Biochemical and haematological changes in HIV subjects receiving winniecure antiretroviral drug in Nigeria

Improving the Understanding of the Immunopathogenesis of Lymphopenia as a Correlate of SARS-CoV-2 Infection Risk and Disease Progression in African Patients: Protocol for a Cross-sectional Study

BACKGROUND

The COVID-19 pandemic, caused by SARS-CoV-2, continues to impact health systems throughout the world with serious medical challenges being imposed on many African countries like Nigeria. Although emerging studies have identified lymphopenia as a driver of cytokine storm, disease progression, and poor outcomes in infected patients, its immunopathogenesis, as well as environmental and genetic determinants, remain unclear. Understanding the interplay of these determinants in the context of lymphopenia and COVID-19 complications in patients in Africa may help with risk stratification and appropriate deployment of targeted treatment regimens with repurposed drugs to improve prognosis.

OBJECTIVE

This study is designed to investigate the role of vitamin D status, vasculopathy, apoptotic pathways, and vitamin D receptor (VDR) gene polymorphisms in the immunopathogenesis of lymphopenia among African people infected with SARS-CoV-2.

METHODS

This cross-sectional study will enroll 230 participants, categorized as "SARS-CoV-2 negative" (n=69), "COVID-19 mild" (n=32), "hospitalized" (n=92), and "recovered" (n=37), from two health facilities in Lagos, Nigeria. Sociodemographic data, travel history, and information on comorbidities will be obtained from case files and through a pretested, interview-based structured questionnaire. Venous blood samples (5 mL) collected between 8 AM and 10 AM and aliquoted into EDTA (ethylenediaminetetraacetic acid) and plain tubes will be used for complete blood count and CD4 T cell assays to determine lymphopenia (lymphocyte count <1000 cells/µL) and CD4 T lymphocyte levels, as well as to measure the concentrations of vitamin D, caspase 3, soluble vascular cell adhesion molecule-1 (sVCAM-1), and soluble Fas ligand (sFasL) using an autoanalyzer, flow cytometry, and ELISA (enzyme-linked immunosorbent assay) techniques. Genomic DNA will be extracted from the buffy coat and used as a template for the amplification of apoptosis-related genes (Bax, Bcl-2, BCL2L12) by polymerase chain reaction (PCR) and genotyping of VDR (Apa1, Fok1, and Bsm1) gene polymorphisms by the PCR restriction fragment length polymorphism method and capillary sequencing. Total RNA will also be extracted, reverse transcribed, and subsequently quantitated by reverse transcription PCR (RT-PCR) to monitor the expression of apoptosis genes in the four participant categories. Data analyses, which include a test of association between VDR gene polymorphisms and study outcomes (lymphopenia and hypovitaminosis D prevalence, mild/moderate and severe infections) will be performed using the R statistical software. Hardy-Weinberg equilibrium and linkage disequilibrium analyses for the alleles, genotypes, and haplotypes of the genotyped VDR gene will also be carried out.

RESULTS

A total of 45 participants comprising 37 SARS-CoV-2-negative and 8 COVID-19-recovered individuals have been enrolled so far. Their complete blood counts and CD4 T lymphocyte counts have been determined, and their serum samples and genomic DNA and RNA samples have been extracted and stored at -20 °C until further analyses. Other expected outcomes include the prevalence and distribution of lymphopenia and hypovitaminosis D in the control (SARS-CoV-2 negative), confirmed, hospitalized, and recovered SARS-CoV-2-positive participants; association of lymphopenia with CD4 T lymphocyte level, serum vitamin D, sVCAM-1, sFasL, and caspase 3 levels in hospitalized patients with COVID-19; expression levels of apoptosis-related genes among hospitalized participants with COVID-19, and those with lymphopenia compared to those without lymphopenia; and frequency distribution of the alleles, genotypes, and haplotypes of VDR gene polymorphisms in COVID-19-infected participants.

CONCLUSIONS

This study will aid in the genotypic and phenotypic stratification of COVID-19-infected patients in Nigeria with and without lymphopenia to enable biomarker discovery and pave the way for the appropriate and timely deployment of patient-centered treatments to improve prognosis.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/21242.

Effect of highly active antiretroviral therapy (HAART) on some specific clotting profile in Human Immunodeficiency Virus -(HIV) positive pregnant women

BACKGROUND

In many developing countries with a significant proportion of human immunodeficiency virus (HIV)-positive patients are women of child-bearing age and would require antiretroviral therapy. This study aimed at evaluating the effect of highly active antiretroviral therapy (HAART) on some specific clotting profile in HIV-positive pregnant women.

SUBJECTS AND METHODS

This study comprised 150 patients consisting of 50 blood samples from pregnant women on HAART as test subjects, 50 pregnant HIV-positive women that were not on HAART as test subjects, and 50 pregnant HIV-negative women which served as controls. The test subjects were attending the prevention of mother-to-child transmission Clinic at the Central Hospital, Benin City. Specific clotting factors assayed were factors 11, V, V11, V111, 1X, X, X1, and X11. All were done using ELISA methods.

