidence of Human Immunodeficiency Virus (HIV)-associated Kaposi Sarcoma (KS) in the pre-antiretroviral therapy (ART) population remains high in several countries in sub-Saharan Africa. We examined trends of KS prevalence in adults, establishing initial outpatient HIV care from 2006 to 2017 in Nigeria. Methods We analyzed data of 16,431 adults (age ≥ 18 years) enrolled for HIV care from January 1, 2006, to December 31, 2017, in a large clinic in Jos, Nigeria. KS at enrollment was defined as KS recorded in the electronic health record within 30 days of clinic enrollment. Time trends were compared among four periods: 2006–2008, 2009–2011, 2012–2014, and 2015–2017 using logistic regression models. Annual trends were analyzed using join point regression and restricted splines. Results The study population had a mean age 35.1 (standard deviation, SD 9.5) years, and were 65.7% female (n = 10,788). The mean CD4 cell count was 220 (95% CI 117–223). The overall KS prevalence at entry was 0.59% (95% CI 0.48–0.72). Compared to 2006–2008, KS prevalence was significantly higher in 2009–2011 (adjusted odds ratio 5.07 (95% CI 3.12–8.24), p Conclusions Despite ART expansion, KS at enrollment showed no significant decline. The low CD4 cell count, across all periods, indicates delay in enrollment for HIV care, which increases KS risk. Interventions aimed at early HIV diagnosis and linkage to ART is critical to KS risk reduction in this population.

Immunisation and vaccination programmes are preventive and cost-effective child health interventions for reducing childhood mortality and disability from infectious diseases. Timely administration of these vaccines is important to ensure their effectiveness in disease prevention.The aim was to determine the timeliness, barriers and predictors of at-birth vaccinations.This was a cross-sectional study of 355 mother-newborn pairs using simple random sampling technique by balloting. SPSS version 23.0 was used for data analysis. Crude and adjusted odds ratios (AORs) were used as point estimates in the binary logistic regression model, while 95% confidence interval (CI) was used as the interval estimate. A P0.05 was considered statistically significant for the study.The mean age of the mothers was 31.0 ± 6 years. The median age of newborns at vaccination was 18 h (IQR = 1 - 17) h. About 185 (52.1%) of the newborns studied were males. Only 191 (53.8%) newborns received at-birth vaccination within 24 h of life. Weekend delivery, birth outside vaccination days, delivery during public holidays and vaccine stock-outs were barriers to timely vaccinations. Private hospital delivery was an independent predictor of delayed at-birth vaccinations (AOR = 2.616; 95% CI = 1.382-4.951).Our study has identified weekend delivery, preterm birth, delivery outside vaccination days and vaccines stock-outs as barriers to timely at-birth vaccinations. Private hospital delivery is a significant predictor of delayed at-birth vaccinations.

Background: Improved access to antiretroviral therapy (ART) significantly reduced the prevalence of Kaposi Sarcoma (KS) among patients initiating care for Human Immunodeficiency Virus (HIV) care in western nations. A similar pattern has not been universally documented across sub-Saharan Africa where the majority of people with HIV reside. This study examined trends in KS prevalence among adults initiating HIV care in Nigeria from 2006 to 2017.Methods: Data of patients 18 years or older, who initiated HIV care at the Jos University Teaching Hospital HIV clinic Jos, Nigeria from 2006 and 2017, were analyzed. Prevalence of KS over three consecutive four-year periods of increased ART coverage: 2006-2009, 2010-2013 and 2014-2017 were estimated. Logistic regression models were used to compare age- and sex-adjusted trends in KS prevalence rates at HIV care initiation over the three-time periods, and determine independent predictor of KS.Results: Among 16,431 adults who initiated HIV care from January 2006 to Decemeber 2017, mean age 35.1 (9.5) years, 65.7% female, and 51.1% with CD4 T-cell count < 200 cells/mm3; the overall prevalence of KS was 0.59 % (95% CI 0.48-0.72). KS prevalence was lowest at the time of HIV care initiation from 2006-2009 (0.39%; 95% CI 0.29-0.53), peaked at 1.12% (95% CI 0.82-1.52) from 2010-2013 and declined to 0.72% (95% CI 0.42-1.20) from 2014-2017. Compared to 2006-2009, age- and sex-adjusted odds for KS were 2.81 (95% CI 1.83-4.34, pConclusion: Expansion of ART access was not associated with a decline in KS prevalence among adults initiating ART in Nigeria.

