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Mazambara F, Chagwena D, Mudzviti T, Sithole S, Monera-Penduka T, Maponga CC, Morse GD. Utility of HIV support groups in advancing implementation research in resource-limited settings: experiences from an urban-setting HIV support group in Zimbabwe. AIDS Res Ther 2022; 19:7. [PMID: 35164769 PMCID: PMC8843025 DOI: 10.1186/s12981-022-00431-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/24/2022] [Indexed: 11/24/2022] Open
Abstract
Support groups for people living with the Human Immunodeficiency Virus (HIV) have continued to evolve since their emergence over two decades ago. In addition to providing HIV education and fostering psychosocial support, recent efforts have shifted the focus to socio-economic activities and retention in care. The sense of urgency to adopt new treatment and prevention strategies in sub-Saharan Africa necessitates greater engagement of established HIV care programs, especially among researchers seeking to conduct implementation research, promote prevention strategies and optimize treatment as prevention. To maximize the utility of support groups in doing so, efforts to create an organized, collaborative framework should be considered. This paper aims to describe the process of refocusing an adult HIV peer-support group and illustrate how a structured program was strengthened to sustain implementation research in resource-limited settings, while promoting patient recruitment and retention. A multidisciplinary team of scientists supporting an HIV peer-support group spearheaded the implementation process that authored the successes, challenges and lessons documented over eight years. Psychosocial support, nutrition care and support, adherence education and income generating projects were the main interventions employed. The initiative resulted in seven peer-reviewed publications, submission of 23 scientific abstracts, scientific dissemination at 12 international conferences. Eleven research studies and 16 income generating projects were successfully conducted over eight years. More than 900 patients participated in peer-support group activities every month and 400 were engaged in income generating activities. This multidisciplinary structured program was valuable in the retention and recruitment of patients for implementation research and benefits extended to psychosocial support, microeconomic projects, and improved nutrition. The support group contributed to strengthening implementation research through providing a platform for identification of research priorities, patient recruitment and retention in studies and dissemination of research findings.
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Maponga CC, Monera-Penduka TG, Mtisi TJ, Difrancesco R, Makita-Chingombe F, Mazambara F, Tooley K, Mudzviti T, Morse GD. Two decades (1998 to 2018) of collaborative human immunodeficiency virus clinical pharmacology capacity building in a resource constrained setting. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:73. [PMID: 34758831 PMCID: PMC8579570 DOI: 10.1186/s12962-021-00327-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/30/2021] [Indexed: 11/10/2022] Open
Abstract
While important advances have been made in the prevention and treatment of Human Immunodeficiency Virus (HIV) infection, limited expertise and resource constraints to effectively manage rollout of HIV programs often contribute to poor treatment outcomes in Sub-Saharan Africa. In 1998, the University of Zimbabwe (UZ) and the University at Buffalo, State University of New York (UB), developed a collaborative clinical pharmacology capacity building program in Zimbabwe to train the next generation of HIV researchers and support rollout of the national HIV program. The collaboration was funded by research and training grants that were competitively acquired through United States of America government funding mechanisms, between 1998 and 2016. Thirty-eight research fellows were trained and a specialty clinical pharmacology laboratory was established during this period. Knowledge and skills transfer were achieved through faculty and student exchange visits. Scientific dissemination output included sixty-two scholarly publications that influenced three national policies and provided development of guidelines for strategic leadership for an HIV infection—patient adherence support group. The clinical pharmacology capacity building program trained fellows that were subsequently incorporated into the national technical working group at the Ministry of Health and Child Care, who are responsible for optimizing HIV treatment guidelines in Zimbabwe. Despite serious economic challenges, consistent collaboration between UZ and UB strengthened UZ faculty scholarly capacity, retention of HIV clinical research workforce was achieved, and the program made additional contributions toward optimization of antiretroviral therapy in Zimbabwe.
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Affiliation(s)
- Charles C Maponga
- International Pharmacotherapy Education and Research Initiative (IPERI), Department of Pharmacy and Pharmaceutical Science, University of Zimbabwe Faculty of Medicine and Health Sciences, c/o Drug and Toxicology Information Services (DaTIS), PO Box A178, Avondale Harare, Zimbabwe.,Center for Integrated Global Biomedical Sciences, School of Pharmacy and Pharmaceutical Sciences, Translational Pharmacology Research Core, New York State Center of Excellence in Bioinformatics and Life Sciences, The State University of New York, Buffalo, NY, USA
| | - Tsitsi G Monera-Penduka
- International Pharmacotherapy Education and Research Initiative (IPERI), Department of Pharmacy and Pharmaceutical Science, University of Zimbabwe Faculty of Medicine and Health Sciences, c/o Drug and Toxicology Information Services (DaTIS), PO Box A178, Avondale Harare, Zimbabwe.
