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West Afr J Med. 2007 Apr-Jun;26(2):143-7. Links Prevalence of abnormal cervical smears among patients with HIV in Lagos, Nigeria. Anorlu RI, Igwilo CI, Akanmu AS, Banjo AA, Odunukwe NN, Okany CC, Abudu OO, Dim ST. Department of Obstetrics & Gynecology, College of Medicine of the University of Lagos, Nigeria. [email protected] BACKGROUND: There are over four million people living with HIV/AIDS in Nigeria. Cervical cancer is the most common genital cancer in Nigeria. There are many reports on the association of HIV with increased risk of cervical dysplasia. OBJECTIVE: To determine the prevalence of abormal cervical smears in Nigerian women who are HIV positive in Lagos. METHODS: Cervical smears were taken from 233 HIV positive women and 235 HIV negative women who attended the HIV clinic and the family planning clinic respectively of the Lagos University Teaching Hospital during the period January-April 2004. Proportions were compared with the X2 test. RESULTS: Data were complete for analysis in 227 of HIV positive and 228 of HIV negative women. Mean (SD) ages of HIV positive and HIV negative patients were respectively 35.2 (9.81) and 34.5 (7.37) years. Prevalence of squamous intraepithelial lesion (SIL) was higher in those who were HIV positive than in those who were HIV negative, 10.9% vs 4.3% (X2, 7.04; p=0.00798). Prevalence of high grade SIL was higher in HIV positive than HIV negative subjects, 7.9% vs 2.6% (X2, 6.38; p=0.0115). There was no significant difference in the prevalence of inflammatory smears, 15.7% in HIV positive vs 16.2% in HIV negative. CONCLUSION: Prevalence of cervical dysplasia is high in women who harbour HIV. Afr J Med Med Sci. 2006 Dec;35 Suppl:57-70. Related Articles, Links AIDS-associated malignancies. Akanmu AS. Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Nigeria. [email protected] A number of immunodeficiency states--both inherited (such as agammaglobulinaemia, Bloom's syndrome, hereditary telangiectasia) and acquired (e.g. immunosuppressive therapy) have been associated with varieties of cancers. HIV induces more profound immunodeficiency state and it should not be difficult to imaging why cancer diagnosis is made in over 40% of HIV infected patients. Impairment of normal function of natural killer cells as a result of lack of helper signals from CD4+ T-lymphocytes may be a major mechanism of increased susceptibility to cancer development in HIV infected patients. Although many neoplastic diseases could occur at a frequency not higher than would be expected by chance alone, the biological behaviour of such malignancies tend to be more aggressive. Three neoplastic diseases are associated so commonly with HIV infection that each of them has become recognized as an AIDS defining illness. These are Kaposi's Sarcoma (KS), NonHodgkin's Lymphoma (NHL) and Cervical Carcinoma. Both KS and NHL were recognized as AIDS associated cancers from the onset of the epidemic in 1981 but carcinoma of the cervix became AIDS defining in 1993. The epidemiology, aetiopathogenesis, clinical manifestation, diagnostic tools and modalities of therapeutic intervention for KS and NHL form the subject of this review. Publication Types: Review PMID: 18050776 [PubMed - indexed for MEDLINE] 2: Afr J Med Med Sci. 2006 Mar;35(1):5-8. Related Articles, Links Evaluation of a rapid test kit for detection of HBsAg/eAg in whole blood: a possible method for pre-donation testing. Akanmu AS, Esan OA, Adewuyi JO, Davies AO, Okany CC, Olatunji RO, Babalola T. Dept of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Nigeria. In many developing countries where hepatitis B is endemic, positivity rate for HBsAg in donor blood is high, and in some places, up to 20% of donated blood has to be discarded for being HBsAg positive. This degree of wastage may be financially crippling for some developing countries. Pre-donation testing may be useful, so that donors who test HBsAg positive are deferred and wastage of costly blood bags is reduced. The study is to evaluate the suitability of the AMRAD kit, for pre-donation testing for HBsAg. One hundred and one (101) healthy blood donors were screened for HBsAg/eAg using the test kit. The same