Usman A, et al. Infect Chemother. 2023 Dec;55:e55. https://doi.org/10.3947/ic.2023.0080

Background: The peripartum period is both a highly vulnerable stage and a significant indicator of a population’s health status. Interest is increasing in human T-cell lymphotropic virus type-1 (HTLV-1) transmission due to its adverse health impacts. However, nationally representative data on HTLV-1 that are important for health planning are unavailable for this subpopulation.Purpose: This study aimed to conduct a pooled estimate of HTLV-1 prevalence among pregnant women in Nigeria to quantify its clinical burden and public health implications.Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement.Results: After a systematic review of the Nigerian literature, 12 studies (2,821 pregnant or postnatal women) were included in the final evidence synthesis. The estimated HTLV-1 prevalence in Nigerian peripartum women following a positive screening test by enzyme-linked immunosorbent assay was 5.44% (95% confidence interval [CI], 3.16%–9.20%). A subgroup analysis of the 2 major regions showed a slightly higher prevalence in the Western versus Southern region (5.55% [95% CI, 2.49%–11.87%]; and 4.91% [95% CI, 2.11%–11.02%]; P=0.84). However, a subgroup analysis by geopolitical zone revealed that Southwestern and Northwestern Nigeria had the highest prevalence (9.23% [95% CI, 4.35%–18.55%; I2=93%] and 7.15% [95% CI, 1.54%–27.54%]; I2=92%). Our decade-old subgroup analysis found inconsistencies in the HTLV-1 prevalence. Furthermore, our literature review revealed a prevalence of HTLV infection among patients with various clinical types of lymphomas/leukemias and myelopathy of 2%–22%.Conclusion: These findings have important implications in defining the epidemiological patterns of HTLV-1 infection in Nigeria. They also suggest the presence of HTLV-endemic clusters near low-endemic areas, even within the same geopolitical zones.

Background: In HIV infection, dysregulation of cytokines, including interleukin 18 (IL-18), has been linked to poor clinical outcomes in studies mainly conducted in resource-rich countries. This phenomenon has not been well-studied in resource-limited settings where outcomes could be confounded by exposure to endemic infections and genetic factors. Objectives: Therefore, the influence of immunological and virological status of HIV-infected, antiretroviral therapy (ART)-naïve patients on serum IL-18 levels at baseline (pretreatment) and 24 weeks following initiation of combination ART (cART24) in a resource-limited setting was investigated. Methods Using the cross-sectional and longitudinal mixed method design, a total of Forty-four (44) newly diagnosed consenting HIV patients were consecutively recruited during routine clinic visits at the Nasara Treatment & Care Centre of the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria between December 2016 to January 2018, and followed up for 24 weeks on initiation of first-line cART. Results: Serum IL18 concentrations, CD4+ T-cell counts (CD4+), and HIV-I RNA levels were determined at on in both≥200 cell/mm3subgroups despite the high proportion of subjects having virological suppression (n=35, [80%]) at cART24. However, at cART24 there was a more than a threefold decrease in the level of IL-18 concentration compared to baseline in patients with/mm3 and a significant decrease in the median plasma IL-18 concentration in patients with HIV1 RNA/mL at cART24. A multivariate logistic regression model shows IL-18 intermediate quartile to be more related to immunological poor gain as compared to the highest quartile. Conclusion: Our study found high baseline and significantly low levels of IL-18 at cART24 in virologically suppressed subjects but not among virological non-suppressed responders despite comparable IL-18 levels by CD4+ T cell count strata at cART24. These findings have implications for risk stratification and treatment outcomes in HIV-positive persons.

Background: Immunological CD4+ T cell gain is representative of an effective response to combined antiretroviral therapy (cART) in HIV-infected persons. Nevertheless, baseline clinical and socio-demographic factors are significant moderators of this response. Objective: This study investigates the impact of viral suppression on immune reconstitution and body mass index (BMI) following ART initiation in Zaria, a resource-poor subpopulation in Northwestern Nigeria. Methods: A hospital-based prospective study was conducted among 44 cART-naïve HIV positive individuals. BMI, CD4 counts, and viral load were measured using standard methods at baseline and six months after initiation of cART. Results: There was no significant difference in the CD4+ T-cell count at baseline and 6 months on cART along with the different categories (C: < 200 cells/mm3, B: 200-499 cell/mm3, A: >500 cell/mm3). However, ~90% of subjects in category C had immunological failure 6 months on cART. The number of subjects with viral copies < 1000/ml at baseline was 7(16%), while at 6 months on cART, the number increased to 35(80%), P<0.05. Viral suppression (VL copies 200 cell/mm3) in obese individuals (P<0.02). There was a significant association between subjects with CD4+ count < 200 cells/mm3 after 6 months on ART and having baseline VL copies of <1000/ml and low BMI (aOR 2.2 and 2.4 respectively, p≤0.05). Conclusion: Findings from this study suggest a high prevalence of paradoxical VL suppression but not immune CD4 gain in the studied subjects following cART. Larger studies are needed to corroborate these findings.