Poster Session : PS 0288 ; Nutrition : Prevalence of Lifestyle Risk Factors among Diabetic Patients at Kenyatta National Hospital (Nairobi, Kenya)

( Njeri Rahab Mbugua ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Modifi cation of lifestyle risk factors like exercise, diet, alcoholism and smoking is important in management of diabetes (5, 6). Urbanisation in Kenya is likely to affect adherence to lifestyle changes. No studies have looked at lifestyle adherence among diabetes patients in Kenya. Methods: This descriptive cross sectional survey assessed the prevalence of lifestyle risk factors among Kenyatta National Hospital diabetic clinic patients and how this relates to diabetes control. A structured questionnaire was used to collect socio demographic as well as biophysical and biochemical data (weight, height, blood pressure & random blood sugar) from each patient. Results: Majority of the respondents (85%) consume less than the WHO recommended fi ve servings of fruits and vegetables per day and a signifi cant number (42%) is not involved in any type of moderate intensity physical exercise. Forty seven percent of those who exercise do so for less than 5 days in a week. The prevalence of alcohol consumption (6. 4%) and smoking (3%) is low. Moderate physical activity and consumption of fruits and vegetables was associated with better blood sugar control while gender, level of education and working statu`s were found to be important factors in lifestyle practices. Conclusions: Lifestyle modifi cation needs to be emphasized in diabetes management. There is need for a population-based studyon the prevalence of lifestyle risk factors for diabetes and other non-communicable diseases.

Poster Session : PS 0373 ; Immunology ; Acute HIV Infection among Kenyan Infants

( Njeri Rahab Mbugua ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Clinical signs and symptoms of acute human immunodefi ciency virus (HIV) infection in infants are not well characterized. Methods: Clinical signs and symptoms of acute human immunodefi ciency virus (HIV) infection in infants are not well characterized. Results: There were 125 acute infection visits (among 56 infants) and 3491 noninfection visits (among 306 infants). Acute HIV infection was associated with rash (odds ratio [OR], 1.8; 95% confi dence interval [CI], 1.1-2.8), failure to thrive (OR, 1.9; 95% CI, 1.0-3.5), and lymphadenopathy (OR, 2.5; 95% CI, 1.4-4.8). Acute HIV infection was associated with lymphadenopathy (OR, 2.6; 95% CI, 1.3-5.0) in infants <2 months of age and with pneumonia (OR, 3.2; 95% CI, 1.1-9.3) and dehydration (OR, 6.0; 95% CI, 1.9-18.5) in infants >or=2 months of age. Infant peak viral load and mortality were not associated with symptoms of acute HIV infection. However, infants with symptoms had higher viral levels later in the course of infection than did those without symptoms (P=.05). Conclusions: Infants may manifest symptoms early during the course of HIV infection, and symptoms of acute HIV infection may correlate with poor viral control. Rash, failure to thrive, lymphadenopathy, pneumonia, and dehydration may signify acute HIV infection in infants.

Poster Session : PS 0372 ; Immunology ; HV-1-Specifi c Cytotoxic T Lymphocytes and Breast Milk HIV-1 Transmission