| | - Takudzwa J Mtisi
- International Pharmacotherapy Education and Research Initiative (IPERI), Department of Pharmacy and Pharmaceutical Science, University of Zimbabwe Faculty of Medicine and Health Sciences, c/o Drug and Toxicology Information Services (DaTIS), PO Box A178, Avondale Harare, Zimbabwe
| | - Robin Difrancesco
- Center for Integrated Global Biomedical Sciences, School of Pharmacy and Pharmaceutical Sciences, Translational Pharmacology Research Core, New York State Center of Excellence in Bioinformatics and Life Sciences, The State University of New York, Buffalo, NY, USA
| | - Faithful Makita-Chingombe
- International Pharmacotherapy Education and Research Initiative (IPERI), Department of Pharmacy and Pharmaceutical Science, University of Zimbabwe Faculty of Medicine and Health Sciences, c/o Drug and Toxicology Information Services (DaTIS), PO Box A178, Avondale Harare, Zimbabwe
| | - Fine Mazambara
- International Pharmacotherapy Education and Research Initiative (IPERI), Department of Pharmacy and Pharmaceutical Science, University of Zimbabwe Faculty of Medicine and Health Sciences, c/o Drug and Toxicology Information Services (DaTIS), PO Box A178, Avondale Harare, Zimbabwe
| | - Kathleen Tooley
- Center for Integrated Global Biomedical Sciences, School of Pharmacy and Pharmaceutical Sciences, Translational Pharmacology Research Core, New York State Center of Excellence in Bioinformatics and Life Sciences, The State University of New York, Buffalo, NY, USA
| | - Tinashe Mudzviti
- International Pharmacotherapy Education and Research Initiative (IPERI), Department of Pharmacy and Pharmaceutical Science, University of Zimbabwe Faculty of Medicine and Health Sciences, c/o Drug and Toxicology Information Services (DaTIS), PO Box A178, Avondale Harare, Zimbabwe
| | - Gene D Morse
- Center for Integrated Global Biomedical Sciences, School of Pharmacy and Pharmaceutical Sciences, Translational Pharmacology Research Core, New York State Center of Excellence in Bioinformatics and Life Sciences, The State University of New York, Buffalo, NY, USA
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Morse GD. Strategies for Implementation Research to Investigate the Negative Pharmacokinetic Interaction Between Efavirenz and Dolutegravir. Clin Infect Dis 2021; 72:1823-1825. [PMID: 32667998 DOI: 10.1093/cid/ciaa982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/09/2020] [Indexed: 11/12/2022] Open
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Matyanga CMJ, Morse GD, Gundidza M, Nhachi CFB. African potato (Hypoxis hemerocallidea): a systematic review of its chemistry, pharmacology and ethno medicinal properties. BMC Complement Med Ther 2020; 20:182. [PMID: 32527245 PMCID: PMC7289225 DOI: 10.1186/s12906-020-02956-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND African Potato (hypoxis hemerocallidea), is used for enhancing immune system in Southern Africa. It is among the plants of intense commercial and scientific interest; hence, the aim of this study was to describe its chemistry and pharmacology. METHODS PubMed, Cochrane Controlled Trials Register (CENTRAL) and Google Scholar were searched independently for relevant literature. The last search occurred in October 2018. Other research material was obtained from Google. The following search terms were used, but not limited to: "African Potato", "hypoxis", "hemerocallidea", "rooperol." Articles that were explaining the chemistry and pharmacology of hypoxis hemerocallidea were included. RESULTS Thirty articles from PubMed, Cochrane and Google Scholar were eligible. Three webpages were included from Google. Results showed that the tuberous rootstock (corm) of African Potato is used traditionally to treat wasting diseases, testicular tumours, insanity, barrenness, impotency, bad dreams, intestinal parasites, urinary infection, cardiac disease and enhancing immunity. The plant contains hypoxoside, which is converted rapidly to a potent antioxidant, rooperol in the gut. The corm contains sterols, sterol glycosides, stanols, terpenoids, saponins, cardiac glycosides, tannins and reducing sugars. A dose of 15 mg/kg/day of hypoxoside is reportedly therapeutic. Preclinical studies of African Potato have shown immunomodulation, antioxidant, antinociceptive, hypoglycaemic, anti-inflammatory, anticonvulsant, antibacterial, uterolytic, antimotility, spasmolytic and anticholinergic effects. The common side effects of African Potato are nausea and vomiting, which subside over time. In vitro, African Potato demonstrated inhibitory effects on CYP1A2, 2C9, 2D6, 3A4, 3A5, CYP19-metabolism and induction of P-glycoprotein. In vivo, it did not alter the pharmacokinetics of efavirenz or lopinavir/ritonavir. CONCLUSION African Potato is mainly used as an immunostimulant. The exact mechanisms of action for all the pharmacological actions are unknown. More research is required to substantiate claims regarding beneficial effects. There are many research gaps that require investigation including pharmacokinetic interactions with conventional drugs, especially those used in HIV/AIDS.
