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      CD4 Count Pattern and Demographic Distribution of Treatment-Naïve HIV Patients in Lagos, Nigeria


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          Background. CD4 count measures the degree of immunosuppression in HIV-positive patients. It is also used in deciding when to commence therapy, in staging the disease, and in determining treatment failure. Using the CD4 count, this study aimed at determining the percentage of HIV-positives who require antiretroviral therapy at enrollment in an HIV treatment and care centre. Methods. The Baseline CD4 count, age and gender of 4,042 HAART-naïve patients, who registered between December 2006 and June 2010, at Lagos State University Teaching Hospital, Ikeja, were retrospectively studied. Data were analyzed using SPSS version 16.0 (Statistical Package for Social Sciences, Inc., Chicago, Ill). Results. Patients consisted of 2507 (62%) female and 1535 (38%) males. The mean age of males was 37.73 ± 9.48 years and that of females 35.01 ± 9.34 years. Overall, the mean CD4 count was of 298.76 ± 246.93  cells/mm 3. The mean CD4 count of males was 268.05 ± 230.44  cells/mm 3 and that of females 317.55 ± 254.72 cells/mm 3. A total of 72.3% males, 64.3% females and 67.4% overall registered patients had CD4 count <350 cells/mm 3, while only 15.1% males , 20.3% females, and 18.3% overall registered patients had CD4 count >500 cells/mm 3 at registration. Conclusion. Females account for more than half of registered patients in HIV clinic and have a relatively higher CD4 count than males. About three-quarter of HIV positives require antiretroviral therapy at registration.

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          Why do young women have a much higher prevalence of HIV than young men? A study in Kisumu, Kenya and Ndola, Zambia.

          To examine the factors responsible for the disparity in HIV prevalence between young men and women in two urban populations in Africa with high HIV prevalence. Cross-sectional survey, aiming to include 1000 men and 1000 women aged 15-49 years in Kisumu, Kenya and Ndola, Zambia. Participants were interviewed and tested for HIV and other sexually transmitted infections. Analyses compared the marital and non-marital partnership patterns in young men and women, and estimated the likelihood of having an HIV-infected partner. Overall, 26% of individuals in Kisumu and 28% in Ndola were HIV-positive. In both sites, HIV prevalence in women was six times that in men among sexually active 1 5-19 year olds, three times that in men among 20-24 year olds, and equal to that in men among 25-49 year olds. Age at sexual debut was similar in men and women, and men had more partners than women. Women married younger than men and marriage was a risk factor for HIV, but the disparity in HIV prevalence was present in both married and unmarried individuals. Women often had older partners, and men rarely had partners much older than themselves. Nevertheless, the estimated prevalence of HIV in the partners of unmarried men aged under 20 was as high as that for unmarried women. HIV prevalence was very high even among women reporting one lifetime partner and few episodes of sexual intercourse. Behavioural factors could not fully explain the discrepancy in HIV prevalence between men and women. Despite the tendency for women to have older partners, young men were at least as likely to encounter an HIV-infected partner as young women. It is likely that the greater susceptibility of women to HIV infection is an important factor both in explaining the male-female discrepancy in HIV prevalence and in driving the epidemic. Herpes simplex virus type 2 infection, which is more prevalent in young women than in young men, is probably one of the factors that increases women's susceptibility to HIV infection.
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            Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies.

            To estimate the prognosis over 5 years of HIV-1-infected, treatment-naive patients starting HAART, taking into account the immunological and virological response to therapy. A collaborative analysis of data from 12 cohorts in Europe and North America on 20,379 adults who started HAART between 1995 and 2003. Parametric survival models were used to predict the cumulative incidence at 5 years of a new AIDS-defining event or death, and death alone, first from the start of HAART and second from 6 months after the start of HAART. Data were analysed by intention-to-continue-treatment, ignoring treatment changes and interruptions. During 61 798 person-years of follow-up, 1005 patients died and an additional 1303 developed AIDS. A total of 10 046 (49%) patients started HAART either with a CD4 cell count of less than 200 cells/microl or with a diagnosis of AIDS. The 5-year risk of AIDS or death (death alone) from the start of HAART ranged from 5.6 to 77% (1.8-65%), depending on age, CD4 cell count, HIV-1-RNA level, clinical stage, and history of injection drug use. From 6 months the corresponding figures were 4.1-99% for AIDS or death and 1.3-96% for death alone. On the basis of data collected routinely in HIV care, prognostic models with high discriminatory power over 5 years were developed for patients starting HAART in industrialized countries. A risk calculator that produces estimates for progression rates at years 1 to 5 after starting HAART is available from www.art-cohort-collaboration.org.
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              Hematological reference ranges among healthy Ugandans.

              Reference values are essential for the interpretation of hematologic data in clinical practice and research studies. Symptom-free human immunodeficiency virus antibody-negative Ugandan adults (183 subjects, aged 15 to 74 years, 37.7% women and 62.3% men) were studied to establish hematological reference ranges. The central 95% areas under the distribution curves were 1,453 to 4,448 cells per microliters for the absolute lymphocyte count, 559 to 2,333 cells per microliters for the absolute CD4 count, 253 to 1,396 cells per microliters for the absolute CD8 count, and 0.68 to 4.4 for the CD4/CD8 ratio. Women had significantly higher mean absolute lymphocyte counts (2,826 versus 2,568/microliters), absolute CD4 counts (1,425 versus 1,154/microliters) and absolute CD4/CD8 ratios (2.58 versus 1.88) than did men. These reference ranges differ from those reported for populations outside Africa.

                Author and article information

                AIDS Res Treat
                AIDS Res Treat
                AIDS Research and Treatment
                Hindawi Publishing Corporation
                26 September 2012
                : 2012
                1Department of Haematology and Blood Transfusion, College of Medicine, Lagos State University, Ikeja, PMB 21266, Lagos, Nigeria
                2Department of Haematology and Blood Transfusion, Faculty of Clinical Sciences, College of Medicine, University of Lagos, PMB 12003, Idiaraba, Lagos, Nigeria
                3Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, PMB 12003, Idiaraba, Lagos, Nigeria
                4Department of Medicine, College of Medicine, Lagos State University, Ikeja, PMB 1266, Lagos, Nigeria
                5Department of Community Health and Primary Health Care, College of Medicine, Lagos State University, Ikeja, PMB 21266, Lagos, Nigeria
                Author notes

                Academic Editor: Giuseppe Ippolito

                Copyright © 2012 Akinsegun Akinbami et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Research Article

                Infectious disease & Microbiology
                Infectious disease & Microbiology


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