RESULTS

Factors 11 and V were reduced significantly in HIV-infected pregnant women on HAART and those not on HAART (P < 0.05) when compared with HIV-negative pregnant women. A significant increase in factors V11, V111, 1X, X, and X11 were observed in HIV-positive patients on HAART and those not on HAART when compared with HIV-negative pregnant women (P < 0.05). However, when HIV-positive patients on HAART were compared to HIV-positive women not on HAART, no statistical difference were observed (P > 0.005).

CONCLUSION

There are changes in clotting profile of HIV-positive women on HAART and on those not on HAART and these changes are not due to the administration of antiretroviral therapy.

Covariate random effects on the CD4 count variation during HIV disease progression in women

Purpose: To investigate the variation in CD4 count between HIV positive patients due to clinical covariates at each phase of the HIV disease progression. Patients and methods: The Centre for the AIDS Programme of Research in South Africa (CAPRISA) conducted different studies in which female patients were initially enrolled in HIV negative cohorts (phase 1). Seroconverts were further followed-up weekly to fortnightly visits up to 3 months (phase 2: acute infection), monthly visits from 3 to 12 months (phase 3: early infection), quarterly visits thereafter (phase 4: established infection) until antiretroviral therapy (ART) initiation (phase 5). Results: Eighteen out of the 46 CD4 count covariates investigated were significant. Low average CD4 counts at acute and early phase entry improved at a faster rate than entries at higher average CD4 count. During therapy, all the 18 covariates induced significantly different patients' average CD4 counts. The rate of change of CD4 count greatly varied in response to lactate dehydrogenase during the acute phase. Red blood cells increase resulted in the patients' CD4 counts approaching a common higher level during the early phase. During therapy, the already high CD4 counts improved faster than lower ones in response to the red blood cells increase. As the monocytes increased, patients with lower average CD4 counts became worse than those with higher average CD4 counts. Conclusion: Changes in the covariates measurements either induced no variation effects in certain phases or improved the CD4 count at a faster rate for those patients whose average CD4 was already high or worsen the CD4 level which was already low or caused the patients' CD4 counts to approach the same level - higher or lower than the general cohort. The studied covariates induced wide variations in the CD4 count between HIV positive patients during the ART phase.

Food elimination, food substitution, and nutrient supplementation among ARV-exposed HIV-positive persons in southern Ghana

BACKGROUND

Optimal nutrition is a determinant of health in all persons. In persons living with HIV (PLHIV), nutrition is particularly important. Various factors, including dietary practices, play a role in guaranteeing nutritional health.

OBJECTIVES

We investigated multiple non-prescription drugs use among HIV-positive persons receiving antiretroviral therapy (ART) from four treatment centers in southern Ghana. This paper, however, focuses on nutrient supplement use, food elimination, and food substitution practices by the PLHIV.

METHODS

Using quantitative and qualitative methods, we collected data from 540 HIV-positive persons at the health facility level. This paper focuses on only the quantitative data. Individual study participants were selected using a systematic random sampling procedure. Participants were interviewed after informed consent. We used univariate analysis to generate descriptive tabulations for key variables. Multivariable logistic regression modeling identified predictors of three practices (nutrient supplementation, food elimination, and food substitution). P value less than 0.05 or 95% confidence intervals facilitated determination of statistical significance. All analyses were performed using IBM SPSS Statistics for Windows, version 20.0.

RESULTS

The use of nutrient supplements was a popular practice; 72% of the PLHIV used various kinds. The primary motive for the practice was to boost appetite and to gain weight. A little over 20% of the participants reportedly eliminated certain foods and beverages, while 17% introduced new foods since their initial HIV diagnosis. All the three practices were largely driven by the quest for improved health status. We determined predictors of nutrient supplementation to be ART clinic location and having an ART adherence monitor. Having an ART adherence monitor was significantly associated with reduced odds of nutrient supplementation (AOR = 0.34; 95% CI 0.12-0.95). The only predictor for food elimination was education level (AOR = 0.29; 95% CI 0.30-0.92); predictors of food substitution were ART clinic location (AOR = 0.11; 95% CI 0.02-0.69) and anemia (defined as hemoglobin concentration less than 11.0 g/dl) (AOR = 0.21; 95% CI 0.12-0.85).

CONCLUSIONS

The practice of supplementation is popular among this group of PLHIV. Food elimination and substitution are practiced, albeit in moderation. The predictors identified may prove helpful in provider-client encounters as well as local HIV programming.