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Affiliation(s)
- Celia M J Matyanga
- Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe. .,School of Pharmacy, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
| | - Gene D Morse
- Center for Integrated Global Biomedical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Mazuru Gundidza
- Department of Pharmaceutical Technology, School of Industrial Sciences and Technology, Harare Institute of Technology, Belvedere, Harare, Zimbabwe
| | - Charles F B Nhachi
- Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Makita-Chingombe F, Ocque AJ, DiFrancesco R, Maponga C, Muzambi F, Monera-Penduka TG, Mudzviti T, Mtisi TJ, Morse GD. Development and validation of a high performance liquid chromatography method to determine nevirapine in plasma in a resource-limited setting. Afr J Lab Med 2019; 8:880. [PMID: 31205870 PMCID: PMC6556864 DOI: 10.4102/ajlm.v8i1.880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/02/2018] [Indexed: 12/14/2022] Open
Abstract
Background There are several instances where nevirapine pharmacokinetic monitoring may be useful, such as in special populations or pharmacokinetic drug interaction studies that require the ascertainment of nevirapine pharmacokinetics in the sub-Saharan region. Objectives The main aim of this study was to produce a validated, sustainable and relevant nevirapine assay method that meets bio-analytical regulatory requirements. Methods The developed method utilised a Waters 2795 Alliance high performance liquid chromatography system with a 2996 photo diode array detector, an Atlantis dC18 5 micron, 3.9 mm × 150 mm analytical column and a gradient flow rate of 1 mL/min. Ultraviolet detection data were collected from 210 nm to 400 nm, extracted at 260 nm, and processed for nevirapine and internal standard peak height responses. Results The method proved to be linear (R2 0.995), precise (+1.92% – +9.69%) and accurate (-9.70% – 12.0%). Recovery for the analyte and internal standard was between 98.8% and 114%. The method showed good specificity as no interferences were caused by common African traditional medicines, anti-tuberculosis medications or other concomitant antiretrovirals nor endogenous components. Conclusion The method is reproducible, relevant to our setting and uses considerably low plasma volumes with preservation of some consumables, a desirable key factor in a resource-limited setting.
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Affiliation(s)
- Faithful Makita-Chingombe
- International Pharmacology Specialty Laboratory, School of Pharmacy, University of Zimbabwe College of Health Science, Harare, Zimbabwe
| | - Andrew J Ocque
- Center for Integrated Global Biomedical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Translational Pharmacology Research Core, New York State Center of Excellence in Bioinformatics and Life Sciences, The State University of New York, Buffalo, New York, United States
| | - Robin DiFrancesco
- Center for Integrated Global Biomedical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Translational Pharmacology Research Core, New York State Center of Excellence in Bioinformatics and Life Sciences, The State University of New York, Buffalo, New York, United States
| | - Charles Maponga
- International Pharmacology Specialty Laboratory, School of Pharmacy, University of Zimbabwe College of Health Science, Harare, Zimbabwe.,Center for Integrated Global Biomedical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Translational Pharmacology Research Core, New York State Center of Excellence in Bioinformatics and Life Sciences, The State University of New York, Buffalo, New York, United States
| | - Farai Muzambi
- International Pharmacology Specialty Laboratory, School of Pharmacy, University of Zimbabwe College of Health Science, Harare, Zimbabwe
| | - Tsitsi G Monera-Penduka
- International Pharmacology Specialty Laboratory, School of Pharmacy, University of Zimbabwe College of Health Science, Harare, Zimbabwe
| | - Tinashe Mudzviti
- International Pharmacology Specialty Laboratory, School of Pharmacy, University of Zimbabwe College of Health Science, Harare, Zimbabwe
| | - Takudzwa J Mtisi
- International Pharmacology Specialty Laboratory, School of Pharmacy, University of Zimbabwe College of Health Science, Harare, Zimbabwe
| | - Gene D Morse
- Center for Integrated Global Biomedical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Translational Pharmacology Research Core, New York State Center of Excellence in Bioinformatics and Life Sciences, The State University of New York, Buffalo, New York, United States
