Background: Advanced HIV disease (AHD) represents a stage of HIV infection characterized by severe immunosuppression and a high risk of mortality. An understanding of the burden and associated risk factors for AHD is important in order to design programs targeted at prevention and treatment with the aim of reducing HIV associated morbidity and mortality. This study set out to determine the prevalence and risk factors for AHD in a tertiary health facility in Southern Nigeria as well as to ascertain the frequency of Same day initiation of Highly Active Antiviral Therapy in AHD patients. Methodology: This was a retrospective cross-sectional review of data from 419 adults and children diagnosed with AHD seen at the antiretroviral therapy clinic and Emergency department of the Rivers State University Teaching Hospital (RSUTH) over a 1year period. Details including personal bio-data and clinical information were obtained from the HIV registry of the hospital. Results: Four hundred and nineteen (419) patients were diagnosed with Advanced HIV disease between January 2021- January 2022 with a mean age of 35.8 years. Regarding the co-factors, Sixty- four (29.4%) of the 218 persons tested were positive for tuberculosis while 18(9.2%) of the 196 patients tested for cryptococcus infection were positive.  One hundred and forty-eight (148) of the AHD population had CD4 cell count of <200cells comprising 144 (97%) adults and 4(3%) children. AHD, defined by a CD4 count of <200 cells was more prevalent within the age bracket of 40-49years (n=51, 34%) and among females [F:M 81 (55%) vs 67 (45%)]. Majority of the patients presented with WHO stage 3 disease (n=64, 43.2%) closely followed by stage 2 disease (n=47, 31.79%). Stage 4 disease was found in only 2.02%. The overall same day initiation (SDI) of AHD patients was 97% (n=144). Conclusion: Advanced HIV disease is highly prevalent despite the test and treat approach to care. Interventions aimed at prevention, adherence to therapy as well as early recognition and treatment is paramount in reducing the burden of AHD.

Background: Viral hepatitis C (HCV) is a global health challenge affecting at least 3.3% of the world population. Sub-Saharan Africa still battles with under diagnosis,  and poor access to diagnostic facilities occasioned by a lack of manpower/facilities to treat infected persons bringing about an increase in HCV-associated morbidity and mortality.  The goal of this prospective observational study is to assess the efficacy of sofosbuvir/daclatasvir (SOF/DAC) combination as a pangenotypic treatment for hepatitis C without HCV genotype determination in patients with hepatitis C attending the hepatology clinic at the Rivers State University Teaching Hospital (RSUTH). Method: One hundred and fifty (150) HCV RNA positive patients were enrolled into the study. Their sociodermographic factors, clinical and laboratory parameters including pre and post treatment HCV RNA were assessed. Treatment eligible patients received sofosbuvir 400mg and daclatasvir 60/90mg for 12 weeks which was extended to 24 weeks in patients with decompensated liver disease. Treatment success was defined as undetectable HCV RNA 12 weeks after completion of therapy (SVR-12). Results: One hundred and nine (109) of the 150 recruited patients were eligible for treatment. The male to female ratio of the study population was 1.1:1(79, 52.7%):71,49.3%) with a mean age of 47.78±13.39 years. Eighty-six (86,78.9%) of the 109 treated patients had undetectable HCV RNA at SVR-12 and this was most likely to occur in patients with low viremia (OR=2.52, 95%CI=0.985-6.436, p=0.050). Extension of treatment duration played no apparent role in the achievement of SVR-12 (SVR-12=33.3%), however, previously treated HCV patients had a better outcome. Conclusion: Sofosbuvir/ daclatasvir pangenotypic therapy is effective for treatment of HCV patients without genotyping.

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Background: The Human immunodeficiency disease (HIV) remains a global menace decades after its discovery and despite advances in therapeutics and use of Highly active antiviral therapies (HAART). HIV/AIDS patients now have longer lifespan with increased non-AIDS related morbidity and mortality. Non-alcoholic fatty liver diseases (NAFLD), a global public health challenge has been identified as one of the leading causes of morbidity and mortality in HIV infected persons. Our study aimed to identify the risk factors for NAFLD in HIV infected patients and to relate the liver enzymes derangement to NAFLD. Method: we retrospectively analyzed data from 170 HAART experienced viral hepatitis sero-negative HIV patients. Sociodemographic, anthropometric, and laboratory characteristics were extracted. Hepatic steatosis was diagnosed by ultrasound scan. Result: NAFLD was present in 27.9% of the patients and the duration of HAART use (p<0.001), elevated plasma glucose level (p<0.001), increased waist circumference (p=0.004), duration of HIV infection (p=0.026), and elevated serum triglycerides (p=0.033) were identified as the major risk factors for NAFLD. Using the Wald test of variables, duration of HAART use was identified as the key prognosticator of NAFLD in HIV patient [Wald value (WV) of 10.749 (p= 0.001)]. Reduced CD4 cell count and liver enzyme derangement were not identified as risk factors for NAFLD. Conclusion: NAFLD is common in HAART experienced HIV patients and the duration of HAART use is the most important predictor for its occurrence. Early recognition and vigorous modification of these risk factors among HIV patients are necessary to prevent further progression of NAFLD.