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Breast-feeding by infants exposed to human immunodefi ciency virus type 1 (HIV-1) provides an opportunity to assess the role played by repeated HIV-1 exposure in eliciting HIV-1-specifi c immunity and in defi ning whether immune responses correlate with protection from infection. Methods: Breast-feeding infants born to HIV-1-seropositive women were assessed for HLA-selected HIV-1 peptide-specifi c cytotoxic T lymphocyte interferon (IFN)-gamma responses by means of enzyme-linked immunospot (ELISpot) assays at 1, 3, 6, 9, and 12 months of age. Responses were deemed to be positive when they reached > or = 50 HIV-1-specifi c sfu/1 x 10(6) peripheral blood mononuclear cells (PBMCs) and were at least twice those of negative controls. Results: A total of 807 ELISpot assays were performed for 217 infants who remained uninfected with HIV-1 at approximately 12 months of age; 101 infants (47%) had at least 1 positive ELISpot result (median, 78-170 sfu/1 x 10(6) PBMCs). The prevalence and magnitude of responses increased with age (P = .01 and P = .007, respectively); the median log(10) value for HIV-1-specifi c IFN-gamma responses increased by 1.0 sfu/1 x 10(6) PBMCs/month (P<0.001) between 1 and 12 months of age. Of 141 HIV-1-uninfected infants with 1-month ELISpot results, 10 (7%) acquired HIV-1 infection (0/16 with positive vs. 10/125 [8%] with negative ELISpot results; P = .6). Higher values for log(10) HIV-1-specifi c spot-forming units at 1 month of age were associated with a decreased risk of HIV-1 infection, adjusted for maternal HIV-1 RNA level (adjusted hazard ratio, 0.09 [95% confi dence interval, 0.01-0.72]). Conclusions: Breast-feeding HIV-1-exposed uninfected infants frequently had HIV-1-specific IFN-gamma responses. Greater early HIV-1-specific IFN-gamma responses were associated with decreased HIV-1 acquisition.

Poster Session : PS 0371 ; Immunology ; Pediatric HIV -1 in Kenya

( Njeri Rahab Mbugua ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: There is limited information regarding the pattern and correlates of viral replication in vertically HIV-1-infected children and its role on their outcomes in resource- limited settings. Methods: HIV-1-infected infants were followed from birth to 24 months. Serial HIV- 1 RNA levels were compared in infants infected in utero (<48 hours), peripartum (48 hours-1 month), and late postnatal (after 1 month). Cofactors for viral peak [highest viral load (VL) within 6 months of infection] and set point and mortality were determined. Results: Among 85 HIV-1-infected infants, 24 were infected in utero, 41 peripartum, 13 late postnatal; 7 had no 48-hour assay. HIV-1 VL set point was signifi cantly lower in infants infected >1 month vs. =1 month (5.59 vs. 6.24 log10 copies per milliliter, P = 0.01). Maternal VL correlated with peak infant VL (P < 0.001). Univariately, infant peak and set point VL and 6-month CD4% <15% predicted mortality; and 6-month CD4% <15% remained independently predictive in multivariate analyses (hazard ratio = 4.85, 95% confi dence interval: 1.90 to 12.36). Conclusions: Infants infected after the age of 1 month contained virus better than infants infected before 1 month of age. Maternal VL predicted infant VL, which, in turn was associated with early mortality.

Poster Session : PS 0454 ; Infectious Disease ; Risk Factors for Neonatal Conjunctivitis in Babies of HIV-1 Infected Mothers

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: To determine the prevalence and correlates of neonatal conjunctivitis in infants born to human immunodefi ciency virus type 1 (HIV-1) infected mothers. Methods: This was a nested case-control study within a perinatal HIV-1 cohort. HIV-1 seropositive mothers were enrolled during pregnancy and mother-infant pairs followed after delivery with assessment for neonatal conjunctivitis at 48 hours and up to 4 weeks after birth. Genital infections (chlamydia, gonorrhea, syphilis, trichomonas, bacterial vaginosis, and candida) were screened for at 32 weeks gestation. Mothers received treatment for genital infections diagnosed during pregnancy and shortcourse zidovudine. Newborns did not receive ocular prophylaxis at hospital deliveries. Multivariate logistic regression models were used to determine cofactors for neonatal conjunctivitis overall and stratifi ed for infant HIV-1 status. Results: Four hundred and fi fty-two infants were assessed and 101 (22.3%) had neonatal conjunctivitis during the fi rst month postpartum. In multivariate analyses using odds ratios (OR) and confi dence intervals (CI), neonatal conjunctivitis was associated with neonatal sepsis (adjusted OR 21.95, 95% CI 1.76, 274.61), birth before arrival to hospital (adjusted OR 13.91, 95% CI 1.39, 138.78) and birth weight (median 3.4 versus 3.3 kilograms, p=0.016, OR 1.79, 95% CI 1.01, 3.15). Infant HIV-1 infection was not associated with conjunctivitis. Conclusions: Despite detection and treatment of genital infections during pregnancy, neonatal conjunctivitis was frequently diagnosed in infants born to HIV-1 infected mothers suggesting a need for increased vigilance and prophylaxis for conjunctivitis in these infants. Neonatal sepsis, birth before arrival to hospital, and higher birthweight are factors that may predict higher risk of neonatal conjunctivitis in this population.