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Mtisi TJ, Maponga C, Monera-Penduka TG, Mudzviti T, Chagwena D, Makita-Chingombe F, DiFranchesco R, Morse GD. Strategic establishment of an International Pharmacology Specialty Laboratory in a resource-limited setting. Afr J Lab Med 2018. [PMID: 29535916 PMCID: PMC5843799 DOI: 10.4102/ajlm.v7i1.659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background A growing number of drug development studies that include pharmacokinetic evaluations are conducted in regions lacking a specialised pharmacology laboratory. This necessitated the development of an International Pharmacology Specialty Laboratory (IPSL) in Zimbabwe. Objectives The aim of this article is to describe the development of an IPSL in Zimbabwe. Methods The IPSL was developed collaboratively by the University of Zimbabwe and the University at Buffalo Center for Integrated Global Biomedical Sciences. Key stages included infrastructure development, establishment of quality management systems and collaborative mentorship in clinical pharmacology study design and chromatographic assay development and validation. Results Two high performance liquid chromatography instruments were donated by an instrument manufacturer and a contract research organisation. Laboratory space was acquired through association with the Zimbabwe national drug regulatory authority. Operational policies, standard operating procedures and a document control system were established. Scientists and technicians were trained in aspects relevant to IPSL operations. A high-performance liquid chromatography method for nevirapine was developed with the guidance of the Clinical Pharmacology Quality Assurance programme and approved by the assay method review programme. The University of Zimbabwe IPSL is engaged with the United States National Institute of Allergy and Infectious Diseases Division of AIDS research networks and is poised to begin drug assays and pharmacokinetic analyses. Conclusions An IPSL has been successfully established in a resource-limited setting through the efforts of an external partnership providing technical guidance and motivated internal faculty and staff. Strategic partnerships were beneficial in navigating challenges leading to laboratory development and training new investigators. The IPSL is now engaged in clinical pharmacology research.
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Affiliation(s)
- Takudzwa J Mtisi
- International Pharmacology Specialty Laboratory, School of Pharmacy, University of Zimbabwe College of Health Sciences, Harare, Zimbabawe
| | - Charles Maponga
- International Pharmacology Specialty Laboratory, School of Pharmacy, University of Zimbabwe College of Health Sciences, Harare, Zimbabawe.,Center for Integrated Global Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Tsitsi G Monera-Penduka
- International Pharmacology Specialty Laboratory, School of Pharmacy, University of Zimbabwe College of Health Sciences, Harare, Zimbabawe
| | - Tinashe Mudzviti
- International Pharmacology Specialty Laboratory, School of Pharmacy, University of Zimbabwe College of Health Sciences, Harare, Zimbabawe
| | - Dexter Chagwena
- International Pharmacology Specialty Laboratory, School of Pharmacy, University of Zimbabwe College of Health Sciences, Harare, Zimbabawe
| | - Faithful Makita-Chingombe
- International Pharmacology Specialty Laboratory, School of Pharmacy, University of Zimbabwe College of Health Sciences, Harare, Zimbabawe
| | - Robin DiFranchesco
- Center for Integrated Global Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Gene D Morse
- Center for Integrated Global Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
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Monera-Penduka TG, Jani ZT, Maponga CC, Mudzengi J, Morse GD, Nhachi CFB. Quality and labeling information of Moringa oleifera products marketed for HIV-infected people in Zimbabwe. J Public Health Afr 2016; 7:84-88. [PMID: 28239441 PMCID: PMC5321099 DOI: 10.4081/jphia.2016.618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Labeling information and quality of marketed Moringa oleifera products were assessed. Personnel in 60 pharmacies and 11 herbal shops were interviewed about the sources, dosages, indications and counseling information of Moringa oleifera products. Content analysis of written information provided on Moringa oleifera products was also done. Three samples of Moringa from popular sources were acquired to determine heavy metal content and microbial contamination. The results were compared to specified limits in the European and Chinese pharmacopeia, World Health Organization guidelines and Bureau of Indian Standards. Moringa was available as capsules or powder in 73% of the premises. Moringa was recommended for seven different disease conditions. Four different dosage regimens were prescribed. The main references cited for the counseling information were unscientific literature (62%). The selected Moringa samples were contaminated with bacteria and fungi above the European Pharmacopeia specified limits. Escherichia coli and Salmonella species were present in all three samples. All three samples contained arsenic, nickel and cadmium above the permissible limits. Moringa oleifera with variable labeling information and poor microbial and heavy metal quality is widely available in Zimbabwe.