Background The burden of healthcare-associated infection (HAI) is 2 to 18 times higher in developing countries. However, few data are available regarding infection prevention and control (IPC) process indicators in these countries. We evaluated hand hygiene (HH) facilities and compliance amongst healthcare workers (HCW) in a 600-bed healthcare facility in Northcentral Nigeria providing tertiary care service for a catchment population of about 20 million. Methods An in-house facility assessment tool and the World Health Organization (WHO) direct observation method were used to assess the HH facilities and compliance, respectively. Factors associated with good compliance were determined by multivariate analysis. Results The facility survey was carried out in all 46 clinical units of the hospital. 72% of the units had no poster or written policy on HH; 87% did not have alcohol-based hand rubs; 98% had at least one handwash sink; 28% had flowing tap water all day while 72% utilized cup and bucket; and 58% had no hand drying facilities. A total of 406 HH opportunities were observed among 175 HCWs. The overall compliance was 31%, ranging from 18% among ward attendants to 82% among medical students. Based on WHO “5 moments” for HH, average compliance was 21% before patient contact, 23% before aseptic procedure, 63% after body fluid exposure risk, 41% after patient contact and 40% after contact with patients’ surrounding. Being a medical student was independently associated with high HH compliance, adjusted odds ratio: 13.87 (1.70–112.88). Conclusions Availability of HH facilities and HCW compliance in a large tertiary hospital in Nigeria is poor. Our findings confirm that HCWs seem more sensitized to their risk of exposure to potential pathogens than to the prevention of HAI cross-transmission. Inadequate HH facilities probably contributed to the poor compliance. Specific measures such as improved facilities, training and monitoring are needed to improve HH compliance.

Lassa virus (LASV) is endemic in West Africa, causing an estimated 100,000-300,000 new infections and up to 5,000-10,000 deaths yearly. There are no vaccines and therapeutics are extremely limited. Typical case fatality rates are ~1%, although a recent 2018 Nigerian outbreak featured an unprecedented 25.4% case fatality rate. Survivors of infection suffer a lifetime of sequelae with sudden onset sensorineural hearing loss (SNHL) being the most prevalent. The cause of this hearing loss remains unknown, and there is a critical need for further research on its mechanisms and potential therapeutics. The objective of this review is to outline the only currently available small animal model for LASV-induced hearing loss and to identify potential surrogate models.

Background: Hand hygiene (HH) is the single most important means of preventing hospital-acquired infections. We set out to determine the knowledge, training gaps, and practice of HH in a tertiary health institution in a resource constrained setting. Methods: This cross-sectional study was conducted among health care workers in a 600-bed capacity tertiary health centre. The study was conducted between April and November 2013. A multi-stage randomized sampling method was used to self-administer 322 WHO HH knowledge questionnaires. Information on HH training in the past 3 years, knowledge and practice of HH were obtained, and data were analysed using Epi-Info version 3.5.1. Results: A response rate of 98.5% was obtained for the HH knowledge assessment. Mean age of the study population was 39 ± 9.8. About 64% were females. Of all the respondents, only 16% had good knowledge of HH, 52% had moderate knowledge while 32% had poor knowledge. About 24% had formal training on HH. In terms of practice, only about 22% of the respondents self-reported routine practice of HH. Conclusions: The findings in this study suggest that there is sub-optimal HH knowledge, practice and training. It is imperative to improve the HH training and retraining of health care workers with a focus on attendants. Administrative controls and bold signage in healthcare institutions are also recommended.

Background and ObjectivesMeasuring head circumference (HC) of newborns is an important tool for evaluating intra-uterine brain development. HC reference charts currently in use in Nigeria are not representative of the local population. We thus present locally derived HC reference data for Nigerian infants at birth.Subjects and MethodsWe reviewed birth records of all infants at the Jos University Teaching Hospital (JUTH) over a 10 year period from January 2006. JUTH is a tertiary care center offering obstetric services to a large population of women in Jos and its environs. All births with gestational age between 28 and 42 weeks were included in the study. STATA version 14 was used to calculate gestational age associated HC percentile measurements.ResultsWe included 18 282 babies to generate the reference values. The mean HC value was 34.4 ± 2.1 cm (M = 34.6 ± 2.16 cm, F = 34.1 ± 2.02 cm, p ConclusionsThe use of our locally derived HC reference values could be more appropriate in defining normal head growth in Nigerian infant populations thereby improving newborn care.

