Scholarly works in Obstetrics and Gynecology
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Item Age-specific burden of cervical cancer associated with HIV: A global analysis with a focus on sub-Saharan Africa(Wiley, 2021) Khalil, A. I.; Mpunga, T.; Wei, F.; Baussano, I.; de Martel, C.; Bray, F.; Stelzle, D.; Dryden-Peterson, S.; Jaquet, A.; Horner, M. J.; Awolude, O. A.; Trejo, M. J.; Mudini, W.; Soliman, A. S.; Sengayi-Muchengeti, M.; Coghill, A. E.; van Aardt, M. C.; DeVuyst, H.; Hawes, S. E.; Broutet, N.; Dalal, S.; Clifford, G. M.HIV substantially worsens human papillomavirus (HPV) carcinogenicity and contributes to an important population excess of cervical cancer, particularly in subSaharan Africa (SSA). We estimated HIV- and age-stratified cervical cancer burden at a country, regional and global level in 2020. Proportions of cervical cancer (a) diagnosed in women living with HIV (WLHIV), and (b) attributable to HIV, were calculated using age-specific estimates of HIV prevalence (UNAIDS) and relative risk. These proportions were validated against empirical data and applied to age- specific cervical cancer incidence (GLOBOCAN 2020). HIV was most important in SSA, where 24.9% of cervical cancers were diagnosed in WLHIV, and 20.4% were attributable to HIV (vs 1.3% and 1.1%, respectively, in the rest of the world). In all world regions, contribution of HIV to cervical cancer was far higher in younger women (as seen also in empirical series). For example, in Southern Africa, where more than half of cervical cancers were diagnosed in WLHIV, the HIV-attributable fraction decreased from 86% in women <34 years to only 12% in women >55 years. The absolute burden of HIV-attributable cervical cancer (approximately 28 000 cases globally) also shifted toward younger women: in Southern Africa, 63% of 5341 HIV-attributable cervical cancer occurred in women <45 years old, compared to only 17% of 6901 non-HIV-attributable cervical cancer. Improved quantification of cervical cancer burden by age and HIV status can inform cervical cancer prevention efforts in SSA, including prediction of the impact of WLHIV-targeted vs general population approaches to cervical screening, and impact of HIV prevention.Item Partner’s profile and unmet need for child limiting among women living with HIV in Ibadan, Nigeria(Polish AIDS Research Society, 2021) Eniade, O. D.; Akinyemi, J. O.; Afolabi, R. F.; Awolude, O. A.Introduction: In many African countries, the success of secondary prevention among reproductive-age women living with HIV (WLH) is affected by unmet need for family planning and marital contexts. The influence of the latter has not received adequate attention, especially among WLH. This study describes the level of unmet need for child limiting and the effects of partner’s characteristics among childbearing WLH in Ibadan, South-West, Nigeria. Material and methods: A cross-sectional study was conducted among married women of childbearing age attending antiretroviral treatment clinic, University College Hospital, Ibadan between November and December 2015. Data were analyzed using descriptive statistics and generalized linear models. Results: Of 781 women, 171 (21.9%) had unmet need for child limiting, while 14.2% and 45.7% have partners who were unemployed and in unskilled occupation, respectively. Controlling for partner’s characteristics, socio-economic and demographic variables, having a partner who is unemployed (OR = 3.51; 95% CI: 1.71-7.21), and unknown HIV status (OR = 2.09; 95% CI: 1.20-3.62), significantly increased odds of unmet need. Age between 45 and 49 years (OR = 4.34; 95% CI: 1.36-13.90), Christianity (OR = 1.75; 95% CI: 1.06-2.87), earning <= minimum wage (OR = 1.72; 95% CI: 1.07-2.76), and having more than two children ever born were also significant factors associated with unmet need. Conclusions: HIV care and treatment programs require innovative approaches to promote partner’s testing and economic empowerment of WLH to reduce the level of unmet need for child limiting among reproductive-age women living with HIV.Item Oral Melanotic Hyperpigmentation (OMH) among HIV Seropositive Patients: A Clinical Study at the University College Hospital, Ibadan(Nigerian Association of Oral and Maxillofacial Pathology and Medicine, 2017) Abe, E. O.; Adeyemi, B. F.; Adisa, A. O.; Okoje-Adesomoju, V. N.; Awolude, O. A.BACKGROUND: Oral melanin hyperpigmentation (OMH) has been classified as a HIV associated condition which may present as a brown-black macule or patch of the oral mucosa in HIV seropositive