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Item Clinical and immunological profile of pediatric HIV infection in Ibadan, Nigeria(SAGE, 2011) Brown, B. J.; Oladokun, R. E.; Odaibo, G. N.; Olaleye, D. O.; Osinusi, K.; Kanki, P.In spite of the increasing number of children living with HIV in Nigeria, published data on their clinical profile are few. We describe the clinical profile at presentation of HIV-infected children at the University College Hospital, Ibadan, in a prospective study. Among 272 children studied (149 [54.8%] males; mean age 4.2 years [range 2 months to 15 years]), infection was acquired through vertical transmission in 252 (92.6%), blood transfusion in 5 (1.80%), and undetermined routes in 15 (5.5%) cases. Clinical features included weight loss (62.5%), prolonged fever (55.4%), generalized lymphadenopathy (48.6%), chronic cough (45.4%), and persistent diarrhea (28.3%). Tuberculosis was present in 45.3%, World Health Organization (WHO) clinical stages 3 and 4 disease in 70.6% and severe immunosuppression in 44.5% of cases. Pediatric HIV in Ibadan is acquired mainly vertically and most cases present with severe disease. Improved access to prevention services and early diagnosis are recommended.Item Service uptake and performance of the prevention of mother-to-child transmission (PMTCT) programme in Ibadan, Nigeria(2010) Oladokun, R. E.; Awolude, O.; Brown, B. J.; Adesina, O.; Oladokun, A.; Roberts, A.; Odaibo, G.; Osinusi, K.; Olaleye, D.; Adewole, I. F.; Kanki, P.The Prevention of Mother to Child Transmission (PMTCT) programme in the University College Hospital (UCH), Ibadan has been in existence for more than five years and has scaled up to other sites. The study evaluated the service uptake and performance of the programme using national key indicators. Antenatal and delivery records of women enrolled between July 2002 and June 2007 were reviewed. A total of 51952 women attended first antenatal visits and received HIV pre-test counselling. Of these, 51614 (99.5%) accepted HIV test and 49134 (95.2%) returned for their results. Out of the tested patients, 2152 (4.2%) were identified to be HIV positive. Partners of positive patients accepting HIV testing were 361 (16.7%) with 87 (18.6%) testing positive. There were a total of 942 deliveries out of which 39.2% of the mothers and 95.2% of the babies respectively received ARV prophylaxis. In all, 85.8% (788/918) of the mothers opted for formula as the method of infant feeding. Out of the 303 babies eligible for ELISA testing, 68.3% reported for the test and 17 (8.7%) tested positive. There has been progress in the programme, reflected in the increase in the number of new clients accessing the PMTCT service. However, partner testing and follow up of mother-infant pairs remain formidable challenges that deserve special attention.Item Prevalence of hepatitis B virus and C seropositivity in a Nigerian cohort of HIV-infected patients(2008) Otegbayo, J. A.; Taiwo, B. O.; Akingbola, T. S.; Odaibo, G. N.; Adedapo, K. S.; Penugonda, S.; Adewole, I. F.; Olaleye, D. O.; Murphy, R.; Kanki, P."INTRODUCTION:The clinical and public health implications of the convergence of the human immunodeficiency virus (HIV) epidemic and chronic viral hepatitis in sub-Saharan Africa are poorly understood. This study was designed to determine the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV), and the impact of co-infection on baseline serum alanine transaminase (ALT), CD4+ T lymphocyte (CD4) count, and plasma HIV-RNA (viral load) in a cohort of HIV-infected Nigerians. METHODS:A retrospective study was conducted, on eligible treatment-naive patients who presented between August 2004 and February 2007 to the University College Hospital (UCH), Ibadan, Nigeria. Demographic data and pre-treatment laboratory results (hepatitis B surface antigen (HBsAg), HCV antibodies (anti-HCV), ALT, CD4 count and viral load) were retrieved from the medical records. Fisher's exact, two sample t-tests, and the Wilcoxon rank sum tests were used to compare groups. A logistic regression model was fitted to explore characteristics associated with co-infection status. RESULTS:A total of 1779 HIV-infected patients (male: female ratio, 1:2) met inclusion criteria. HBsAg was present in 11.9%, anti-HCV in 4.8% and both markers in 1%. HBsAg was more common among males than females (15.4% vs 10.1%, respectively p = 0.001) while anti-HCV was detected in a similar proportion of males and females (5.3% versus 4.6%, respectively p = 0.559). HIV-infected patients with anti-HCV alone had a lower mean baseline CD4 count compared to those without anti-HCV or HBsAg (197 cells/mm3 vs 247 cells/mm3, respectively p = 0.008). Serum ALT was higher among patients with HBsAg compared to those without HBsAg or