specimens were screened using Monolisa (ELISA) kits for HBsAg and eAg as the standard. True positive (TrP), False negative (FN), True negative (TrN) and, false positive (FP) values were then found, from which, sensitivity and specificity, were derived. The AMRAD test kit detected 93 specimens as negative and 8 specimens as positive for HBsAg as against 94 negatives (TrN) and 7 positives (TrP) by monolisa. Thus, one false positive (FP) result was found in using the kit while no false negative (FN) occurred. The findings in this preliminary study suggest that AMRAD kit may be a useful predonation screening test for HBsAg. Publication Types: Evaluation Studies PMID: 17209320 [PubMed - indexed for MEDLINE] 3: Niger Postgrad Med J. 2006 Mar;13(1):6-9. Related Articles Seroprevalence of HIV among male prisoners in Lagos State, Nigeria. Dada MO, Akanmu AS, Esan OA. Department of Haematology and Blood Transfusion, College of Medicine, Lagos State University P.M.B21266, Ikeja, Lagos, Nigeria. OBJECTIVE: To determine the seroprevalence of HIV I & II antibodies among prisoners in Lagos State. PATIENTS & METHODS: A total of 300 male prisoners from Kirikiri Maximum and Medium security prisons and Ikoyi prisons had their blood samples screened for antibodies against human immunodeficiency virus (HIV) types I & II by ELISA-based technique using immunocomb II HIV I & II Bispot kits. Samples that were positive were confirmed by another ELISA-based technique using immunocomb I & II combifirm kits. RESULTS: The seroprevalence of HIV antibodies was 6.7, which translated to 20 of the 300 prisoners screened. Only one (0.3) of the prisoners had HIV II infection, the rest being due to HIV I. There was no prisoner with concomitant HIV I & II infection. The age groups 20-29 and 30-39 were most affected. CONCLUSION: The finding of 6.7 as prevalence in this study, which is slightly higher than the national prevalence in the year 2000 confirms that there may be activities in the prisons that increase the risk of acquiring HIV infection. PMID: 16633370 [PubMed - indexed for MEDLINE] 4: Afr J Med Med Sci. 2004 Dec;33(4):335-40. Related Articles, Links Efficacy and safety of enoxaparin, a low molecular weight heparin in the prevention of deep vein thrombosis in Nigerian patients after orthopaedic surgery. Akanmu AS, Nnodu OE, Giwa SO, Salako LA, Akinsete I, Adebule GT, Adekoya-Cole TO, Odunubi OO. Department of Haematology & Blood Transfusion, Lagos University, Teaching Hospital, Lagos, Nigeria. The objective was to determine the efficacy and safety of Enoxaparin as an antithrombotic agent in orthopaedic patients at risk for thromboembolism. 49 patients who had lower limb orthopaedic surgery were studied. They received subcutaneous Enoxaparin 40mg 12 hours before surgery and subsequently, daily for one week. Blood specimens were drawn at 2 and 12 hours after the first injection, and 24 hours after the fourth injection for anti Factor Xa assay. Specimens were also taken preoperatively, 1st, 5th and 7th post operative days (POD) for determination of Packed Cell Volume (PCV), Haemoglobin level, White Blood Cell (WBC) and Platelet Counts. The mean pre-treatment, 2, 12 and 24 hours anti Factor Xa clotting times were 14.5 +/- 0.8, 36.2 +/- 5.6, 30.6 +/- 9.8 and 25.8 +/- 9.3 seconds respectively. The changes were significant, P = 8.2 x 10(-12). The 2 and 24 hours clotting times corresponded to plasma heparin concentration level of 0.12 - 0.22U/ml read off from prepared Enoxaparin standardisation curve. Significant changes were observed in haemoglobin level, PCV, WBC and Platelet Counts when preoperative, 1st, 5th and 7th POD mean values were compared by Analysis of Variance--P < 0.01 in all cases. The study showed that Enoxaparin 40 mg daily caused hypocoagulation within prophylactic range of 0.12 - 0.22U/ml of heparin in the plasma. Changes in blood counts were within the limits expected post surgery. Publication Types: Clinical Trial PMID: 15977441 [PubMed - indexed for MEDLINE] 5: J Trop Pediatr. 