patients. HIV-OMH may be idiopathic, drug- induced or due to adrenal insufficiency. This cross-sectional study was conducted to determine the prevalence of HIV- OMH among HIV seropositive patients attending the Infectious Disease Institute centre, UCH Ibadan. METHODOLOGY: Consecutive, consenting HIV seropositive patients attending PEPFAR clinic, UCH, Ibadan were enrolled. Data collected included age, gender, duration since diagnosis of HIV and commencement of HAART, history of smoking, any systemic disease, WHO staging of HIV, CD4 count, presence of OMH and site affected. Data analysis was done using SPSS version 15. RESULTS: The study group of 150 HIV sero-positive patients comprised 24 males (16%) and 126 females (84%). Out of all the patients seen, OMH was seen in 97 of them, majority reported not being aware of the condition, some noted it before being diagnosed of HIV, while only 14(14.4%) reported the presence of OMH after being diagnosed with HIV and commencement of HAART (p= 0.032). Concerning the OMH sites, gingiva was most noted followed by tongue, palate, buccal and labial mucosa. CONCLUSION: The prevalence of HIV-OMH in this study was 14.4%. Gingiva was the most common site affected.Item Effect of Hepatitis C virus infection on selected laboratory values in pregnant women with Human Immunodeficiency virus infection(Society for Gastroenterology and Hepatology in Nigeria (SOGHIN), 2016) Adesina, O. A.; Akinyemi, J. O.; Michael, O. S.; Fayemiwo, S. A.; Awolude, O. A.; Ogunbosi, B. O.; Kuti, M. A.; Adewole, I. F.Background and Objectives: Both hepatitis C and Human Immunodeficiency viruses affect laboratory indices. The objective of this study was to describe the impact of both viruses on laboratory indices among 1,821 HIV-positive pregnant women. Methods: This was a cross-sectional retrospective study at the University College Hospital, Ibadan Results: Twenty-six (1.7%) women were HCV positive, 139 (8.8%) were HBsAg positive and 1, 407 (89.3%) were negative for both viruses. Three patients (0.19%) were positive for both viruses. These patients, the HBsAg positive women and 246 with no result for either virus were excluded from analysis. The HCV positive women had lower hematocrit (27.3% + 4.5 vs. 28.4% + 4.6, p=0.29), lower WBC (5, 200 vs. 5, 500 cells/ml, p =0.766) but higher platelet count (209, 000 vs. 199, 000 cells / ml, p = 0.019). The coinfected group had higher CD4 (380 vs. 326 cells/ml, p = 0.319), higher urea (16.0vs.ll.0mg/ml, p =0.013) but comparable ALT (16.0 vs.15.0 iu/ml, p = 0.95), log viral load (4.08+1.22 vs. 4.08+1.11, p=0.97) and creatinine levels (0.6vs.0.6, p=0.329). Only the difference in urea level was statistically significant. Conclusion: While values were comparable between both groups, the synergistic effect of both viruses makes it necessary for health-care providers to closely monitor patients.Item Invasive cervical cancer in Ibadan: socio-sexual characteristic, clinical stages at presentation, histopathology distributions and HIV status(2019) Awolude, O. A.; Oyerinde, S. O.Background: Human Papillomavirus (HPV) infection persistence is the necessary but not sufficient cause of invasive cervical cancer (ICC). The effects of Human Immunodeficiency Virus (HIV) co-infection have been well documented. The purpose of this study was to describe our experience on the clinico-pathological characteristics of patients with cervical cancer and HIV status at a tertiary Hospital in Nigeria. Materials and Methods: This was a descriptive study among ICC patients presenting for clinical staging and biopsy for histological diagnosis at the Obstetrics and Gynaecology outpatient theatre of our hospital between January 2009 and February 2011. Results: Sixteen (6.8%) of the 248 patients with histologically confirmed ICC in this study were HIV positive. The mean age of all the participants was 55.4 (SD±10.2) years with the HIV positive patients’ younger than the HIV-negative and those that declined HIV testing. Coitarche was at lower age (18 [SD±4.4] vs 22[SD±3.4] years vs 24.5[SD±4.4], respectively). The modal lifetime sexual partners were four, one and two, respectively. Clinically, more HIV positive patients, presented at advanced stage of ≥ 2B. Also, the adenocarcinoma histological variant was slightly more among the HIV positive patients. Conclusion: HIV seemed relatively common among ICC patients and they presented at lower ages, at more advanced stages, earlier coitarche and more lifetime sexual partners. The proportion of adenocarcinoma histological types was