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Narh CT, Der J, Ofosu A, Blettner M, Wollschlaeger D. Time trends, sociodemographic and health factors associated with discharge and length of stay of hospitalised patients with sickle cell disease in Ghana: a retrospective analysis of national routine health database. BMJ Open 2021; 11:e048407. [PMID: 34610933 PMCID: PMC8493906 DOI: 10.1136/bmjopen-2020-048407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Patients with sickle cell disease (SCD) are prone to multiple episodes resulting in frequent hospital visits. We determined the time trends, sociodemographic and health factors associated with length of stay (LoS) for patients with SCD in Ghana. DESIGN, PARTICIPANTS, SETTING We retrospectively analysed SCD hospitalisation records of 22 680 patients from a nationwide database of the Ghana Health Service from 2012 to 2017. OUTCOME MEASURES Factors associated with LoS were estimated using Cox regression, while the cumulative incidence of being discharged alive was estimated with in-hospital death as a competing risk. RESULTS Patients admitted for SCD over 6 years constituted 22 680 (0.8%) of nearly 3 million admissions. The median age and LoS for the patients were 16 years (IQR=8-24) and 3 days (IQR=2-4), representing 14 202 (62.6%) of the patients discharged alive by the third day. Patients with sickle cell anaemia (6139, 52.6%) with a crisis were more frequent than those without a crisis. Increasing age was associated with shorter LoS when comparing age groups 10-14 years (HR=1.08, 95% CI 1.01 to 1.14) and 25-29 years (HR=1.27, 95% CI 1.17 to 1.37) to patients aged 0-4 years. Patients with comorbidities had a longer LoS compared with those without (HR=0.88, 95% CI 0.86 to 0.90). CONCLUSION This is the largest study to date documenting factors associated with LoS for patients admitted for SCD. The association of younger age with increased LoS supports recent calls for early SCD screening, especially newborns. The emerging trends and factors accounting for SCD admission require a multisector approach as these patients already experience frequent episodes of pain and hospital visits.
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Affiliation(s)
- Clement Tetteh Narh
- Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
- Biostatistics, Johannes-Gutenberg Universitat Mainz Institut für Medizinische Biometrie Epidemiologie und Informatik, Mainz, Rheinland-Pfalz, Germany
| | - Joyce Der
- Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Anthony Ofosu
- Policy, Planning, Monitoring and Evaluation Division (PPMED), Ghana Health Service, Accra, Greater Accra, Ghana
| | - Maria Blettner
- Radiation Epidemiology, Johannes-Gutenberg Universitat Mainz Institut für Medizinische Biometrie Epidemiologie und Informatik, Mainz, Rheinland-Pfalz, Germany
| | - Daniel Wollschlaeger
- Radiation Epidemiology, Johannes-Gutenberg Universitat Mainz Institut für Medizinische Biometrie Epidemiologie und Informatik, Mainz, Rheinland-Pfalz, Germany
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2
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Shayo G, Makundi I, Luzzatto L. The prevalence of human immunodeficiency and of hepatitis B viral infections is not increased in patients with sickle cell disease in Tanzania. BMC Infect Dis 2021; 21:1028. [PMID: 34592961 PMCID: PMC8485526 DOI: 10.1186/s12879-021-06726-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tanzania ranks as the fourth country in the world with respect to the number of sickle cell disease (SCD) births; it is also endemic to the human immunodeficiency virus (HIV) and the hepatitis B virus (HBV). This study was done to determine the prevalence of HIV and HBV infections among SCD patients in Dar es Salaam, Tanzania. METHODS A multicenter hospital-based descriptive cross sectional study was carried out among participants aged ≥ 16 years with a proven diagnosis of SCD. Socio-demographic and clinical data were recorded. Blood samples were drawn for HIV and HBV diagnosis. All categorical variables were summarized into frequencies. RESULTS There were 185/325 (56.9 %) females. The mean age (SD) was 23.0 ± 7.5 years. The prevalence of HIV was 1.8 %; the prevalence of HBV was 1.2 %. CONCLUSIONS The prevalence of both HIV and HBV in SCD patients is no greater than in the general population of Dar es Salaam or Tanzania. For associations, a large study would be needed. From a detailed blood transfusion history of SCD patients we found no evidence that HIV or HBV infection was transmitted through blood transfusion.