2005 Aug;51(4):200-5. Epub 2005 May 25. Related Articles, Links Clinical evaluation of extract of Cajanus cajan (Ciklavit) in sickle cell anaemia. Akinsulie AO, Temiye EO, Akanmu AS, Lesi FE, Whyte CO. Department of Paediatrics, College of Medicine of University of Lagos (CMUL), Nigeria. The major pathology in sickle cell anaemia (SCA) is sickling of red cells due to the precipitation of reduced haemoglobin. We report our experience with extract of Cajanus cajan as a possible antisickling agent by determining changes, if any, in clinical and laboratory features of the disease in patients given the extract in a single-blind placebo-controlled study. One hundred patients with steady-state SCA were randomized into treatment and placebo arms. The extract/placebo were administered twice daily to the subjects. Weight, hepatosplenomegaly, blood levels of biliurubin, urea, creatinine, and packed cell volume (PCV) were monitored over a 6-month period. Recall episodes of pain 6 months before enrolment were compared with episodes of pains recorded during the treatment period. Twenty-six cases (55.3 per cent) had hepatomegaly on enrolment. This significantly reduced to 33.3 per cent at 6 months (p = 0.03); but increased in the placebo arm (p > 0.05). The total number of recall painful episodes in cases was 207 (mean 4.4 +/- 10.3 (SD), range 0-60) and fell to 191 (mean 4.2 +/- 4.4 (SD), range 0-16); p = 0.03. Episodes of pain increased from 109 in controls (mean 2.6 +/- 5.0 (SD), range 0-26) to 164 (mean 3.9 +/- 4.3 (SD), range 0-22); p = 0.01. Mean PCV in the cases showed no appreciable changes (p = 0.1) but there was a significant increase in the controls (p = 0.02). In conclusion, the extract may cause a reduction of painful crises and may ameliorate the adverse effects of sickle cell anaemia on the liver. The mechanism of action remains to be determined. Publication Types: Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't PMID: 15917266 [PubMed - indexed for MEDLINE] 6: Niger Postgrad Med J. 2003 Jun;10(2):71-5. Related Articles HIV seroprevalence in emergency department patients: Lagos University Teaching Hospital, Lagos, 1999. Esan OA, Akanmu AS, Akinsete I. Department of Haematology & Blood Transfusions, Lagos University Teaching Hospital, Idi-Araba, Lagos State. The emergency department patients represent a cross-section of the entire population and values of HIV seroprevalence in them have been used to assess the general trends of HIV surveillance in other countries. The objectives of this study is to determine 1. Whether seroprevalence of HIV antibodies in patients attending emergency departments could serve as a marker of prevalence of HIV antibody in the general population. 2. The degree of clinical suspicion or knowledge of the medical personnel to the status o the HIV seropositive patients is also evaluated. A total of 312 emergency department patients of Lagos University Teaching Hospital (LUTH) had their blood samples screened for antibodies against Human Immunodeficiency Virus (HIV) types I and II by ELISA based techniques: Immunocomb II HIV I & II Bispot Kits. Repeatedly reactive samples were confirmed by another ELISA based technique using Immunocomb I & II Combfirm kits. The attending medical doctor was asked whether there was any suspicion or knowledge that the patient being attended to, was HIV seropositive. The seroprevalence of HIV antibodies was 5.77% with no significant difference in sex incidence. The age groups 20-29 and 30-39 years were most affected. The seropositive nature of affected patients was unsuspected by medical personnel in 55.56% of the HIV antibodies seropositive patients. The Federal Ministry of Health in 2000, estimated the National prevalence rate of HIV to have been 5.4% in 1998. This figure is comparable to that obtained in this study and revalidates the fact that emergency department patients may be used for disease surveillance in the population. The seropositive status of majority of the HIV positive patients was unsuspected by the attending medical personnel. Thus, strict adherence to universal safety precautions is essential for all medical personnel. Post exposure prophylaxis should be made readily accessible to all medical personnel. PMID: 14567038 [PubMed - indexed for MEDLINE] 7: West Afr J Med. 2003 Jun;22(2):124-7. Related Articles, Links Uses and misuse of blood transfusion in obstetrics in Lagos, Nigeria. Anorlu RI, Orakwe CO, Abudu OO, Akanmu AS. Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Nigeria. The objectives of this study were to identify obstetric and medical conditions in transfused patients, appraise the justification for the transfusion and recommend measures for reducing transfusion in obstetrics in Nigeria. Available case records of obstetric patients transfused at the Lagos University Teaching Hospital between the period 1st November 1995 and 31 October 1998 were reviewed retrospectively. Data collected included booking status, mode of delivery, amount of blood-transfused, post transfusion packed cell volume (PCV), and obstetric and medical conditions found in the patients. There were 4,159 cases out of which 503 were transfused. The overall transfusion rate was 12.1%, in booked and unbooked patients, it was 6.6% and 45.8% respectively. Only 231 cases were available for full analysis, mean age was 28.9 +/- 5.2 years (range 16-43 years). Sixty-three (27.3%) had unit-transfusions. Mean post transfusion PCV was 28.4% +/- 4.3% (range 17%-43%). In 63 (27.3%), the post transfusion PCV was above 30%. Some of the obstetric and medical conditions in the transfused patients were caesarean section (68.8%), previous caesarean section (20.4%), antepartum haemorrhage (16.9%), pregnancy induced hypertension (15.6%), anaemia and malaria (14.0%), induction of labour (13.0%), ruptured uterus (8.8%), and sickle cell anaemia (5.2%). Multi-unit transfusions were found in ruptured uterus (5.8 units), sickle cell anaemia (4.9 units), vaginal and cervical lacerations (4.0 units), forceps delivery (3.9 units) and malaria and anaemia (2.9 units). Conclusion: The study shows a high transfusion rate; an appreciable number were unnecessary transfusions. A number of the obstetric and medical factors for blood transfusion were avoidable. A reduction in blood transfusion rate can be achieved by the provision of adequate, available and affordable maternal health services in Nigeria. PMID: 14529219 [PubMed - indexed for MEDLINE] 8: Afr J Med Med Sci. 2001 Dec;30(4):305-8. Related Articles, Links Evaluation of saliva-based diagnostic test kit for routine detection of antibodies to HIV. Akanmu AS, Akinsete I, Adesemoye EF, Okany CC. Department of Haematology & Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria. The study was carried out to determine the reliability of a saliva based test kit for routine detection of HIV antibodies. 150 paired plasma and saliva samples were collected from 50 patients who were known to be positive for HIV-I and 100 others whose HIV serostatus were previously unknown. All the plasma samples were tested for HIV antibodies using Novopath Immunoblot Technique (as the gold standard), Wellcozyme (Murex) ELISA, Latex Agglutination Test (Capillus) and SeroCard Kit. The saliva samples were screened for HIV antibodies using SalivaCard Test Kit. All the 50 known positive patients tested positive when retested with immunoblot and 9 of 100 whose serostatus were unknown also tested positive giving a total of 59 positive results and 91 negative results. Of the 59 positive results, 59, 57, 58 and 47 were correctly identified as true positives by Wellcozyme, Capillus, SeroCard and SalivaCard respectively. Of the 91 negatives, 90, 91, 90 and 85 were correctly identified as true negatives respectively. Sensitivities in the same order were 100%, 97%, 98.3% and 79.7% whilst specificities were 98.9%, 100%, 98.9% and 97.8%. Whereas evaluation parameters for Wellcozyme, Capillus and SeroCard test kits met the criteria for licensure of a test kit as a routine test method for HIV antibody detection, the SalivaCard values fell far short of the stipulated criteria. The Sensitivity, Test Efficiency and Positive Predictive Values of 79.7%, 88% and 67.8% respectively obtained for SalivaCard are too low and the test kit cannot be recommended for routine use as HIV antibody detection kit. Publication Types: Comparative Study Evaluation Studies PMID: 14510108 [PubMed - indexed for MEDLINE] 9: Niger Postgrad Med J. 2001 Dec;8(4):170-4. Related Articles Otorhinolaryngological manifestations of HIV/AIDS in Lagos. Somefun A, Nwawolo CC, Okeowo PA, Ogban LU, Akanmu AS, Okanny CC, Akinsete I. Department of Surgery, College of