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Odeghe EA, Owoseni OO, Chukwudike ES, Adeniyi OF, Adigun BE, Oyeleke GK, Oluyemi AO, Lesi OA. Appropriateness and diagnostic yield of open access gastroscopy in two tertiary centers in South-western Nigeria. Afr Health Sci 2023; 23:386-392. [PMID: 38223609 PMCID: PMC10782350 DOI: 10.4314/ahs.v23i2.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background There is need for the appropriate use of gastroscopy. Objective To determine the appropriateness of upper gastrointestinal endoscopy, and its association with significant endoscopy findings in our environment. Methods This was a prospective study of subjects who underwent gastroscopy at two centers in south-western Nigeria between August 2020 and August 2021. Indications were classified as either appropriate or inappropriate according to the ASGE guidelines, gastroscopic findings as either significant or not significant, patients as either elderly (≥ 60 years) or not, inpatients or outpatients, and referrals as either gastroenterologist referral, or not. Results There were 227 subjects, 131 (57.7%) females, mean age 45 ± 13.7 years. Fifteen percent were elderly, 65.6% were gastroenterologist referrals, 14.1% were inpatients, while 45.8% had co-morbidities. Endoscopy was appropriately indicated in 81.9%, and significant endoscopy findings were detected in 95.6%. Appropriateness was not associated with significant endoscopy findings. The sensitivity, specificity and AUROC of the ASGE guidelines were 10%, 82%, and 0.46 respectively. Conclusion According to our study, most procedures are appropriately indicated. However, appropriateness did not determine endoscopy yield. Larger studies are needed to determine the utility of the ASGE guidelines in our environment.
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Affiliation(s)
- Emuobor A Odeghe
- Medicine department, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | | | | | - Ganiyat K Oyeleke
- Medicine department, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Olufunmilayo A Lesi
- Medicine department, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
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2
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Davwar PM, Okeke E, Duguru M, Nyam D, Bell K, Odeghe EA, Oyeleke G, Lesi OA, Singh R, Kim KY, Imade G, Akanmu AS, Sagay AS, Ogunsola FT, Peters MG, Roberts LR, Hou L, Murphy RL, Hawkins CA. Hepatocellular carcinoma presentation and prognosis among Nigerian adults with and without HIV. PLoS One 2023; 18:e0282539. [PMID: 36877687 PMCID: PMC9987777 DOI: 10.1371/journal.pone.0282539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is an increasing cause of mortality in Nigeria among persons with HIV (PLH), as access to antiretroviral therapy (ART) improves. In this study we describe clinical, radiological, and laboratory characteristics in Nigerian adults with HCC, with and without HIV, and examine how HIV impacts survival. METHODS This prospective observational study was conducted between August 2018 and November 2021 at two Nigerian hospitals [Jos University Teaching Hospital (JUTH) and Lagos University Teaching Hospital (LUTH)]. Subjects ≥18 years with HCC diagnosed according to American Association for the Study of Liver Diseases (AASLD) criteria were included. Baseline characteristics were compared, and Kaplan-Meier curves were generated to estimate survival. RESULTS 213 subjects [177 (83%) without HIV and 36 (17%) with HIV (PLH)] were enrolled. Median age was 52 years (IQR 42,60) and most subjects were male (71%). 83% PLH were on antiretroviral therapy (ART). Hepatitis B surface antigen (HBsAg) positivity was similar between the two groups [91/177 (51%) without HIV vs. 18/36 (50%) with HIV; p = 0.86]. 46/213 (22%) subjects had active hepatitis C (anti-HCV+/HCV RNA>10 IU/mL). Cirrhosis was more common in PLH but there were no other significant differences in clinical and tumor characteristics between the groups. Overall, 99% subjects were symptomatic and 78% in late-stage HCC. Median overall survival was significantly shorter in PLH vs. without HIV (0.98 months vs 3.02 months, HR = 1.55, 95%CI 1.02, 2.37, p = 0.04). This association was not significant after adjusting for known risk factors including gender, current alcohol use, alpha-fetoprotein (AFP), albumin, and total bilirubin (HR = 1.38, 95%CI 0.84, 2.29, p = 0.21). CONCLUSION HCC presented late with an extremely poor overall prognosis, highlighting the urgent need for more intensive surveillance in Nigeria to diagnose HCC at earlier stages. Early diagnosis and management of viral hepatitis, and access to HCC therapies, could prevent early mortality among persons with HCC, especially among PLH.
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Affiliation(s)
| | | | | | | | - Kristen Bell
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
| | | | | | | | - Revika Singh
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
| | - Kwang-Youn Kim
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
| | | | | | | | | | - Marion G. Peters
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
| | - Lewis R. Roberts
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota, United States of America
| | - Lifang Hou
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
| | - Robert L. Murphy
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
| | - Claudia A. Hawkins
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
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3
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Spearman CW, Dusheiko G, Jonas E, Abdo A, Afihene M, Cunha L, Desalegn H, Kassianides C, Katsidzira L, Kramvis A, Lam P, Lesi OA, Micah EA, Musabeyezu E, Ndow G, Nnabuchi CV, Ocama P, Okeke E, Rwegasha J, Shewaye AB, Some FF, Tzeuton C, Sonderup MW. Hepatocellular carcinoma: measures to improve the outlook in sub-Saharan Africa. Lancet Gastroenterol Hepatol 2022; 7:1036-1048. [PMID: 35810766 DOI: 10.1016/s2468-1253(22)00041-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 02/08/2023]
Abstract
Hepatocellular carcinoma is a leading public health concern in sub-Saharan Africa, and it is most prevalent in young adults (median 45 years [IQR 35-57]). Overall, outcomes are poor, with a median survival of 2·5 months after presentation. Major risk factors for hepatocellular carcinoma are hepatitis B virus (HBV), hepatitis C virus, aflatoxin B1 exposure, and alcohol consumption, with metabolic dysfunction-associated fatty liver disease slowly emerging as a risk factor over the past few years. Crucially, these risk factors are preventable and manageable with effective implementation of the HBV birth-dose vaccination, treatment of chronic viral hepatitis, provision of harm reduction services, and by decreasing aflatoxin B1 exposure and harmful alcohol consumption. Primary prevention is central to the management of hepatocellular carcinoma, especially in poorly resourced environments. Effective screening and surveillance programmes with recall policies need to be implemented, because detection and curative management of hepatocellular carcinoma is possible if it is detected at an early stage, even in countries with minimal resources, with appropriate upskilling of medical personnel. The establishment of centres of excellence with advanced diagnostic and therapeutic capabilities within countries should improve hepatocellular carcinoma outcomes and assist in driving the implementation of much needed systematic data systems focused on hepatocellular carcinoma to establish the accurate burden in sub-Saharan Africa. Such data would support the public health importance of hepatocellular carcinoma and provide a strong basis for advocacy, programme development, resource allocation, and monitoring of progress in reducing mortality.
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Affiliation(s)
- C Wendy Spearman
- Division of Hepatology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Geoffrey Dusheiko
- University College London Medical School, London, UK; Kings College Hospital, London, UK
| | - Eduard Jonas
- Surgical Gastroenterology Unit, Division of General Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Abdelmounem Abdo
- National Centre for Gastrointestinal and Liver Disease, Ibn Sina Hospital, Alamarat, Khartoum, Sudan
| | - Mary Afihene
- Department of Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lina Cunha
- Gastroenterology Unit, Maputo Private Hospital, Maputo, Mozambique
| | - Hailemichael Desalegn
- Department of Internal Medicine, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Chris Kassianides
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Leolin Katsidzira
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Olufunmilayo A Lesi
- Gastroenterology and Hepatology Unit, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Eileen A Micah
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Gibril Ndow
- Disease Control and Elimination Theme, MRC Unit The Gambia at the London School of Tropical Medicine, London, UK; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Chidi V Nnabuchi
- Asokoro District Hospital, Nile University Teaching Hospital, Abuja, Nigeria
| | - Ponsiano Ocama
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Edith Okeke
- Gastroenterology and Hepatology Unit, Department of Internal Medicine, College of Health Sciences, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - John Rwegasha
- Gastroenterology Training Centre, Department of Internal Medicine, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Abate B Shewaye
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fatuma F Some
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Christian Tzeuton
- Faculty of Medicine and Pharmaceutical Sciences of Douala, University of Douala, Douala, Cameroon
| | - Mark W Sonderup
- Division of Hepatology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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4
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Lesi OA, Ward JW. Paving the way towards hepatitis B virus-free generations in Africa. Lancet Glob Health 2021; 9:e1491-e1492. [PMID: 34678185 DOI: 10.1016/s2214-109x(21)00415-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 02/09/2023]
Affiliation(s)
- Olufunmilayo A Lesi
- Department of Global HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, Switzerland.
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, GA, USA
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5
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Spearman CW, Abdo A, Ambali A, Awuku YA, Kassianides C, Lesi OA, Ndomondo-Sigonda M, Onyekwere CA, Rwegasha J, Shewaye AB, Sonderup MW. Health-care provision and policy for non-alcoholic fatty liver disease in sub-Saharan Africa. Lancet Gastroenterol Hepatol 2021; 6:1047-1056. [PMID: 34508669 DOI: 10.1016/s2468-1253(21)00296-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 12/13/2022]
Abstract
Sub-Saharan Africa, which has a population of more than 1 billion people, carries 24% of the global burden of disease and spends the least on health care of any region, relying heavily on international development assistance to deliver health care for HIV, tuberculosis, and malaria. The demographic and epidemiological transitions occurring in sub-Saharan Africa, with rising prevalences of obesity and diabetes, enhance the risk of non-alcoholic fatty liver disease (NAFLD), yet this remains an unrecognised complication of metabolic syndrome. There are no guidance documents on NAFLD from sub-Saharan Africa, and non-communicable disease (NCD) guidance documents do not include the associated burden of fatty liver disease. Combating the health and socioeconomic burden of NAFLD requires an integrated liver health approach, with task-shifting to primary health care. Using clear guidance documents to link education and management of HIV, viral hepatitis, NAFLD, and associated NCDs is also crucial to an integrated approach to infectious diseases and NCDs, which requires targeted funding from both governments and international development agencies.