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Affiliation(s)
- Grace Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O.Box 65001, Dar es Salaam, Tanzania. .,Department of Internal Medicine, Muhimbili National Hospital, P.O.Box 65000, Dar es Salaam, Tanzania.
| | - Irene Makundi
- Department of Internal Medicine, Muhimbili National Hospital, P.O.Box 65000, Dar es Salaam, Tanzania
| | - Lucio Luzzatto
- Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, P.O.Box 65001, Dar es Salaam, Tanzania
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3
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Blatyta PF, Kelly S, Goncalez TT, Carneiro-Proietti AB, Salomon T, Miranda C, Sabino E, Preiss L, Maximo C, Loureiro P, Custer B, de Almeida-Neto C. Characterization of HIV risks in a Brazilian sickle cell disease population. BMC Public Health 2020; 20:1606. [PMID: 33097032 PMCID: PMC7585195 DOI: 10.1186/s12889-020-09702-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 10/14/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A low prevalence of HIV in sickle cell disease (SCD) patients has been reported in the literature though mechanisms for this are not understood. METHODS HIV risk behaviors were compared between SCD cases and non-SCD controls using a self-administered audio computer-assisted self-interview. SCD cases were recruited from a multi-center SCD cohort established in Brazil; controls were recruited from SCD social contacts. Categorical variables were analyzed using Chi-Square or Fisher exact test. Continuous variables were compared using the Mann-Whitney U test. RESULTS There were 152 SCD cases and 154 age/location matched controls enrolled at three participating Brazilian centers during 2016-17. No significant differences in number of sexual partners (lifetime or previous 12 months), male-to-male sex partners or intravenous drug use were observed. Cases received more transfusions, surgeries, and acupuncture treatment. CONCLUSIONS Besides the risk of transfusion-transmitted HIV, which is now exceedingly rare, SCD and non-SCD participants demonstrated similar HIV risk behaviors. Causes other than risk behaviors such as factors inherent to SCD pathophysiology may explain the reported low prevalence of HIV in SCD.
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Affiliation(s)
- P F Blatyta
- Hospital Moysés Deutsch, São Paulo, SP, Brazil.
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | - S Kelly
- Vitalant Research Institute, San Francisco, CA, USA
| | - T T Goncalez
- Vitalant Research Institute, San Francisco, CA, USA
| | | | - T Salomon
- Fundação Hemominas, Belo Horizonte, MG, Brazil
| | - C Miranda
- Fundação Hemominas, Belo Horizonte, MG, Brazil
| | - E Sabino
- Instituto de Medicina Tropical da FMUSP, São Paulo, SP, Brazil
| | - L Preiss
- Research Triangle Institute, International, Rockville, MD, USA
| | - C Maximo
- Hemorio, Rio de Janeiro, RJ, Brazil
| | - P Loureiro
- Fundação Hemope and Universidade de Pernambuco, Recife, PE, Brazil
| | - B Custer
- Vitalant Research Institute, San Francisco, CA, USA
| | - C de Almeida-Neto
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Fundação Pró-Sangue de São Paulo, São Paulo, SP, Brazil
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4
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Belisário AR, Blatyta PF, Vivanco D, Oliveira CDL, Carneiro-Proietti AB, Sabino EC, de Almeida-Neto C, Loureiro P, Máximo C, de Oliveira Garcia Mateos S, Flor-Park MV, de Oliveira Werneck Rodrigues D, Afonso Mota R, Gonçalez TT, Hoffmann TJ, Kelly S, Custer B. Association of HIV infection with clinical and laboratory characteristics of sickle cell disease. BMC Infect Dis 2020; 20:638. [PMID: 32854639 PMCID: PMC7457248 DOI: 10.1186/s12879-020-05366-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a multisystem disorder characterized by a wide spectrum of clinical manifestations and severity. Studies investigating potential effects of co-morbid human immunodeficiency virus (HIV) and SCD have produced conflicting results, and additional investigations are needed to elucidate whether the interaction between the two disease states might impact both HIV and SCD clinical outcomes. The association of HIV infection with clinical and laboratory characteristics of patients with SCD was assessed. METHODS This nested case-control study included individuals with SCD with HIV treated at six Brazilian SCD centers. Clinical and laboratory data were abstracted from medical records. HIV positive participants were compared to age, gender, center, and SCD genotype matched HIV negative participants (ratio 1:4). Individual clinical outcomes as well as a composite outcome of any SCD complication and a composite outcome of any HIV-related complication were compared between the two groups. RESULTS Fifteen HIV positive participants were included, 12 (80%) alive and 3 (20%) deceased. Most of the HIV positive patients had HbSS (60%; n = 9), 53% (n = 8) were female, and mean age was 30 ± 13 years. The frequency of individual SCD complications of acute chest syndrome/pneumonia, sepsis/bacteremia, pyelonephritis, ischemic stroke, hemorrhagic stroke, abnormal transcranial Doppler (TCD), and pulmonary hypertension was higher in HIV positive participants when compared to HIV negative, although analyzed individually none were statistically significant. HIV positive participants had significantly higher risk of any SCD complication and of a composite HIV-related complication compared to the HIV negative group (HR = 4.6; 95%CI 1.1-19.6; P = 0.04 and HR = 7.7; 95%CI 1.5-40.2; P = 0.02, respectively). There was a non-significant trend towards higher risk of any infections in participants with HIV positive (HR = 3.5; 95%CI 0.92-13.4; P = 0.07). Laboratory parameters levels were not significantly different in individuals with and without HIV. CONCLUSIONS In summary, our study in SCD patients shows that those with HIV have an increased risk of any SCD complication and HIV-related complications, as well as a suggestive but not significantly increased risk of infections.