Medicine, University of Lagos, Idi-Araba. A prospective study was carried out at the Lagos University Teaching Hospital in Lagos. The aims were to determine the prevalence of otorhinolaryngological disease among patients who were HIV+ and or had clinical AIDS and to correlate the presence of ORL disease with the clinical state of HIV infection. The study was done between October 1998 and September 1999. A total of ninety-eight patients were studied. The age range of the patients was between 15 and 69 years with 83% of them being in the age group of 20-49 years. The results showed that while only 17% of the patients were referred because of ORL diseases, 80% of them actually had O.R.L./head and neck conditions. This difference of proportion is highly significant P = 0.000037. 160.20% of the patients had oral/pharyngeal lesions and 24.5% had identifiable otological disease. Hearing impairment was noted in 30.6% of the patients on pure tone audiometric assessment of which 26.5% were sensorineural. The correlation between O.R.L./head and neck manifestation and the CDC classification of HIV/AIDS infection did not reveal a definite pattern. PMID: 11922022 [PubMed - indexed for MEDLINE] 10: Niger Postgrad Med J. 2001 Sep;8(3):105-11. Related Articles, Links Absolute lymphocyte count as surrogate for CD4+ cell count in monitoring response to antiretroviral therapy. Akanmu AS, Akinsete I, Eshofonie AO, Davies AO, Okany CC. Department of Haematology & Blood Transfusion, College of Medicine, University of Lagos, P. M. B. 12003, Lagos, Nigeria. The objective of the study is to determine whether Absolute Lymphocyte Count (ALC) can serve as a surrogate for CD4 T-lymphocyte Cell Count (CCC) in HIV infected Nigerians on Lamivudine/Zidovudine anti-retroviral therapy. 32 adult Nigerians infected with HIV were recruited into the study. They were assessed clinically and categorised into three clinical stages A, B and C according to CDC criteria. They all received lamivudine 150 mg b.d and Zidovodine 300 mg b.d for six months. Blood specimens were taken on enrollment and at four weekly intervals for paired ALC and CCC determination. ANOVA statistics was used to determine whether ALC and CCC (separately) change significantly with increasing duration of therapy. Paired ALC and CCC values were tested for correlation. Sensitivity and specificity of low ALC values in predicting low CCC values were also calculated. The 32 patients comprised 18 males and 14 females aged between 16 and 49 years. The mean age (SD) was 36.1 (+/-7.85) years. The mean ALC value rose from 2485/l and 2352/microl before commencement of therapy to 3026/microl and 3151/microl four weeks after for males and females respectively. These changes were not significant, P>0.05. No further changes were noted over the next 24 weeks. However, the mean CCC values increased from 233/microl before therapy through 339/microl at four weeks, 362/microl at eight weeks to 398/micro1 at 12 weeks. It then fluctuated between 372/microl and 310/microl for the remaining part of the study. These changes were not significant: F: ratio = 1.28 (df = 6,181), P>0.05. A weak but significant positive correlation was established between ALC and CCC. Correlation coefficient was 0.25, P<0.05. The sensitivity and specificity of ALC 2000/microl as a predictor of CCC 200/microl were 57% and 72% respectively. ALC correlates weakly with CCC in patients undergoing antiretroviral therapy and it may not serve as a perfect surrogate for CCC as a monitor of immunological response to therapy. West Afr J Med. 2000 Oct-Dec;19(4):286-92. Related Articles, Links Interferon alfa-2a (Roferon-A) monotherapy in chronic myelogenous leukemia: a pilot study in Nigerian patients in early chronic phase. Okanny CC, Durosimi MA, Chukwuani CM, Njoku OS, Akinola NO, Herrada SC, Ogbe OP, Onwukeme KE, Faluyi JO, Akanmu AS, Akinsete I. Department of Haematology, Lagos University Teaching Hospital, Lagos, Nigeria. The efficacy and safety of interferon alfa-2a monotherapy was evaluated in seventeen Nigeria patients with chronic myelogenous leukaemia (CML). Male and female patients with a mean age of 34.5 +/- 10.6 years were recruited into the study. Interferon therapy was administered at a maintenance