anti-HCV (43 International Units (IU) vs. 39 IU, respectively p = 0.015). Male gender was associated with HBV co-infection on logistic regression (OR1.786; 95% CI, 1.306-2.443; p < 0.005). CONCLUSION:More HIV-infected females than males presented for care in this cohort. We identified a relatively high prevalence of HBV and HCV co-infection in general, and a higher rate of HBV co-infection among males than females. Pre-treatment CD4 count was significantly lower among those with HCV co-infection, while ALT was slightly higher among those with HBV co-infection. Triple infection with HIV, HBV and HCV was present in a small but significant proportion of patients. These findings underscore the importance of testing for HBV and HCV in all HIV-infected persons in our setting."Item The complexity of circulating HIV type 1strains in Oyo state, Nigeria(Mary Ann Liebert, Inc, 2007) Sankale, J.; Langevin, S.; Odaibo, G. T.; Meloni, S. T.; Ojesina, A. I.; Olaleye, D.; Kanki, P.Multiple HIV-1 subtypes and circulating recombinant forms (CRFs) are known to circulate in west Africa. We undertook a survey of HIVs in Oyo state, in southwestern Nigeria. We analysed 71 samples from Ibadan the capital city, and 33 samples form Saki, 100 miles west of Ibadan. We sequenced part of the gag gene and the envelope C2V3 region from 102 and 89 samples, respectively. In the 87 samples for which both genes were sequenced, subtypes G and CRF02_AG were found in equal proportions (32.2%each). Other samples included CRF06_cpx(8.0%), subtype A (2.3%), C(1.1%), unclassified(1.1%), or discordant sequences suggesting the presence of a large number of recombinants involving CRF02_AG and/or subtype G(20.7%) or other subtypes(2.3%). The subtype/CRF designation was concordant in two gene fragments in the majority of samples evaluated. However, we observed difference in subtype distribution between the two locations with a predominance of subtypes G in Ibadan and CRF02 in Saki. This is first in-depth analysis of HIV variability at a state level in Nigeria. Our analysis revealed a significant level of viral heterogeneity and a geographical difference in subtype distribution, and demostrated that CRF02_AG does not account for the majority of circulating strains.Item Pattern if sexually transmitted Disease among HIV-! Infected commercial sex workers in Ibadan, Nigeira(MEDIMOND, 2004) Fayemiwo, S. A.; Bakare, R. A.; Odaibo, G. N.; Oni, A. A.; Fasina, A. A.; Olaleye, D. O.; Sankale, J. L.; Kanki, P."This study evaluatcd the association of HXV-1 infection with some other sexually transmitted diseases (STDs) among fernaIe commercial sex workers. BIood samples were collected from 250 female commercial sex workers in Ibadan Oyo State, Nigeria and tested for the presence of HEV antibodies using ELISA and Western blot. Endocervical and high vaginal swab samples were also collected for microscopy and culture. The prevalence of HIV- 1 infection among CSWs in Ibadan, Nigeria was 25.6% with 2.8% having dual reactivity to HIV- 1 and HIV- 2. Bacterial vaginosis was the commonest STDs (32.8%) followed by herpes genitalis, vaginal candidiasis, gonorrhoea, trichornoniasis, chancroid,syphilis, tinea curiz, genital warts, Iympholgranuloma venerum (LGV) and scabics. Recurrcnt vaginal discharge, gcnital ulccr discascs as well as non-genital ulcer diseases (tinea curiz and scabies) were associated with increased risk of HIV infections. Access to prevention and prompt management of these STDs will reduce the spread of HIV."Item Demographic and laboratory evidence of non sexual transmission of HIV in Nigeria(MEDIMOND, 2004) Odaibo, G. N.; Bamgbose, G.; Jegede, A. S.; Sankale, J. L.; Omotade, O. O.; Olaleye, D. O.; Kanki, P.Apart from heterosexual transmission, not much is known about the contribution of the other modes of spread of HIV in Africa. To evaluate the importance of non-sexual/non-vertical transmission in adults and children in Nigeria, data from mother-child pairs (community and hospital) and a community HIV surveillance among adult populations in two communities of Oyo State in SW Nigeria were analysed. In the community-based mother-child pair HIV testing, 18 of 476 (3.8%) under 5 years children were positive for HIV antibodies with only one positive mother-child pair. In the hospital surveillance (1996-1997) 10(7.0%) children of 132 mother-child pairs were positive while three (30%) of the 10 mothers were HIV negative. Similarly, 5(10%) of the mothers of 10 H1V positive children (2004) were HIV negative. In another community study, 5(13.2%) of the 38 adults from Ibadan and 12(4.8%) of 251 from Saki who claimed they never had sexual experience were HIV positive. Use of contaminated instruments and blood transfusion remain important routes of transmission of HIV in Nigeria.