FACULTY OF CLINICAL SCIENCES

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    Sleep disturbance and associated factors among Nigerian adults living with HIV in the dolutegravir era
    (Frontiers Media S.A., 2022) Osiyemi, A. O.; Owoaje, E.; Mundt, J. M.; Oladeji, B.; Awolude, O.; Ogunniyi, A.; Okonkwo, P.; Berzins, B.; Taiwo, B. O.
    Sleep disturbance is common among persons living with HIV (PLWH) causing significant health impacts. Nigeria recently switched from efavirenz to dolutegravir (DTG) for first-line antiretroviral therapy (ART). This study aimed to assess the prevalence of sleep disturbance and to determine factors associated with sleep disturbance among treatment-experienced PLWH. Using a cross-sectional study design and systematic random sampling, 300 participants were recruited from the Infectious Diseases Institute, Ibadan, Nigeria (IDI). Interviewer administered questionnaire was used to collect data regarding sociodemographic, sleep disturbance (Pittsburgh Sleep Quality Index; PSQI), depression (Patient Health Questionnaire; PHQ-9), anxiety (Generalized Anxiety Disorder-7; GAD-7), and psychoactive substance use. HIV-specific data were retrieved from IDI’s medical records. The relationship between the PSQI score and the scores on the PHQ-9 and GAD-7 were explored with the Pearson correlation coeffcient. Chi-square global tests of independence were used to assess factors associated with sleep disturbance and a multivariable binary logistic model was used to determine independent predictors of sleep disturbance. The mean age of the sample was 44.5 ± 11.4 (years), the average duration of HIV diagnosis was 8.13 ± 5.33 (years) and the majority were on DTG-based regimens (95%). Depression and anxiety were present in 14 and 17.3%, respectively. Prevalence of sleep disturbance (PSQI score of 6 ormore) was 21.7%. Higher PSQI scores were associated with higher PHQ-9 scores (r = 0.526; p < 0.001) and higher GAD-7 scores (r = 0.529; p < 0.001). Sleep disturbance was associated with age ($ 2 = 4.483, p = 0.038), marital status ($ 2 = 7.187, p < 0.01), depression ($ 2 = 46.589, p < 0.001), and anxiety ($ 2 = 38.379, p < 0.001). There was no significant association between sleep disturbance and HIV clinical stage at diagnosis, virological suppression status, and ART regimen type (p > 0.05), whereas tea intake was associated with an absence of sleep disturbance ($ 2 = 6.334, p < 0.014). Age (>45 years), depression and anxiety were associated with higher odds of sleep disturbance among PLWH. Sleep disturbance remains common among PLWH in the DTG era. Depression and anxiety are significant factors associated with sleep disturbance. Assessing these factors in future studies may improve the sleep health of PLWH.
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    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.
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    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.
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    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.
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    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.
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    Human Immunodeficiency Virus Type 1 and tuberculosis co-infection in multinational resource limited settings: increased neurological dysfunction
    (Oxford Academic, 2019) Robertson, K.; Oladeji, B.; Jiang, H.; Kumwenda, J.; Supparatpinyo, K.; Campbell, T.; Hakim, J.; Tripathy, S.; Hosseinipour, M.; Marra, C. M.; Kumarasamy, N.; Evans, S.; Vecchio, A.; La Rosa, A.; Santos, B.; Silva, M. T.; Montano, S.; Kanyama, C.; Firnhaber, C.; Price, R.; Marcus, C.; Berzins, B.; Masih, R.; Lalloo, U.; Sanne, I.; Yosief, S.; Walawander, A.; Nair, A.; Sacktor, N.; Hall, C.; AIDS Clinical Trials Group
    Background. AIDS Clinical Trial Group 5199 compared neurological and neuropsychological test performance of human immunodeficiency virus type 1 (HIV-1)–infected participants in resource-limited settings treated with 3 World Health Organization–recommended antiretroviral (ART) regimens. We investigated the impact of tuberculosis (TB) on neurological and neuropsychological outcomes. Methods. Standardized neurological and neuropsychological examinations were administered every 24 weeks. Generalized estimating equation models assessed the association between TB and neurological/neuropsychological performance. Results. Characteristics of the 860 participants at baseline were as follows: 53% female, 49% African; median age, 34 years; CD4 count, 173 cells/μL; and plasma HIV-1 RNA, 5.0 log copies/mL. At baseline, there were 36 cases of pulmonary, 9 cases of extrapulmonary, and 1 case of central nervous system (CNS) TB. Over the 192 weeks of follow-up, there were 55 observations of pulmonary TB in 52 persons, 26 observations of extrapulmonary TB in 25 persons, and 3 observations of CNS TB in 2 persons. Prevalence of TB decreased with ART initiation and follow-up. Those with TB coinfection had significantly poorer performance on grooved pegboard (P < .001) and finger tapping nondominant hand (P < .01). TB was associated with diffuse CNS disease (P < .05). Furthermore, those with TB had 9.27 times (P < .001) higher odds of reporting decreased quality of life, and had 8.02 times (P = .0005) higher odds of loss of productivity. Conclusions. TB coinfection was associated with poorer neuropsychological functioning, particularly the fine motor skills, and had a substantial impact on functional ability and quality of life.
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    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.
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    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.
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    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.
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    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 high