Poster Session : PS 0437 ; Infectious Disease ; Predictors of Mortality in HIV-1 Infected Children on Antiretroviral Therapy in Kenya

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Among children, early mortality following highly active antiretroviral therapy (HAART) remains high. It is important to defi ne correlates of mortality in order to improve outcome. Methods: HIV-1-infected children aged 18 months-12 years were followed up at Kenyatta National Hospital, Nairobi after initiating NNRTI-based HAART. Cofactors for mortality were determined using multivariate Cox regression models. Results: Between August 2004 and November 2008, 149 children were initiated on HAART of whom 135 were followed for a total of 238 child-years (median 21 months) after HAART initiation. Baseline median CD4% was 6.8% and median HIV-1-RNA was 5.98-log10 copies/ml. Twenty children (13.4%) died at a median of 35 days post- HAART initiation. Mortality during the entire follow-up period was 8.4 deaths per 100 child-years (46 deaths/100 child-years in fi rst 4 months and 1.0 deaths/100 childyears after 4 months post-HAART initiation). On univariate Cox regression, baseline hemoglobin (Hb) < -2, and WHO clinical stage 4 were associated with increased risk of death (Hb < -2 HR 3.41 [95% C.I. 1.28-9.08], p = 0.01, and WHO clinical stage 4, HR 3.08 [1.17-8.12], p = 0.02). On multivariate analysis Hb < 9 g/dl remained predictive of mortality after controlling for age, baseline CD4%, WHO clinical stage and weightfor- height z-score (HR 2.95 (95% C.I. 1.04-8.35) p = 0.04). Conclusions: High early mortality was observed in this cohort of Kenyan children receiving HAART, and low baseline hemoglobin was an independent risk factor for death.

Slide Session : OS-ONC-12 ; Oncology : The Prevalence of Depression among Family Caregivers of Children with Intellectual Disability on a Rural Settingin Kenya

( Njeri Rahab Mbugua ),( Judy W Kamau ),( Muthoni Mathai ),( Wangari Kuria ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: The objective of the study was to determine the risk of depression in caregivers ofchildren with intellectua ldisability. Caregivers of children with intellectual disability have a great responsibility that may be stressful. The psychological well-being of the care giver may a ect the quality of care given to children with intellectual disability. Methods: The study was conducted at Gachie Catholic Parish, Archdiocese of Nairobi (Kenya). Design. Cross sectional, descriptive study.The study was conducted among 114 caregivers registered at the Gachie Parish program (in Kenya) for the intellectual disabled children. A researcher-designed social demographic questionnaire and the Beck depression inventory were administered to those that met the inclusion criteria Results: Seventy-nine percent (79%) of the caregivers were at risk of clinical depression. Conclusions: Majority of the caregivers of children with intellectual disability were at risk of developing clinical depression.

Poster Session : PS 0433 ; Infectious Disease ; Anal and Dry Sex in Commercial Sex Work, and Relation to Risk for Sexually Transmitted Infections and HIV

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: To examine the practices of anal intercourse and dry sex within a cohort of female sex workers (FSWs) in Kenya, focusing on the prevalence and perceived risk of the practices, demographic and behavioural correlates, and association with sexually transmitted infections (STI). Methods: A survey was conducted among FSWs with 147 participants randomly sampled from an existing cohort of self identifi ed FSWs.Results: 40.8% of participants reported ever practising anal intercourse and 36.1% reported ever practising dry sex. Although the majority of women surveyed believed anal intercourse and dry sex to be high risk practices for HIV infection compared with vaginal sex, about one third of women reported never or rarely using condoms during anal intercourse, and about 20% never or rarely using condoms during dry sex. Reported consistent condom use was lower with both of these practices than with penile-vaginal intercourse. Anal intercourse was associated with experience of recent forced sexual intercourse, while dry sex was not. Anal intercourse was almost always initiated by clients, whereas dry sex was likely to be initiated by the women themselves. Sex workers reported charging higher fees for both practices than for vaginal intercourse. Both practices were associated with reported symptoms and diagnoses of STI. Conclusions: Both anal intercourse and dry sex were common in this sample, and although perceived as high risk practices, were not adequately protected with condom use. Education and other interventions regarding these high risk sexual behaviours need to be translated into safer practices, particularly consistent condom use, even in the face of fi nancial vulnerability.

