Placid Ugoagwu - Academia.edu (original) (raw)

Papers by Placid Ugoagwu

Antiviral Therapy, 2021

Background In Nigeria, the effect of Hepatitis B virus (HBV) on long-term liver outcomes in perso... more Background In Nigeria, the effect of Hepatitis B virus (HBV) on long-term liver outcomes in persons with HIV (PLH) has not been described. We determined changes in liver stiffness measure (LSM) using transient elastography over 6 years in HIV mono-infected and HIV-HBV co-infected Nigerians initiating antiretroviral therapy (ART) and factors associated with LSM decline. Methods This single centre, cohort study enrolled ART-naïve HIV mono- and HIV-HBV co-infected adults (≥18 years) at the APIN Public Health Initiatives–supported HIV Care and Treatment Centre at Jos University Teaching Hospital, Nigeria, from 7/2011 to 2/2012. LSM at baseline, Years 3 and 6 were analysed using longitudinal models to estimate changes over time and their predictors. Results Data from 100 (31%) HIV-HBV co-infected and 225 (69%) HIV mono-infected participants were analysed. Median LSM at baseline was 6.10 (IQR: 4.60–7.90) kPa in co-infected and 5.10 (IQR: 4.40–6.10) kPa in mono-infected participants. In ad...

Pan African Medical Journal Conference Proceedings, 2018

Introduction : haematological abnormalities are common findings in later stages of Human Immune D... more Introduction : haematological abnormalities are common findings in later stages of Human Immune Deficiency Virus/Acquired Immunodeficiency syndrome (HIV/AIDs). These Haematological abnormalities which are common findings in later stages of the infection usually results from bone marrow defects and immune cytopenias thereby allowing life threatening opportunistic infections to thrive. We conducted this study to determine the trend of haematological indices of HIV/AIDs patients at diagnosis and 144th week visit. Methods : a retrospective cross-sectional study was conducted. Case records of 434 HIV/AIDs patients who presented at the APIN clinic from January, 2011 to December, 2013 were retrieved from the electronic patient data base. Variables extracted were socio-demographics, commencement of antiretroviral treatment and haematological tests. Data was entered in Microsoft excel and analysed using Epi-info 7.2. Univariate analysis such as frequency and proportion were performed. Results : a total of 72 (16.6%) patients had complete records of which 55(68.2%) were females. Age-groups, 31 - 40 years had the highest frequency of HIV/AIDs. A mean age of 41.2 ± 10.3 was recorded. Civil servants 15 (20.8%) recorded the highest HIV/AIDs infection among other occupations taking antiretroviral drug. At presentation, 40 (55.6%) patients had anaemia however, the figure decreased to 19 (26.4%) after initiation of ART. 34 (38.8%) patients had neutropenia at diagnosis, and reduced to 28 (47.2%) on the 144th week. Leucocytes and platelets counts did not vary significantly from diagnosis to the 144th week of visit. Conclusion : haematological dysfunctions in HIV patients exist more at presentation, than after the commencement of ART. A significant drop in the neutrophils and haemoglobin level occur in course of effective ART. Routine monitoring of some haematological indices are important in the management of HIV/AIDs patients.

Journal of Antimicrobial Chemotherapy, 2019

Background There are limited data from sub-Saharan Africa on long-term liver fibrosis changes in ... more Background There are limited data from sub-Saharan Africa on long-term liver fibrosis changes in HIV- and HIV/HBV-infected individuals. Objectives To assess the effects of ART on liver stiffness measurement (LSM) using transient elastography (TE) in HIV- and HIV/HBV-infected Nigerian adults and examine factors associated with fibrosis regression. Methods We included ART-naive HIV- and HIV/HBV-infected adults (≥18 years) enrolled in a prospective, longitudinal study of liver disease between July 2011 and February 2015 at Jos University Teaching Hospital HIV Care and Treatment Centre in Nigeria. Patients initiated ART and had TE at baseline and follow-up (year 3). LSM cut-offs for Metavir scores were 5.9, 7.6 and 9.4 kPa for moderate fibrosis, advanced fibrosis and cirrhosis, respectively. We used multivariable regression to identify factors associated with TE (≥1 Metavir) stage decline. Results A total of 106 HIV- and 71 HIV/HBV-infected patients [70.5% female and median age = 34 yea...

