Журнал СПИДа и клинических исследований

Background: Antiretroviral therapy (ART) has decreased the mortality and morbidity among people living with HIV and AIDS (PLWH). Viral load (VL) has been used by clinicians as primary tool recommended by WHO to monitor patients progress on High Antiretroviral active therapy (HAART). There is a paucity of information on Virological and immunological outcomes of HIV infected drug experience adults’ patients in north central Nigeria. We conducted a tertiary hospital based cross-sectional study at federal medical centre in Nasarawa state between December 2019 to march 2020.

Method: A total of 474 HIV positive adult were enrolled using a Systematic random technique. Blood specimen for CD+4 T cells count and viral load determination were obtained and PCR-Real time and Flow-cytometry were used to estimate plasma viral load and CD4+ T cell count respectively. Frequency was used to determine percentage and logistic regression was used to determine the associated factors with Virological suppression and immunology outcome in patients on HAART 95% CI and odd ratio (OR) was used to measure strength of association.

Results: From the 474 cohort that were enrolled 34.6% were on WHO baseline clinical stage IIV and 57.8% of cohort were on HAART, started treatment regimen in less than a year with 42.2% diagnosed and confirmed with HIV infection between 1-5years. 57.8% were transferred into the centre as a major reason for enrolment. 57.8% has history of TB treatment in the past while 42.2% of the study participants who were eligible for treatment initiation were determine by CD4+ counts with a median interquartile range of 180 (92-300) cells/mm³. virological suppression (VL level < 1000 copies/ml) was found in 85% (95% CI 77.7, 86.1) of study participants, and it has been associated with CD4 cell count between 250 and 400 cells/mm³ (adjusted odds ratio (AOR) = 2.56; 95% CI 1.14, 5.75) and > 499 cells/mm³ (AOR = 7.71; 95% CI 3.48, 17.09) at VL testing and current age > 40 years old (AOR = 5.40; 95% CI 2.3, 10.01). Similarly, favourable immunological status (≥250 cells/mm³ for male and ≥ 600 cells/mm³ for female) was observed in 52.9% (95% CI 47.4, 58.8) of the study participants. Baseline CD4 cell count of > 200 cells/mm³, age at enrolment of 26 through 40 years old, and urban residency were significantly associated with favourable immunological outcome.

Conclusion: Low Immunological recovery among study cohort was observed although viral suppression was shown in majority of the HIV infected adult who are on HAART. Early initiation on HAART should be encouraged in other to achieve immunological recovery and viral suppression in order to achieve the USAIDS- 90-90-90 to end HIV pandemic by 2030.

Introduction: Human Immuno Deficiency Virus (HIV) deplete CD4+ T cell in human and weaken the immune system, this makes HIV positive patients more susceptible to parasitic and other opportunistic infection. Intestinal parasitic infection plays vital role in the prognosis of people living with HIV/AIDS. This study was aimed to determine the magnitude of intestinal parasitic infection and its determinant among people living HIV/AIDS.

Method: A cross-sectional study was conducted from February 2020 to April 2020. A total of 223 study participants were recruited using simple random sampling. A Pre-tested questionnaire was used to collect socio-demographic and other risk factor data. A stool sample was collected to detect parasitic infection using wet mount, formol-ether concentration and Modified ziehl-neelsen technique. The whole blood sample was collected to determine CD4⁺ T cell count using BD FACSCount™ System. Data was entered into Epi Data version 3.1 and analyzed using SPSS version 20.

Results: Out of 223 participants 166 (74.4%) were males. The mean age of the study participants was 37.9 years old with the majority being found in the age group 26-49 years (64.1%). The overall prevalence of intestinal parasitic infection was found to be 38.1%. The prevalence was significantly higher in males (23.7%) than in females (p≤0.002). The most predominant parasite detected was G. lamblia (40%) followed by E. histolytica (32.9%). The prevalence of opportunistic infection was 2.24%. The detected opportunistic parasites were S. stercoloaris, Cryptosporidium spps and I. beli. Sex, residence and low CD4⁺ T cell counts were significantly associated with the prevalence intestinal parasitic infection among HIV/ AIDS patients.

Conclusion: The finding showed intestinal parasitic infections being a major health problem in HIV patients. Low-level CD4 T cell is a risk factor for the high prevalence of parasitic infection. The high prevalence of intestinal parasitic infection indicates the need of routine investigation of the infection that will aid for rapid therapeutic management.

Despite the increase number of people living with HIV still there are limited information about the factors associated with viral load suppression among HIV+ individual enrolled into HIV care and treatment centers in Tanzania. Data reports that 87% of those who are living with HIV have attained viral suppression. However this is still low compare to the UNAIDS global targets that by 2020 of 90% on treatment must achieve viral suppression. Viral load remains a gold standard for assessing treatment outcome for those who are on treatment. In 2014 UNAIDS introduced 90- 90-90 goal so as to combat HIV epidemic by 2020. First 90% know there status, second 90 accessing treatment and Third 90% viral suppression. The aim of this study was therefore to identify factors affecting viral load suppression among HIV+ adults attending care and treatment services in the regions. Crossectional analytical study conducted at Dodoma, Mtwara and Lindi regions in randomly selected health facilities. 459 participants who are on ART for atleast 12 months and 18+ years were recruited for the study. Structured questionnaire was used. Data was entered, cleaned and analyzed using EPI info 7.2.2.16. Odds ratio was used to establish association, 95% CI, and P value of 0.05 were used for statistically significance. A total of 459 study participants were enrolled. The prevalence of viral load suppression was 79%. Viral load suppression was found to be association with Satisfaction to care OR, 11.6 (95% CI: 1.2, 113.6) and Stigma level OR, 2.5 (95% CI: 1.03, 6.1) and found to be statistically significant. Majority of participants were female 165 (68.6%), married 185 (40.3%), with primary education 309 (67.3%) and 280 (61%) had small business or self-employed. Those younger than 35 years had a 70% reduced chance of having viral load suppression OR 0.7 (95% CI: 0.41 OR 1.18), gender OR 0.85 (95% CI: 0.5,1.35), marital status OR, 0.93 ( 95% CI: 0.59, 1.47), those with primary education level OR, 0.47, (95% CI: 0.22 OR 0.99), duration on ART OR, 0.46 (95%:0.15,1.42) disclosure status OR, 0.39 (95% CI: 0.15, 1.01)there were found to be associated with viral suppression but not statistically significant. Satisfaction with care and low level of stigma were associated with viral load suppression.