A review of the legal and ethical perspectives in HIV/AIDS management in Nigeria

 

*[1]Obaro, H. K., [2]Suleiman, B. A., [3]Ajide, O. B., [4]Aminu, B. T., 4Okonta, N. E., [5]Ojo, O. S.,    and 5Olatoke, S. O.

 

1Department of Medical Microbiology, Umaru Musa Yar’adua University, Katsina, Nigeria

2Department of Family Medicine, Federal Teaching Hospital, Katsina, Nigeria

3Department of Paediatrics, Federal Teaching Hospital, Katsina, Nigeria

4Department of Internal Medicine, Federal Teaching Hospital, Katsina, Nigeria

5Department of Emergency Medicine, Federal Teaching Hospital, Katsina, Nigeria

*Correspondence to: obarohasan@yahoo.com; +2348136436916; ORCiD: //orcid.org/000000033983657X

 

Abstract:

Human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) remain major public health issues in Nigeria and other developing countries. Discrimination even among healthcare workers (HCWs), which includes poor service delivery at the point-of-care and human rights abuses, are the main factors that continue to hinder HIV eradication in developing countries, and these spread across all levels of HIV/AIDS services, from counseling and testing, to treatment and care. People living with HIV/AIDS (PLWHA) have continued to suffer from unethical conduct, human rights abuses, discrimination, and stigmatization from HCWs, employers of labor, educational institutions, religious houses, and the public. There exist Federal and some State laws that protect the rights and privileges of PLWHA, prevent discrimination and stigmatization from the general public, prevent employers from discriminating against persons with HIV infection, protect workers who criticize hazardous conditions in the workplace, and offer compensation to victims of HIV-related human rights abuses and employees for contracting job-related diseases. However, HIV-related human rights abuses, stigmatization, and discrimination, have continued unabated, not because there are no laws to protect victims, but due to ignorance of the law, complicated by the fact that some existing laws have remained dormant with regard to implementation and enforcement. Domestication of these laws by various State Governments in the country and enforcement by relevant institutions are also big issues. It is imperative for healthcare professionals to be aware of current professional standards and the general public to be aware of laws protecting victims of the virus. Continue reading “A review of the legal and ethical perspectives in HIV/AIDS management in Nigeria”

Salmonella Kentucky: prevalence and challenges in Nigeria and the Africa continent

Igomu, E. E.
Bacterial Vaccine Production Division, National Veterinary Research Institute, P. M. B. 01 Vom, Nigeria Correspondence to: elayonigomu@gmail.com; +2348032786224

Abstract:

Salmonella Kentucky is ubiquitous in most African countries and the multidrug resistant (MDR) strains remain underreported across the continent. In Nigeria, poverty, inter country livestock trades, nomadic system of cattle production, indiscriminate use of antibiotics and prevalent immuno-compromising diseases such as human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and tuberculosis are factors that have enabled ease of transmission and complications of S. Kentucky infections. In the present decade, S. Kentucky is reported to be the most prevalent serovar associated with poultry in Nigeria, but very few reports underline the risk associated with consumption of poultry and acquisition of MDR S. Kentucky strains. The Nigerian poultry is one of the most commercialized subsectors of Nigerian agriculture, therefore, the presence of S. Kentucky especially strains carrying broad spectrum antimicrobial resistance pose a great risk to public health. The lack of proper monitoring, surveillance, isolation and control of the multidrug resistant S. Kentucky will remain a challenge to the export potential of the Nigerian poultry subsector and livestock in general. As a nation, modalities and actions against the smuggling of poultry products, indiscriminate use of antibiotics and nomadic system for the production of dairy and beef that promotes spread of virulent strains of Salmonellae must change. The impact of non-typhoidal salmonellosis in humans in Nigeria also remains under studied and under reported, especially those caused by S. Kentucky ST198. Compounding these concerns is the lack of commercial veterinary or human vaccines against S. Kentucky or where vaccines against the broad serogroup C non-typhoidal Salmonella (NTS) are available, they are rarely supplied, with no evidence they could be cross-protective. This review emphasizes the emergence and widespread occurrence of MDR S. Kentucky strains on the African continent, and discussed risk factors contributing to its spread in Nigeria and the potential public health challenge especially to high-risk immunocompromised individuals.
Keywords: Salmonella Kentucky, ST198 strain, multidrug resistant, tuberculosis, HIV/AIDS, Nigeria, Africa
Received April 30, 2020; Revised May 8, 2020; Accepted May 10, 2020
Copyright 2020 AJCEM Open Access. This article is licensed and distributed under the terms of the Creative Commons Attrition 4.0 International License <a rel=”license” href=”//creativecommons.org/licenses/by/4.0/”, which permits unrestricted use, distribution and reproduction in any medium, provided credit is given to the original author(s) and the source.
Salmonella Kentucky: prévalence et défis au Nigeria et sur le continent africain
Igomu, E. E.
Division de la production de vaccins bactériens, Institut national de recherche vétérinaire, P. M. B. 01 Vom, Nigéria Correspondance à: elayonigomu@gmail.com; +2348032786224 Continue reading “Salmonella Kentucky: prevalence and challenges in Nigeria and the Africa continent”