slightly higher among the HIV positive patients compared with seronegative patients and those with unknown HIV status. Larger studies to substantiate these findings and ICC-HIV causal relationship are required.Item HCV co-infection is associated with metabolic abnormalities among HAART naïve HIV-infected persons(2017) Kuti, M. A.; Akinyemi, J. O.; Ogunbosi, B. O.; Kuti, K. M.; Adesina, O. A.; Awolude, O. A.; Michael, O. S.; Adewole, I. F.Objectives: To determine the metabolic abnormalities among Hepatitis C Virus (HCV) coinfected HAART naïve HIV infected persons within the adult ARV clinic of the University College Hospital/University of Ibadan, Ibadan, Nigeria Methods: This was a retrospective study involving the review of clinical records of newly recruited HIV-infected persons in the adult antiretroviral (ARV) clinic over a 12month period (January - December 2006). Baseline results for fasting plasma glucose (FPG) and fasting lipid profile were retrieved. Results: Out of the 1,260 HIV infected persons seen during the study period, HCV co-infection was found in 75 (6%) persons. The median values for total cholesterol, LDL-cholesterol and HDLcholesterol were lower in the HCV co-infected persons. HIV-HCV co–infection was associated with a 0.31 mmol/L depression in Total Cholesterol (TC). The median FPG concentration was significantly higher in HIV-HCV co–infected than HIV only infected persons (5.33mmol/L vs. 5.00mmol/L, p = 0.047). However, regression analysis showed there was no relationship between the HIV-HCV coinfected State and fasting glucose levels. Conclusion: HIV-HCV co-infection may be associated with a predictable decline in plasma cholesterol, but FPG may not be sufficient to demonstrate insulin resistance in these persons.Item External genital warts in HIV-infected patients with sexually transmitted infections in Ibadan, Nigeria(2017) Fayemiwo, S. A.; Adesina, O. A.; Akinyemi, J. O.; Michael, O. S.; Adekanmbi, O. A.; Awolude, O. A.; Kuti, M. A.; Odaibo, G. N.; Adewole, I. F.Background: Human Papilloma Virus (HPV) infection in the genital area is usually asymptomatic, and when symptomatic, manifests in cither benign or malignant forms. This study aims at providing information on the prevalence of external genital warts (EGWs) among people living with HIV (PLWHIVs) attending Antiretroviral Treatment (ART) clinic at the University College Hospital. Ibadan, Nigeria. Methods: This is a descriptive cross-sectional survey of PLWHIVs attending ART clinic between January 2006 and December 2007. Diagnosis of genital warts was based on the findings of typical lesions on the external genitalia, vaginal, cervix or perianal region after clinical examination and informed consent from each participant. Antibodies against Herpes and HPV were measured using, Enzyme-linked immunosorbent Assay (ELISA). Results: A total of 5.207 patients, 3519 female and 1688 males attended the ART clinic during the period. The mean age of the patients was 34,67 yrs (± 9.16). Five hundred and forty-two (10.0%) had various sexually transmitted infections (STIs). The prevalence of anogenital warts was 3.65% among the HIV-infected patients and 35.0 % among the subset of HIV- infected patients with STIs. The prevalence of genital warts was 1.5 times higher in treatment experienced patients (OR =1.46; 95%CI: 1.02,2.10). Genital wart was found to be associated with low CD4 count, high viral load, treatment- experience and non-use of condom during sexual intercourse. (P = 0.002). Conclusions: External genital warts are common among people living with HIV infection. According to the appropriate guidelines, HPV vaccine should also be offered to HIV-infectcd adolescents that are non-rcactivc to the virus.Item Oral melanotic hyperpigmentation (OMH) among HIV seropositive patients: a clinical study at the University College Hospital, Ibadan(2017-06) Abe, E. O.; Adeyemi, B. F.; Adisa, A. O.; Okoje-Adesomoju, V. N.; Awolude, O. A.BACKGROUND: Oral melanin hyperpigmentation (OMH) has been classified as a HIV associated condition which may present as a brown-black macule or patch of the oral mucosa in HIV seropositive patients. HIV-OMH may be idiopathic, drug- induced or due to adrenal insufficiency. This cross-sectional study was conducted to determine the prevalence of HIV- OMH among HIV seropositive patients attending the Infectious Disease Institute centre, UCH Ibadan. METHODOLOGY: Consecutive, consenting HIV seropositive patients attending PEPFAR clinic, UCH, Ibadan were enrolled. Data collected included age, gender, duration