FACULTY OF CLINICAL SCIENCES
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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.Item Dyslipidemia in ART-naive infected Persons in Nigeria- implications for care(Sage Publications, 2015) 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.; Okonkwo, P.; 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-naïve 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 developing countries and prevalence of HIV infection(College of Medicine, University of Ibadan, Ibadan, 2009) Awolude, O. A.; Adesina, O. A.; Oladokun, A.; 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. HIV positive patients were post-test counselled and offered single dose nevirapine tablet (200 mg) in labour with syrup given to the baby at birth at 2 mg/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 HIV 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.