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Affiliation(s)
- André Rolim Belisário
- Fundação Hemominas, Alameda Ezequiel Dias, 321, Belo Horizonte, Minas Gerais, 30130-110, Brazil.
| | - Paula F Blatyta
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Diana Vivanco
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | | | | | - Ester Cerdeira Sabino
- Faculdade de Medicina (FMUSP) and Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Cesar de Almeida-Neto
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, SP, Brazil
| | - Paula Loureiro
- Fundação Hemope, Recife, Pernambuco, Brazil
- Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Sheila de Oliveira Garcia Mateos
- Faculdade de Medicina (FMUSP) and Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
- Fundação Hemorio, Rio de Janeiro, Brazil
| | - Miriam V Flor-Park
- ITACI, Unidade de Onco-hematologia, Instituto da Criança, HCFMUSP, São Paulo, Brazil
| | | | - Rosimere Afonso Mota
- Fundação Hemominas, Alameda Ezequiel Dias, 321, Belo Horizonte, Minas Gerais, 30130-110, Brazil
| | | | - Thomas J Hoffmann
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Shannon Kelly
- Vitalant Research Institute, San Francisco, USA
- UCSF Benioff Children's Hospital Oakland, Oakland, USA
| | - Brian Custer
- University of California, San Francisco (UCSF), San Francisco, CA, USA
- Vitalant Research Institute, San Francisco, USA
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5
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Ssenyondwa J, George PE, Carlos Bazo-Alvarez J, Mercedes R, Kanywa JB, Naturinda E, Wasswa PLM, Lubega J. Impact of sickle cell disease on presentation and progression of paediatric HIV: a retrospective cohort study. Trop Med Int Health 2020; 25:897-904. [PMID: 32329120 DOI: 10.1111/tmi.13408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES HIV and sickle cell disease (SCD) are significant causes of morbidity and mortality in sub-Saharan Africa. Given their separate roles in immune dysregulation, our objective was to characterise the impact that SCD has on the presentation and progression of paediatric HIV. METHODS The study was a retrospective cohort study (study period 2004-2018). Cases of HIV + and SCD-afflicted patients (HIV+/SCD+) were obtained via electronic chart review from a paediatric HIV clinic in Kampala, Uganda and matched 1:3 with HIV + controls without SCD (HIV+/SCD-). RESULTS Thirty-five HIV+/SCD + subjects and 95 HIV+/SCD- controls were analysed (39% female (51/130), age 3.6 years (SD3.9)). At baseline, WHO clinical stage (64% total cohort Stage III/IV) and nutritional status (9.4% severe acute malnutrition) were similar for both groups, whereas HIV+/SCD + had higher though non-significant baseline CD4 count (1036 (SD713) vs 849 (SD638) cells/microlitre, P = 0.20, two-tailed t-test). There were 19 deaths, 6 (17%) HIV+/SCD + and 13 (14%) HIV+/SCD-, with unadjusted/adjusted models showing no significant difference. Nutritional progression and clinical stage progression showed no significant differences between groups. Kaplan-Meier analysis showed a slower rate of treatment failures in the HIV+/SCD + cohort (P = 0.11, log-rank survival test). Trajectory analysis showed that in the time period analysed, the HIV+/SCD + cohort showed a more rapid rise and higher total CD4 count (P = 0.012, regression analysis). CONCLUSION The study suggests that SCD does not adversely affect the progression of HIV in patients on ART. Further, HIV+/SCD + achieved higher CD4 counts and fewer HIV treatment failures, suggesting physiological effects due to SCD might mitigate HIV progression.