Journal of the International Association of Providers of AIDS Care (JIAPAC), 2019

Objectives and Method: There are growing concerns of tenofovir disoproxil fumarate (TDF)–associat... more Objectives and Method: There are growing concerns of tenofovir disoproxil fumarate (TDF)–associated renal toxicity. We evaluated the effect of long-term TDF exposure on renal function in a cohort of HIV-1-infected Nigerians between 2006 and 2015. Multivariate logistic regression was used to identify predictors of renal impairment at different time over 144 weeks of antiretroviral therapy (ART). Results: Data of 4897 patients, median age 42 years (interquartile range: 36-49), and 61% females were analyzed. The prevalence of renal impairment increased from 10% at week 24 to 45% at 144 weeks in TDF-exposed participants compared to an increase from 8% at 24 weeks to 14% at 144 weeks in TDF-unexposed participants. Tenofovir disoproxil fumarate exposure predicted the risk of renal impairment at 144 weeks of ART (odds ratio: 2.36; 95% confidence interval: 1.28-4.34). Conclusion: Long-term exposure to TDF-based ART significantly increases the likelihood of renal impairment. The continued us...

Tropical medicine & international health : TM & IH, Jun 4, 2017

Molecular characteristics of hepatitis B virus (HBV), such as genotype and genomic mutations, may... more Molecular characteristics of hepatitis B virus (HBV), such as genotype and genomic mutations, may contribute to liver-related morbidity and mortality. The association of these characteristics with liver fibrosis severity in sub-Saharan Africa is uncertain. We aimed to characterize molecular HBV features in HIV/HBV co-infected Nigerians and evaluate associations between these characteristics and liver fibrosis severity before and after antiretroviral therapy (ART) initiation. HIV/HBV co-infected Nigerians underwent liver fibrosis estimation by transient elastography (TE) prior to and 36 months after ART initiation. Basal core promoter/precore (BCP/PC) and preS1/preS2/S regions of HBV were sequenced from baseline plasma samples. We evaluated associations between HBV mutations and liver fibrosis severity by univariate and multivariable regression. At baseline, 94 patients underwent TE with median liver stiffness of 6.4 (IQR 4.7-8.7) kPa. Patients were predominantly infected with HBV ge...

African Journal of Biotechnology, Apr 24, 2013

The presence of human immunodeficiency virus (HIV) type-1 diversity has an impact on vaccine effi... more The presence of human immunodeficiency virus (HIV) type-1 diversity has an impact on vaccine efficacy and drug resistance. It is important to know the circulating genetic variants and associated drug-resistance mutations in the context of scale up of antiretroviral therapy (ART) in Nigeria. The objective of this study was to determine the genetic diversity of HIV-1 and the prevalence of antiretroviral (ARV) drug resistance mutations among antiretroviral treatment-naïve HIV-1 infected patients in Jos, North Central Nigeria. Plasma samples were collected from 105 ARV drug-naïve patients enrolled for HIV care at the Jos University Teaching Hospital (JUTH) HIV Treatment Center between October 2010 and April 2011. One hundred (100) samples were successfully amplified. Viral subtyping was done using REGA subtyping tool and by phylogenetic analysis using PAUP software. The drug resistance mutations were determined using the Stanford University HIVdb sequence interpretation algorithm. HIV-1 subtypes identified were; CRF02_AG (48.0%), G (41.0%), CRF06_cpx (6.0%) and A1 (5.0%). 8% of the patients' isolates had at least one major resistance mutation in the RT gene: Nucleoside reverse transcriptase inhibitors: M41L (1%), K65KR (1%), M184IM (1%), M184V (2%) and T215ADNT (1%), non-nucleoside reverse transcriptase inhibitors: K103N (2%), K101E (1%), G190A (1%), P225HP (1%), Y181I (1%), Y188L (1%), and Y181C (1%). Among antiretroviral (ARV) naïve patients in Jos, North Central Nigeria, the common HIV-1 subtypes was CRF_02 and G. And the prevalence of drug resistance mutations was found to be high (8%). Further study and national surveillance will be critically important to understand the clinical impact of transmitted resistance mutations on ART naïve individuals in resource limited settings.