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Affiliation(s)
- C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Abdelmounem Abdo
- National Centre for Gastrointestinal and Liver Disease, Ibn Sina Hospital, Khartoum, Sudan
| | - Aggrey Ambali
- African Union Development Agency-New Partnership for Africa's Development (AUDA-NEPAD), Midrand, South Africa
| | - Yaw A Awuku
- Department of Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Chris Kassianides
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Olufunmilayo A Lesi
- Gastroenterology & Hepatology Unit, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Margareth Ndomondo-Sigonda
- African Union Development Agency-New Partnership for Africa's Development (AUDA-NEPAD), Midrand, South Africa
| | - Charles A Onyekwere
- Department of Medicine, Lagos State University College of Medicine, Lagos, Nigeria
| | - John Rwegasha
- Gastroenterology Training Centre, Department of Internal Medicine, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Abate B Shewaye
- Division of Gastroenterolgy and Hepatology, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mark W Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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6
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Lesi OA, Audu RA, Okwuraiwe AP, Adeleye OO, Ige FA, Iwuorah JC. Serological and virological markers of nigerian patients with hepatitis B infection. Niger J Clin Pract 2019; 22:534-538. [PMID: 30975959 DOI: 10.4103/njcp.njcp_273_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The natural history of chronic hepatitis B virus (HBV) infection and the spectrum of diseases attributable to chronic hepatitis B are diverse. It is estimated that 15%-25% of chronic carriers will die from complications of progressive disease such as liver cirrhosis, hepatocellular carcinoma, and hepatic decompensation. The main aim of this study is to evaluate the serological and virological profile of patients with hepatitis B infection to enhance the evaluation of the natural history of viral hepatitis in an endemic population. Methods Characteristics of hepatitis B surface antigen (HBsAg) patients (2010-2016) were extracted from the database of a reference laboratory in Lagos. These included serological tests for hepatitis B antigens (HBeAg, HBsAg), antibodies (anti-HBcIgM, anti-HBeAb) (DIA.PRO), and HBV DNA (Roche Diagnostics). SPSS version 20.0 was used for data analysis. Results Of the 1,983 patients, 1,252 were male and 731 female. HBeAg was detected in 8.0% (128/1,605) of the subjects, anti-HBe was positive in 90.0% (1,257/1,396), while HBcore subclass IgM antibody was detected in 12.6% (116/930). Detectable HBV DNA was identified in 1,781 (89%), with viral load exceeding 2,001 IU/mL in 712 (35.9%) subjects. HBV viral loads >200,000 IU/mL were more frequently detected in HBeAg-positive compared with HBeAg-negative subjects (65.7% vs 4.9%, P < 0.0001). Conclusion We have demonstrated the predominance of low replicative phase HBV infection and highlighted the importance of HBeAg-negative infections that may require antiviral therapy. HBeAg-positive infections occurred significantly in younger adults with new or acute infections. Our findings have implications for patient evaluation and planning of hepatitis treatment programs.
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Affiliation(s)
- O A Lesi
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - R A Audu
- Human Virology Laboratory, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - A P Okwuraiwe
- Human Virology Laboratory, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - O O Adeleye
- Department of Medicine, College of Medicine, Olabisi Onabanjo University Teaching Hospital, Ogun State, Nigeria
| | - F A Ige
- Human Virology Laboratory, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - J C Iwuorah
- Clinical Science Division, Nigerian Institute of Medical Research, Lagos, Nigeria
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7
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Cooke GS, Andrieux-Meyer I, Applegate TL, Atun R, Burry JR, Cheinquer H, Dusheiko G, Feld JJ, Gore C, Griswold MG, Hamid S, Hellard ME, Hou J, Howell J, Jia J, Kravchenko N, Lazarus JV, Lemoine M, Lesi OA, Maistat L, McMahon BJ, Razavi H, Roberts T, Simmons B, Sonderup MW, Spearman CW, Taylor BE, Thomas DL, Waked I, Ward JW, Wiktor SZ. Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2019; 4:135-184. [PMID: 30647010 DOI: 10.1016/s2468-1253(18)30270-x] [Citation(s) in RCA: 330] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 01/26/2023]
Abstract
Viral hepatitis is a major public health threat and a leading cause of death worldwide. Annual mortality from viral hepatitis is similar to that of other major infectious diseases such as HIV and tuberculosis. Highly effective prevention measures and treatments have made the global elimination of viral hepatitis a realistic goal, endorsed by all WHO member states. Ambitious targets call for a global reduction in hepatitis-related mortality of 65% and a 90% reduction in new infections by 2030. This Commission draws together a wide range of expertise to appraise the current global situation and to identify priorities globally, regionally, and nationally needed to accelerate progress. We identify 20 heavily burdened countries that account for over 75% of the global burden of viral hepatitis. Key recommendations include a greater focus on national progress towards elimination with support given, if necessary, through innovative financing measures to ensure elimination programmes are fully funded by 2020. In addition to further measures to improve access to vaccination and treatment, greater attention needs to be paid to access to affordable, high-quality diagnostics if testing is to reach the levels needed to achieve elimination goals. Simplified, decentralised models of care removing requirements for specialised prescribing will be required to reach those in need, together with sustained efforts to tackle stigma and discrimination. We identify key examples of the progress that has already been made in many countries throughout the world, demonstrating that sustained and coordinated efforts can be successful in achieving the WHO elimination goals.
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Affiliation(s)
- Graham S Cooke
- Division of Infectious Diseases, Imperial College London, London, UK.
| | | | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Hugo Cheinquer
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Jordan J Feld
- Toronto Center for Liver Disease, Toronto General Hospital, Toronto, Canada
| | | | - Max G Griswold
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | - JinLin Hou
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Guangzhou, China
| | - Jess Howell
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Beijing, China
| | | | - Jeffrey V Lazarus
- Health Systems Research Group, Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Maud Lemoine
- Division of Surgery and Cancer, Imperial College London, London, UK
| | | | | | - Brian J McMahon
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AL, USA
| | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | | | - Bryony Simmons
- Division of Infectious Diseases, Imperial College London, London, UK
| | - Mark W Sonderup
- Division of Hepatology, Department of Medicine, University of Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, University of Cape Town, South Africa
| | | | - David L Thomas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Imam Waked
- National Liver Institute, Menoufiya University, Egypt
| | - John W Ward
- Program for Viral Hepatitis Elimination, Task Force for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stefan Z Wiktor
- Department of Global Health, University of Washington, Seattle, WA, USA
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8
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Iwuala SO, Lesi OA, Olamoyegun MA, Sabir AA, Fasanmade OA. Lipoatrophy among patients on antiretroviral therapy in Lagos, Nigeria: Prevalence, pattern and association with cardiovascular risk factors. Niger J Clin Pract 2018; 18:626-32. [PMID: 26096241 DOI: 10.4103/1119-3077.154208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT Antiretroviral therapy (ART) is linked with morphologic abnormalities such as lipoatrophy (LA), which may accompany metabolic alterations (dysglycemias, dyslipidemia and insulin resistance) that increase cardiovascular disease risk. LA and its association with metabolic alterations have been infrequently studied amongst Nigerians on ART. AIMS To determine the prevalence, pattern and association of LA with metabolic abnormalities and hypertension among patients on ART attending an ambulatory human immunodeficiency virus clinic in Lagos, Nigeria. SUBJECTS AND METHODS A cross-sectional study was carried out among patients on ART using a structured interviewer administered questionnaire. Data obtained included patients and physician's assessment of body fat changes, drug history, blood pressure, body composition assessment using bioelectrical impedance analysis and biochemical evaluation (glucose, lipids). LA was defined clinically. Data were analyzed using IBM SPSS statistical software version 21. RESULTS A total of 48 (33.1%) of the 145 patients had LA. The face was the most frequently affected body region. Patients with LA with lower body circumferences, skin-fold thickness and body fat (P < 0.05). The frequencies of lipid abnormalities were: Reduced high density lipoprotein-cholesterol (47.1%), elevated total cholesterol (35.6%), reduced low density lipoprotein-cholesterol (19.2%), elevated triglycerides (14.4%). Fasting plasma glucose (FPG)≥6.1 mmol/l and hypertension were present among 9.6% and 40.7% respectively. LA was not significantly associated with the presence of glucose intolerance, dyslipidemia or hypertension (P > 0.05). CONCLUSIONS Lipoatrophy, though commonly encountered in patients on ART in Nigeria was not associated with the presence of dyslipidemia, abnormal FPG or hypertension. Regular monitoring by the physician and increased patients awareness are necessary to reduce its prevalence and impact.
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Affiliation(s)
- S O Iwuala
- Department of Medicine, College of Medicine, University of Lagos, Idi Araba, Lagos, Lagos State, Nigeria
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9
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Siemieniuk RAC, Lytvyn L, Mah Ming J, Mullen RM, Anam F, Otieno T, Guyatt GH, Taylor GP, Beltrán-Arroyave C, Okwen PM, Nduati R, Kinuthia J, Luma HN, Kirpalani H, Merglen A, Lesi OA, Vandvik PO, Agoritsas T, Bewley S. Antiretroviral therapy in pregnant women living with HIV: a clinical practice guideline. BMJ 2017; 358:j3961. [PMID: 28893728 PMCID: PMC5590100 DOI: 10.1136/bmj.j3961] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Approximately 1.4 million women living with HIV become pregnant every year. Most women use antiretroviral therapy, to reduce the risk of vertical transmission or for personal health reasons. Using the GRADE framework according to the BMJ Rapid Recommendation process, we make recommendations for optimal choice of combination antiretroviral regimen considering patient values and preferences, the balance of desirable and undesirable outcomes, their uncertainty, and practical issues. We suggest a zidovudine and lamivudine-based regimen over one that includes tenofovir or emtricitabine (weak recommendation). We recommend alternatives over the combination of tenofovir, emtricitabine, and lopinavir/ritonavir (strong recommendation).