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Affiliation(s)
- Joseph Ssenyondwa
- Baylor College of Medicine Children's Foundation, Kampala, Uganda.,Texas Children's Hospital - Global HOPE Program, Kampala, Uganda
| | - Paul E George
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | | | - Rebecca Mercedes
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | | | - Ernest Naturinda
- Baylor College of Medicine Children's Foundation, Kampala, Uganda.,Texas Children's Hospital - Global HOPE Program, Kampala, Uganda
| | - Peter L M Wasswa
- Texas Children's Hospital - Global HOPE Program, Kampala, Uganda.,Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Joseph Lubega
- Texas Children's Hospital - Global HOPE Program, Kampala, Uganda.,Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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6
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Blatyta PF, Kelly S, Sabino E, Preiss L, Mendes F, Carneiro-Proietti AB, Werneck Rodrigues DDO, Mota R, Loureiro P, Maximo C, Park M, Mendrone-Jr A, Gonçalez TT, de Almeida Neto C, Custer B. Prevalence of serologic markers of transfusion and sexually transmitted infections and their correlation with clinical features in a large cohort of Brazilian patients with sickle cell disease. Transfusion 2020; 60:343-350. [PMID: 31804727 PMCID: PMC8010912 DOI: 10.1111/trf.15619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) often require red blood cell (RBC) transfusion for clinical complications, so may be exposed to transfusion-transmitted infections (TTIs). The prevalence of markers for human immunodeficiency virus (HIV), hepatitis C virus (HCV) and B (HBV), human T-cell lymphotropic virus (HTLV-1/2), Chagas disease, and syphilis in an SCD cohort in Brazil were studied. STUDY DESIGN AND METHODS Clinical history, interview data, blood samples, and medical chart review data were collected during cohort enrollment from November 2013 to May 2015. Serologic markers of infection were assessed. Standard measures of statistical association were calculated, and multivariable models were developed for the most prevalent infections to identify associated factors. RESULTS Infection markers were evident in 5.2% (144/2779) of the enrolled cohort. Anti-HCV was detected in 69 (2.5%), syphilis antibodies in 34 (1.2%), anti-HTLV-1/2 in 17 (0.6%), HBV surface antigen in 13 (0.5%), Chagas disease antibodies in 13 (0.5%), and anti-HIV in 8 (0.3%) of participants. Factors associated with increased odds of being anti-HCV reactive were older age, illegal drug use, increasing number of RBCs, more than three pain crises in the previous year, and geographic location. Syphilis was associated with older age, females, and smoking history. CONCLUSION HCV infection was more common in older patients who may have received RBCs before testing was performed on donations, suggesting possible historic transfusion transmission. The cohort showed decreasing rates of infections and a reduction in transfusion transmission markers in younger patients compared to historical literature except for syphilis, indicating contemporary reduced risk of TTI.
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Affiliation(s)
- Paula F Blatyta
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Shannon Kelly
- Vitalant Research Institute, San Francisco, California
| | - Ester Sabino
- Instituto de Medicina Tropical da FMUSP, Sao Paulo, Brazil
| | - Liliana Preiss
- Research Triangle Institute International, Rockville, Maryland
| | | | | | | | - Rosimere Mota
- Hemominas Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Paula Loureiro
- Hemope and Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Miriam Park
- Instituto da Criança-Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Cesar de Almeida Neto
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California
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7
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Ochocinski D, Dalal M, Black LV, Carr S, Lew J, Sullivan K, Kissoon N. Life-Threatening Infectious Complications in Sickle Cell Disease: A Concise Narrative Review. Front Pediatr 2020; 8:38. [PMID: 32154192 PMCID: PMC7044152 DOI: 10.3389/fped.2020.00038] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/27/2020] [Indexed: 12/19/2022] Open
Abstract
Sickle cell disease (SCD) results in chronic hemolytic anemia, recurrent vascular occlusion, insidious vital organ deterioration, early mortality, and diminished quality of life. Life-threatening acute physiologic crises may occur on a background of progressive diminishing vital organ function. Sickle hemoglobin polymerizes in the deoxygenated state, resulting in erythrocyte membrane deformation, vascular occlusion, and hemolysis. Vascular occlusion and increased blood viscosity results in functional asplenia and immune deficiency in early childhood, resulting in life-long increased susceptibility to serious bacterial infections. Infection remains a main cause of overall mortality in patients with SCD in low- and middle-income countries due to increased exposure to pathogens, increased co-morbidities such as malnutrition, lower vaccination rates, and diminished access to definitive care, including antibiotics and blood. Thus, the greatest gains in preventing infection-associated mortality can be achieved by addressing these factors for SCD patients in austere environments. In contrast, in high-income countries, perinatal diagnosis of SCD, antimicrobial prophylaxis, vaccination, aggressive use of antibiotics for febrile episodes, and the availability of contemporary critical care resources have resulted in a significant reduction in deaths from infection; however, chronic organ injury is problematic. All clinicians, regardless of their discipline, who assume the care of SCD patients must understand the importance of infectious disease as a contributor to death and disability. In this concise narrative review, we summarize the data that describes the importance of infectious diseases as a contributor to death and disability in SCD and discuss pathophysiology, prevalent organisms, prevention, management of acute episodes of critical illness, and ongoing care.
