Musa Baba Maiyaki, Gebi Usman, Etiebet Mary-Ann, Omuh Helen, Ekedegwa Patrick, Dakum Patrick, Blattner William
Rasta Nurah General Hospital, Eastern province, Saudi Arabia.
Institute of Human Virology, Abuja, Nigeria.
J Public Health Afr. 2010 Aug 19;1(1):e3. doi: 10.4081/jphia.2010.e3. eCollection 2010 Sep 1.
Human immunodeficiency virus (HIV) contributes significantly to morbidity and mortality in sub-Saharan Africa, with Nigeria having the third highest burden of HIV infection globally; efforts are made to increases access to HIV/AIDS care and treatment. This has currently reached rural areas with limited manpower and laboratory evaluation capacity. This review is necessitated by the paucity of interim report on treatment profile in Nigerian rural areas. We report on the immunological profile of patients on antiretroviral therapy (ART) in Otukpo General Hospital, a rural Nigerian hospital. This is a retrospective cohort study of patients receiving ART treatment and care, on April 2009, when 2347 patients were under ART therapy. Out of these, 96 patients were selected by simple random sampling from hospital register, with their data abstracted from standardized Ministry of Health registers and facility documents kept at the hospital, and analyzed for descriptive and biometric measures. Ninty-six patients (29% males) with a median age of 35 years, median baseline CD4 lymphocyte count 221 cells/mL, median one year CD4 lymphocyte count of 356 cells/mL and median one year CD4 lymphocyte increment of 124 cells/mL were studied. There is no statistically significant difference in baseline CD4 lymphocyte count when data is disaggregated by type of drug regimen (AZT, D4T and TDF). Fourty-four percent, 23% and 33% of patients were on TDF, D4T & AZT based regimen, respectively (P=0.66). Increment of >100 cells/mL was seen in 64.58% of the reviewed patients. There was a higher CD4 lymphocyte count increment in patients on TDF & D4T compared with those in AZT based regimens (ANOVA; P<0.0003). Multivariate linear regression model showed one year CD4 lymphocyte count, one year increment in CD4 lymphocyte count, WBC count, and absolute neutrophil count to be significant correlates of baseline CD4 lymphocyte count (P<0.0001). Equally, multivariate logistic regression found age, platelet count and CD4 lymphocyte count at 12 months showed to be significant predictors of CD4 lymphocyte increment above 100 cells/µL (P<0.0001). Despite advanced disease presentation and a very large-scale program, high quality HIV/AIDS care was achieved as indicated by good short-term, immunologic outcomes, while TDF & D4T induce higher immunological recovery compared with AZT. This report suggests that quality HIV care and treatment can be effective despite the challenges of a resource-limited setting.
人类免疫缺陷病毒（HIV）在撒哈拉以南非洲地区的发病率和死亡率中占很大比例，尼日利亚的HIV感染负担在全球排名第三；人们正在努力增加获得艾滋病毒/艾滋病护理和治疗的机会。目前，这一努力已延伸至人力和实验室评估能力有限的农村地区。由于尼日利亚农村地区治疗情况的中期报告匮乏，因此进行了本综述。我们报告了尼日利亚农村一家医院——奥图克波综合医院接受抗逆转录病毒疗法（ART）患者的免疫状况。这是一项对接受ART治疗和护理患者的回顾性队列研究，研究时间为2009年4月，当时有2347名患者正在接受ART治疗。其中，通过简单随机抽样从医院登记册中选取了96名患者，他们的数据从标准化的卫生部登记册和医院保存的机构文件中提取，并进行描述性和生物统计学分析。研究了96名患者（29%为男性），中位年龄为35岁，基线CD4淋巴细胞计数中位数为221个细胞/毫升，一年CD4淋巴细胞计数中位数为356个细胞/毫升，一年CD4淋巴细胞增量中位数为124个细胞/毫升。按药物治疗方案类型（齐多夫定、司他夫定和替诺福韦）分类的数据显示，基线CD4淋巴细胞计数无统计学显著差异。分别有44%、23%和33%的患者采用基于替诺福韦、司他夫定和齐多夫定的治疗方案（P = 0.66）。在接受审查的患者中，64.58%的患者CD4淋巴细胞增量>100个细胞/毫升。与基于齐多夫定治疗方案的患者相比，接受替诺福韦和司他夫定治疗的患者CD淋巴细胞计数增量更高（方差分析；P<0.0003）。多变量线性回归模型显示，一年CD4淋巴细胞计数、一年CD4淋巴细胞计数增量、白细胞计数和绝对中性粒细胞计数是基线CD4淋巴细胞计数的显著相关因素（P<0.0001）。同样，多变量逻辑回归发现，年龄、血小板计数和12个月时的CD4淋巴细胞计数是CD4淋巴细胞增量高于100个细胞/微升的显著预测因素（P<0.0001）。尽管疾病呈现晚期且项目规模非常大，但良好的短期免疫结果表明实现了高质量的艾滋病毒/艾滋病护理，同时与齐多夫定相比，替诺福韦和司他夫定可诱导更高的免疫恢复。本报告表明，尽管资源有限环境存在挑战，但高质量的艾滋病毒护理和治疗仍可能有效。