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Affiliation(s)
- Reed A C Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Lyubov Lytvyn
- Oslo University Hospital, Forskningsveien 2b, Blindern 0317 Oslo, Norway
| | | | | | - Florence Anam
- International Community of Women living with HIV (ICW-Global), Nairobi, Kenya
| | | | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | | | | | | | | | | | | | | | | | - Olufunmilayo A Lesi
- Lagos University Teaching Hospital, Lagos, Nigeria; College of Medicine, University of Lagos, Nigeria
| | - Per Olav Vandvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Division General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, CH-1211, Geneva, Switzerland
| | - Susan Bewley
- Women's Health Academic Centre, King's College London, London, UK
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10
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Yang JD, Mohamed EA, Aziz AOA, Shousha HI, Hashem MB, Nabeel MM, Abdelmaksoud AH, Elbaz TM, Afihene MY, Duduyemi BM, Ayawin JP, Gyedu A, Lohouès-Kouacou MJ, Ndam AWN, Moustafa EF, Hassany SM, Moussa AM, Ugiagbe RA, Omuemu CE, Anthony R, Palmer D, Nyanga AF, Malu AO, Obekpa S, Abdo AE, Siddig AI, Mudawi HMY, Okonkwo U, Kooffreh-Ada M, Awuku YA, Nartey YA, Abbew ET, Awuku NA, Otegbayo JA, Akande KO, Desalegn HM, Omonisi AE, Ajayi AO, Okeke EN, Duguru MJ, Davwar PM, Okorie MC, Mustapha S, Debes JD, Ocama P, Lesi OA, Odeghe E, Bello R, Onyekwere C, Ekere F, Igetei R, Mah'moud MA, Addissie B, Ali HM, Gores GJ, Topazian MD, Roberts LR. Characteristics, management, and outcomes of patients with hepatocellular carcinoma in Africa: a multicountry observational study from the Africa Liver Cancer Consortium. Lancet Gastroenterol Hepatol 2016; 2:103-111. [PMID: 28403980 DOI: 10.1016/s2468-1253(16)30161-3] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hepatocellular carcinoma is a leading cause of cancer-related death in Africa, but there is still no comprehensive description of the current status of its epidemiology in Africa. We therefore initiated an African hepatocellular carcinoma consortium aiming to describe the clinical presentation, management, and outcomes of patients with hepatocellular carcinoma in Africa. METHODS We did a multicentre, multicountry, retrospective observational cohort study, inviting investigators from the African Network for Gastrointestinal and Liver Diseases to participate in the consortium to develop hepatocellular carcinoma research databases and biospecimen repositories. Participating institutions were from Cameroon, Egypt, Ethiopia, Ghana, Ivory Coast, Nigeria, Sudan, Tanzania, and Uganda. Clinical information-demographic characteristics, cause of disease, liver-related blood tests, tumour characteristics, treatments, last follow-up date, and survival status-for patients diagnosed with hepatocellular carcinoma between Aug 1, 2006, and April 1, 2016, were extracted from medical records by participating investigators. Because patients from Egypt showed differences in characteristics compared with patients from the other countries, we divided patients into two groups for analysis; Egypt versus other African countries. We undertook a multifactorial analysis using the Cox proportional hazards model to identify factors affecting survival (assessed from the time of diagnosis to last known follow-up or death). FINDINGS We obtained information for 2566 patients at 21 tertiary referral centres (two in Egypt, nine in Nigeria, four in Ghana, and one each in the Ivory Coast, Cameroon, Sudan, Ethiopia, Tanzania, and Uganda). 1251 patients were from Egypt and 1315 were from the other African countries (491 from Ghana, 363 from Nigeria, 277 from Ivory Coast, 59 from Cameroon, 51 from Sudan, 33 from Ethiopia, 21 from Tanzania, and 20 from Uganda). The median age at which hepatocellular carcinoma was diagnosed significantly later in Egypt than the other African countries (58 years [IQR 53-63] vs 46 years [36-58]; p<0·0001). Hepatitis C virus was the leading cause of hepatocellular carcinoma in Egypt (1054 [84%] of 1251 patients), and hepatitis B virus was the leading cause in the other African countries (597 [55%] of 1082 patients). Substantially fewer patients received treatment specifically for hepatocellular carcinoma in the other African countries than in Egypt (43 [3%] of 1315 vs 956 [76%] of 1251; p<0·0001). Among patients with survival information (605 [48%] of 1251 in Egypt and 583 [44%] of 1315 in other African countries), median survival was shorter in the other African countries than in Egypt (2·5 months [95% CI 2·0-3·1] vs 10·9 months [9·6-12·0]; p<0·0001). Factors independently associated with poor survival were: being from an African countries other than Egypt (hazard ratio [HR] 1·59 [95% CI 1·13-2·20]; p=0·01), hepatic encephalopathy (2·81 [1·72-4·42]; p=0·0004), diameter of the largest tumour (1·07 per cm increase [1·04-1·11]; p<0·0001), log α-fetoprotein (1·10 per unit increase [1·02-1·20]; p=0·0188), Eastern Cooperative Oncology Group performance status 3-4 (2·92 [2·13-3·93]; p<0·0001) and no treatment (1·79 [1·44-2·22]; p<0·0001). INTERPRETATION Characteristics of hepatocellular carcinoma differ between Egypt and other African countries. The proportion of patients receiving specific treatment in other African countries was low and their outcomes were extremely poor. Urgent efforts are needed to develop health policy strategies to decrease the burden of hepatocellular carcinoma in Africa. FUNDING None.
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Affiliation(s)
- Ju Dong Yang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Essa A Mohamed
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Ashraf O Abdel Aziz
- Endemic Medicine and Hepatogastroenterology Department, University of Cairo, Cairo, Egypt
| | - Hend I Shousha
- Endemic Medicine and Hepatogastroenterology Department, University of Cairo, Cairo, Egypt
| | - Mohamed B Hashem
- Endemic Medicine and Hepatogastroenterology Department, University of Cairo, Cairo, Egypt
| | - Mohamed M Nabeel
- Endemic Medicine and Hepatogastroenterology Department, University of Cairo, Cairo, Egypt
| | - Ahmed H Abdelmaksoud
- Department of Diagnostic and Interventional Radiology, University of Cairo, Cairo, Egypt
| | - Tamer M Elbaz
- Endemic Medicine and Hepatogastroenterology Department, University of Cairo, Cairo, Egypt
| | - Mary Y Afihene
- Department of Internal Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Babatunde M Duduyemi
- Department of Pathology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joshua P Ayawin
- Department of Internal Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Adam Gyedu
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Marie-Jeanne Lohouès-Kouacou
- Department of Hepatology and Gastroenterology, Centre Hospitalier Universitaire de Cocody, Abidjan, Côte d'Ivoire
| | - Antonin W Ndjitoyap Ndam
- Department of Hepatology and Gastroenterology, Centre Hospitalier Universitaire de Cocody, Abidjan, Côte d'Ivoire
| | - Ehab F Moustafa
- Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut Governorate, Egypt
| | - Sahar M Hassany
- Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut Governorate, Egypt
| | - Abdelmajeed M Moussa
- Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut Governorate, Egypt
| | - Rose A Ugiagbe
- Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Casimir E Omuemu
- Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Richard Anthony
- Department of Internal Medicine, Effia Nkwanta Regional Hospital, Sekondi, Ghana
| | - Dennis Palmer
- Department of Internal Medicine, Mbingo Baptist Hospital, Bamenda, Cameroon
| | - Albert F Nyanga
- Department of Internal Medicine, Mbingo Baptist Hospital, Bamenda, Cameroon
| | - Abraham O Malu
- Department of Medicine, Benue State University Teaching Hospital, Benue, Nigeria
| | - Solomon Obekpa
- Department of Medicine, Benue State University Teaching Hospital, Benue, Nigeria
| | | | | | - Hatim M Y Mudawi
- Department of Internal Medicine, University of Khartoum, Khartoum, Sudan
| | - Uchenna Okonkwo
- Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Mbang Kooffreh-Ada
- Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Yaw A Awuku
- Department of Internal Medicine, School of Medical Sciences, Cape Coast, Ghana
| | - Yvonne A Nartey
- Department of Internal Medicine, School of Medical Sciences, Cape Coast, Ghana
| | - Elizabeth T Abbew
- Department of Internal Medicine, School of Medical Sciences, Cape Coast, Ghana
| | - Nana A Awuku
- Department of Internal Medicine, School of Medical Sciences, Cape Coast, Ghana
| | | | | | - Hailemichael M Desalegn
- Department of Internal Medicine, St. Paul's Hospital Millenium Medical College, Addis Ababa, Ethiopia
| | - Abidemi E Omonisi
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Akande O Ajayi
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Edith N Okeke
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Mary J Duguru
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Pantong M Davwar
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Michael C Okorie
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Shettima Mustapha
- Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Jose D Debes
- Department of Medicine, University of Minnesota, MN, USA; Department of Medicine, Arusha Lutheran Medical Center, Arusha, Tanzania
| | - Ponsiano Ocama
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Olufunmilayo A Lesi
- Division of Gastroenterology and Hepatology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Emuobor Odeghe
- Division of Gastroenterology and Hepatology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ruth Bello
- Department of Medicine, Dalhatu Araf Specialist Hospital, Lafia, Nigeria
| | - Charles Onyekwere
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Francis Ekere
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Rufina Igetei
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | | | - Benyam Addissie
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Hawa M Ali
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Mark D Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
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Oreagba IA, Usman SO, Olayemi SO, Oshikoya KA, Opanuga O, Adeyemo TA, Lesi OA, Dodoo AN, Akanmu AS. Pharmacoepidemiology of antiretroviral drugs in a teaching hospital in Lagos, Nigeria. Ghana Med J 2015; 48:194-203. [PMID: 25709134 DOI: 10.4314/gmj.v48i4.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Prescribing, adherence, and adverse drug events to HAART in a large antiretroviral programme in Lagos was evaluated. DESIGN A retrospective 5 year open cohort study. SETTING The AIDS Prevention Initiative in Nigeria (APIN) clinic at LUTH is one of the United States Presidential Emergency Plan for AIDS Relief (PEP-FAR) funded centers for HIV relief program in Nigeria Participants The case files of 390 patients on HAART and attending the APIN clinic were reviewed sequel to random selection. MAIN OUTCOME MEASURES Demographics of the patients and pattern of antiretroviral (ARV) combination drugs prescribed were extracted from their case files. The details of the adverse drug events (ADEs) were extracted from drug toxicity forms regularly filled for each patient. A Chi-square test with Yates correction was used to determine the association between adherence and therapeutic outcome. RESULTS A total of 2944 prescriptions were assessed. Zidovudine + lamivudine + nevirapine (35.87%) and stavudine + lamivudine + nevirapine (35.63%) were the most frequently prescribed combinations. Over 2000 ADEs were reported with cough (13.3%), fever (8.75%) and skin rashes (8.01%) being the most frequently reported. Drug adherence was associated with good therapeutic outcome (χ(2) = 115.60, p<0.0001). CONCLUSIONS Zidovudine + lamivudine + nevirapine was the most frequently prescribed ARV combination. Cough was the most frequently reported ADE. Interventions aimed at rational prescribing of ARV drugs and improving adherence to antiretroviral drugs is essential for good therapeutic outcome in the treatment of HIV infection.