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Affiliation(s)
- Dominik Ochocinski
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - Mansi Dalal
- Division of Pediatric Hematology/Oncology, University of Florida, Gainesville, FL, United States
| | - L Vandy Black
- Division of Pediatric Hematology/Oncology, University of Florida, Gainesville, FL, United States
| | - Silvana Carr
- Division of Pediatric Infectious Disease, University of Florida, Gainesville, FL, United States
| | - Judy Lew
- Division of Pediatric Infectious Disease, University of Florida, Gainesville, FL, United States
| | - Kevin Sullivan
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States.,Congenital Heart Center, University of Florida, Gainesville, FL, United States
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
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8
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Kiyaga C, Hernandez AG, Ssewanyana I, Schaefer BA, McElhinney KE, Ndeezi G, Howard TA, Ndugwa CM, Ware RE, Aceng JR. Sickle cell screening in Uganda: High burden, human immunodeficiency virus comorbidity, and genetic modifiers. Pediatr Blood Cancer 2019; 66:e27807. [PMID: 31094093 DOI: 10.1002/pbc.27807] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/03/2019] [Accepted: 04/23/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Uganda Sickle Surveillance Study provided evidence for a large sickle burden among HIV-exposed infants in Uganda. To date, however, no large scale screening program has been developed for Central or East Africa. METHODS A 3-year targeted sickle cell screening project in Uganda was designed by the Ministry of Health to (1) determine sickle cell trait and disease prevalence within high-burden districts, (2) document the prevalence among HIV-exposed and nonexposed children, (3) confirm previously suggested HIV comorbidity, and (4) estimate the co-inheritance of known genetic modifiers of sickle cell disease. RESULTS A total of 163 334 dried blood spot samples collected between April 2015 and March 2018 were analyzed, including 112 352 samples within the HIV Early Infant Diagnosis program. A high burden with >1% sickle cell disease was found within targeted East Central and Mid-Northern districts, in both HIV-exposed and nonexposed children. Based on crude birth-rate data, 236 905 sickle cell trait births and 16 695 sickle cell disease births will occur annually in Uganda. Compared to sickle cell disease without HIV, the odds ratio of having sickle cell disease plus HIV was 0.50 (95% confidence interval = 0.40-0.64, P < .0001). Alpha-thalassemia trait and G6PD deficiency were common with sickle cell disease, but with different geospatial distribution. CONCLUSIONS High sickle cell burden and potential HIV comorbidity are confirmed in Uganda. Genetic modifiers are common and likely influence laboratory and clinical phenotypes. These prospective data document that targeted sickle cell screening is feasible and effective in Uganda, and support development of district-level comprehensive care programs.
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Affiliation(s)
- Charles Kiyaga
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Arielle G Hernandez
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Isaac Ssewanyana
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Beverly A Schaefer
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kathryn E McElhinney
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Thad A Howard
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christopher M Ndugwa
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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9
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Sickle Cell Disease and Infections in High- and Low-Income Countries. Mediterr J Hematol Infect Dis 2019; 11:e2019042. [PMID: 31308918 PMCID: PMC6613623 DOI: 10.4084/mjhid.2019.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/21/2019] [Indexed: 01/17/2023] Open
Abstract
Infections, especially pneumococcal septicemia, meningitis, and Salmonella osteomyelitis, are a major cause of morbidity and mortality in patients with sickle cell disease (SCD). SCD increased susceptibility to infection, while infection leads to SCD-specific pathophysiological changes. The risk of infectious complications is highest in children with a palpable spleen before six months of age. Functional splenectomy, the results of repeated splenic infarctions, appears to be a severe host-defense defect. Infection is the leading cause of death, particularly in less developed countries. Defective host-defense mechanisms enhance the risk of pneumococcal complications. Susceptibility to Salmonella infections can be explained at least in part by a similar mechanism. In high-income countries, the efficacy of the pneumococcal vaccine has been demonstrated in this disease. A decreased in infection incidence has been noted in SCD patients treated prophylactically with daily oral penicillin. Studies in low-income countries suggest the involvement of a different spectrum of etiological agents.
