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Federal Capital Territory, Nigeria

Etiebet M.-A.A.,University of Maryland Baltimore County | Shepherd J.,University of Maryland Baltimore County | Nowak R.G.,University of Maryland Baltimore County | Charurat M.,University of Maryland Baltimore County | And 8 more authors.
AIDS | Year: 2013

BACKGROUND: In resource-limited settings, HIV-1 drug resistance testing to guide antiretroviral therapy (ART) selection is unavailable. We retrospectively conducted genotypic analysis on archived samples from Nigerian patients who received targeted viral load testing to confirm treatment failure and report their drug resistance mutation patterns. METHODS: Stored plasma from 349 adult patients on non-nucleoside reverse transcriptase inhibitor (NNRTI) regimens was assayed for HIV-1 RNA viral load, and samples with more than 1000copies/ml were sequenced in the pol gene. Analysis for resistance mutations utilized the IAS-US 2011 Drug Resistance Mutation list. RESULTS: One hundred and seventy-five samples were genotyped; the majority of the subtypes were G (42.9%) and CRF02-AG (33.7%). Patients were on ART for a median of 27 months. 90% had the M184V/I mutation, 62% had at least one thymidine analog mutation, and 14% had the K65R mutation. 97% had an NNRTI resistance mutation and 47% had at least two etravirine-associated mutations. In multivariate analysis tenofovir-based regimens were less likely to have at least three nucleoside reverse transcriptase inhibitor (NRTI) mutations after adjusting for subtype, previous ART, CD4, and HIV viral load [P<0.001, odds ratio (OR) 0.04]. 70% of patients on tenofovir-based regimens had at least two susceptible NRTIs to include in a second-line regimen compared with 40% on zidovudine-based regimens (P=0.04, OR=3.4). CONCLUSIONS: At recognition of treatment failure, patients on tenofovir-based first-line regimens had fewer NRTI drug-resistant mutations and more active NRTI drugs available for second-line regimens. These findings can inform strategies for ART regimen sequencing to optimize long-term HIV treatment outcomes in low-resource settings. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Charurat M.E.,University of Maryland Baltimore County | Emmanuel B.,University of Maryland Baltimore County | Akolo C.,University of Maryland Baltimore County | Akolo C.,Institute of Human Virology Nigeria | And 8 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2015

Background: Experimental evidence has shown that treatment of HIV infection with antiretroviral therapy (ART) prevents heterosexual transmission of HIV to an uninfected partner. However, the "real-world" application of this strategy to key populations such as menwho have sex with men (MSM) has been limited. We report findings on acceptability of a treatment as prevention (TasP) strategy among HIV-infected MSM at a Trusted Community Center providing comprehensive HIV prevention and treatment services to MSM in Abuja, Nigeria. Methods: Using respondent-driven sampling (RDS), MSM who were 16 years and older and have engaged in either receptive or insertive anal intercourse within the previous 12 months were recruited into a prospective combination HIV prevention and treatment study (TRUST). Two weeks after enrollment, HIV testing and counseling was conducted. At each 3-month follow-up visits, HIV-infected individuals underwent clinical and laboratory evaluation, including CD4 count, plasma HIV viral load, immediate 3 weekly sessions of ART preparation, and then ART initiation per TasP strategy irrespective of CD4 count. Reasons for not engaging in pre-TasP preparation and TasP were documented. Characteristics associated with TasP engagement and loss to follow-up (LTFU) were determined using logistic and Cox regression, respectively. Results: Of 186 HIV-positive MSM enrolled, 58 (31.2%) were on ART at the time of recruitment, whereas 128 (68.8%) were ART-naive and provided opportunity for engaging TasP. Of these, 70 (54.7%) engaged in TasP. Compared with MSM who did not engage in TasP, those who engaged had significantly lower mean CD4 count (P = 0.001), were more likely to be Christian (P = 0.01), and had disclosed being MSM to family (P = 0.02) or health care providers (P = 0.02). In multivariate models, disclosure of being MSM to health care providers remained significantly associated with uptake of TasP. Among individuals engaged in TasP, 10% were LTFU in care at 18 months since enrollment. Being engaged in TasP (relative hazards = 0.08, P < 0.001) and on ART (relative hazards = 0.17, P < 0.001) were associated with decreased risk of LTFU. Conclusions: Although there was high acceptance of HIV testing and low LTFU among individuals who were already on ART or engaged in TasP, a higher than expected proportion did not engage in TasP, suggesting the need for customized treatment preparation and an increase in enabling environments to support HIV treatment access with this key population. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Sam-Agudu N.A.,Institute of Human Virology Nigeria | Sam-Agudu N.A.,University of Maryland, Baltimore | Sam-Agudu N.A.,University Of Cape Coast | Folayan M.O.,Obafemi Awolowo University | Ezeanolue E.E.,University of Nevada, Las Vegas
Pediatric Research | Year: 2016

More than 80% of the HIV-infected adolescents live in sub-Saharan Africa. Acquired immune deficiency syndrome (AIDS)-related mortality has increased among adolescents 10-19 y old. The impact is highest in sub-Saharan Africa, where >80% of HIV-infected adolescents live. The World Health Organization has cited inadequate access to HIV testing and counseling (HTC) as a contributing factor to AIDS-related adolescent deaths, most of which occur in sub-Saharan Africa. This review focuses on studies conducted in high adolescent HIV-burden countries targeted by the "All In to End Adolescent AIDS" initiative, and describes barriers to adolescent HTC uptake and coverage. Fear of stigma and family reaction, fear of the impact of a positive diagnosis, perceived risk with respect to sexual exposure, poor attitudes of healthcare providers, and parental consent requirements are identified as major impediments. Most-at-risk adolescents for HIV infection and missed opportunities for testing include, those perinatally infected, those with early sexual debut, high mobility and multiple/older partners, and pregnant and nonpregnant females. Regional analyses show relatively low adolescent testing rates and more restrictive consent requirements for HTC in West and Central Africa as compared to East and southern Africa. Actionable recommendations for widening adolescent access to HTC and therefore timely care include minimizing legal consent barriers, healthcare provider training, parental education and involvement, and expanding testing beyond healthcare facilities. Copyright © 2016 International Pediatric Research Foundation, Inc.