A two year old infected with Dicrocoelium dendriticum: a case report

J.O Okwuzu, T.A Gbaja-Biamila, A. E. Wapmuk, P.C Austin-Akaigwe, O.O Odubela, A.N, David, O.C. Ezechi

 

Abstract

Dicrocoelium dendriticum infection is rare in human and generally non-fatal unless infection of liver is severe. The disease could lead to biliary colic, digestive disturbances that include bloating and diarrhea. In heavy infections, bile ducts and the biliary epithelium may become enlarged with the generation of fibrous tissues around the ducts leading to hepatomegaly or inflammation of the liver (cirrhosis). This is a case presentation of a two-year old male child who is infected with Human Immune deficiency virus (HIV). BMI was 10.3kg/m2, which is below the fifth percentile. Child lost 1.5kg on retrospective review of case file and another 0.5kg after presentation with loss of appetite, cough and fever. Patient was reportedly fed with liver on several occasion. Stool examination revealed many Dicrocoelium dendriticum and Ascaris lumbricoidesova. Albendazole treatment was instituted and after three months, body weight improved to 10.5kg. It becomes important to screen underweight children for helminthiasis, particularly HIV/AIDS patients whose HIV treatment plan might be of priority to the physician.

KeywordsDicrocoelium dendriticum, Child, Ascaris lumbricoides, HIV/AIDS, Albendazole.

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A two year old infected with Dicrocoelium dendriticum a case report

Residual mother-to-child transmission of HIV in Burkina Faso

A Ky Ba, M Sanou, L Toguyeni Tamini, I Diallo, A.S. Ouédraogo, J Catrayé, P.T. Sanou, C Ki Toe, A.Y. Ky, I Sanou, R Ouédraogo Traoré, L Sangaré

 

Abstract

Background: Burkina Faso is one of the countries in West Africa most affected by the HIV/AIDS pandemic, despite the implementation of a mother-to-child HIV transmission prevention program as a strategy to reduce the risk of vertical transmission of the disease.

Objective: To assess the current risk of mother-to-child transmission of HIV in Burkina Faso.

Materials and methods: A prospective study was conducted between December 2014 and July 2016, in the 13 health regions of Burkina Faso. Women who were screened HIV-positive during a prenatal consultation were followed until delivery. Their babies received dry blood spot (DBS) at birth, at week 6 and at 1year, to screen for HIV.

Results: Overall, 186 pregnant women were included in the study, with a mean age of 29.17±6.13 years. Of their children, 430 DBS actually received a PCR test, giving a 91.1% PCR implementation rate. After analyses, 6 (1.3%) babies were identified as carriers of HIV1. The newborn’s serological status was associated with delivery pattern (p=0.000), the administration of antiretroviral drugs to the mother after delivery (p=0.0064), the administration of Nevirapine to the newborn at birth (p=0.022), the use of contraceptive methods after delivery (p=0.028) and the presence of breast affections/infections since delivery (p=0.013).

Conclusion: The results of our study are encouraging and demonstrate the effectiveness of interventions in the mother-tochild prevention program (PMTCT) for HIV-positive pregnant women can be improved through early initiation of triple therapy in early pregnancy and improved adherence to antiretroviral (ARV) therapy.

