FACULTY OF CLINICAL SCIENCES
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Item Perception and utilization of prevention of mother-to-child transmission of human immunodeficiency virus (HIV) services among women living with HIV(European Publishing in Heraklion, Greece, 2021) Saka, A. O.; Onyeneho, C. A.; Ndikom, C. M.INTRODUCTION: Mother-to-child transmission is the major route of pediatric Human Immunodeficiency Virus (HIV) infection accounting for 90% of childhood HIV infection. Poor utilization of prevention of mother-to-child transmission (PMTCT) of HIV services has been shown in this situation. Hence, the study assessed the perception and utilization of PMTCT services among Women Living with HIV (WLHIV). METHODS: A cross-sectional research design was used with a purposive sampling technique to select 182 WLHIV within reproductive age attending President’s Emergency Plan for Acquired Immunodeficiency Syndrome (AIDS) Relief (PEPFAR)/AIDS Prevention Initiative in Nigeria (APIN) clinic in two secondary Health facilities in Ibadan, Oyo State. A validated structured questionnaire was used for data collection. Descriptive and inferential statistics were used for data analysis. RESULTS: The mean age of the women was 37.0±6.5 years. Majority (74.2%) of the respondents had good knowledge on PMTCT of HIV, positive perception (89%) towards PMTCT services while only 42.9% of the respondents have utilized PMTCT services during pregnancy. However, some of the challenges to use of PMTCT services identified by the respondents were stigma (16.5%), discrimination (15.4%), financial constraint (11.5%) and non-involvement of partner (8.2%). There was a significant association between level of knowledge and PMTCT services utilization (χ2=6.244, p=0.012). CONCLUSIONS: There is need for improvement of knowledge and perception of HIV, MTCT and PMTCT among women through counseling and antenatal education, thereby increasing PMTCT services uptake. Partner involvement, good quality PMTCT services and lack of discrimination of people living with HIV in our society should be encouraged, hence promoting the utilization of PMTCT services.Item Knowledge and Behaviour of Nurse/Midwives in the Prevention of Vertical Transmission of HIV in Owerri, Imo state, Nigeria. A Cross Sectional Study(Springer Science+Business Media, 2007) Ndikom, C. M.; Onibokun, A.Background: Mother-to-Child Transmission (MTCT) of HIV remains the main mode of acquisition of HIV in children. Transmission of HIV may occur during pregnancy, delivery or breastfeeding. Studies have shown that some specific interventions help to reduce the transmission of the virus to the baby. In order to target safe, rational and effective intervention to reduce MTCT of HIV, it is necessary to ensure that the nurse/midwife has knowledge of the strategies for the prevention of vertical transmission of HIV. Method: The cross-sectional design was utilized to determine the knowledge and behaviour of nurse/midwives in the prevention of vertical transmission of HIV in Owerri, Imo State, Nigeria. The study sample consisted of 155 nurse/midwives drawn from three selected hospitals through stratified random sampling method. Official permission was obtained from the institutions and consent from participants. Data was collected through the use of a self-administered questionnaire. Information sought included respondents' demographic characteristics, knowledge about and behaviour of prevention of vertical transmission as well as factors influencing behaviour. Results: Findings revealed that nurse/midwives had moderate level of knowledge with mean score of 51.4%. The mean score on behaviour was 52.5%, major factors that influence behaviour in these settings were mainly fear of getting infected, irregular supply of resources like gloves, goggles, sharp boxes, and water supply was not regular also. Hypotheses tested revealed that there is a positive relationship between knowledge and behaviour (r = 0.583, p = 0.00). Knowledge level of nurse/ midwives who had educational exposure was not different from those who did not (t = 1.439, p = 0.152). There was a significant difference in the knowledge of nurse/midwives who had experience in managing pregnant women living with HIV/AIDS and those who did not (t = 2.142, p = 0.03). Also, there was a significant relationship between behaviour and availability of resources (r = 0.318, p = 0.000). Conclusion: The study revealed that the nurse/midwives though moderately knowledgeable still had gaps in certain areas. Their behaviours were fairly appropriate. There is need for improved knowledge through structured educational intervention. Resources needed for practice should always be made available and the environment should be much more conducive for practice.Item Health‑Related quality of life of patients on antiretroviral therapy at the Federal Medical Center, Makurdi, Nigeria(Thieme Medical and Scientifuc Publishers Pvt. Ltd., 2019) Shaahu, V. N.; Adebimpe, W. O.; Asuzu, M. C.; Belabo, D. A.; Popoola, O. A.; Uchendu, O.Context: Health related quality of life (HRQL) indices could provide information about the effects of disease progression