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10
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David AN, Jinadu MY, Wapmuk AE, Gbajabiamila TA, Okwuzu JO, Herbertson EC, Ezechi OC. Prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria. Pan Afr Med J 2018; 31:113. [PMID: 31037173 PMCID: PMC6462387 DOI: 10.11604/pamj.2018.31.113.15097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/14/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION sickle cell disease and HIV infection are prevalent in sub-Saharan Africa. While Haemoglobin S (HbS) contributes to significant morbidity and mortality in the homozygous or double heterozygous states, in the carrier state it confers a survival advantage in disease conditions such as malaria. However the interaction between sickle haemoglobin and HIV infection, especially in children remains largely unknown. This study aimed to assess the prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria. METHODS a cross-sectional study among HIV infected children in an HIV treatment centre in Lagos, Nigeria. Socio-demographic and clinical characteristics were obtained and blood sample collected for haemoglobin electrophoresis, HIV RNA viral load and haematologic profile. Data was analysed with SPSS version 20. RESULTS the prevalence of sickle cell trait was 18.8% among the 208 study participants, with none having sickle cell disease (SCD). Participants with SCT were significantly younger (OR = 4.0 95% CI (1.74-9.24)), more likely to be from the Yoruba ethnic group (OR = 3.3 95% CI [1.45-7.52)), had more opportunistic infections (OR = 2.4 95% CI (1.18-5.03), and lower mean HIV RNA viral load (p = 0.05) at baseline. However response to HIV care and treatment was similar in both groups of participants. CONCLUSION the finding of absence of SCD, low prevalence of SCT, and lower HIV viraemia in HIV infected children with SCT may have implications for childhood survival which requires further clarification in future studies.
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Affiliation(s)
- Agatha Nkiruka David
- Department of Clinical Sciences Nigerian Institute of Medical Research 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Munirah Yewande Jinadu
- Department of Clinical Sciences Nigerian Institute of Medical Research 6 Edmund Crescent, Yaba, Lagos, Nigeria
- Department of Community Health, Federal Medical Centre, Ebute Meta, Lagos Nigeria
| | - Agatha Eileen Wapmuk
- Department of Clinical Sciences Nigerian Institute of Medical Research 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Titilola Abike Gbajabiamila
- Department of Clinical Sciences Nigerian Institute of Medical Research 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Jane Ogoamaka Okwuzu
- Department of Clinical Sciences Nigerian Institute of Medical Research 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Ebiere Clara Herbertson
- Department of Clinical Sciences Nigerian Institute of Medical Research 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Oliver Chukwujekwu Ezechi
- Department of Clinical Sciences Nigerian Institute of Medical Research 6 Edmund Crescent, Yaba, Lagos, Nigeria
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Affiliation(s)
- Baba Inusa
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Joyce Popoola
- St. George’s University Hospitals NHS Foundation Trust, London, United Kingdom
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Owusu EDA, Brown CA, Grobusch MP, Mens P. Prevalence of Plasmodium falciparum and non-P. falciparum infections in a highland district in Ghana, and the influence of HIV and sickle cell disease. Malar J 2017; 16:167. [PMID: 28438159 PMCID: PMC5404324 DOI: 10.1186/s12936-017-1823-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 04/18/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In the past two decades, there has been a reported decline in malaria in Ghana and the rest of the world; yet it remains the number one cause of mortality and morbidity. Human immuno-deficiency virus (HIV) and sickle cell disease (SCD) share a common geographical space with malaria in sub-Saharan Africa and an interaction between these three conditions has been suggested. This study determined the Plasmodium falciparum and non-P. falciparum status of symptomatic and non-symptomatic residents of Mpraeso in the highlands of Kwahu-South district of Ghana based on evidence of current national decline. The influence of HIV and SCD on malaria was also determined. METHODS Participants were 354 symptomatic patients visiting the Kwahu Government Hospital and 360 asymptomatic residents of the district capital. This cross-sectional study was conducted during the minor rainy season (October-December 2014). Rapid diagnostic tests (RDT), blood film microscopy and real-time polymerase chain reaction assessment of blood were done. Participants who tested positive with RDT were treated with artemisinin-based combination therapy; and assessment of venous blood was repeated 7 days after treatment. HIV screening and haemoglobin genotyping was done. Univariate and multivariate regression analysis was used to determine the influence of SCD and HIV. RESULTS Plasmodium falciparum was prevalent at 124/142 (87.3%). Plasmodium malariae was the only non-falciparum species detected at 18/142 (12.7%). HIV and SCD did not significantly increase odds of malaria infection. However, the use of ITN and recent anti-malarial intake significantly decreased the odds of being malaria infected by 0.45-fold and 0.46-fold respectively. CONCLUSION Plasmodium falciparum and P. malariae infection are the prevailing species in the study area; albeit varying from the national average. HIV and SCD were not associated with the risk of having malaria.