Keywords: Burkina Faso, HIV/AIDS, mother-to-child transmission, antiretroviral drugs, pregnant women

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Residual mother-to-child transmission of HIV in Burkina Faso

CD4 cells profile of HAART naive HIV seropositive clients in Kogi State University Teaching Hospital, Anyigba, Kogi State. Nigeria

OJ Alabi, SPO Akogu, M Akpa, V Ukeje, PO Okpanachi, OG Agama, S Gideon, B Adegboro

 

Abstract

CD4 lymphocyte cells are the primary targets of Human immune-deficiency virus (HIV). Enumeration of CD4 T lymphocytes in the peripheral blood is used in the assessment of disease clinical stage, risk of  opportunistic infections, evaluation of prognosis and guide decision on the commencement of  antiretroviral therapy. The objective was to determine CD4 cells profile of HIV sero-positive naïve  patients in Kogi State University Teaching Hospital( KSUTH) Anyigba. A total of 404 HIV sero-positive Highly Active Anti Retro Viral Treatment ( HAART) naïve patients comprising 147(36.4%) males and  257 (63.6%) females were examined. Approval was obtained from ethical committee of Kogi State University Teaching Hospital (KSUTH), Anyigba. Written and verbal informed consent was taken from all patients. The overall mean age of patients was 33.0 ± 12.7 years and female-male ratio was  1.7:1. Majority of patients were in the clinical stage two 121(30.5%) and three 200(50.4%). Patients had overall mean CD4 cells count of 381.8 ± 240.8 cells /mm3. Patients CD4 cells count varied statistically with the HIV clinical staging (F =4.512 & P value=0.004) and statistically insignificant with gender (P value = 0.7562 & t Test= 0.3106) and tuberculosis status (P value=0.223 & F=  1.505).Conclusion: This study showed HIV sero-positive HAART naive patients presented in KSUTH with mean age of 33 years. Majority of patients presented in disease clinical stage two and three with a mean CD4 cells counts of 381.8 cells/mm3 . This study recommend the need to reduce stigmatization, discrimination and promote early access to treatment , care and support services.

Keywords: HIV/AIDS, CD4, Patient/clients, KSUTH, Nigeria.

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CD4 cells profile of HAART naive HIV seropositive clients in Kogi State University Teaching Hospital, Anyigba, Kogi State. Nigeria

Prevalence and distribution of intestinal parasite infections in HIV seropositive individuals on antiretroviral therapy in Vom, Plateau State Nigeria

PM Lar, VK Pam, Julius Ayegba, Hosea Zumbes

 

Abstract

Background: The immunologic status of an individual can determine outcomes of treatment and their capacity to combat opportunistic infections. Co-infection with other parasites will confound the situation; however there is inadequate information on the interaction of HIV and helminth infections. We wanted to establish the relationship of the immunologic status and the prevalence of intestinal parasites in HIV/AIDS patients enrolled for antiretroviral therapy at the Vom Christian health centre.

Materials & Methods: With their consent, stool samples of 205 subjects were collected and examined parasitologically by direct microscopy and concentration techniques. Their most resent CD4+ cell counts were obtained at the centre. The demographic characteristics of the subjects were determined from their response to a questionaire.

Results: Out of the 205 subjects examined 61.9% of them had various parasites with helminthes occurring in 51.9% of the cases. The age group of 31-40 years was the most significantly infected (P< 0.05). Hookworms and Schistosoma mansonii were most frequent with prevalence rates of 18.1% and 16.5% respectively. The highest prevalence of parasites occurred in HIV/AIDS people with CD4+ cells between 101-200 cells/μ and those with counts below 100 cells/al.Occupation was highly associated with parasitic infections (p< 0.05).

Conclusion: Parasitic infection remained highly prevalent among the subjects examined in spite of ART treatment and in the case of intense infection in the immunocompromised, treatment outcome may be compromised.