GERMS, 2016

Introduction Studies on the prevalence of and risk factors for tuberculosis (TB) among newly diag... more Introduction Studies on the prevalence of and risk factors for tuberculosis (TB) among newly diagnosed human immunodeficiency virus (HIV)-infected children in sub-Saharan Africa are scarce and in Nigeria there is paucity of reported data. We determined the prevalence of and risk factors for pulmonary TB (PTB) in newly diagnosed (treatment-naïve) HIV-1 infected children at the pediatric HIV clinic of the Jos University Teaching Hospital (JUTH) in Nigeria. Methods We performed a retrospective analysis of 876 children, aged 2 months-13 years, diagnosed with HIV-1 infection between July 2005 and December 2012, of which 286 were diagnosed with PTB at presentation after TB screening. The study site was the AIDS Prevention Initiative in Nigeria (APIN)supported Pediatric HIV clinic at JUTH, Jos. A multivariate forward logistic regression modelling was used to identify risk factors for PTB-HIV co-infection. Results The prevalence of PTB-HIV co-infection was 32% (286/876). Severe immunosuppression (SI) and World Health Organization (WHO) HIV clinical stage 3/4 were identified as independent risk factors for PTB-HIV co-infection in HIV infected children. The odds of PTB-HIV co-infection was increased twofold in HIV-infected children with WHO clinical stage 3/4 compared to those with stage 1/2 (adjusted odds ratio (AOR) 1.76 [1.31-2.37], p<0.001) and 1.5-fold in children with SI compared to those without SI (AOR 1.52 [1.12-2.06], p=0.007). Conclusion In our setting, the burden of PTB was high among newly diagnosed HIV-infected children, and late WHO HIV clinical stage and severe immunosuppression were associated with PTB-HIV co-infection. Therefore there is a clear need to improve strategies for early diagnosis of both HIV and PTB to optimize clinical outcomes.

no. A-641-0120-07827 www.aids2014.org Background

Journal of Medicine in the Tropics, 2014

In 2010, it was estimated that Nigeria had about 440,000 children below the age of 15 years livin... more In 2010, it was estimated that Nigeria had about 440,000 children below the age of 15 years living with HIV/ AIDS [2] of which 280,000 were eligible for antiretroviral therapy (ART), but only 7% were receiving it. [3] Among children who were able to get ART there usually would be those that may fail to adhere to ART. One systematic review of pediatric adherence to ART in low-and middle-income countries showed that this ranged from 49% to 100%, with 76% of the articles reporting >75% adherence. [4] Several factors such as socioeconomic, cultural, behavioral and clinical factors [4-10] have been reported to be

Current HIV Research, 2015

Background: Retention in care and treatment services is critical to health outcomes of individual... more Background: Retention in care and treatment services is critical to health outcomes of individuals diagnosed and living with HIV. We evaluated the incidence of and risk factors for treatment discontinuation (TD) in a large adult HIV population on ART in Nigeria. Method: A retrospective cohort study of adult HIV patients initiated on first-line ART between 2004 and 2011 at the Jos University Teaching Hospital (JUTH) in Nigeria. Follow up information of participants was retrieved from various sources (patient visit database, pharmacy data and patients charts) up to the end of 2012.The primary study endpoint was TD, defined as discontinuation of ART for any reason, including death or loss to follow-up (lack of pharmacy pickup for periods ≥12 months). The Incidence and hazard for TD were estimated by Kaplan Meier and Cox proportional regression analysis, respectively.

Journal of AIDS & clinical research, Jan 29, 2013

Hepatitis B has been reported to be high in HIV-infected African populations. However, the impact... more 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. 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. Patients were ...

Background: With the recommendation of highly active anti-retroviral therapy (HAART) as the stand... more Background: With the recommendation of highly active anti-retroviral therapy (HAART) as the standard of care for children infected with HIV, their quality of life has improved dramatically. However anti-retroviral (ARV) drugs used in HAART regimens are often associated with adverse drug reactions (ADRs), some of which may be life-threatening. This study aimed to determine the frequency and pattern of adverse drug reactions to ARVs in children in a large treatment centre in Nigeria. Methods: HIV-infected children initiated on ART between April 2008 and March 2013 at AIDS Prevention Initiative in Nigeria (APIN)-supported HIV clinic of Jos University Teaching Hospital, Jos, Nigeria were included in the study. Each child was followed up for a period of 12 months. A thorough symptom checklist, physical examination, and laboratory evaluation were done at baseline. We reviewed them on each scheduled monthly visit and on any event-triggered visit and assessed for adverse drug reactions. Rou...