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Affiliation(s)
- Ewurama D A Owusu
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-bu, Accra, Ghana. .,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - Charles A Brown
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-bu, Accra, Ghana
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Centre de Recherches Médicales de Lambaréné (CERMEL), Hôpital Albert Schweitzer, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Petra Mens
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Microbiology, Clinical Parasitology, Division of Laboratory Specialisms, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Increased iron export by ferroportin induces restriction of HIV-1 infection in sickle cell disease. Blood Adv 2016; 1:170-183. [PMID: 28203649 DOI: 10.1182/bloodadvances.2016000745] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The low incidence of HIV-1 infection in patients with sickle cell disease (SCD) and inhibition of HIV-1 replication in vitro under the conditions of low intracellular iron or heme treatment suggests a potential restriction of HIV-1 infection in SCD. We investigated HIV-1 ex vivo infection of SCD peripheral blood mononuclear cells (PBMCs) and found that HIV-1 replication was inhibited at the level of reverse transcription (RT) and transcription. We observed increased expression of heme and iron-regulated genes, previously shown to inhibit HIV-1, including ferroportin, IKBα, HO-1, p21, and SAM domain and HD domain-containing protein 1 (SAMHD1). HIV-1 inhibition was less pronounced in hepcidin-treated SCD PBMCs and more pronounced in the iron or iron chelators treated, suggesting a key role of iron metabolism. In SCD PBMCs, labile iron levels were reduced and protein levels of ferroportin, HIF-1α, IKBα, and HO-1 were increased. Hemin treatment induced ferroportin expression and inhibited HIV-1 in THP-1 cells, mimicking the HIV-1 inhibition in SCD PBMCs, especially as hepcidin similarly prevented HIV-1 inhibition. In THP-1 cells with knocked down ferroportin, IKBα, or HO-1 genes but not HIF-1α or p21, HIV-1 was not inhibited by hemin. Activity of SAMHD1-regulatory CDK2 was decreased, and SAMHD1 phosphorylation was reduced in SCD PBMCs and hemin-treated THP-1 cells, suggesting SAMHD1-mediated HIV-1 restriction in SCD. Our findings point to ferroportin as a trigger of HIV-1 restriction in SCD settings, linking reduced intracellular iron levels to the inhibition of CDK2 activity, reduction of SAMHD1 phosphorylation, increased IKBα expression, and inhibition of HIV-1 RT and transcription.
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Pule GD, Mowla S, Novitzky N, Wonkam A. Hydroxyurea down-regulates BCL11A, KLF-1 and MYB through miRNA-mediated actions to induce γ-globin expression: implications for new therapeutic approaches of sickle cell disease. Clin Transl Med 2016; 5:15. [PMID: 27056246 PMCID: PMC4824700 DOI: 10.1186/s40169-016-0092-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 03/29/2016] [Indexed: 12/29/2022] Open
Abstract
Background The major therapeutic benefit of hydroxyurea, the only FDA-approved pharmacologic treatment for sickle cell disease (SCD), is directly related to fetal hemoglobin (HbF) production that leads to significant reduction of morbidity and mortality. However, potential adverse effects such as infertility, susceptibility to infections, or teratogenic effect have been subject of concerns. Therefore, understanding HU molecular mechanisms of action, could lead to alternative therapeutic agents to increase HbF with less toxicity. This paper investigated whether HU-induced HbF could operate through post-transcriptional miRNAs regulation of BCL11A, KLF-1 and MYB, potent negative regulators of HbF. Both ex vivo differentiated primary erythroid cells from seven unrelated individuals, and K562 cells were treated with hydroxyurea (100 μM) and changes in BCL11A, KLF-1, GATA-1, MYB, β- and γ-globin gene expression were investigated. To explore potential mechanisms of post-transcriptional regulation, changes in expression of seven targeted miRNAs, previously associated with basal γ-globin expression were examined using miScript primer assays. In addition, K562 cells were transfected with miScript miRNA inhibitors/anti-miRNAs followed by Western Blot analysis to assess the effect on HbF protein levels. Direct interaction between miRNAs and the MYB 3′-untranslated region (UTR) was also investigated by a dual-luciferase reporter assays. Results Down-regulation of BCL11A and MYB was associated with a sevenfold increase in γ-globin expression in both primary and K562 cells (p < 0.003). Similarly, KLF-1 was down-regulated in both cell models, corresponding to the repressed expression of BCL11A and β-globin gene (p < 0.04). HU induced differential expression of all miRNAs in both cell models, particularly miR-15a, miR-16, miR-26b and miR-151-3p. An HU-induced miRNAs-mediated mechanism of HbF regulation was illustrated with the inhibition of miR-26b and -151-3p resulting in reduced HbF protein levels. There was direct interaction between miR-26b with the MYB 3′-untranslated region (UTR). Conclusions These experiments have shown the association between critical regulators of γ-globin expression (MYB, BCL11A and KLF-1) and specific miRNAs; in response to HU, and demonstrated a mechanism of HbF production through HU-induced miRNAs inhibition of MYB. The role of miRNAs-mediated post-transcriptional regulation of HbF provides potential targets for new treatments of SCD that may minimize alterations to the cellular transcriptome. Electronic supplementary material The online version of this article (doi:10.1186/s40169-016-0092-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gift Dineo Pule
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, Republic of South Africa
| | - Shaheen Mowla
- Division of Hematology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa
| | - Nicolas Novitzky
- Division of Hematology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, Republic of South Africa.