Pandemics have been an important part of human history and have caused widespread morbidity and mortality as well as economic devastation in their wake. As the world struggles to contain its latest pandemic coronavirus disease 2019, it is important to look at all the human pandemics that have been recorded. The PubMed and Google Scholar databases were searched for, all in English language literature, using the search words “pandemics” and “history of pandemics.” Further references were obtained through cross-referencing the bibliography cited in each work. Available literature showed pandemics are a recurrent feature in human existence globally. Detailed description of effects of pandemics in Africa were few. The pandemics were classified according to the periods they occurred. From 430BC to 2020AD, different epidemics largely caused by bacteria and viruses have affected the human. With the recurrent patterns of earlier pandemics and advances in international travel, it is obvious that for the foreseeable future, pandemics will remain a global health challenge.

Background: The coronavirus spike (S) glycoprotein and M protease are two key targets that have been identified for vaccines and drug development against COVID-19. Methods: Virtual screening of some compounds of plant origin that have shown antiviral activities were carried out on the two targets, the M protease (PDB ID 6LU7) and S glycoprotein (PDB ID 6VSB), by docking with PyRx software. The binding affinities were compared with other compounds and drugs already identified as potential ligands for the M protease and S glycoprotein, as well as chloroquine and hydroxychloroquine. The docked compounds with best binding affinities were also filtered for drug likeness using the SwissADME and PROTOX platforms on the basis of physicochemical properties and toxicity, respectively. Results: The docking results revealed that scopadulcic acid and dammarenolic acid had the best binding affinity for the S glycoprotein and Mpro protein targets, respectively. Silybinin, through molecular docking, also demonstrated good binding affinity for both protein targets making it a potential candidate for further evaluation as repurposed candidate for SARS-CoV-2, with likelihood of having multitarget activity as it showed activities for both targets. Conclusions: The study proposes that scopadulcic acid and dammarenolic acid be further evaluated in vivo for drug formulation against SARS-COV-2 and possible repurposing of Silybinin for the management of COVIV-19.

Kaposi sarcoma (KS) was the first AIDS defining malignancy described, and it commonly involves the skin, although visceral lesions exist. Visceral KS lesions are easy to miss, especially when symptoms are atypical or suggestive of another condition. This is a case of KS of the stomach in an HIV/AIDS patient presenting with symptoms, suggestive of bleeding peptic ulcer disease. Keywords: Kaposi sarcoma, HIV/AIDS, Nigeria, peptic ulcer disease, visceral Kaposi sarcoma

Background and Objectives: The use of Highly Active Antiretroviral Therapy (HAART) has dramatically improved the quality of life and overall survival of HIV patients. UNAIDS has set a target of viral suppression for 90% of those treated by 2020 in order to end the HIV epidemic. We set out to determine patients’ virologic and immunological response after medium term first-line ART. Methods: This retrospective study was done between April 2017 and May 2018 at the AIDS Prevention Initiative in Nigeria (APIN)-supported HIV clinic of the Jos University Teaching Hospital (JUTH), north central Nigeria. Included in this analysis were patients who had been on either TDF/FTC/EFV or AZT/FTC/NVP consistently for at least 12 months and who had at least 95% adherence based on pharmacy drug pick up. Data were analysed using SPSS version 23.0. Results: A total of 301 patients who met the inclusion criteria were studied of which 187 (62.1%) were females and the overall mean (SD) age was 40±9 years. There were 204 (67.8%) patients on AZT/FTC/NVP while 97 (32.2%) were on TDF/FTC/EFV. Overall, the CD4 count increased from a median (IQR) baseline of 201 cells/mm3 by the end of 12 months of HAART. Or was it 24 months you used? (112–284) to 488 cells/mm3 by the end of 12 months of HAART (344.5–628.0) P =

Lassa fever (LF) outbreaks in Nigeria mostly occur in rural areas and during the dry season, peaking between December through February. Fever is a cardinal presenting feature among the myriad manifestations of LF. Thirty four patients with clinical diagnosis of LF were analyzed. However, only 11 (32%) LASV infections were confirmed by RT-PCR. The 2016 LF outbreak showed a preferential urban occurrence and a high case fatality. Fever (≥38°C) was not detected in over a fourth of the patients at the time of examination. Bleeding diathesis was the most common presentation while abdominal pain and headache were present in more than half of the confirmed cases. Changes in the geographical distribution and clinical presentation may have implications for disease control efforts and the risk of transmission, both locally and internationally. In order to guide interventions, public health authorities should be aware that the epidemic patterns may be changing.