and the effectiveness of medical interventions that cannot be obtained using objective clinical measures. Aim: The aim of this study is to assess HRQL of patients on highly active antiretroviral therapy (HAART) at the Federal Medical Center, Makurdi in North Central Nigeria. Settings and Design: The study was a cross‑sectional survey among people living with HIV/AIDs (PLWHAs) on HAART. Methods: The 546 PLWHAs on HAART were selected using systematic sampling technique. A modification of the 36‑Item Short‑Form Health Survey Version 2 questionnaire was used to assess respondents’ HRQL in eight dimensions: Physical functioning (PF), role‑physical (RP), role‑emotional (RE), social functioning (SF), bodily pain (BP), vitality (VT), mental health (MH), and general health (GH). Data generated after measuring and scoring HRQL using standard methods were analyzed using the SPSS 17. Results: Good HRQL ratings included: PF (98.9%), RE (98.7%), SF (98.2%), VT (96.9%), RP (96.5%), MH (96.3%), BP (94.1%), and GH (93.4%). Predictors of good HRQL were as follows: Age <40 years (odds ratio [OR] = 4.26, confidence interval [CI] = 1.49–12.11) and being currently employed (OR = 3.20, CI = 1.08–9.49) (RP); and having a caregiver (OR = 4.94, CI = 1.33–18.27). Predictors of less likelihood of good HRQL were: Enjoying social support (OR = 0.12, CI = 0.03–0.55) (RP; MH); being without spouse/partner (OR = 0.43, CI = 0.21–0.91) (GH). Conclusions: HAART improves HRQL of HIV patients. Clinicians need to be responsive to factors related to disclosure, having a caregiver, and social support as a means of improving HRQL.Item Kidney disease in hospitalised HIV positive children in Ibadan, South West Nigeria(College of Medicine, University of Ibadan, 2012) Ademola, A. D.; Asinobi, O. O.; Oladokun, R. E.; Ogunkunle, O. O; Okolo, C. A; Ogbole. G. E.Background: There is a paucity of data on the clinicopathologic pattern of kidney disease in Human Immunodeficiency Virus (HIV) seropositive children from sub-Saharan Africa and non from South West Nigeria. Objective: To determine the clinical pattern and outcome of kidney disease among HIV positive children hospitalised at a tertiary hospital South West Nigeria Methodology: A retrospective study of all HIV positive children who were hospitalised and managed for kidney diseases over a period of 78 months at the University College Hospital Ibadan, South West Nigeria was reviewed. Patients were followed up over the duration of hospital admission. Results: Ten children (six males and four females) aged 4 -15(10.4±3.2) years were identified. Four presented in acute kidney injury, (AKI) three with nephrotic syndrome (NS) and two in chronic kidney failure (CKF). One patient had left renal artery stenosis. Renal biopsy performed in three children showed focal segmental glomerulosclerosis in two patients and membranous nephropathy in the third. Management included antiretroviral therapy, Angiotensin Converting Enzyme Inhibitors and acute haemodialysis. Mortality was 40%. Conclusion: AKI, NS and CKF were the predominant clinical patterns of kidney disease in hospitalised HIV positive children and the mortality is highItem Urinary transforming growth Factor-Beta 1 (uTGF-β1) and prevalent CKD risk in HIVpositive patients in West Africa(2019) Ekrikpo, U.E.; Okuku, C.N.; Ajayi, S.O.; Ayodele, O.E.; Bello, A.K.; Wonkam, A.; Dandara, C.; Kengne, A.P.; Okpechi, I.Introduction: This study investigated the association of urinary transforming growth factor-b1 (uTGF-b1) with prevalent chronic kidney disease (CKD) in the HIV-infected population. Methods: HIV-positive patients without CKD (HIVþCKD, n ¼ 194) and 114 with CKD (HIV CKD) who did not have hypertension, diabetes mellitus, or hepatitis B or C, had their urinary protein-creatinine ratio (uPCR), serum transforming growth factor (TGF)–b1, and uTGF-b1 measured. uTGF-b1-creatinine ratios (uTGF-b1Cr) were calculated. Spearman correlation was used to determine the association between uTGF-b1Cr and various attributes, and the Cuzick trend test was used to assess the presence of a linear trend in median uTGF-b1Cr levels across the stages of CKD. Multivariable robust linear regression models were used to assess independent association with variability in uTGF-b1Cr and estimated glomerular filtration rate (eGFR) levels. Results: The age of the participants was 38.3 0.3 years with 73.4% women. The median uTGF-b1Cr was higher among HIV CKD (4.85 ng/mmol [25th–75th percentile 1.96–12.35] vs. 2.95 [1.02–5.84]; P ¼ 0.001]). There was significant correlation between uTGF-b1Cr and age (P ¼ 0.02), eGFR (P ¼ 0.001), and uPCR (P < 0.001) in the HIV CKD group. Among the HIV CKD patients, there was gradual reduction in the median level of uTGF-b1Cr with CKD severity (P ¼ 0.04). HIV CKD patients had significantly higher levels of uTGF-b1Cr after controlling for potential confounders. Using eGFR as dependent variable, proteinuria explained the changes associated with uTGF-b1Cr levels. Conclusion: HIV CKD patients express higher levels of uTGF-b1 especially in the early stages of CKD apparently related to proteinuria levels.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.