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Affiliation(s)
- I A Oreagba
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria, 12003 ; National Pharmacovigilance Centre, National Agency for Food and Drug Administration and Control, Abuja, Nigeria
| | - S O Usman
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria, 12003
| | - S O Olayemi
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria, 12003
| | - K A Oshikoya
- Department of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - O Opanuga
- AIDS Prevention Initiative in Nigeria (APIN) Clinic, Lagos University Teaching Hospital, Lagos, Nigeria, 12003
| | - T A Adeyemo
- AIDS Prevention Initiative in Nigeria (APIN) Clinic, Lagos University Teaching Hospital, Lagos, Nigeria, 12003 ; Department of Haematology and Blood Transfusion, University of Lagos, Lagos, Nigeria
| | - O A Lesi
- AIDS Prevention Initiative in Nigeria (APIN) Clinic, Lagos University Teaching Hospital, Lagos, Nigeria, 12003
| | - A N Dodoo
- Centre for Clinical Pharmacology and Therapeutics University of Ghana Medical School Accra Ghana
| | - A S Akanmu
- AIDS Prevention Initiative in Nigeria (APIN) Clinic, Lagos University Teaching Hospital, Lagos, Nigeria, 12003 ; Department of Haematology and Blood Transfusion, University of Lagos, Lagos, Nigeria
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12
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Ladep NG, Lesi OA, Mark P, Lemoine M, Onyekwere C, Afihene M, Crossey MM, Taylor-Robinson SD. Problem of hepatocellular carcinoma in West Africa. World J Hepatol 2014; 6:783-92. [PMID: 25429316 PMCID: PMC4243152 DOI: 10.4254/wjh.v6.i11.783] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/08/2014] [Accepted: 09/16/2014] [Indexed: 02/06/2023] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) is known to be high in West Africa with an approximate yearly mortality rate of 200000. Several factors are responsible for this. Early acquisition of risk factors; with vertical or horizontal transmission of hepatitis B (HBV), environmental food contaminants (aflatoxins), poor management of predisposing risk factors and poorly-managed strategies for health delivery. There has been a low uptake of childhood immunisation for hepatitis B in many West African countries. Owing to late presentations, most sufferers of HCC die within weeks of their diagnosis. Highlighted reasons for the specific disease pattern of HCC in West Africa include: (1) high rate of risk factors; (2) failure to identify at risk populations; (3) lack of effective treatment; and (4) scarce resources for timely diagnosis. This is contrasted to the developed world, which generally has sufficient resources to detect cases early for curative treatment. Provision of palliative care for HCC patients is limited by availability and affordability of potent analgesics. Regional efforts, as well as collaborative networking activities hold promise that could change the epidemiology of HCC in West Africa.
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Affiliation(s)
- Nimzing G Ladep
- Nimzing G Ladep, Maud Lemoine, Mary ME Crossey, Simon D Taylor-Robinson, Hepatology Unit, Imperial College London, St Mary's Hospital Campus, London W2 1NY, United Kingdom
| | - Olufunmilayo A Lesi
- Nimzing G Ladep, Maud Lemoine, Mary ME Crossey, Simon D Taylor-Robinson, Hepatology Unit, Imperial College London, St Mary's Hospital Campus, London W2 1NY, United Kingdom
| | - Pantong Mark
- Nimzing G Ladep, Maud Lemoine, Mary ME Crossey, Simon D Taylor-Robinson, Hepatology Unit, Imperial College London, St Mary's Hospital Campus, London W2 1NY, United Kingdom
| | - Maud Lemoine
- Nimzing G Ladep, Maud Lemoine, Mary ME Crossey, Simon D Taylor-Robinson, Hepatology Unit, Imperial College London, St Mary's Hospital Campus, London W2 1NY, United Kingdom
| | - Charles Onyekwere
- Nimzing G Ladep, Maud Lemoine, Mary ME Crossey, Simon D Taylor-Robinson, Hepatology Unit, Imperial College London, St Mary's Hospital Campus, London W2 1NY, United Kingdom
| | - Mary Afihene
- Nimzing G Ladep, Maud Lemoine, Mary ME Crossey, Simon D Taylor-Robinson, Hepatology Unit, Imperial College London, St Mary's Hospital Campus, London W2 1NY, United Kingdom
| | - Mary Me Crossey
- Nimzing G Ladep, Maud Lemoine, Mary ME Crossey, Simon D Taylor-Robinson, Hepatology Unit, Imperial College London, St Mary's Hospital Campus, London W2 1NY, United Kingdom
| | - Simon D Taylor-Robinson
- Nimzing G Ladep, Maud Lemoine, Mary ME Crossey, Simon D Taylor-Robinson, Hepatology Unit, Imperial College London, St Mary's Hospital Campus, London W2 1NY, United Kingdom
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13
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da Costa AN, Plymoth A, Santos-Silva D, Ortiz-Cuaran S, Camey S, Guilloreau P, Sangrajrang S, Khuhaprema T, Mendy M, Lesi OA, Chang HK, Oh JK, Lee DH, Shin HR, Kirk GD, Merle P, Beretta L, Hainaut P. Osteopontin and latent-TGF β binding-protein 2 as potential diagnostic markers for HBV-related hepatocellular carcinoma. Int J Cancer 2014; 136:172-81. [PMID: 24803312 DOI: 10.1002/ijc.28953] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 04/17/2014] [Indexed: 12/12/2022]
Abstract
Chronic Hepatitis B (HB) is the main risk factor for chronic liver disease (CLD) and hepatocellular carcinoma (HCC) in many low-resource countries, where diagnosis is constrained by lack of clinical, histopathological and biomarker resources. We have used proteomics to detect plasma biomarkers that outperform α-Fetoprotein (AFP), the most widely used biomarker for HCC diagnosis in low-resource contexts. Deep-plasma proteome analysis was performed in HCC patients, patients with CLD and in HB-carrier controls from Thailand (South-East Asia) and The Gambia (West-Africa). Mass spectrometry profiling identified latent-transforming growth factor β binding-protein 2 (LTBP2) and Osteopontin (OPN) as being significantly elevated in HCC versus CLD and controls. These two proteins were further analyzed by ELISA in a total of 684 plasma samples, including 183 HCC, 274 CLD and 227 asymptomatic controls. When combined, LTBP2 and OPN showed an area under the receiver operating curve of 0.85 in distinguishing HCC from CLD in subjects with AFP <20 ng/mL. In a prospective cohort of 115 CLD patients from Korea, increased plasma levels of LTBP2 and/or OPN were detected in plasma collected over 2 years prior to diagnosis in 21 subjects who developed HCC. Thus, the combination of LTBP2 and OPN outperformed AFP for diagnosis and prediction of HCC and may therefore improve biomarker-based detection of HBV-related HCC.
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14
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Oshikoya KA, Oreagba IA, Lawal S, Awodele O, Ogunleye OO, Senbanjo IO, Olayemi SO, Ezeaka VC, Temiye EO, Adeyemo TA, Opanuga O, Lesi OA, Akanmu SA. Potential drug-drug interactions in HIV-infected children on antiretroviral therapy in Lagos, Nigeria. HIV AIDS (Auckl) 2014; 6:49-59. [PMID: 24741328 PMCID: PMC3982970 DOI: 10.2147/hiv.s52266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Multi-therapy is common in HIV-infected children, and the risk for clinically significant drug interactions (CSDIs) is high. We investigated the prevalence of CSDIs between antiretroviral (ARV) and co-prescribed drugs for children attending a large HIV clinic in Lagos, Nigeria. Methods The case files of pediatric patients receiving treatment at the HIV clinic of the Lagos University Teaching Hospital (LUTH), Idi-Araba, between January 2005 and December 2010 were reviewed. The ARV and co-prescribed drug pairs were evaluated for potential interactions using the Liverpool HIV Pharmacology Group website. The potential interactions were rated as A (no known interaction), B (minor/no action needed), C (moderate/monitor therapy), D (major/therapy modification), and X (contraindicated/avoid combination). Results Of the 310 cases reviewed, 208 (67.1%) patients were at risk of CSDIs. Artemisinin-based combination therapy was prescribed for over one-half of the patients, accounting for 40% of the CSDIs. Excluding this drug class, the prevalence of CSDIs reduced from 67.1% to 18.7% in 58 patients. Most of the CSDIs (579; 97.2%) were moderately significant and frequently involved nevirapine and fluconazole (58; 9.7%), zidovudine and fluconazole (55; 9.2%), zidovudine and rifampicin (35; 5.9%), and nevirapine and prednisolone (31; 5.2%). Age (P=0.392), sex (P=0.783), and moderate (P=0.632) or severe (P=0.755) malnutrition were not associated with risk for CSDIs. Conclusion There is a tendency for CSDIs between ARV and co-prescribed drugs among the group of children evaluated in this study. Measures are necessary to prevent important drug interactions and to manage those that are unavoidable.
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Affiliation(s)
- Kazeem A Oshikoya
- Department of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Ibrahim A Oreagba
- Department of Pharmacology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Saheed Lawal
- Department of Pharmacology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Olufunsho Awodele
- Department of Pharmacology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Idowu O Senbanjo
- Department of Paediatrics, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Sunday O Olayemi
- Department of Pharmacology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Veronica C Ezeaka
- APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Paediatrics, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Edamisan O Temiye
- APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Paediatrics, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Titilope A Adeyemo
- APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Oluranti Opanuga
- APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Pharmacy, Lagos University Teaching Hospital, Idi-Araba Lagos, Nigeria
| | - Olufunmilayo A Lesi
- APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Sulaimon A Akanmu
- APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
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15
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Smith SI, Fowora MA, Lesi OA, Agbebaku E, Odeigah P, Abdulkareem FB, Onyekwere CA, Agomo CA, Contreras M. Application of stool-PCR for the diagnosis of Helicobacter pylori from stool in Nigeria- a pilot study. Springerplus 2012; 1:78. [PMID: 23419882 PMCID: PMC3568462 DOI: 10.1186/2193-1801-1-78] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 12/13/2012] [Indexed: 02/07/2023]
Abstract
There are various methods for detection of Helicobacter pylori and the gold standard for non-invasive detection is the urea breath test (UBT). The aim of the study is therefore to detect H. pylori from the stool of patients with dyspepsia by PCR and compare results obtained with UBT. A total of 97 stool samples from patients presenting with dyspeptic symptoms in Lagos University Teaching Hospital (LUTH) were screened for urea breath test (UBT) and the presence of H. pylori DNA using stool-PCR. Out of 97 stool samples analysed, 38 (39.2%) were positive for Helicobacter spp. and 20 (20.6%) positive for H. pylori by PCR, through amplification of 16S rRNA and glmMgenes respectively. Of the 20 positive by glmM gene, the cagAgene was detected in 8 (40%) samples, while 47 (48.5%) out of 97 stool samples were positive for H. pylori by UBT. The sensitivity and specificity of the glmM gene compared with UBT as the gold standard is 42.6% and 100% respectively. The positive predictive value (PPV) was 100% while the negative predictive value (NPV) was 60%.The method may be useful for detecting H. pylori from stool amongst children especially where most hospitals lack endoscope for children although the method is expensive.