dose of 9 MIU daily for 12 months. Efficacy was evaluated by assessing both haematologic and cytogenetic response, tolerability by incidence of adverse events and safety by laboratory haematological and biochemical indices. At the end of 12 months of therapy 6 patients (54.4%) had complete haematologic remission whilst 3 patients (100% of those evaluated) showed partial cytogenetic remission. The incidence of adverse event was 70% and the monitored haematologic and biochemical indices were not adversely affected by treatment. In conclusion, the study clearly demonstrated a significant benefit of interferon alpha-2a in the management of Nigerian patients with CML. The changes in the haematological and cytogenetic profiles between baseline and term were significant (p < 0.05). However, it is imperative and important to encourage and continue monitoring of the responding and stabilized patients beyond 12 months in order to demonstrate sustained response. The drug was reasonably well tolerated, however life threatening pancytopenia may pose a major problem in certain cases. Publication Types: Clinical Trial Controlled Clinical Trial PMID: 11391843 [PubMed - indexed for MEDLINE] 2: West Afr J Med. 2000 Oct-Dec;19(4):265-8. Related Articles, Links Management of HIV infection in Nigeria with zalcitabine in combination with saquinavir mesylate: preliminary findings. Akinsete I, Njoku OS, Okanny CC, Chukwuani CM, Akanmu AS; Hivid/Inverase Compassionate Programme Investigation Team. Department of Haematology, College of Medicine of Unilag, Idi-Araba Lagos. The efficacy and safety of a combination therapy with two anti-retroviral drugs, zalcitabine (ddC) and saquinavir mesylate was evaluated in 24 adult Nigerian patients with HIV infection. The result of an interim analysis after a 6-month course of therapy is presented herein. Patients were given zalcitabine 2.25 mg and saquinavir 1800 mg per day. Efficacy was evaluated by improvement in the CD4 cell count and disappearance and/or resolution of clinical signs and symptoms from the patient baseline condition. Tolerability and safety were assessed by the occurrence of adverse event and monitoring of biochemical parameters such as alanine transaminase, alkaline phosphatase and total bilirubin. The haemogram profile of patients was also monitored. There was clinical improvement in 79.2% of the patients, a minimal increase in the CD4 cell count was observed and the incidence of adverse event was 40%. The haematological and biochemical profile of the patients were not significantly affected by treatment (p > 0.05). We therefore conclude that the drug cocktail comprising zalcitabine and saquinavir does posses good potentials for effective management of Nigerian patients with HIV infection. However, it is imperative and important to continue treatment with the drugs for a longer time in order to demonstrate sustained response. Publication Types: Clinical Trial Controlled Clinical Trial Research Support, Non-U.S. Gov't PMID: 11391837 [PubMed - indexed for MEDLINE] 3: Cent Afr J Med. 1998 May;44(5):130-4. Related Articles, Links Seroprevalence study of HTLV-1 and HIV infection in blood donors and patients with lymphoid malignancies in Lagos, Nigeria. Analo HI, Akanmu AS, Akinsete I, Njoku OS, Okany CC. Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Nigeria. OBJECTIVE: To document the seroprevalence of HTLV-1 and HIV in blood donors and in patients with lymphoma and leukaemia in Lagos metropolis. DESIGN: Cross sectional. SETTING: The Lagos University Teaching Hospital (LUTH) and General Hospital, Lagos (GH). SUBJECTS: 406 apparently healthy voluntary blood donors from the LUTH and GH and 30 patients [20 patients with histological diagnosis of Non-Hodgkin's Lymphoma (NHL) and 10 patients with diagnosis of Chronic Lymphocytic Leukaemia (CLL)] were recruited at LUTH. MAIN OUTCOME MEASURES: HTLV-1 and HIV-1 seroprevalence. RESULTS: Out of 406 donors, three (0.7%) were positive for HTLV-1 and 20 (4.9%) were positive for HIV-1. None of the 30 patients with NHL or CLL were positive for HTLV-1. Five of NHL patients were positive for HIV-1. CONCLUSION: HTLV-1 seroprevalence is low among Lagos donors. Routine screening of donors for this virus will