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Affiliation(s)
| | - Zvinji Tella Jani
- School of Pharmacy, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Charles Chiedza Maponga
- School of Pharmacy, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe; Pharmacy Practice, State University of New York at Buffalo, NY, USA
| | - Josephine Mudzengi
- Department of Clinical Pharmacology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Gene D Morse
- Pharmacy Practice, State University of New York at Buffalo, NY, USA
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Mncengeli S, Manimbulu NM, Panjasaram N. Concurrent use of Antiretroviral and African traditional medicines amongst people living with HIV/AIDS (PLWA) in the eThekwini Metropolitan area of KwaZulu Natal. Afr Health Sci 2016; 16:1118-1130. [PMID: 28479905 PMCID: PMC5398459 DOI: 10.4314/ahs.v16i4.30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND People living with HIV/AIDS (PLWA) often use African Traditional Medicines (ATM) either alone or in combination with Western medicines including Antiretrovirals (ARV). OBJECTIVES To explore the prevalence of concurrent Antiretrovirals (ARV) and African Traditional medicines (ATM) use and determine the effects of any concurrent use on the CD4+ Lymphocyte count and Viral Load (VL) of PLWA in the eThekwini Metropolitan area. METHODS A descriptive and exploratory study was carried out on 360 patients. Information was gathered on patients socioeconomic characteristics, ATM usage, outcome measures of HIV disease progression (CD4+ Count, VL). The data was analysed using descriptive statistics, univariate and multivariate analyses. RESULTS 4.98% (14/281) of the patients used ATM and ARV concurrently during the study period. Over 65% (185/281) reported ATM use before diagnosis with HIV whilst 77.6% (218/281) reported previous ATM use after their HIV diagnosis but before initiation with ARV. Place of residence (p=0.004), age (p<0.001) and education level (P=0.041) were found to be significantly and positively correlated with ATM use. There were no statistically significant changes in mean plasma CD4+ Count and inconclusive effects on VL during the period of the study in the group taking ARV alone when compared with the group using ARV and ATM concomitantly. CONCLUSION Concurrent ARV and ATM use is quite low (4.98%) when compared to ATM use before HIV diagnosis and after HIV diagnosis but before initiation with ARV. This may point to efficient pre-counselling efforts before ARV initiation by health care professionals. This study also demonstrated that there were no significant differences in the CD4+ and inconclusive effects on VL, between patients taking both ARV and ATM concomitantly and those using ARV alone.
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Affiliation(s)
- Sibanda Mncengeli
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal (Westville Campus), Private Bag X54001, Durban 4000. South Africa
| | - Nlooto M Manimbulu
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal (Westville Campus), Private Bag X54001, Durban 4000. South Africa
| | - Naidoo Panjasaram
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal (Westville Campus), Private Bag X54001, Durban 4000. South Africa
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Ogedengbe OO, Jegede AI, Onanuga IO, Offor U, Naidu EC, Peter AI, Azu OO. Coconut Oil Extract Mitigates Testicular Injury Following Adjuvant Treatment with Antiretroviral Drugs. Toxicol Res 2016; 32:317-325. [PMID: 27818734 PMCID: PMC5080853 DOI: 10.5487/tr.2016.32.4.317] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/26/2016] [Accepted: 07/18/2016] [Indexed: 12/12/2022] Open
Abstract
Increased access to highly active antiretroviral therapy (HAART) has made the management of drug toxicities an increasingly crucial component of HIV. This study investigated the effects of adjuvant use of coconut oil and HAART on testicular morphology and seminal parameters in Sprague- Dawley rats. Twelve adult male Sprague-Dawley rats, weighing 153~169 g were distributed into four groups (A–D) and treated as follows: A served as control (distilled water); B (HAART cocktail- Zidovudine, Lamivudine and Nevirapine); C (HAART + Virgin coconut oil 10 mL/kg) and D (Virgin coconut oil 10 mL/kg). After 56 days of treatment, animals were killed and laparotomy to exercise the epididymis for seminal fluid analyses done whilst testicular tissues were processed for histomorphometric studies. Result showed a significant decline in sperm motility (P < 0.05) and count (P < 0.0001) in HAART-treated animals while there was insignificant changes in other parameters in groups C and D except count that was reduced (P < 0.0001) when compared with controls. Histomorphological studies showed HAART caused disorders in seminiferous tubular architecture with significant (P < 0.01) decline in epithelial height closely mirrored by extensive reticulin framework and positive PAS cells. Adjuvant Virgin coconut oil + HAART resulted in significant decrease in seminiferous tubular diameter (P < 0.05), but other morphometric and histological parameters were similar to control or Virgin coconut oil alone (which showed normal histoarchitecture levels). While derangements in testicular and seminal fluid parameters occurred following HAART, adjuvant treatment with Virgin coconut oil restored the distortions emanating thereof.