The association of Zika virus (ZIKV) infection with congenital malformation and neurological sequelae has brought significant global concern. Consequently, the World Health Organization (WHO) declared it "a public health emergency of International concern" on 1 February, 2016. A critical review of its pathogenesis would lead to a better understanding of the clinical features and the neurological complications. This review is based on literature search in PubMed/Medline, Google Scholar and the WHO, http://www.who.int. This include all relevant articles written in English published through June 2018, with subject heading and keywords such as Zika, ZIKV, Zika pathogenesis, diagnosis of Zika, Zika Nigeria, Zika Africa and Zika resource-limited settings. Following ZIKV infection, viraemia ensues targeting primarily the monocytes for both the Asian and African strains. ZIKV infection by an African strain appears to be more pathogenic, in early pregnancy tends to result in spontaneous abortion. Whereas an Asian strain tends to be less pathogenic and more chronic, this allows the pregnancy to continue, ultimately resulting in congenital malformations. There is no routine laboratory diagnosis of ZIKV infection in resource-constrained countries. Serologic tests should be interpreted with caution since there can be cross-reactivity with other flaviviruses, especially in Africa where the burden of infection with flaviviruses is comparatively high. There is a paucity of well-equipped laboratories for comprehensive ZIKV diagnosis. It is imperative to strengthen the health systems, improve health workforce and diagnostic capacity of such settings.

Background Zika virus (ZIKV) has been known for decades in Africa but contemporary data is lacking at large. Objectives To describe the seroepidemiology of ZIKV in North Central Nigeria. Study design We performed a cross-sectional study at six health care facilities in North Central Nigeria from January to December 2016. Detection of ZIKV antibodies was done using an anti-ZIKV recombinant non-structural protein 1 (NS1)-based ELISA. A colorimetric assay to detect ZIKV neutralizing antibodies was used on ELISA reactive and randomly selected ELISA non-reactive samples. ZIKV real-time RT-PCR was done on a subset of samples. Results A total of 468 individual samples were included with almost 60% from pregnant women. Using NS1-based ELISA, an anti-ZIKV positive rate of 6% for IgM and 4% for IgG was found. Pregnant women showed anti-ZIKV positive rates of 4% for IgM and 3% for IgG. None of the ZIKV antibody positive samples tested ZIKV RT-PCR positive. An association with male sex was found for anti-ZIKV IgG ELISA positivity (prevalence ratio 3.49; 95% confidence interval: 1.48–8.25; p = .004). No association with pregnancy, yellow fever vaccination or malaria was found for anti-ZIKV IgM or IgG positivity. ZIKV neutralizing antibodies were detected in 17/18 (94%) anti-ZIKV NS1 positive/borderline samples and in one sample without detectable ZIKV NS1 antibodies. Partial ZIKV E gene sequence was retrieved in one sample without ZIKV antibodies, which clustered within the West African ZIKV lineage. Conclusions Our results show a largely ZIKV immunologically naive population and reinforce the importance of ZIKV surveillance in Africa.

Background Individuals with HIV, especially those on antiretroviral therapy (ART), may have increased risk of hypertension. We investigated the prevalence of hypertension at enrolment and 12 months after commencing ART in a Nigerian HIV clinic. Methods Data from patients enrolled for ART from 2011 to 2013 were analysed, including 2310 patients at enrolment and 1524 re-evaluated after 12 months of ART. The presence of hypertension, demographic, clinical and biochemical data were retrieved from standardized databases. Bivariate and logistic regressions were used to identify baseline risk factors for hypertension. Results Prevalence of hypertension at enrolment was 19.3% (95% CI 17.6-20.9%), and age (p

Background: The transmission of Yellow fever,a viral hemorrhagic feveris facilitated in countries which have close proximity to the mosquito vectors and large number of unvaccinated population. Globally, mass vaccination campaigns have significantlyreduced the incidence of this disease, but recent reports from the World Health Organization (WHO), indicates an increase in the rate of transmission, especially in Sub-Saharan Africa. Between 2017 and 2018,some Nigerian states including Plateau state reported confirmed cases of yellow fever. In this study, we assessed the yellow fever immunization coverage in Jos North Local Government area (LGA) of Plateau state.Methodology: A retrospective cross-sectional study was carried out to assess yellow fever immunization coverage in Jos North LGA over a 3-year period from January 2015 to December 2017, with data obtained from the Local Government Area office. This included both data from routine and supplemental immunization activities. The number of children immunized was then compared to the target population to assess coverage for each year.Results: Overall, 71, 734 children were immunized. This comprised of infants 9-11 months 69,344(96.7%) and 1 -5 year old infants 2390(3.3%). The overall average immunization coverage was (21,514/92,652) 23.2% in 2015, (24,977/93,569) 26.6% in 2016, and (25,243/94,495) 26.7% in 2017, with a mean coverage of 25.5% over the 3 year period.Conclusion: Yellow fever immunization coverage in this LGA is low. Urgent work needs to be done to increase immunization coverage across the local government, and by extension the state and country, especially in view of the recent outbreak of yellow fever in some states.Key words: Yellow fever, Immunization, North-Central Nigeria.