Journal of the International Association of Providers of AIDS Care (JIAPAC), 2015

We described the magnitude, type, and factors associated with first-line antiretroviral therapy (... more We described the magnitude, type, and factors associated with first-line antiretroviral therapy (ART) modification in HIV-1-infected adults on ART in Jos, Nigeria. Data on 6309 patients initiated on first-line ART between January 2004 and December 2006 were analyzed retrospectively. Factors predictive of modification to initial ART were assessed by chi-square and multivariable logistic regression analysis. Overall, 5212 (83%) included patients incurred a modification (73.3% drug substitution and 9.7% drug switch) to their initial first-line ARV regimen during a median (interquartile range) follow-up period of 7 (3-8) years. Drug substitutions of zidovudine (ZDV) were less likely than of tenofovir (TDF; adjusted odd ratio [AOR] 0.6; 95% confidence interval [CI]: 0.51-0.71), and Drug substitutions of efavirenz (EFV) were more likely than of nevirapine (NVP)-containing (AOR 1.82; 95% CI: 1.42-2.33) regimens. Predictors of switch to second-line regimen include older age (AOR 2.05; 95% CI: 1.68-2.51), CD4 count ≤ 100 cells/mm(3) (AOR 1.89; 95% CI: 1.49-2.37), EFV compared to NVP (AOR 1.38; 95% CI: 1.02-1.88), and drug toxicity (AOR 1.90; 95% CI: 1.48-2.43). Modification to initial ART was common in this study. Further evaluation of the contribution of guideline changes on regimen modification and treatment outcomes is recommended.

Indian Heart Journal, 2013

Background/Aim: To evaluate the prevalence of pulmonary hypertension among patients living with H... more Background/Aim: To evaluate the prevalence of pulmonary hypertension among patients living with HIV/AIDS and to determine its contribution to cardiac dysfunction. Method: A hospital based cross sectional study was carried out over a 6-month period at the Jos University Teaching Hospital. The subjects were 200 confirmed HIV positive patients, !18 years of age who consented to the study. Physical examination, laboratory investigations, 2 dimensional and Doppler echocardiography were conducted on the subjects. Results: The mean age of the patients was 38 AE 9 years, and there were 142 females (71%). Females were younger, mean age 36 AE 8 years versus 41 AE 10 years for males (p-value <0.01). The median CD4 cell count was 312 cells/ml, there were no homosexual or intravenous drug user among the subjects. Eight of the subjects had pulmonary hypertension, with a case prevalence of 4%, and this had no relationship to CD4 cell count. Both systolic and diastolic functions were worse in subjects with pulmonary hypertension, with a negative correlation between mean pulmonary arterial systolic pressure (mPASP) and parameters like ejection fraction (r ¼ À0.28, p-value 0.0003), fractional shortening (r ¼ À0.21, p-value 0.003), deceleration time (r ¼ À0.13. p-value 0.09). Conclusion: Immune-suppression affects the cardiac function adversely and coexisting pulmonary hypertension contributes to poor systolic and diastolic function in affected patients. The subtle nature of presentation of pulmonary hypertension and other cardiac dysfunctions in HIV/AIDS patients demand a high-index of suspicion and early intervention if detected, to ensure better care for these emerging threats to our patients.

Journal of Advances in Medical and Pharmaceutical Sciences, 2014

Aims: To determine the incidence and severity of zidovudine-induced anaemia in HIVinfected childr... more Aims: To determine the incidence and severity of zidovudine-induced anaemia in HIVinfected children initiated on anti-retroviral therapy in Jos, Nigeria. Study Design: This was an observational cohort study.