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Affiliation(s)
- Oluwatosin O Ogedengbe
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa; Department of Anatomy, College of Medicine and Health Sciences, Afe Babalola University, Ado Ekiti, Nigeria
| | - Ayoola I Jegede
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa; Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Ismail O Onanuga
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa; Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Ishaka, Uganda
| | - Ugochukwu Offor
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - Edwin Cs Naidu
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - Aniekan I Peter
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa; Department of Anatomy, Faculty of Basic Medical Sciences, University of Uyo-Nigeria, Uyo, Nigeria
| | - Onyemaechi O Azu
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
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Gweshelo D, Muswe R, Mukanganyama S. In vivo and in vitro inhibition of rat liver glutathione transferases activity by extracts from Combretum zeyheri (Combretaceae) and Parinari curatellifolia (Chrysobalanaceae). Altern Ther Health Med 2016; 16:238. [PMID: 27457758 PMCID: PMC4960700 DOI: 10.1186/s12906-016-1235-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 07/19/2016] [Indexed: 01/01/2023]
Abstract
Background Parinari curatellifolia and Combretum zeyheri are medicinal plants used in Zimbabwe and other Southern African countries for stomach ailments, fever, body aches, wound healing, cancer and tuberculosis. Glutathione transferases (GSTs) are mammalian enzymes that play a significant role in the detoxification and metabolism of many xenobiotic and endogenous compounds and as such can interact with many exogenous compounds including herbal medicines. The effects of Parinari curatellifolia and Combretum zeyheri leaf extracts on glutathione transferases of male Sprague–Dawley rats were investigated in vivo and in vitro after oral administration of either leaf ethanol or water extracts of each plant. Methods For Parinari curatellifolia, 18 male Sprague-Dawley rats were administered with 0, 500 and 1000 mg/kg body weight of the leaf extracts in corn oil or saline. Animals were sacrificed after 96 h and the kidney and liver samples were removed and used to prepare the cytosolic fractions. GST activity was determined using 1-chloro-2, 4-dinitrobezene. For Combretum zeyheri, twenty four male Sprague–Dawley rats were randomly divided into two groups. These two groups were further divided into three groups of four animals each. They were given either the aqueous or ethanol extract at doses of C. zeyheri at 0, 50 mg/kg body weight and 200 mg/kg body weight. The extracts were administered orally by oral gavage for four consecutive days and the rats were sacrificed by cervical dislocation on the fifth day. Results In animals administered with C. zeyheri, GST activity was significantly increased by the 200 mg/kg aqueous extract in the kidneys and livers in vivo whilst the ethanolic extract at 200 mg/kg decreased enzyme activity significantly both organs. Both the ethanol and aqueous extracts inhibited GST activity in vitro with the ethanol extract being more potent inhibitor than ethacrynic acid, a standard GST inhibitor. The increased GST activity in vivo and versus inhibition in vitro suggests that metabolites may be responsible for the effects observed in vivo. For P. curatellifolia, a dose-dependent decrease in GST activity was observed in vivo for the animals given the aqueous extract but no changes were observed with the ethanol extract. There was a concentration-dependent inhibition of cytosolic GSTs when P. curatellifolia leaf extracts in vitro. The ethanol extract of P. curatellifolia exhibited GST-inhibitory activity in the liver with an IC50 value of 12 μg/mL and for ethacrynic acid, the IC50 was found to be 10 μg/mL. This showed that this extract was a potent inhibitor of GSTs in vitro. Conclusions C. zeyheri had an inductive effect on GST activity when administered in aqueous solution but inhibited GST in vitro whilst P. curatellifolia inhibited GST activity in vivo. Induction of GSTs would be cytoprotective against the toxic effects electrophilic chemicals. Since GSTs are responsible for the synthesis of prostaglandins, the inhibition of GST activity of by these two plants in vivo maybe one of the reasons that makes the plants important for use in the treatment pain and fever in ethnopharmacology.