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Affiliation(s)
- Stella I Smith
- Molecular Biology and Biotechnology Division, Nigerian Institute of Medical Research, 6 Edmond Crescent, Yaba, PMB 2013, Lagos, Nigeria
| | - Muinah A Fowora
- Molecular Biology and Biotechnology Division, Nigerian Institute of Medical Research, 6 Edmond Crescent, Yaba, PMB 2013, Lagos, Nigeria
| | - Olufunmilayo A Lesi
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Elizabeth Agbebaku
- Department of Cell Biology and Genetics, University of Lagos, Lagos, Nigeria
| | - Peter Odeigah
- Department of Cell Biology and Genetics, University of Lagos, Lagos, Nigeria
| | | | - Charles A Onyekwere
- Department of Medicine, Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria
| | - Chimere A Agomo
- Biochemistry and Nutrition Division, Nigerian Institute of Medical Research, 6 Edmond Crescent, Yaba, Lagos, Nigeria
| | - Monica Contreras
- Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela
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16
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Gouas DA, Villar S, Ortiz-Cuaran S, Legros P, Ferro G, Kirk GD, Lesi OA, Mendy M, Bah E, Friesen MD, Groopman J, Chemin I, Hainaut P. TP53 R249S mutation, genetic variations in HBX and risk of hepatocellular carcinoma in The Gambia. Carcinogenesis 2012. [PMID: 22759751 DOI: 10.1093/carcin/bgs135] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In regions with high prevalence of chronic hepatitis B virus (HBV) infection and dietary aflatoxin B(1) (AFB(1)) exposure, hepatocellular carcinomas (HCCs) often contain TP53 mutation at codon 249 (R249S). Furthermore, a C-terminal truncated HBx protein expressed from hepatocyte integrated HBV is associated with HCC development. This study evaluates the association between R249S and HBX status in relation to HCC in West African population. HBX (complete or 3'-truncated) and HBS genes were assessed by PCR in cell-free DNA (CFDNA) from plasma of subjects recruited in a hospital-based case-control study (325 controls, 78 cirrhotic patients and 198 HCC cases) conducted in The Gambia. These samples had been previously analyzed for R249S and HBV serological status. Complete HBX sequence was frequently detected in CFDNA of HCC-R249S positive (77%, 43/56) compared with HCC-R249S-negative cases (44%, 22/50). Conversely, the proportion of 3'-truncated HBX gene was significantly higher in HCC-R249S negative than positive cases (34%, 17/50, compared with 12%, 7/56) (χ(2) = 12.12; P = 0.002; distribution of R249S negative and positive according to HBX status). Occult HBV infection (detected by PCR) was present in 24% of HCC previously considered as negative by HBV serology. Moreover, HBV mutation analysis revealed that double mutation at nucleotides 1762(T)/1764(A) was associated with diagnosis of cirrhosis or HCC {cirrhosis: odds ratio (OR): 9.50 [95% confidence interval (CI) 1.50-60.11]; HCC: OR: 11.29 [95% CI 2.07-61.47]}. These findings suggest that in HCC from The Gambia, complete HBX sequences are often associated with the presence of TP53 R249S mutation.
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Affiliation(s)
- Doriane A Gouas
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, Lyon, France
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Gouas DA, Villar S, Ortiz-Cuaran S, Legros P, Ferro G, Kirk GD, Lesi OA, Mendy M, Bah E, Friesen MD, Groopman J, Chemin I, Hainaut P. TP53 R249S mutation, genetic variations in HBX and risk of hepatocellular carcinoma in The Gambia. Carcinogenesis 2012; 33:1219-24. [PMID: 22759751 PMCID: PMC3388490 DOI: 10.1093/carcin/bgs068] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/13/2012] [Accepted: 03/17/2012] [Indexed: 02/06/2023] Open
Abstract
In regions with high prevalence of chronic hepatitis B virus (HBV) infection and dietary aflatoxin B(1) (AFB(1)) exposure, hepatocellular carcinomas (HCCs) often contain TP53 mutation at codon 249 (R249S). Furthermore, a C-terminal truncated HBx protein expressed from hepatocyte integrated HBV is associated with HCC development. This study evaluates the association between R249S and HBX status in relation to HCC in West African population. HBX (complete or 3'-truncated) and HBS genes were assessed by PCR in cell-free DNA (CFDNA) from plasma of subjects recruited in a hospital-based case-control study (325 controls, 78 cirrhotic patients and 198 HCC cases) conducted in The Gambia. These samples had been previously analyzed for R249S and HBV serological status. Complete HBX sequence was frequently detected in CFDNA of HCC-R249S positive (77%, 43/56) compared with HCC-R249S-negative cases (44%, 22/50). Conversely, the proportion of 3'-truncated HBX gene was significantly higher in HCC-R249S negative than positive cases (34%, 17/50, compared with 12%, 7/56) (χ(2) = 12.12; P = 0.002; distribution of R249S negative and positive according to HBX status). Occult HBV infection (detected by PCR) was present in 24% of HCC previously considered as negative by HBV serology. Moreover, HBV mutation analysis revealed that double mutation at nucleotides 1762(T)/1764(A) was associated with diagnosis of cirrhosis or HCC {cirrhosis: odds ratio (OR): 9.50 [95% confidence interval (CI) 1.50-60.11]; HCC: OR: 11.29 [95% CI 2.07-61.47]}. These findings suggest that in HCC from The Gambia, complete HBX sequences are often associated with the presence of TP53 R249S mutation.
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Affiliation(s)
- Doriane A. Gouas
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Stéphanie Villar
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Sandra Ortiz-Cuaran
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Pénélope Legros
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Gilles Ferro
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Gregory D. Kirk
- Gambia Hepatitis Intervention Study, Laboratories Fajara, Banjul, The Gambia
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Olufunmilayo A. Lesi
- Gambia Hepatitis Intervention Study, Laboratories Fajara, Banjul, The Gambia
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Maimuna Mendy
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ebrima Bah
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
- Gambia Hepatitis Intervention Study, Laboratories Fajara, Banjul, The Gambia
| | - Marlin D. Friesen
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Groopman
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Isabelle Chemin
- Inserm U1052, Centre de Recherche en Cancérologie de Lyon, Hépatocarcinogenése et infection virale, Lyon, France
| | - Pierre Hainaut
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
- Present address: International Prevention Research Institute, 96 cours Franklin Roosevelt, 69006 Lyon, France
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Ladapo TA, Onifade EU, Lesi AE, Lesi OA. Successful treatment of hepatitis B virus associated nephrotic syndrome with oral Lamivudine in a Nigerian child: a case report. J Trop Pediatr 2012; 58:157-8. [PMID: 21624925 DOI: 10.1093/tropej/fmr046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hepatitis B virus is a well described cause of nephrotic syndrome (NS) worldwide, the typical lesion being membranous glomerulonephropathy. HBV associated NS has been successfully treated with intravenous alpha interferon (IFN), an anti-viral agent. In recent times there have been reports of treatment with lamivudine, an orally administered nucleoside analogue inhibitor of HBV DNA polymerase in Caucasian children. Data is however limited and it's actual efficacy and safety in children is yet to be determined. We present the case of an 8-year-old Nigerian boy with NS and active hepatitis B virus infection. He went into remission 3 months after commencing oral lamivudine which he had for a year with no significant side effects observed. He remains in remission 3 years later. This, to our knowledge is the first report in literature of successful treatment in an African child.
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Affiliation(s)
- Taiwo A Ladapo
- Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria.
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Obienu O, Nwokediuko S, Malu A, Lesi OA. Risk factors for hepatitis C virus transmission obscure in nigerian patients. Gastroenterol Res Pract 2011; 2011:939673. [PMID: 21785583 PMCID: PMC3139196 DOI: 10.1155/2011/939673] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 05/23/2011] [Indexed: 01/08/2023] Open
Abstract
Aim. To determine the prevalence of anti-HCV and risk factors associated with HCV infection in Nigerians. Materials and Method. Patients attending a general outpatient clinic were administered a structured questionnaire on the risk factors for HCV infection. They were also tested for anti-HCV using a third generation enzyme-linked immunosorbent assay. Result. The seroprevalence of anti-HCV was 4.7%. Among the risk factors evaluated, none was found to be significantly associated with anti-HCV seropositivity. Conclusion. The risk factors associated with HCV infection in Nigerian patients are obscure. This warrants further studies on the epidemiology of this important cause of liver disease.
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Affiliation(s)
- Olive Obienu
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, PMB 01129 Enugu, Nigeria
| | - Sylvester Nwokediuko
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, PMB 01129 Enugu, Nigeria
| | - Abraham Malu
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
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Umoh NJ, Lesi OA, Mendy M, Bah E, Akano A, Whittle H, Hainaut P, Kirk GD. Aetiological differences in demographical, clinical and pathological characteristics of hepatocellular carcinoma in The Gambia. Liver Int 2011; 31:215-21. [PMID: 21143369 DOI: 10.1111/j.1478-3231.2010.02418.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, with a high burden in West Africa. Data evaluating aetiological differences in HCC presentation from this region are limited. AIMS The aim of this study was to describe the demographical, clinical and pathological characteristics of HCC by aetiology (hepatitis B or C infection, aflatoxin associated). METHODS One hundred and ninty-three cases of HCC diagnosed between 1997 and 2001 in The Gambia were analysed. Characteristics were compared by aetiology using χ(2)-tests, student t-test and Wilcoxon's rank sum tests as appropriate. RESULTS The prevalence of hepatitis B surface antigen, hepatitis C antibody and aflatoxin-associated 249(ser) TP53 mutations among HCC patients was 60, 20 and 38% respectively. The typical HCC patient was a 49-year-old male positive for hepatitis B surface antigen presenting with hepatomegaly (93%), abdominal pain (94%) and weight loss (95%) 8 weeks after symptom onset. Most patients had multifocal lesions with background cirrhosis. The median largest tumour was 10.3 cm and the median α-fetoprotein level was 500 ng/ml. Eighty-four per cent of patients had advanced HCC (patients not meeting the Milan criteria) at presentation. CONCLUSIONS Irrespective of aetiological agent, HCC among West Africans presents at very advanced stages. Few clinical or pathological differences exist by aetiology. More studies are needed to understand the mechanisms of hepatocarcinogenesis among these patients as well as identify high-risk populations in which early detection through screening will be beneficial.