Background In Nigeria, where malaria is endemic, greater than 70% of febrile illnesses are treated presumptively as malaria, often without a laboratory evaluation for other possible causes of fever. This cross-sectional study evaluated the presence of dengue virus infection in febrile patients, presumptively diagnosed of malaria infections in the clinic. Methodology Blood samples were collected from 529 febrile patients (246 in Jos and 283 in Maiduguri) attending the general outpatient clinics of the Jos University Teaching Hospital (JUTH) and the University of Maiduguri Teaching Hospital (UMTH) and tested for anti-dengue immunoglobulin M (IgM) and immunoglobulin G (IgG), as well as anti-non-structural protein (NS1) by ELISA. The samples were also evaluated for presence of P. falciparum malaria parasites by microscopic examination of Giemsa-stained blood smears. Results The prevalence of confirmed, highly suggestive and probable dengue virus infections categorized in relation to duration of illness since onset of fever were 2.3%, 5.5% and 1.5% respectively, while the prevalence of anti-flavivirus IgG and IgM seropositivity was 11.7%. In a total of 117 (22.1%) patients (32 in Jos, 85 in Maiduguri), malaria parasites were detected by blood smear microscopy, out of which 7 (6%) also had a positively confirmed, highly suggestive or probable dengue test result. Conclusion Although the high cross-reactivity of anti-flavivirus antibodies should be taken into account in the interpretation of the seroprevalence data, our findings suggest a significant presence of dengue virus in this environment, some of which may otherwise be misdiagnosed as malaria. These findings are strong enough to recommend serological screening for anti-dengue virus titer and NS1 antigen for all febrile patients, as part of fever diagnostic protocols in tropical regions. Given the prevalence of dengue virus infections, there is also a need for a dengue control program and public education to prevent outbreaks and occurrence of severe dengue complications.

INTRODUCTION Studies on the prevalence of and risk factors for tuberculosis (TB) among newly diagnosed human immunodeficiency virus (HIV)-infected children in sub-Saharan Africa are scarce and in Nigeria there is paucity of reported data. We determined the prevalence of and risk factors for pulmonary TB (PTB) in newly diagnosed (treatment-naive) HIV-1 infected children at the pediatric HIV clinic of the Jos University Teaching Hospital (JUTH) in Nigeria. METHODS We performed a retrospective analysis of 876 children, aged 2 months - 13 years, diagnosed with HIV-1 infection between July 2005 and December 2012, of which 286 were diagnosed with PTB at presentation after TB screening. The study site was the AIDS Prevention Initiative in Nigeria (APIN)-supported Pediatric HIV clinic at JUTH, Jos. A multivariate forward logistic regression modelling was used to identify risk factors for PTB-HIV co-infection. RESULTS The prevalence of PTB-HIV co-infection was 32% (286/876). Severe immunosuppression (SI) and World Health Organization (WHO) HIV clinical stage 3/4 were identified as independent risk factors for PTB-HIV co-infection in HIV infected children. The odds of PTB-HIV co-infection was increased two-fold in HIV-infected children with WHO clinical stage 3/4 compared to those with stage 1/2 (adjusted odds ratio (AOR) 1.76 [1.31-2.37], p