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Ndeezi G, Kiyaga C, Hernandez AG, Munube D, Howard TA, Ssewanyana I, Nsungwa J, Kiguli S, Ndugwa CM, Ware RE, Aceng JR. Burden of sickle cell trait and disease in the Uganda Sickle Surveillance Study (US3): a cross-sectional study. LANCET GLOBAL HEALTH 2016; 4:e195-200. [DOI: 10.1016/s2214-109x(15)00288-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/19/2015] [Accepted: 11/23/2015] [Indexed: 02/06/2023]
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Obaro S. Is integrating sickle cell disease and HIV screening logical? LANCET GLOBAL HEALTH 2016; 4:e144-5. [PMID: 26833238 DOI: 10.1016/s2214-109x(15)00298-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/02/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Stephen Obaro
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, 982165 Nebraska Medical Center, Omaha, NE 68198, USA.
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Pule GD, Mowla S, Novitzky N, Wiysonge CS, Wonkam A. A systematic review of known mechanisms of hydroxyurea-induced fetal hemoglobin for treatment of sickle cell disease. Expert Rev Hematol 2015; 8:669-79. [PMID: 26327494 DOI: 10.1586/17474086.2015.1078235] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM To report on molecular mechanisms of fetal hemoglobin (HbF) induction by hydroxyurea (HU) for the treatment of sickle cell disease. STUDY DESIGN Systematic review. RESULTS Studies have provided consistent associations between genomic variations in HbF-promoting loci and variable HbF level in response to HU. Numerous signal transduction pathways have been implicated, through the identification of key genomic variants in BCL11A, HBS1L-MYB, SAR1 or XmnI polymorphism that predispose the response to the treatment, and signal transduction pathways that modulate γ-globin expression (cAMP/cGMP; Giα/c-Jun N-terminal kinase/Jun; methylation and miRNA). Three main molecular pathways have been reported: i) Epigenetic modifications, transcriptional events and signaling pathways involved in HU-mediated response, ii) Signaling pathways involving HU-mediated response and iii) Post-transcriptional pathways (regulation by miRNAs). CONCLUSIONS The complete picture of HU-mediated mechanisms of HbF production in Sickle Cell Disease remains elusive. Research on post-transcriptional mechanisms could lead to therapeutic targets that may minimize alterations to the cellular transcriptome.
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Affiliation(s)
- Gift D Pule
- a 1 Department of Medicine, Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa
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Sobota A, Sabharwal V, Fonebi G, Steinberg M. How we prevent and manage infection in sickle cell disease. Br J Haematol 2015; 170:757-67. [PMID: 26018640 DOI: 10.1111/bjh.13526] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sickle cell disease (SCD) affects approximately 100,000 people in the US, 12,500 in the UK, and millions worldwide. SCD is typified by painful vaso-occlusive episodes, haemolytic anaemia and organ damage. A secondary complication is infection, which can be bacterial, fungal or viral. Universal newborn screening, routine use of penicillin prophylaxis, availability of conjugated vaccines against S. pneumoniae and comprehensive care programmes instituted during the past few decades in industrialized countries have dramatically reduced childhood mortality and improved life expectancy. Yet patients with SCD remain at increased risk of infection. Unfortunately, the treatment of most bacterial infections that are common in SCD is not based on the results of randomized controlled clinical trials. In their absence, treatment decisions are based on consensus guidelines, clinical experience or adapting treatment applied in other diseases. This leads to wide variation in treatment among institutions and even between treating physicians in a single institution. Prevention of infection, when possible, is most important and we focus on prevention through targeted prophylaxis and vaccination. We will share our management strategies for managing the more common infections in SCD and provide the rationale for our recommendations.
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Affiliation(s)
- Amy Sobota
- Boston University School of Medicine, Boston, MA, USA.,Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Vishakha Sabharwal
- Boston University School of Medicine, Boston, MA, USA.,Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Gwendoline Fonebi
- Boston University School of Medicine, Boston, MA, USA.,Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Martin Steinberg
- Boston University School of Medicine, Boston, MA, USA.,Department of Medicine, Boston Medical Center, Boston, MA, USA
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