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Affiliation(s)
- Nsikak J Umoh
- Department of Surgery, Geisinger Medical Center, Danville, PA 17822, USA.
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Smith SI, Oyedeji KS, Goodluck HA, Fowora MA, Anomneze E, Lesi OA. The use of Helicobacter pylori stool antigen test for the diagnosis of Helicobacter pylori in Lagos, Nigeria. W INDIAN MED J 2011; 60:33-35. [PMID: 21809708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES This study was carried out to screen the use of Helicobacter pylori stool antigen (HpSA) tests for diagnosis and monitoring of H pylori in Nigeria. METHODS Seven hundred and forty participants were enrolled after informed consent was obtained, while 83 came back for a post-eradication test. The stool samples were taken from the patients at endoscopy and tested for HpSA. RESULTS The proportion of patients that were positive at the pretest, 520 (70.3%) was significantly higher (Fisher's exact p = 0.001) than those positive at the post-test, 44 (53%). There was a significant difference (F = 4.106, p = 0.043) between the mean age of those that came for the pretest (40.0 +/- 14.5 years) and those that came for the post-test, 43.6 +/- 11.6 years. More males than females had the tendency to come back for a post-eradication test. CONCLUSION Although potential bias was introduced during this study, HpSA using monoclonal antibody could still be used for diagnosis and monitoring of H pylori in Nigeria.
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Affiliation(s)
- S I Smith
- Molecular Biology and Biotechnology Division, Nigerian Institute of Medical Research, PMB 2013, Yaba, Logos, Nigeria.
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Mendy ME, Welzel T, Lesi OA, Hainaut P, Hall AJ, Kuniholm MH, McConkey S, Goedert JJ, Kaye S, Rowland-Jones S, Whittle H, Kirk GD. Hepatitis B viral load and risk for liver cirrhosis and hepatocellular carcinoma in The Gambia, West Africa. J Viral Hepat 2010; 17:115-22. [PMID: 19874478 PMCID: PMC2817443 DOI: 10.1111/j.1365-2893.2009.01168.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The main objectives of this study were to define the occurrence and levels of hepatitis B virus (HBV) DNA in asymptomatic HBV carriers, cirrhosis patients and hepatocellular carcinoma (HCC) cases from The Gambia, and to evaluate the risk for cirrhosis or HCC associated with HBV viremia. We used sensitive real-time quantitative PCR assays to measure HBV DNA in samples from a case-control study consisting of 60 asymptomatic HBV carriers, 53 cirrhotic patients and 129 HCC cases. Logistic regression was used to estimate the risks of cirrhosis and HCC associated with HBV-DNA levels and HBV e antigenemia (HBeAg) detection (a surrogate marker for viral replication). Detectable HBV viremia and HBeAg positivity were both significantly associated with cirrhosis (increasing risk by fourfold and 11-fold respectively) and with HCC (increasing risk by sixfold and threefold respectively). HBV-DNA levels were significantly higher in both HCC cases and cirrhotic patients compared to asymptomatic carriers (P < 0.01 for both). High-level HBV DNA (>10,000 copies/mL) was strongly associated with both HCC and cirrhosis (17- and 39-fold increased risk). Lower level HBV viremia (200-10,000 copies/mL) conferred a significant risk of HCC, although the association with cirrhosis was not significant. In conclusion, we find that high HBV-DNA levels are strongly associated with the serious sequelae of HBV infection, independent of HBeAg status. While risk for cirrhosis and for HCC notably increases at HBV-DNA levels >or=10,000 copies/mL, low-level viremia was also associated with significant risk for HCC.
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Affiliation(s)
- M E Mendy
- Viral Diseases Programe, Medical Research CouncilBanjul, The Gambia
| | - T Welzel
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteRockville, MD, USA
| | - O A Lesi
- Lagos University Teaching HospitalLagos, Nigeria
| | - P Hainaut
- International Agency for Research on CancerLyon, France
| | - A J Hall
- London School of Hygiene and Tropical MedicineLondon; England
| | - M H Kuniholm
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthBaltimore, MD, USA
| | - S McConkey
- Royal College of Surgeons in IrelandDublin, Ireland
| | - J J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteRockville, MD, USA
| | - S Kaye
- Imperial CollegeLondon, UK
| | - S Rowland-Jones
- Viral Diseases Programe, Medical Research CouncilBanjul, The Gambia
| | - H Whittle
- Viral Diseases Programe, Medical Research CouncilBanjul, The Gambia
| | - G D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthBaltimore, MD, USA
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Lesi OA, Soyebi KS, Eboh CN. Fatty liver and hyperlipidemia in a cohort of HIV-positive Africans on highly active antiretroviral therapy. J Natl Med Assoc 2009; 101:151-5. [PMID: 19378632 DOI: 10.1016/s0027-9684(15)30828-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM To determine the prevalence of fatty liver and to assess its association with hyperlipidemia and other metabolic risk factors in HIV/AIDS patients on long-term antiretroviral therapy. METHODS A prospective cross-sectional study of 113 adults attending an urban outpatient HIV clinic in Lagos, Nigeria. Demographic characteristics were obtained using interviewer administered questionnaires, and serum levels of fasting glucose, total cholesterol, high-density lipoprotein (HDL-C) and low-density lipoprotein cholesterol (LDL-C), and alanine transaminase were determined. Ultrasound scan imaging was used to identify hepatic steatosis. RESULTS One hundred thirteen subjects, mean age (SD), 38.7 (9.9) years on highly active antiretroviral therapy (HAART) therapy for 6 to 42 months were evaluated. Sixty-six (58.4%) were female and 47 (41.6) were male. Fifteen (13.3%) had hepatic steatosis. Total cholesterol > 200 mg/dL, LDL-C > 130 mg/dL, and fasting serum triglycerides > 150 mg/dL were seen in 28%, 24% and 35%, respectively. The presence of fatty liver was significantly associated with hepatomegaly (p = .03) and elevated LDL-C (p = .01). CONCLUSION The prevalence of hepatic steatosis is lower than reported in Caucasian populations, but strongly associated with hepatomegaly and hyperlipidemia in subjects on long-term HAART. Early recognition of fatty liver and regular screening for lipid are warranted in Africans receiving long-term HAART.
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Affiliation(s)
- Olufunmilayo A Lesi
- Department of Medicine, University of Lagos Teaching Hospital, PMB 12003, Idi-Araba, Lagos, Nigeria.
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Lesi OA, Orenuga OO, Roberts A, Abudu OO. Research productivity of junior academic staff at a tertiary medical college in south west, Nigeria. Nig Q J Hosp Med 2009; 19:119-124. [PMID: 20836313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND The research productivity of medical faculty has been well studied in developed countries, unlike in the developing countries. OBJECTIVES This study proposes to assess the level of research productivity over a 2 year period and identify the challenges to conducting research among junior academic staff of the College of Medicine, University of Lagos. METHODS An observational cross-sectional study in which the 120 junior academic staff from both basic sciences and clinical sciences were evaluated between January and September 2005. Data collection was by self-administered questionnaires distributed to the study population. RESULTS There were 83 (69.1%) respondents comprising 38 males (45.6%) and 45 females (54.2%). The median age group was 31-40 years. Most respondents (57, 83%) spent less than 10 hours/week on research. On average they had completed 3-4 scholarly articles within the past 2 years. Nineteen (21.7%) of the subjects were considered to have optimal research productivity having completed over 5 scholarly research papers. The lecturers with optimal research productivity were significantly more likely to be male, and spent over 10 hours a week in hospital related clinical and laboratory related activities. (p = 0.02, and p = 0.03). Inadequate funding and laboratory facilities, and poor technological infrastructure were the most common causes of impediments to research reported by 78%, 69% and 55% of the lecturers respectively. CONCLUSION Optimal research productivity was seen in about one quarter of the study population and was associated with male gender and prolonged duration of clinical/laboratory activities. Negligible research financing and poor laboratory support were major impediments to research productivity.
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Affiliation(s)
- O A Lesi
- Department of Medicine, College of Medicine, University of Lagos, PMB 12003, Idi-Araba, Lagos
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Igetei R, Otegbayo JA, Ndububa DA, Lesi OA, Anumudu CI, Hainaut P, Gormally E. Detection of p53 codon 249 mutation in Nigerian patients with hepatocellular carcinoma using a novel evaluation of cell-free DNA. Ann Hepatol 2009; 7:339-44. [PMID: 19034233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This case-control study was done to determine the association and prevalence of p53 codon 249 mutation using cell-free DNA in the plasma of patients with hepatocellular carcinoma (HCC) in South-Western Nigeria. METHOD Eighty-five adults with HCC and seventy-seven age and gender matched controls without evidence of liver disease or malignancy involving any part of the body, were recruited. Plasma DNA was analyzed for p53 codon 249 by restriction fragment length polymorphism. Patient evaluation was done by means questionnaire interview, clinical examination, laboratory and radiological tests. The prevalence of the p53 codon 249 mutation was expressed as a percentage amplifiable DNA samples analyzed from HCC patients while that of controls was expressed in the same way. Fisher's exact test or the student t-test where appropriate were used to assess statistical significance of prevalence between both groups as well as comparison of some characteristics in the HCC cases between those who had codon 249 mutation and those who did not. Associations between the various parameters assessed were determined by odds ratio and significant difference was specified at p < 0.05. RESULTS p53 codon 249 mutation was present in 6 (7.6%) of the 79 samples from the HCC patients with amplifiable plasma DNA while none (i.e. 0%) of the 73 samples with amplifiable plasma DNA from the controls had this mutation. This prevalence is significantly higher among HCC patients than controls (0.029). The mutation was also found to be significantly associated with HCC (odds ratio = 2.00; 95% C I: 1.70 - 2.35). CONCLUSION The prevalence of the p53 codon 249 mutation from plasma DNA of hepatocellular carcinoma patients is significantly higher than among controls in South-Western Nigeria and the presence of this mutation is significantly associated with HCC in this region.
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Affiliation(s)
- Rufina Igetei
- Department of Medicine, University College Hospital, Ibadan.