Anaedobe C.G.,Institute of Human Virology Nigeria | Fowotade A.,University of Ibadan | Omoruyi C.E.,University of Nigeria | Bakare R.A.,University of Nigeria
Pan African Medical Journal | Year: 2015

Introduction: Hepatitis B virus is responsible for 50%-80% of Hepatocellular carcinoma cases worldwide. In Nigeria, vertical transmission remains a major route of Hepatitis B virus infection. Primary (vaccines and post-exposure prophylaxis) and secondary prevention of HBV transmission by appropriate sexual and sanitary practices are not yet optimal in the country yet measures for early detection (serological, molecular) and treatment of infected pregnant women is not a practice. This study aimed at identifying the prevalence and risk factors for Hepatitis B virus infection among pregnant women in Ibadan, Southwestern Nigeria. Methods: A cross-sectional study was done at the Ante-natal clinic of the University College Hospital Ibadan. One hundred and eighty pregnant women were recruited from March to August 2013, and tested for Hepatitis B surface antigen (BIORAD FRANCE) using third generation ELISA, as well as HIV-1 and 2 using Uni-Gold Recombigen and ALERE determine (a rapid immunoassay designed to detect antibodies to HIV 1 and/or 2). Positive HBsAg samples were tested for Hepatitis B envelope antigen, antibody and Hepatitis B core antibody (DIAPRO Italy) while serum HBV DNA was detected using PCR. Data were obtained using questionnaires to establish and analysis was performed using SPSS version 20. Results: The seroprevalence of HBsAg was 8.3% out of which 26.7% were positive for HBeAg, 53.3% had HBeAb, 20% had neither HBeAg nor HBeAb, 100% had total HBcAb and 86.7% had HBV DNA in their serum. The mean age was 32.1years, the highest HBV infection rate occurred in 25-29 year age group. Multiple sexual partners (OR- 3.987, Pvalue= 0.026) and early age at sexual debut (OR 11.996, P- value=0.022) were independent risk factors for HBV infection. Conclusion: Hepatitis B virus infection is of high endemicity in Nigeria thus early detection, treatment of infected pregnant women, immunoprophylaxis for exposed newborns and surveillance for those with chronic infection is essential. Health education programs on prevention and control measures must be instituted. © Chinenye Gloria Anaedobe et al.

Anude C.J.,University of Maryland Baltimore County | Anude C.J.,Johns Hopkins University | Eze E.,University of Benin | Onyegbutulem H.C.,Asokoro District Hospital | And 9 more authors.
BMC Infectious Diseases | Year: 2013

Background: Predictors of immuno-virologic outcomes and discordance and their associations with clinical, demographic, socio-economic and behavioral risk factors are not well described in Nigeria since HIV viral load testing is not routinely offered in public HIV treatment programs.Methods: The HACART study was a multi-center observational clinic-based cohort study of 2585 adults who started HAART between April 2008 and February 2009. A total of 628 patients were randomly selected at 12 months for immuno-virologic analyses.Results: Virologic suppression rate (<400 copies/ml) was 76.7%, immunologic recovery rate (CD4 change from baseline ≥50 cells/mm3) was 77.4% and immuno-virologic discordance rate was 33%. In multivariate logistic regression, virologic failure was associated with age <30 years (OR 1.79; 95% CI: 1.17-2.67, p=0.03), anemia (Hemoglobin < 10 g/dl) (OR 1.71; 95% CI: 1.22-2.61, p=0.03), poor adherence (OR 3.82; 95% CI: 2.17-5.97, p=0.001), and post-secondary education (OR 0.60; 95% CI: 0.30-0.86, p=0.02). Immunologic failure was associated with male gender (OR 1.46; 95% CI: 1.04-2.45, p=0.04), and age <30 years (OR 1.50; 95% CI: 1.11-2.39, p=0.03). Virologic failure with immunologic success (VL-/CD4+) was associated with anemia (OR 1.80; 95% CI: 1.13-2.88, p=0.03), poor adherence (OR 3.90; 95% CI: 1.92-8.24, p=0.001), and post-secondary education (OR 0.40; 95% CI: 0.22-0.68, p=0.005).Conclusions: Although favorable immuno-virologic outcomes could be achieved in this large ART program, immuno-virologic discordance was observed in a third of the patients. Focusing on intensified treatment preparation and adherence, young patients, males, persons with low educational status and most importantly baseline anemia assessment and management may help address predictors of poor immuno-virologic outcomes, and improve overall HIV program impact. Viral load testing in addition to the CD4 testing should be considered to identify, characterize and address negative immuno-virologic outcomes and discordance. © 2013 Anude et al; licensee BioMed Central Ltd.

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