Platelet aggregation and serum adenosine deaminase (ADA) activity in pregnancy associated with diabetes, hypertension and HIV

Platelet aggregation and adenosine deaminase (ADA) activity were evaluated in pregnant women living with some disease conditions including hypertension, diabetes mellitus and human immunodeficiency virus infection. The subject population is consisted of 15 non-pregnant healthy women [control group (CG)], 15 women with normal pregnancy (NP), 7 women with hypertensive pregnancy (HP), 10 women with gestational diabetes mellitus (GDM) and 12 women with human immunodeficiency virus-infected pregnancy (HIP) groups. The aggregation of platelets was checked using an optical aggregometer, and serum ADA activity was determined using the colorimetric method. After the addition of 5 µM of agonist adenosine diphosphate, the percentage of platelet aggregation was significantly (p < 0·05) increased in NP, HP, GDM and HIP groups when compared with the CG, while the addition of 10 µM of the same agonist caused significant (p < 0·05) elevations in HP, GDM and HIP groups when compared with CG. Furthermore, ADA activity was significantly (p < 0·05) enhanced in NP, HP, GDM and HIP groups when compared with CG. In this study, the increased platelet aggregation and ADA activity in pregnancy and pregnancy-associated diseases suggest that platelet aggregation and ADA activity could serve as peripheral markers for the development of effective therapy in the maintenance of homeostasis and some inflammatory process in these pathophysiological conditions. Copyright © 2016 John Wiley & Sons, Ltd.

Impact of vitamin supplements on HAART related hematological abnormalities in HIV-infected patients

BACKGROUND

The human immunodeficiency virus (HIV) is one of the most life- threatening human infections. The advent of highly active antiretroviral therapy (HAART) has dramatically changed the course of HIV infection and patients' quality of life. In addition to the benefits, HAART can have numerous side effects and toxicities. Therefore, we aimed to assess the impact of short-term vitamins treatment on hematological parameters of HIV infected patients receiving HAART.

METHODS

This cross-sectional study was conducted on 100 confirmed HIV positive patients who referred to Shiraz HIV/AIDS research center in southwest of Iran. The first-line of HAART regimen contained Zidovudine, Lamivudine, and Efavirenz. The studied population received vitamin B12 weekly and folic acid daily for at least one month.

RESULTS

After receiving HAART for at least 6 months with adherence above 90%, significant differences (p<0.05) were observed in MCV, MCH, HCT, TLC and RBC status compared to the baseline parameters. After one month of treatment, vitamins in four hematological parameters including TLC, MCV, RBC, and WBC showed significant differences compared to HAART parameters.

CONCLUSION

Combined administration of B12 and folate supplements is a beneficial adjuster on hematologic status of HIV infected persons receiving HAART. However, future research with larger studied population and longer follow-up periods is required. Moreover, especial attention should be given to gender because the effect of vitamins was significantly different on some hematologic parameters between different genders.

Evaluating the utility of early laboratory monitoring of antiretroviral-induced haematological and hepatic toxicity in HIV-infected persons in Cameroon

Background

The antiretroviral therapy (ART) program of Cameroon recommends routine laboratory monitoring of haematological toxicity if a regimen contains zidovudine (AZT) and of hepatotoxicity for NVP-containing regimens on the 15^th day after ART initiation. This study aimed to assess the relevance of this repeated laboratory measurements considered to be precocious, inaccessible and unavailable in a resource limited setting.

Methods

A retrospective cohort of HIV-infected patients of age 15 years and above enrolled for first line ART at The Regional Hospital of Nkongsamba in Cameroon. We monitored liver transaminases and blood cell indices after two weeks of ART initiation for any significant change from baseline. Factors associated with abnormal changes were examined using a multivariable logistic regression model with random effects.

Results

Enrolled were 154 patients of whom 105 (68.2%) were females. The mean ALAT (alanine aminotransferase) level at baseline was 17.87 ± 20.48 U/L increasing to 19.25 ± 12.01 U/L at two weeks of follow-up (p = 0.53) while the mean ASAT (aspartate aminotransferase) level increased from 17.32 ± 11.87 U/L at baseline to 21.02 ± 14.12 U/L at two weeks of follow-up (p = 0.02). We observed a drop in the mean haemoglobin concentration from 10.86 ± 2.63 g/dL at baseline to 10.36 ± 1.92 g/dL at the second week of follow-up (p = 0.02). The prevalence of elevated liver enzymes and anaemia after two weeks of treatment were 7.5% and 39.2% respectively. Stavudine containing regimens were most likely to induce hepatotoxicity [adjusted Odd Ratio (aOR) = 36.52, 95% CI: 1.44-924.38, p=0.029]. Baseline anaemia (aOR=60.08, 95% CI: 13.36-270.20, p < 0.0001) and body weight ≥ 60kg (aOR=0.28, 95% CI: 0.09-0.83, p = 0.02) were associated with anaemia at follow-up.

Conclusion

There was no significant rise in the mean level of transaminases and thus scheduling their routine monitoring at the end of the second week could be skipped. Conversely, the drop in mean haemoglobin level had little clinical importance but the high prevalence of anaemia after a fortnight on treatment suggests a targeted instead of a routine monitoring; focusing on the high risk population with baseline anaemia and low body weight.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2334-14-519) contains supplementary material, which is available to authorized users.