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Kuniholm MH, Lesi OA, Mendy M, Akano AO, Sam O, Hall AJ, Whittle H, Bah E, Goedert JJ, Hainaut P, Kirk GD. Aflatoxin exposure and viral hepatitis in the etiology of liver cirrhosis in the Gambia, West Africa. Environ Health Perspect 2008; 116:1553-7. [PMID: 19057710 PMCID: PMC2592277 DOI: 10.1289/ehp.11661] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 07/10/2008] [Indexed: 05/09/2023]
Abstract
BACKGROUND Cirrhosis of the liver is thought to be a major cause of morbidity and mortality in sub-Saharan Africa, but few controlled studies on the etiology of cirrhosis have been conducted in this region. OBJECTIVES We aimed to elucidate the association between environmental and infectious exposures and cirrhosis in The Gambia. METHODS Ninety-seven individuals were diagnosed with cirrhosis using a validated ultrasound scoring system and were compared with 397 controls. Participants reported demographic and food frequency information. Blood samples were tested for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), hepatitis C virus (HCV) antibody, HCV RNA, and the aflatoxin-associated 249(ser) TP53 mutation. RESULTS HBsAg seropositivity was associated with a significant increase in risk of cirrhosis [odds ratio (OR) = 8.0; 95% confidence interval (CI), 4.4-14.7] as was the presence of HBeAg (OR = 10.3; 95% CI, 2.0-53.9) and HCV infection (OR = 3.3; 95% CI, 1.2-9.5). We present novel data that exposure to aflatoxin, as assessed both by high lifetime groundnut (peanut) intake and by the presence of the 249(ser) TP53 mutation in plasma, is associated with a significant increase in the risk for cirrhosis (OR = 2.8; 95% CI, 1.1-7.7 and OR = 3.8; 95% CI, 1.5-9.6, respectively). Additionally, aflatoxin and hepatitis B virus exposure appeared to interact synergistically to substantially increase the risk of cirrhosis, although this was not statistically significant. CONCLUSIONS Our results suggest that the spectrum of morbidity associated with aflatoxin exposure could include cirrhosis.
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Affiliation(s)
- Mark H. Kuniholm
- Infectious Disease Program, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olufunmilayo A. Lesi
- International Agency for Research on Cancer, Gambia Hepatitis Intervention Study, Banjul, The Gambia
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Maimuna Mendy
- Medical Research Council Laboratories, Banjul, The Gambia
| | - Aliu O. Akano
- Department of Medical Services, Royal Victoria Teaching Hospital, Government of The Gambia, Banjul, The Gambia
- Department of Radiodiagnosis, National Hospital, Abuja, Nigeria
| | - Omar Sam
- Department of Medical Services, Royal Victoria Teaching Hospital, Government of The Gambia, Banjul, The Gambia
| | - Andrew J. Hall
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hilton Whittle
- Medical Research Council Laboratories, Banjul, The Gambia
| | - Ebrima Bah
- International Agency for Research on Cancer, Gambia Hepatitis Intervention Study, Banjul, The Gambia
| | - James J. Goedert
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Pierre Hainaut
- International Agency for Research on Cancer, Gambia Hepatitis Intervention Study, Lyon, France
| | - Gregory D. Kirk
- Infectious Disease Program, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Address correspondence to G.D. Kirk, 615 N. Wolfe St., E-6533, Baltimore, MD 21205 USA. Telephone: (410) 502-2038. Fax: (410) 955-1383. E-mail:
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Lesi OA, Kehinde MO, Oguh DN, Amira CO. Hepatitis B and C virus infection in Nigerian patients with HIV/AIDS. Niger Postgrad Med J 2007; 14:129-33. [PMID: 17599111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVES This study was designed to assess the prevalence of HBV and HCV infection in HIV patients and evaluate the risk of infection compared with HIV negative control subjects. METHOD This is a prospective case control study in which 240 HIV/AIDS patients and age and sex matched controls were evaluated. The diagnosis of HIV infection was based on a positive HIV screening test using Capillus test kits (Trinity Biotech PLC, Ireland) and confirmed using Western blot assay. HBsAg and anti-HCV were assayed by commercially available chromatographic immunoassay (SD BIOLINE). RESULTS Eleven (9.2%) of the 120 HIV/AIDS patients and 8 (7%) of the 120 control subjects were positive for the HBsAg (OR=1, p=0.27). HBeAg was detected in 3 of the 11 (27.3%) subjects with HIV/HBV co infections. HIV positive patients were 7 times more likely to have HCV infection than control patients (5.8% compared with 0.8%, OR=7.3, p= 0.03). CONCLUSION The lack of a strong association between HBV and HIV infection may be related to different exposure routes in this population where HBV infection is highly endemic and childhood infection almost universal. In this African population, HIV infection may be a super-infection of HBV infections contracted in childhood. This high HCV/HIV co-infection rate is consistent with the shared parenteral and sexual routes of transmission.
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Affiliation(s)
- O A Lesi
- Department of Medicine, College of Medicine, University of Lagos , PMB 12003, Idi Araba, Lagos
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Lleonart ME, Kirk GD, Villar S, Lesi OA, Dasgupta A, Goedert JJ, Mendy M, Hollstein MC, Montesano R, Groopman JD, Hainaut P, Friesen MD. Quantitative analysis of plasma TP53 249Ser-mutated DNA by electrospray ionization mass spectrometry. Cancer Epidemiol Biomarkers Prev 2006; 14:2956-62. [PMID: 16365016 DOI: 10.1158/1055-9965.epi-05-0612] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A mutation in codon 249 of the TP53 gene (249(Ser)), related to aflatoxin B(1) exposure, has previously been associated with hepatocellular carcinoma risk. Using a novel internal standard plasmid, plasma concentrations of 249(Ser)-mutated DNA were quantified by electrospray ionization mass spectrometry in 89 hepatocellular carcinoma cases, 42 cirrhotic patients, and 131 nonliver diseased control subjects, all from highly aflatoxin-exposed regions of The Gambia. The hepatocellular carcinoma cases had higher median plasma concentrations of 249(Ser) (2,800 copies/mL; interquartile range: 500-11,000) compared with either cirrhotic (500 copies/mL; interquartile range: 500-2,600) or control subjects (500 copies/mL; interquartile range: 500-2,000; P < 0.05). About half (52%) of the hepatocellular carcinoma cases had >2,500 copies of 249(Ser)/mL plasma, corresponding to the prevalence of this mutation in liver tumors in The Gambia. In comparison, only 15% of control group and 26% of cirrhotic participants exceeded this level (P < 0.05). Further subset analysis revealed a statistically significant, quantitative relation between diagnosis of hepatocellular carcinoma and levels of 249(Ser) detected at 2,501 to 10,000 copies/mL plasma (odds ratio, 3.8; 95% confidence interval, 1.3-10.9) and at >10,000 copies/mL plasma (odds ratio, 62; 95% confidence interval, 4.7-820) when compared with control subjects and after adjusting for age, gender, recruitment site, hepatitis B and C serologic status, and total DNA concentration. Levels of >10,000 copies of 249(Ser)/mL plasma were also significantly associated with the diagnosis of hepatocellular carcinoma (odds ratio, 15; 95% confidence interval, 1.6-140) when compared with cirrhotic patients. Potential applications for the quantification of 249(Ser) DNA in plasma include estimation of long-term, cumulative aflatoxin exposure and selection of appropriate high-risk individuals for targeted intervention.
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Affiliation(s)
- Matilde E Lleonart
- Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health Sciences, 615 North Wolfe Street, Room E7032, Baltimore, MD 21205, USA.
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Mendy M, Kirk GD, van der Sande M, Jeng-Barry A, Lesi OA, Hainaut P, Sam O, McConkey S, Whittle H. Hepatitis B surface antigenaemia and alpha-foetoprotein detection from dried blood spots: applications to field-based studies and to clinical care in hepatitis B virus endemic areas. J Viral Hepat 2005; 12:642-7. [PMID: 16255766 DOI: 10.1111/j.1365-2893.2005.00641.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In many resource-limited regions with endemic hepatitis B virus (HBV), there is limited infrastructure to collect, process, transport, and store blood samples for identification of persons with chronic HBV infection or with hepatocellular carcinoma (HCC). We describe the application of a simple technique using commercially available kits for detection of HBV surface antigen (HBsAg) and alpha-foetoprotein (AFP) in dried blood spots (DBS) collected on filter paper. Study participants included subjects with and without chronic HBV infection and subjects with HCC or cirrhosis. Three to five blood drops were dried on filter paper. Dried blood (equivalent to 20 muL) was eluted and tested for HBsAg by Determine(TM) HBsAg and for AFP by counter-current immuno-electrophoresis and radio-immunoassay (RIA). The primary analysis focused on comparison of DBS results to serum testing results as the gold standard. The sensitivity of DBS for detecting chronic HBV infection was 96% (98-98) with specificity of 100% (CI 99-100). Sensitivity of DBS in detecting AFP compared with serum RIA was 73% (60-86) with specificity of 90% (81-98). Both HBsAg and AFP recovery were unaffected when DBS were left at room temperature (30-33 degrees C) and under humid conditions for up to 28 days prior to elution. We conclude that DBS can be reliably used as an economical and logical alternative for detection of HBsAg in chronically infected patients and for AFP-based diagnosis of HCC in clinical situations which preclude adequate collection and processing of blood samples. Both research-oriented field studies and routine clinical care may benefit from application of these techniques in resource-limited settings.
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Affiliation(s)
- M Mendy
- Medical Research Council Fajara, Banjul, The Gambia, West Africa.
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Kirk GD, Lesi OA, Mendy M, Szymañska K, Whittle H, Goedert JJ, Hainaut P, Montesano R. 249(ser) TP53 mutation in plasma DNA, hepatitis B viral infection, and risk of hepatocellular carcinoma. Oncogene 2005; 24:5858-67. [PMID: 16007211 DOI: 10.1038/sj.onc.1208732] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hepatocellular carcinoma (HCC) from regions with high dietary exposure to aflatoxins and endemic for hepatitis B virus (HBV) often contain a specific mutation at codon 249 in TP53 (249(ser); AGG to AGT, Arg to Ser). This mutation is also detectable in circulating cell-free DNA from the plasma of HCC patients and healthy subjects in these regions. We have examined the joint effect of plasma 249(ser) and HBV infection in a case-control study design involving 348 control, 98 cirrhotic, and 186 HCC participants from The Gambia, West Africa, an area of high HCC incidence. The 249(ser) mutation was detected in 3.5% of controls, 15.3% of cirrhotics, and 39.8% of HCC cases (adjusted odds ratios (OR): 4.83, (95% confidence interval (CI): 1.71-13.7) for cirrhosis and 20.3 (8.19-50.0) for HCC). HBsAg positivity along with plasma 249(ser) was observed in 45/183 (24.6%) HCC cases compared to only one (0.3%) control. Risk for HCC was associated with markers of HBV alone (OR: 10.0, 95% CI: 5.16-19.6), 249(ser) alone (OR: 13.2, 95% CI: 4.99-35.0), and both markers present (OR: 399, 95% CI: 48.6-3270). These results suggest a multiplicative effect on HCC risk resulting from the mutational effect of aflatoxin on TP53, as monitored by detection of plasma 249(ser), with concomitant chronic infection with HBV.