Keywords: HIV/AIDS, Parasites, ART, Coinfection

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Prevalence and distribution of intestinal parasite infections in HIV seropositive individuals on antiretroviral therapy in Vom, Plateau State Nigeria

Toxoplasma antibodies amongst HIV/AIDS patients attending the University Teaching Hospital Yaounde in Cameroon

JCN Assob, AL Njunda, DS Nsagha, HL Kamga, PE Weledji, VB Che

 

Abstract

Toxoplasmosis is caused by an obligatory intracellular protozoon. It causes a wide range of diseases with toxoplasma encephalitis commonly encountered in HIV/AIDS patients. This work was carried out to determine the seroprevalence of toxoplasma antibodies (IgM and IgG) in HIV/AIDS patients attending the Yaoundé University Teaching Hospital (UTH) in Cameroon. Sera were collected from 133 HIV/AIDS patients at the out-patient department and the ELISA technique was employed serologically to determine toxoplasma antibodies. Of the 133 patients 83 (62.4%) were females and 59 (37.6%) were males; ninety three (69.9%) were positive for toxoplasma antibodies. Fourteen (10.8%) of the 93 of seropositive patients presented with both IgG and IgM-antibodies in their sera while fifty six (42.1%) and 8 (6.0%) were only sero-positive for toxoplasma IgG or IgM-antibody respectively This rate of infection was not dependent on the patient’s sex or age (X2=11.49, P>0.05). The data provides enough evidence to conclude that 64.7% of the positive cases were due to reactivated infection.

Key words: Toxoplasmosis, HIV/AIDS, Pregnancy, Risk factors, Prevalence, Yaounde, Cameroon.

Toxoplasma antibodies amongst HIVAIDS patients attending the University Teaching Hospital Yaounde in Cameroon

Susceptibility profile of yeast-like organisms isolated from HIV/AIDS patients; using NCCLs macrodiltion method compared with agar diffusion technique

CA Enwuru, A Ogunledun, N Idaka, NV Enwuru

 

Abstract

Yeast like opportunistic fungal infection has been reported globally amongst HIV/AIDS patients, particularly as the etiologic agent of oral thrush. Fluconazole antibiotic has been most popularly employed in treating cases of oral thrush in HIV/AIDS patients. Recent reports have recorded antifungal drug resistance amongst immunocompromised subjects. This constitutes a big problem in the management of opportunistic candidiasis. The NCCLS micro/macrodilusion sensitivity testing procedure is expensive, cumbersome and requires a level of sophistication. This study was designed to compare NCCLS M-27-A macrodilution method (expensive) with agar diffusion technique (cheap and simple), to provide a reliable rapid alternative to the new pressing need for antifungal routine sensitivity testing. Sputum specimens from 213(108 females and 105 males) HIV positive patients were plated onto SDA. The isolates were identified by morphotyping, microscopy and speciated using germ tube test, and battery of biochemical sugar fermentation; and assimilation tests. Fluconazole agar diffusion susceptibility testing was carried out on each isolate, compared with the NCCLS macrodilution sensitivity assay standard.
Of the 74 isolates tested for fluconazole sensitivity, 59(79.7%) were sensitive (zone diameter > 19mm, mean diameter 28mm), 6(8.1%) were Sensitive Dose Dependent (S-DD) (zone diameter 13-18mm, mean diameter 16mm), while 9(12.2%) were resistant (zone diameter < 12mm) using agar diffusion method, matched with 58(78.4%) sensitive MIC < 8μg/ml, 9 (12.2%) S-DD MIC 16-32μg/ml and 7(9.5%) resistant MIC >64μg/ml profile, using the NCCLS macrodilution assay. The differences between the test method (Agar diffusion) and the control standard method (NCCLS-M 27-A broth Macrodilution MICS) were not statistically significant using t-test (two tail) (t = 4.302656, P=1.0). Among the C. albicans isolates, 26(86.7%) were sensitive to fluconazole. The rank of susceptibility was C. albicans > C. tropicalis > C. krusei.
It is concluded that broncho-oro-pharyngeal Candida and other yeast-like species existed in about one third of the HIV and AIDS patients studied; in which C. albicans was the most prevalent, while about ten percent of all the Candida isolates were resistant to fluconazole. The reliability of germ tube production as a confirmatory test for Candida albicans in HIV infection was as high as 96.7% and is therefore, recommended for continued use. Agar diffusion compared favourably with the NCCLS macrodilution technique, hence it is recommended for routine antifungal sensitivity test on all isolates of yeast-like cells from HIV and AIDS subjects.