since diagnosis of HIV and commencement of HAART, history of smoking, any systemic disease, WHO staging of HIV, CD4 count, presence of OMH and site affected. Data analysis was done using SPSS version 15. RESULTS: The study group of 150 HIV sero-positive patients comprised 24 males (16%) and 126 females (84%). Out of all the patients seen, OMH was seen in 97 of them, majority reported not being aware of the condition, some noted it before being diagnosed of HIV, while only 14(14.4%) reported the presence of OMH after being diagnosed with HIV and commencement of HAART (p= 0.032). Concerning the OMH sites, gingiva was most noted followed by tongue, palate, buccal and labial mucosa. CONCLUSION: The prevalence of HIV-OMH in this study was 14.4%. Gingiva was the most common site affected.Item Dyslipidemia in ART-naive HIV-infected persons in Nigeria-implications for care(Sage, 2014) Kuti, M. A.; Adesina, O. A.; Awolude, O. A.; Ogunbosi, B. O.; Fayemiwo, S. A.; Akinyemi, J. O.; Adetunji, A. A.; Irabor, A. E.; Odaibo, G. N.; Prosper, O.; Taiwo, B. O.; Olaleye, D.; Murphy, R. L.; Kanki, P.; Adewole, I. F.Aims: This study aimed to describe the prevalence and pattern of lipid abnormalities among antiretroviral therapy (ART)- naive HIV patients, understand if there is any relationship to virologic and immunologic status, and discuss the implications for care. Methods: This was a cross-sectional study in which baseline demographic, clinical, and laboratory data of all ART-naive HIV-infected individuals recruited into the adult ARV clinic, University College Hospital, Ibadan, between January and December 2006, were analyzed. Results: In total, 1316 ART-naive HIV-infected persons were recruited in the period. Females subjects and participants aged 35 years accounted for 67.1% and 57.7% of all participants, respectively. At least 1 abnormal lipid fraction was seen in 73.3% of participants. It was observed that in 11.5% participants the total cholesterol (TC) was ≥5.2 mmol/L, in 2.7% the low-density lipoprotein cholesterol (LDL)-C was >4.1 mmol/L in 56.5% the high-density lipoprotein cholesterol (HDL)-C was <1.0 mmol/L, and in 27.6% the triglyceride (TG) was >1.7 mmol/L. The TC, LDL-C, and HDL-C were all significantly positively correlated with CD4 counts and negatively correlated with viral load. On the contrary, the TG levels were negatively correlated with CD4 counts and positively correlated with viral load. Multivariate linear analysis showed a significant relationship between all the lipid parameters and viral load. CD4 counts were only significantly associated with TC. Conclusions: A significant burden of dyslipidemia exists among ART-naive HIV-infected persons. Low HDL-C was the most frequently observed abnormality. The abnormalities related more with viral load levels than with CD4 counts. Dyslipidemia screening should be done in ART-naive HIV-infected persons. Simple healthy lifestyle changes should be emphasized, with other care given to those with the disorder.Item Emergency obstetric patients in a developing country and prevalence of HIV infection(2009) Awolude, O. A.; Oladokun, A.; Adesina, O. A.; Mutiu, W. B.; Adewole, I. F.The availability of VCT for HIV for booked antenatal patients offers a unique opportunity for best obstetrics practice but not for patients presenting with emergencies and unknown HIV status. Health workers who attend to such patients are at higher risk of acquiring HIV infections. Between 1st March 2005 and 30th September 2007, unbooked emergency obstetric patients in the labour ward of a teaching hospital who consented were tested using double rapid immunodiagnostic technique and confirmed by Western Blot. HTV positive patients were post-test counselled and offered single dose nevirapine tablet (200mg) in labour with syrup given to the baby at birth at 2mg/kg followed by syrup zidovudine for 6 weeks: The results showed that 275 (89.0%) of the 309 women pre-test counselled agreed to testing. The mean age of clients was 27.7 years (± 4.4 SD). The mean gestational age at presentation was 36.4 weeks (± 4.2 weeks). Primigravidae constituted 37.5% of the patients. Twenty-one (7.6%) of these consenting patients were H3V positive. In conclusion, the HIV prevalence of 7.6% among these unbooked obstetric patients is higher than the 4,7% among our booked antenatal patients and National prevalence of 4.4%. This poses substantial risk of transmission of HIV to attending health workers considering the readiness with which needle prick accident can occur in emergency situations.