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Kirk GD, Turner PC, Gong Y, Lesi OA, Mendy M, Goedert JJ, Hall AJ, Whittle H, Hainaut P, Montesano R, Wild CP. Hepatocellular carcinoma and polymorphisms in carcinogen-metabolizing and DNA repair enzymes in a population with aflatoxin exposure and hepatitis B virus endemicity. Cancer Epidemiol Biomarkers Prev 2005; 14:373-9. [PMID: 15734960 DOI: 10.1158/1055-9965.epi-04-0161] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
High rates of hepatocellular carcinoma (HCC) in The Gambia, West Africa, are primarily due to a high prevalence of chronic hepatitis B virus infection and heavy aflatoxin exposure via groundnut consumption. We investigated genetic polymorphisms in carcinogen-metabolizing (GSTM1, GSTT1, HYL1*2) and DNA repair (XRCC1) enzymes in a hospital-based case-control study. Incident HCC cases (n = 216) were compared with frequency-matched controls (n = 408) with no clinically apparent liver disease. Although the prevalence of variant genotypes was generally low, in multivariable analysis (adjusting for demographic factors, hepatitis B virus, hepatitis C virus, and TP53 status), the GSTM1-null genotype [odds ratio (OR), 2.45; 95% confidence interval (95% CI), 1.21-4.95] and the heterozygote XRCC1-399 AG genotype (OR, 3.18; 95% CI, 1.35-7.51) were significantly associated with HCC. A weak association of the HYL1*2 polymorphism with HCC was observed but did not reach statistical significance. GSTT1 was not associated with HCC. The risk for HCC with null GSTM1 was most prominent among those with the highest groundnut consumption (OR, 4.67; 95% CI, 1.45-15.1) and was not evident among those with less than the mean groundnut intake (OR, 0.64; 95% CI, 0.20-2.02). Among participants who had all three suspected aflatoxin-related high-risk genotypes [GSTM1 null, HLY1*2 (HY/HH), and XRCC1 (AG/GG)], a significant 15-fold increased risk of HCC was observed albeit with imprecise estimates (OR, 14.7; 95% CI, 1.27-169). Our findings suggest that genetic modulation of carcinogen metabolism and DNA repair can alter susceptibility to HCC and that these effects may be modified by environmental factors.
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Affiliation(s)
- Gregory D Kirk
- Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH/Department of Health and Human Services, Bethesda, MD 20892, USA.
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Szymańska K, Lesi OA, Kirk GD, Sam O, Taniere P, Scoazec JY, Mendy M, Friesen MD, Whittle H, Montesano R, Hainaut P. Ser-249TP53 mutation in tumour and plasma DNA of hepatocellular carcinoma patients from a high incidence area in the Gambia, West Africa. Int J Cancer 2004; 110:374-9. [PMID: 15095302 DOI: 10.1002/ijc.20103] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hepatocellular carcinoma (HCC) is frequent in areas of high exposure to aflatoxin and high prevalence of HBV infection, such as western Africa and south-east China. A selective mutation in TP53 (AGG-->AGT at codon 249, Arg-->Ser) has been identified as a hotspot in HCCs from such areas, reflecting DNA damage caused by aflatoxin metabolites. Recent studies have shown that circulating free DNA can be retrieved from human plasma, and it is hypothesised that plasma DNA may serve as a source for biomarkers of tumorigenic processes. In our study, we have determined the prevalence of Ser-249 mutation, using a PCR-restriction digestion method, with selective use of short oligonucleotide mass spectrometry analysis (SOMA), in a series of 29 biopsy specimens of HCC from The Gambia in West Africa. Overall, we identified the Ser-249 mutation in 35% (10/29) of the tumours. In parallel, we tested 17 plasma samples from HCC patients with matching tumour tissue. The 249 status concordance between tumour tissues and matched plasma was 88.5%. These results indicate that the Ser-249 mutation is common in HCC in The Gambia (35%), although a higher prevalence has been reported in other regions with high population exposure to aflatoxin (e.g., eastern China: >50%). Moreover, our studies indicate that plasma is a convenient source of liver tumour-derived DNA, thus holding promise for earlier detection and diagnosis of cancer.
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Affiliation(s)
- Katarzyna Szymańska
- International Agency for Research on Cancer and Gambia Hepatitis Intervention Study, Lyon, France
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Lesi OA, Kehinde MO, Anomneze EE. Chronic liver disease in Lagos: a clinicopathological study. Niger Postgrad Med J 2004; 11:91-6. [PMID: 15300268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To evaluate the clinical features and stage of chronic liver disease at presentation in Lagos. METHODS Clinical features, hepatic functional reserve (Child-Pugh classification) and liver histopathology were evaluated in 74 patients with chronic liver disease (CLD). RESULTS The average age of the patients was 44.1 +/- 14yr and most (57, 67% ) were male. Ascites, hepatomegaly and jaundice were noted in 66%, 51%, 47% respectively. Hepatocellular carcinoma, liver cirrhosis and chronic hepatitis were seen in 35, 29, and 10 patients respectively. Significant impairment of hepatic functional reserve was noted in most of the patients with liver cirrhosis (76% ) and carcinoma (68% ). Hepatitis B and C infections were identified in 58% and 12% of the patients respectively. CONCLUSION The majority of clinically identified patients with CLD had severe impairment of hepatic function with underlying advanced liver cirrhosis or hepatocellular carcinoma at presentation. Viral hepatitis was associated with most CLD and thus is potentially preventable and treatable when detected early. Public enlightenment programmes on hepatitis, widespread implementation of HBV vaccination, and surveillance of individual at-risk are essential for the control of hepatitis infection and the early detection of compensated CLD.
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Affiliation(s)
- O A Lesi
- Department of Medicine, Lagos University Teaching Hospital
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Kirk GD, Lesi OA, Mendy M, Akano AO, Sam O, Goedert JJ, Hainaut P, Hall AJ, Whittle H, Montesano R. The Gambia Liver Cancer Study: Infection with hepatitis B and C and the risk of hepatocellular carcinoma in West Africa. Hepatology 2004; 39:211-9. [PMID: 14752840 DOI: 10.1002/hep.20027] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hepatocellular carcinoma (HCC) is the most common cancer in The Gambia. Hepatitis B virus (HBV) infection is endemic, with 15% to 20% of the population being chronic carriers, whereas hepatitis C virus (HCV) prevalence is low. We recruited 216 incident cases of HCC and 408 controls from three sites. HBV carriage was present in 61% (129/211) of HCC patients and 16% (64/402) of controls, whereas 19% (36/191) of HCC patients were HCV seropositive compared with 3% (11/382) of controls. HCC patients with HCV were notably older and were more likely to be female than those with HBV. Increased HCC risk was strongly associated with chronic HBV (odds ratio, 16.7; 95% CI, 9.7-28.7), HCV (16.7; 6.9-40.1), and dual infection (35.3; 3.9-323). We interpret the additive nature of risk with coinfection as representative of HBV and HCV acting primarily through shared steps in the multistage process of hepatocarcinogenesis. HCV infection was not observed among younger participants, suggesting a possible cohort effect. Reasons for the striking age and gender differences in HCC associated with HBV compared with HCV are unclear, but transmission patterns and age at exposure may be factors. In conclusion, in a standardized evaluation of well-characterized study participants from The Gambia, most cases of HCC are attributable to HBV (57%), but HCV adds a significant fraction (20%), especially among older patients and females. If HCV transmission is not perpetuated in future cohorts, focusing available resources on HB vaccination efforts could greatly ameliorate a major cause of cancer death in sub-Saharan Africa.
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Affiliation(s)
- Gregory D Kirk
- Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Lesi OA, Kehinde MO. Hepatitis C virus infection in patients with sickle cell anaemia at the Lagos University Hospital. Niger Postgrad Med J 2003; 10:79-83. [PMID: 14567040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The objective of this studies is to determine the frequency of antibodies to Hepatitis C virus (anti-HCV), (2) assess the role of blood transfusion in transmission of infection, and (3) evaluate the clinical implication of anti-HCV sero-positivity in patients with Sickle cell anaemia (SCA). Two hundred and seventy-eight (278) patients with SCA were evaluated by questionnaire interviews for risk factors, clinical examination and serum testing for anti-HCV using a third generation ELISA kit. The overall anti-HCV prevalence was 5.0% (14/278). Anti-HCV was positive in 7% (5/76) of never transfused compared with 5% (9/202) of previously transfused sicklers. (p = 0.5). Clinically, splenomegaly alone or in combination with hepatomegaly was associated with a positive anti-HCV (p = 0.04 and 0.01 respectively). Anti-HCV was detected in 5% of adult patients with Sickle cell anaemia, especially in patients with persistent splenomegaly alone or in combination with hepatomegaly. Blood transfusion did not appear to be the major route of HCV transmission.
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Affiliation(s)
- O A Lesi
- Department of Medicine, Lagos University Teaching Hospital, P.M.B. 12003, Idi-Araba, Lagos, Nigeria
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Marshall JK, Lesi OA, Hunt RH. Obscure gastrointestinal bleeding: an approach to management. Can J Gastroenterol 2000; 14:111-8. [PMID: 10694283 DOI: 10.1155/2000/843704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Obscure gastrointestinal bleeding provides an uncommon but frustrating and resource-intensive challenge for clinicians. Such patients hemorrhage recurrently from sites within the gastrointestinal tract that are not detected by routine endoscopy or radiography, and require a special diagnostic approach to localize or exclude less common bleeding sources such as small bowel angioectasia or neoplasia. The differential diagnosis of obscure gastrointestinal hemorrhage is discussed, and the performance of available endoscopic, radiological and surgical diagnostic tools including enteroscopy are examined critically. A stepwise management algorithm that progresses from the history and physical examination to surgical exploration is offered to facilitate early and efficient diagnosis.
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Affiliation(s)
- J K Marshall
- Department of Medicine, and Intestinal Disease Research Programme, McMaster University, Hamilton, Ontario, Canada.
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