not be cost effective. NHL is one of the AIDS related malignancies which has been documented in this study. Carcinoma of the scrotum in a Young man with HIV Infection: Is there a Possible Association? (2008) Adetayo, F O, Ogunjinmi, M A, Akanmu, A S, Banjo, A A Abstract Squamous cell carcinoma of the scrotum is rare and its occurrences in the young is even rarer. A 39-yearold gentleman presented with a large non-healing ulcer developing on his left hemi-scrotum 9 months after the excisional biopsy of multiple pruritic nodular lesions on the scrotum. On histological examination it was found to be squamous cell carcinoma. Examination under anaesthesia revealed that the tumour was not resectable and patient was offered radiotherapy. Historically, scrotal carcinoma is occupation related, but none of the occupational predisposing factors was identified in this patient. Patient was however, found to be positive for HIV 1. We suggest that the occurrence of scrotal carcinoma which is normally seen in elderly men in a young man might be due to the associated HIV infection. NQJHM Vol. 16 (3) 2006: pp. 93-96 Impact of Tuberculosis Co-Infection on the Level of PCV in HIV Infected Patients. Audu, R A, Akanmu, A S, Efeienemokwu, C, Dele, A Z, Lemoha, E, Odunnaike, M I, Aniedobe, M, Idigbe, E I Abstract Background: It has been documented that HIV causes anemia in HIV infected patients. One of the commonest opportunistic infection in HIV patients is TB, and this has also been documented to cause anemia. In Nigeria, several cases of HIV and TB co-infections have been diagnosed. This study was carried out to determine any possible impact of TB co-infection on the level of HIV induced anemia. Methods: Anemia in this study was defined as PCV values below 30%. Three categories of subjects were recruited: 22 patients who had HIV infection only, 12 with HIV and co-infected with TB and 29 who are infected with TB only. A group of 10 apparently healthy subjects who were negative for HIV and TB were used as controls. These subjects were recruited from the Lagos University Teaching Hospital (LUTH), the Main land Hospital Yaba and the staff clinic of the Nigeria Institute of Medical Research all in Lagos, Nigeria . Blood samples were obtained from each of the enrolled subjects and the PCV levels were determined by the microhaematocrit method. All patients with TB diagnosis were sputum positive for AFB. CD4 cell count was determined for all HIV infected subjects using a FACScount. Results: PCV was significantly lower in all categories of subjects when compared with the control (0.05) from those co infected with HIV.Conclusion: Co-infection of HIV with TB did not worsen anemia in studied subjects. Keywords: HIV, Tuberculosis, Coinfection, Anemia. NQJHM Vol. 14 (2) 2004: pp. 115-117 An Evaluation Of The Safety And Efficacy Of Combivir® (3TC 150mg/ZDV 300mg) Tablets And Agenerase® (Amprenavir APV 150mg) Capsules In HIV Positive Patients In Three Tertiary Hospitals In Nigeria *I B Keshinro, *J Idoko, **A S Akanmu, ** C C Okany, **W KodjoSoroh, **A Davies SUMMARY Objective: The study was an open labeled non-comparative study to evaluate the safety and efficacy of combining CombivirTM (3TC 150mg/ZDV 300mg) tablets and Agenerase™ (Amprenavir APV 150mg) capsules in the treatment of HIV positive patients with CD4 cell counts of 100 to 500/mm3 . Methods Sixty-four (64) aged 22 to 65 years received CombivirTM 450mg b.d. and AgeneraseTM 1200mg b.d. dispensed four weekly over a 24-week period. Results 90% of the patients showed immunological response to therapy with the mean CD4+ cell count of the patients rising from 254 cells/mm3 at the beginning of the study to 494 cells/mm3 at the end (P=0.0000032). The patients also experienced weight gain and improvement in quality of life. Few side effects were reported. These were mainly gastrointestinal, mild and self-limiting. No significant laboratory abnormalities were noted in most patients. Conclusion It was concluded that the combination of CombivirTM (3TC 150mg/ZDV 300mg) tablets and AgeneraseTM (Amprenavir APV 150mg) capsules was safe and efficacious in the treatment of HIV positive patients with CD4 cell counts of 100 to 500/mm3. Niger Med J.2003; Vol 44 (2): 55-59