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Mouton JP, Njuguna C, Kramer N, Stewart A, Mehta U, Blockman M, Fortuin-De Smidt M, De Waal R, Parrish AG, Wilson DPK, Igumbor EU, Aynalem G, Dheda M, Maartens G, Cohen K. Adverse Drug Reactions Causing Admission to Medical Wards: A Cross-Sectional Survey at 4 Hospitals in South Africa. Medicine (Baltimore) 2016; 95:e3437. [PMID: 27175644 PMCID: PMC4902486 DOI: 10.1097/md.0000000000003437] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/24/2016] [Accepted: 03/28/2016] [Indexed: 01/11/2023] Open
Abstract
Limited data exist on the burden of serious adverse drug reactions (ADRs) in sub-Saharan Africa, which has high HIV and tuberculosis prevalence. We determined the proportion of adult admissions attributable to ADRs at 4 hospitals in South Africa. We characterized drugs implicated in, risk factors for, and the preventability of ADR-related admissions.We prospectively followed patients admitted to 4 hospitals' medical wards over sequential 30-day periods in 2013 and identified suspected ADRs with the aid of a trigger tool. A multidisciplinary team performed causality, preventability, and severity assessment using published criteria. We categorized an admission as ADR-related if the ADR was the primary reason for admission.There were 1951 admissions involving 1904 patients: median age was 50 years (interquartile range 34-65), 1057 of 1904 (56%) were female, 559 of 1904 (29%) were HIV-infected, and 183 of 1904 (10%) were on antituberculosis therapy (ATT). There were 164 of 1951 (8.4%) ADR-related admissions. After adjustment for age and ATT, ADR-related admission was independently associated (P ≤ 0.02) with female sex (adjusted odds ratio [aOR] 1.51, 95% confidence interval [95% CI] 1.06-2.14), increasing drug count (aOR 1.14 per additional drug, 95% CI 1.09-1.20), increasing comorbidity score (aOR 1.23 per additional point, 95% CI 1.07-1.41), and use of antiretroviral therapy (ART) if HIV-infected (aOR 1.92 compared with HIV-negative/unknown, 95% CI 1.17-3.14). The most common ADRs were renal impairment, hypoglycemia, liver injury, and hemorrhage. Tenofovir disoproxil fumarate, insulin, rifampicin, and warfarin were most commonly implicated, respectively, in these 4 ADRs. ART, ATT, and/or co-trimoxazole were implicated in 56 of 164 (34%) ADR-related admissions. Seventy-three of 164 (45%) ADRs were assessed as preventable.In our survey, approximately 1 in 12 admissions was because of an ADR. The range of ADRs and implicated drugs reflect South Africa's high HIV and tuberculosis burden. Identification and management of these ADRs should be considered in HIV and tuberculosis care and treatment programs and should be emphasized in health care worker training programmes.
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Affiliation(s)
- Johannes P Mouton
- From the Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town (JPM, CN, NK, AS, UM, MB, MFDS, RDW, GM, KC); Department of Medicine, East London Hospital Complex and Walter Sisulu University, East London (AGP); Department of Medicine, Edendale Hospital, Pietermaritzburg, South Africa (DPKW), US Centers for Disease Control and Prevention, Pretoria (EUI, GA); National Department of Health, Pretoria (MD); and Pharmaceutical Services, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa (MD)
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12
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O'Brien S, Broom A. HIV in (and out of) the clinic: biomedicine, traditional medicine and spiritual healing in Harare. SAHARA J 2014; 11:94-104. [PMID: 25017937 PMCID: PMC4272101 DOI: 10.1080/17290376.2014.938102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Contemporary lived experiences of the human immunodeficiency virus (HIV) are shaped by clinical and cultural encounters with illness. In sub-Saharan countries such as Zimbabwe, HIV is treated in very different ways in various therapeutic contexts including by biomedical experts, traditional medicine and faith healers. The co-existence of such expertise raises important questions around the potencies and limits of medicalisation and alternative healing practices in promoting HIV recovery. First, in this study, drawing on in-depth qualitative interviews with 60 people from poor urban areas in Harare, we explore the experiences of people living with and affected by HIV. Specifically, we sought to document, interrogate and reflect on their perceptions and experiences of biomedicine in relation to traditional medicine and spiritual healing. Their accounts indicate that traditional medicine and spiritual beliefs continue to significantly influence the way in which HIV is understood, and the forms of help and care people seek. Second, we observe the dramatic and overwhelmingly beneficial impact of Antiretroviral Therapy and conclude through Zimbabwean's own stories that limitations around delivery and wider structural inequalities impede its potential. Lastly, we explore some practical implications of the biomedical clinic (and alternative healing practices) being understood as sites of ideological and expert contestation. This paper aimed to add to our knowledge of the relationships between traditional medicine and spiritual healing in connection with biomedicine and how this may influence HIV treatment and prevention.