Zika virus disease has resonated great concern globally. The World Health Organization declared it “a public health emergency of International concern” on 1st February, 2016. The recent outbreaks have become a major challenge due to a drift from its earlier known benign exanthematous spectrum to a causal link to microcephaly. Historically, the name Zika virus comes from the Zika Forest of Uganda. It was first identified in 1947 among Rhesus Macaque sub-population. Two genetically distinct isolates have been well characterized; the Asian and African strains. This virus is spread by bites of day-time-active Aedes mosquitoes; the Aedes aegypti and Aedes albopictus. Zika Virus appears to spread along a narrow equatorial belt of Africa to Asia through the Pacific Ocean to French Polynesia, New Caledonia (southwest Pacific Ocean), the Cook Islands (south Pacific), and Easter Island (a Chilean territory in Polynesia), and most recently to Mexico, Central America, the Caribbean, and South America, where today has assumed a pandemic proportion.Up to eighty percent of infections are asymptomatic. Symptomatic infections are characterized by a self-limiting febrile illness and maculopapular rash, arthralgia, conjunctivitis, back pain and mild headaches. Maternal Zika viral load is thought to be a significant risk factor to fetal infection leading to invasion of either trophoblasts or placental cells or both through maternal decidua. Zika viral RNA proteins and associated extensive selective tissue injuries have been demonstrated in the brains and spinal cords of abortuses. Diagnosis of Zika virus is essentially based on viral RNA detection from clinical specimens. Currently, licensed preventive medicines or vaccines are unavailable. With the wide spate of recent outbreaks and consequent neurologic morbidity and mortality, there is need for deployment of point-of-care equipment for screening of pregnant women in our environment. This is an ambitious call for advocacy by all relevant health care providers.Keywords: Zika Virus, disease outbreaks, microcephaly, Aedes mosquitoes

The concept of fever is an interesting subject that has intrigued clinicians for centuries. As pain is an important stimuli to withdraw from a noxious stimuli that may be potentially harmful, so is fever an important sign of a possible microbial invasion. Back and forth, there has been arguments and debates about whether fever is deleterious, a foe, or actually beneficial. There has also been question about whether or not to treat it, and when to treat it. This review article tries to paint a broad picture of both sides of this coin.

Background Tuberculosis (TB) could be fatal if left untreated, however, adverse effects of anti-TB medications (anti-TBs) themselves may limit treatment. We determined the incidence and clinical characteristics of hepatotoxicity in hospitalized patients receiving first-line anti-TB treatment. Methods A retrospective cohort study of patients aged ⩾18 years seen at the medical wards of the Jos University Teaching Hospital from January 2013 to June 2013 was carried out. Data were retrieved for 110 patients who were prescribed anti-TBs. Their demographic and clinical characteristics were described, and the incidence of symptomatic hepatotoxicity determined. The incidence of hepatotoxicity by strict American Thoracic Society criteria (symptomatic hepatotoxicity plus alanine transaminase in IU/L levels >3 × upper limit of normal) was also determined. Results Twenty patients developed symptomatic hepatotoxicity, giving an incidence of 18.2%. Furthermore, 18 (16.4%) patients had hepatotoxicity according to the American Thoracic Society criteria. Those with symptomatic hepatotoxicity unexpectedly had lower baseline alanine transaminase interquartile range (IQR) (35 [16–63] vs. 67 [4–226]; p = .04) and bilirubin (μmol/L): total IQR (15.3 [10.2–74.8] vs. 20.4 [20.4–20.4]; p = .01) and conjugated IQR (7.6 [5.1–34.8] vs. 10.2 [10.2–10.2]; p = .004). However, there were no significant differences in age, sex, body mass index, and duration of anti-TB treatment, human immunodeficiency virus infection status, antiretroviral therapy status, alcohol consumption, and the presence of hepatitis B surface antigen or hepatitis C virus antibody. Conclusion Hepatotoxicity due to first-line anti-TBs, whether based on clinical features alone or backed by liver chemistry, is common among hospitalized patients in our environment. Studies to determine the predictors of hepatotoxicity to guide clinical interventions aimed at the prevention or timely identification of cases are needed.

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 Efavirenz is a commonly prescribed antiretroviral drug that is largely well tolerated. However, seizure disorder is a rare side effect. Prompt identification and immediate replacement of efavirenz with an alternative drug would effectively stop the seizures. To the best of our knowledge, we present the first reported case in the literature of complex partial seizures arising due to efavirenz. Case presentation We report a case of a 33-year-old Nigerian man treated with an efavirenz-based antiretroviral regimen for human immunodeficiency virus infection. He presented with seizures soon after commencement of antiretroviral drugs. His magnetic resonance imaging results were unremarkable. His blood levels of sodium, glucose, urea, and creatinine were within normal limits. However, his electroencephalogram showed intermittent bursts of high-voltage sharp waves and spikes bilaterally over frontotemporoparietal regions, a finding consistent with complex partial seizures. His efavirenz plasma level was 209.55 μg/ml. His seizures stopped following a switch to a non-efavirenz-based regimen. Conclusions This report brings to light the occurrence of complex partial seizures in patients on efavirenz. It also demonstrates the effective resolution of seizures when efavirenz treatment is replaced with a non-efavirenz-based regimen.