Journal of HIV and Human Reproduction, 2013

Background: Minor mutations to protease inhibitors often occur as polymorphisms in the protease g... more Background: Minor mutations to protease inhibitors often occur as polymorphisms in the protease gene in non-B human immunodeficiency virus (HIV)-1 subtype among antiretroviral (ARV) treatment-naïve patients. Aims: This study sought to determine the prevalence of minor mutations occurring in the protease gene among ARV naïve HIV-1 infected patients in Jos, Nigeria. Settings and Design: We retrospectively analyzed specimen of 105 patients recruited between October 2010 and April 2011 at the HIV clinic, Jos University Teaching Hospital, Nigeria. Materials and Methods: Genotypic testing was done using an in-house genotyping system at the Kenya Medical Research Institute HIV-Research Laboratory in Kisumu, Kenya; HIV-1 viral resistance mutations assessed using Stanford HIV drug resistance database and classified using International acquired immunodeficiency syndrome (AIDS) Society (IAS)-USA list of mutations. In additional, viral subtypes were determined using REGA subtyping tool v.2.0 and CD4 levels by flow cytometry. Statistical analysis: Prevalence of mutations was computed and participants' baseline clinical and biological properties summarized by percentages for categorical variables and mean/ median for quantitative variables. Results: Of the 105 samples, 100 were successfully amplified. HIV-1 subtypes identified were circulating recombinant form (CRF)-CRF02_AG (48.0%), G (41.0%), CRF06_cpx (6.0%) and A1 (5.0%). The most prevalent minor mutations among the patients occurred at positions L89M (96%), M36I (93%), K20I (77%), V82I (39%), E35Q (29%), L63P (25%) and polymorphisms at I13V (99%), R41K (86%), H69K (86%), K14R (67%). One sample presented with a major PI resistance mutation (Q58E). Conclusions: We found high rates of minor mutations and polymorphisms in circulation, possibly reflecting the drug naivety of participants. In addition, there was an evidence of transmitted drug resistance, hence targeted genetic resistance testing should be considered in national treatment guidelines.

Journal of the International Association of Providers of AIDS Care (JIAPAC), 2014

Objectives: We examined the association between adherence to drug-refill visits and virologic out... more Objectives: We examined the association between adherence to drug-refill visits and virologic outcomes in a cohort of HIV-infected adults on combination antiretroviral therapy (cART) in North Central Nigeria. Methods: Retrospectively, 588 HIV-infected, cART-naive adults (aged ≥15 years), initiated on first-line ART between 2009 and 2010 at the Jos University Teaching Hospital, were evaluated. Association between adherence to drug-refill visits, virologic (viral load > 1000 copies/mL), and immunologic failure was assessed using multivariable logistic regression. Results: After a median of 12 months on cART, 16% (n = 94) and 10% (n = 59) of patients had virologic and immunologic failures, respectively. In the final multivariable model, suboptimal adherence to drug-refill visits was a significant predictor of both virologic (adjusted odds ratio [AOR] 1.6; 95% confidence interval [CI]:1.2–2.3) and immunologic (AOR 1.92; 95% CI:1.06–3.49) failures. Conclusion: Adherence to drug refill...

World Journal of Gastroenterology, 2013

AIM: To determine the rates and impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) inf... more AIM: To determine the rates and impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections on response to long-term highly active antiretroviral therapy (HAART) in a large human immunodeficiency virus (HIV) population in Nigeria. 3) (P = 0.0008). CONCLUSION: High rates of HBV and HCV infections were found in this HIV cohort. CD4 recovery was significantly diminished in patients with HBV co-infection.

International Journal of Infectious Diseases, 2010

e245 drug and is strongly associated with presence of the human leukocyte antigen (HLA)-B*5701. S... more e245 drug and is strongly associated with presence of the human leukocyte antigen (HLA)-B*5701. Screening for HLA-B*5701 reduces the risk of developing an abacavir hypersensitivity reaction. The carriage rate of HLA-B*5701 has not been studied in Georgia before 2009. Objective of the study was to determine HLA-B*5701 prevalence in HIV-infected patients in Georgia. Methods: One hundred and sixty HIV-1 positive patients attending Georgian Infectious Diseases, AIDS and Clinical Immunology Research Center in 2009 within the national treatment and care program were recruited for the study. None of the patients had previously been treated with abacavir. Blood samples were collected and screened for HLA-B*5701 prior to abacavir prescription. Statistical analyses were performed using SAS 9.1. Proportion with exact 95% confidence interval (CI) and median with interquartile range (IQR) are reported. Results: Of 160 patients recruited 108 were male (67.5%) and 42 (32.5%)-female. Median age of subjects was 32 years (IQR 27-36). Nine patients tested HLA B*5701 positive-5.6% (95% CI: 2.6-10.4%). Out of these nine patients 7 were males (male prevalence: 6.5%, [95% CI: 2.6-12.9] %) and 2 females (female prevalence: 4.8% [95% CI: 0.6-16.2%]). Conclusion: The first prospective study of HLA-B*5701 prevalence in Georgia show similar results to the results of other studies conducted in Caucasians. Abacavir still remains one of the key drugs of antiretroviral regimens in Georgia and other resource limited countries. Therefore, prospective HLA-B*5701 screening should be implemented in all settings where abacavir is widely used to guide selection of ART regimens and to reduce the risk of potentially life threatening hypersensitivity reaction.