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Affiliation(s)
- Stephen O'Brien
- a PhD Sociology, is a tutor at the School of Humanities and Social Science , The University of Newcastle , Newcastle , Australia , *
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13
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Ladep NG, Agbaji OO, Agaba PA, Muazu A, Ugoagwu P, Imade G, Cooke GS, Vivas L, Cormack SM, Taylor-Robinson SD, Idoko J, Kanki P. Hepatitis B Co-Infection is Associated with Poorer Survival of HIV-Infected Patients on Highly Active Antiretroviral Therapy in West Africa. ACTA ACUST UNITED AC 2013; Suppl 3. [PMID: 25328814 PMCID: PMC4199237 DOI: 10.4172/2155-6113.s3-006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hepatitis B has been reported to be high in HIV-infected African populations. However, the impact of this co-infection on the survival of HIV-infected Africans on long-term highly active antiretroviral therapy (HAART) remains poorly characterised. We investigated the impact of HBV/HIV co-infection on survival of HIV infected patients undergoing antiretroviral therapy in a West African population. METHODS This was a clinic-based cohort study of HIV-infected adults enrolled in Nigeria, West Africa. Study subjects (9,758) were screened for hepatitis B and hepatitis C at HAART initiation. Kaplan-Meier survival and Cox proportional hazards models were used to estimate probability of survival and to identify predictors of mortality respectively, based on hepatitis B surface antigen status. All patients had signed an informed written consent before enrolment into the study; and we additionally obtained permission for secondary use of data from the Harvard institutional review board. RESULTS Patients were followed up for a median of 41 months (interquartile range: 30-62 months) during which, 181 (1.9%) patients died. Most of the deaths; 143 (79.0%) occurred prior to availability of Tenofovir. Among those that were on antiretroviral therapy, hepatitis B co-infected patients experienced a significantly lower survival than HIV mono-infected patients at 74 months of follow up (94% vs. 97%; p=0.0097). Generally, hepatitis B co-infection: HBsAg-positive/HIV-positive (Hazards Rate [HR]; 1.5: 95% CI 1.09-2.11), co-morbid tuberculosis (HR; 2.2: 95% CI 1.57-2.96) and male gender (HR; 1.5: 95% CI 1.08-2.00) were significantly predictive of mortality. Categorising the patients based on use of Tenofovir, HBV infection failed to become a predictor of mortality among those on Tenofovir-containing HAART. CONCLUSIONS HBsAg-positive status was associated with reduced survival and was an independent predictor of mortality in this African HIV cohort on HAART. However, Tenofovir annulled the impact of HBV on mortality of HIV patients in the present study cohort.
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Affiliation(s)
- Nimzing G Ladep
- Hepatology Unit, Department of Medicine, Imperial College London, St Mary's Hospital Campus, South Wharf Road, London W2 1NY, United Kingdom
| | - Oche O Agbaji
- AIDS Prevention Initiative in Nigeria & Jos University Teaching Hospital, 2 Murtala Mohammed Way, PMB 2076, Jos, Plateau State, Nigeria
| | - Patricia A Agaba
- AIDS Prevention Initiative in Nigeria & Jos University Teaching Hospital, 2 Murtala Mohammed Way, PMB 2076, Jos, Plateau State, Nigeria ; Department of Family Medicine, University of Jos, Plateau State, Nigeria
| | - Auwal Muazu
- AIDS Prevention Initiative in Nigeria & Jos University Teaching Hospital, 2 Murtala Mohammed Way, PMB 2076, Jos, Plateau State, Nigeria
| | - Placid Ugoagwu
- AIDS Prevention Initiative in Nigeria & Jos University Teaching Hospital, 2 Murtala Mohammed Way, PMB 2076, Jos, Plateau State, Nigeria
| | - Godwin Imade
- AIDS Prevention Initiative in Nigeria & Jos University Teaching Hospital, 2 Murtala Mohammed Way, PMB 2076, Jos, Plateau State, Nigeria
| | - Graham S Cooke
- Hepatology Unit, Department of Medicine, Imperial College London, St Mary's Hospital Campus, South Wharf Road, London W2 1NY, United Kingdom
| | - Livia Vivas
- Medical Research Council Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, United Kingdom
| | - Sheena Mc Cormack
- Medical Research Council Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, United Kingdom
| | - Simon D Taylor-Robinson
- Hepatology Unit, Department of Medicine, Imperial College London, St Mary's Hospital Campus, South Wharf Road, London W2 1NY, United Kingdom
| | - John Idoko
- AIDS Prevention Initiative in Nigeria & Jos University Teaching Hospital, 2 Murtala Mohammed Way, PMB 2076, Jos, Plateau State, Nigeria ; National Agency for the Control of AIDS, Plot 823, Ralph Sodeinde Street, CBD, Abuja, Nigeria
| | - Phyllis Kanki
- HarvardSchool of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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