Poster Session : PS 0431 ; Infectious Disease ; Partner Characteristics Predicting HIV-1 Set Point in Sexually Acquired HIV-1 among African Seroconverters

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Plasma HIV-1 RNA set point is an important predictor of HIV-1 disease progression. We hypothesized that inoculum size and HIV-1 exposure prior to HIV-1 transmission may modulate set point. We evaluated predictors of set point among 141 African HIV-1 seroconverters and their HIV-1-infected study partners. Methods: We compared characteristics of seroconverters and their HIV-1-infected partners and HIV-1 set point. Data were from a clinical trial of genital HSV-2 suppressionwith acyclovir to reduce HIV-1 transmission in HIV-1 serodiscordant couples with HIV-1 transmission linkage assigned through virus sequencing. Our analysis includes data from all transmissions including those with transmission linkage to the HIV-1-infected “source partner” and those that were not linked to their HIV-1-infected study partner Results: n multivariable analysis, higher plasma HIV-1 in source partners was associated with higher seroconverter set point ( + 0.44 log10 copies/ml per log(10) source partner plasma HIV-1, p < 0.001). In addition, bacterial vaginosis (BV) among female source partners near the time of infection was associated with higher set point in their male seroconverters ( + 0.49 log(10), p = 0.04). Source partner characteristics associated with lower set point included male circumcision ( - 0.63 log(10), p = 0.03) and assignment to acyclovir ( - 0.44 log10, p = 0.02). The proportion of variation in set point explained by plasma HIV-1 RNA of the source partner, after controlling for other factors, was 0.06. Source partner plasma HIV-1 level is the most signifi cant predictor of seroconverter set point, possibly refi ecting characteristics of the transmitted virus. Conclusions: Acyclovir use, BV among women source partners, and circumcision among male source partners may alter the set point by affecting transmitted virus inoculum in the source partners` genital compartment.

Poster Session : PS 0587 ; Psychiatry ; Factors Associated with Relapse and Remission of Alcohol Dependent Persons after Community Based Treatment

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: This study sought to determine the factors associated with remission and relapse in a group of alcohol dependent persons undergoing Community Based Detoxifi cation and Rehabilitation of alcohol dependent persons Methods: One hundred and eighty eight (188) persons with Alcohol Use Disorder Identi- fi cation Test (AUDIT) positive were subjected to outpatient detoxifi cation for 10 days using a pair of ampoules of high potency Vitamin B and C intravenously daily for 3 consecutive days, diazepam 5 mg and carbamazepine 200 mg for 5 and 10 consecutive nights respectively on an outpatient basis. The participants were visited twice a week (at home) by the community based health workers and reviewed once a week by the principal investigator and attended a bimonthly group therapy session conducted in groups of 20 s as part of the rehabilitation process. The groups were converted to self-help groups after 4 months to generate income for the participants Results: Factors signifi cantly associated with relapse to alcohol use included severity of alcohol use and craving for alcohol at intake and the age of onset of alcohol drinking. Further there was a statistically signifi cant predictive value in the mean score of alcohol re-lated problems in the community based group (health, social, fi nancial and legal). Conclusions: Identifying factors that are associated with relapse after alcohol dependence treatment is likely to improve the effectiveness of treatment and prevent relapse in persons at risk. Knowledge of factors associated with relapse and remission after treatment for alcohol dependence enables the clinician to offer better individualized treatment. It also enables the clinician to predict which patients are likely to relapse and therefore offer appropriate and effective treatment to prevent relapse.