Keywords: HIV/AIDS, oral thrush, yeast-like cells, fluconazole resistance, NCCLS vs agar diffusion technique.

African Journal of Clinical and Experimental Microbiology Vol. 9 (2) 2008 pp. 88-96

Opportunistic infections and clinico-epidemiological factors in HIV/AIDS casesseen in a tertiary care hospital in Nepal

RN Das, HS Joshi, R Biswas, HS Joshi

 

Abstract

Opportunistic infections are the leading cause of morbidity and mortality among HIV/AIDS patients. The spectrum of opportunistic pathogens involved in such infections in Nepal is not well documented. A cross sectional (hospital-based) study was carried out at the AIDS clinic of Manipal Teaching Hospital, Pokhara, Nepal. A total of 404 clinically suspected cases of HIV/AIDS seen at the clinic between July 2001 and December 2002, were screened for HIV. Seventy four (18.3%) were sero-positive for HIV. Fever was the commonest presenting symptoms 48.6% followed by cough and dyspnoea 36.5%, weight loss 36.5% and pulmonary tuberculosis 21.6%. Fifty five of the 74 (74.3%) HIV positive cases were in the age group 20-39 years. Heterosexual mode of acquisition/transmission was seen in 60.8% and 21.6% were intravenous drug abusers (IVDA). A total of 45 opportunistic pathogenic isolates were recovered from the 74 patients. Mycobacterium tuberculosis was the commonest pathogen 60%, followed by Cryptosporidium spp 13.3% and Candida spp 11.1%. Four patients died during the period of study giving a mortality rate of 5.4%. This study shows that HIV/AIDS is rapidly becoming a grave concern in the Pokhara valley of Nepal. Intensive and effective health education programmes among the target population may be a cost effective method to curb the rising prevalence of HIV/AIDS in a developing country like Nepal. Also, further regional studies are required to establish more detailed epidemiological database of opportunistic infections in HIV/AIDS patients in Nepal.

Keywords: HIV/AIDS, opportunistic infections, Nepal

African Journal of Clinical and Experimental Microbiology Vol. 6 (3) 2005: 239-245

OSMOTIC FRAGILITY AND Na+ -K++ ATPase ACTIVITY OF ERYTHROCYTES OF HIV/AIDS PATIENTS

OAT Ebuehi, M Balogun, RA Audu, OE Idigbe

 

Abstract

A cross sectional study was carried out to investigate the osmotic fragility and Na+ -K+ ATPase activity of the erythrocytes of HIV/AIDS patients. Whole blood was taken from subjects at the Human Virology Laboratory of the Nigerian Institute of Medical Research. Subjects were judged suitable for the various investigations by means of a questionnaire. The Genie II HIV diagnostic kit was used to confirm HIV positive status. HIV positive subjects were grouped into two: those receiving anti-retroviral therapy were referred to as the ARV group and those not receiving antiretroviral therapy were designated as non-ARV group. Each group was further sub-divided according to the Centers for Disease Control 1993 classification of HIV disease. HIV negative subjects must have tested no later than two months to the sample collection date and must not lead a high-risk lifestyle. Twenty microliters of whole blood were used for the erythrocytes osmotic fragility assay. One milliliter of whole blood was used to prepare the erythrocyte ghost membrane for the Na+-K+ ATPase activity assay. The two HIV positive groups showed significant increase in percentage haemolysis under osmotic stress at 0.65% saline. The ARV group had an average percentage haemolysis of 2.56 ± 0.81% while the non-ARV group had an average of 3.19 ± 1.11% compared to an average of 0.83 ± 0.36% for the control group (p < 0.05). A pattern observed in the result was an increase in activity with increasing severity of the HIV/AIDS disease. Data from the present study indicate that the osmotic fragility of erythrocytes was significantly potentiated, while Na+-K+ ATPase activity was not significantly altered (p < 0.05) in HIV/AIDS disease.

Key Words: Osmotic fragility, Na+ -K+ ATPase activity, erythrocytes, HIV/AIDS

Afr. J. Clin. Exper. Microbiol. 2004; 5(2): 148 – 154.