Phyllis J. Kanki

Cardiac remodeling has been reported in HIV-exposed but uninfected (HEU) infants. Inflammatory biomarkers have also been observed to be associated with cardiac remodeling in older HEU children but have not been widely studied in infants. We identified left ventricular (LV) cardiac changes in HEU infants exposed to current ARV therapy in utero and determined their association with the inflammatory biomarkers, C-reactive protein (CRP), and cardiac troponin. This comparative cross-sectional study included 196 HEU infants and 198 matched HIV-unexposed controls. We evaluated LV structure and function using echocardiography and tested blood samples using highly sensitive CRP (hsCRP) and cardiac troponin I (cTnI-plus) measurements. Data were analyzed using the R statistical software package; p values of < 0.05 were considered statistically significant. The HEU infants had thicker LV posterior walls and interventricular septa in diastole (median difference 0.55 and 0.30, 95% CI 0.22–0.89 and 0.13–0.54, respectively, p < 0.001), higher left ventricular mass index (median difference 3.8, 95% CI 1.2–6.9, p < 0.001), and left ventricular wall thickness-to-diameter ratio (median difference 0.02, 95% CI 0.01–0.03, p < 0.001) compared with controls. The interventricular septa Z score was significantly thicker in HEU infants with elevated hsCRP levels (AOR 2.3, 95% CI 1.22–3.36, p = 0.006). Cardiac remodeling is present in HEU infants exposed to current ARV regimens in utero. Longitudinal studies are required to identify infants who may require cardiac evaluation and further explore biomarkers associated with cardiac remodeling in HEU infants.

Yellow fever virus (YFV) and West Nile virus (WNV) co-circulate with other arboviruses, including Zika (ZIKV), dengue (DENV), and chikungunya virus (CHIKV), in sub-Saharan Africa. Associations between preexisting YFV and WNV immunity with symptoms and adverse infant outcomes among pregnant women exposed to orthoflaviviruses are unknown. We retrospectively studied a prospective cohort of pregnant women enrolled between 2019 and 2022 in Jos, Nigeria. Rapid tests identified ZIKV, DENV, and CHIKV IgM/IgG reactivity for enrollment; 216 women underwent Western blot for YFV and WNV IgG. Logistic regression evaluated associations between arboviral seropositivity and maternal symptoms or adverse infant outcomes. Sequential serology of mother-infant pairs estimated the persistence of passively transferred maternal YFV antibodies. YFV IgG was detected in 50.5% (109/216) and WNV IgG in 5.1% (11/216) of maternal samples. YFV and WNV seropositivity was significantly associated with maternal symptoms (OR = 2.02, 95% CI: 1.35-3.02, P = 0.001), as was YFV seropositivity alone (OR = 1.77, 95% CI: 1.21-2.61, P < 0.004). CHIKV IgM reactivity was significantly associated with abnormal infant outcomes (OR = 2.38, 95% CI: 1.43-4.02, p = 0.001), but not ZIKV and DENV IgM reactivity. Passive maternal YFV IgG waned in infants at a median of 3.1 months (IQR: 1.65-5.35 months) after birth. YFV and WNV seropositivity was associated with maternal symptoms but not with adverse infant outcomes. Rapid waning of maternal YFV IgG highlights infant vulnerability and supports enhanced surveillance and maternal immunization strategies.

Objective: To assess the effect of dolutegravir (DTG) on obstetrical outcomes for women living with HIV (WLWH).Methods: This retrospective cohort study evaluated adult WLWH in antenatal care between 2016 and 2022 at two Nigerian centers. Patients were stratified into three antiretroviral therapy (ART) exposure groups: non‐DTG ART, DTG‐switch, and DTG. Multivariate linear and logistic regression models were utilized to assess the association between the type of ART and gestational weight gain (GWG), small for gestational age (SGA), gestational hypertension, and preterm birth.Results: The study included 1839 (77.1%) non‐DTG users, 359 (15%) DTG users, and 188 (7.9%) DTG switchers. The adjusted association between DTG exposure and GWG was 0.72 (−0.08, 1.53) kg and 0.51 (−0.51, 1.54) kg for the DTG and DTG‐switch groups, respectively, compared to other ARTs. The adjusted odds ratios for gestational hypertension were 0.47 (0.09, 2.49) and 1.31 (0.43, 4.02), 0.57 (0.22, 1.52) and 0.73 (0.25, 2.10) for preterm birth, and 0.55 (0.25, 1.20) and 0.26 (0.08, 0.83) for SGA in DTG and DTG‐switch, respectively, compared to other ARTs.Conclusions: DTG therapy is not associated with the risk of gestational hypertension nor preterm birth, and antenatal ART switching to DTG decreases the risk of growth restriction.

Background Yellow fever virus (YFV) and West Nile virus (WNV) co-circulate with other arboviruses, including Zika (ZIKV), dengue (DENV), and chikungunya virus (CHIKV), in sub-Saharan Africa. Associations between preexisting YFV and WNV immunity with symptoms and adverse infant outcomes among pregnant women exposed to flaviviruses are unknown. Methods We retrospectively studied a prospective cohort of pregnant women enrolled between 2019 and 2022 in Jos, Nigeria. Rapid tests identified ZIKV, DENV, and CHIKV IgM/IgG reactivity for enrollment; 216 women underwent Western blot for YFV and WNV IgG. Logistic regression evaluated associations between arboviral seropositivity and maternal symptoms or adverse infant outcomes. Sequential serology of mother-infant pairs estimated the persistence of passively transferred maternal YFV antibodies. Findings YFV IgG was detected in 50.5% (109/216) and WNV IgG in 5.1% (11/216) of maternal samples. YFV and WNV seropositivity was significantly associated with maternal symptoms (OR = 2.02, 95% CI: 1.35–3.02, P = 0.001), as was YFV seropositivity alone (OR = 1.77, 95% CI: 1.21–2.61, P < 0.004). CHIKV IgM reactivity was significantly associated with abnormal infant outcomes (OR = 2.38, 95% CI: 1.43–4.02, p = 0.001), but not ZIKV and DENV IgM reactivity. Passive maternal YFV IgG waned in infants at a median of 3.1 months (IQR: 1.65-5.35 months) after birth. Interpretation YFV and WNV seropositivity was associated with maternal symptoms but not with adverse infant outcomes. Rapid waning of maternal YFV IgG highlights infant vulnerability and supports enhanced surveillance and maternal immunization strategies.

Background: The COVID-19 pandemic had a severe impact globally, yet African populations exhibited unexpectedly lower rates of severe disease and mortality. We investigated the potential role of pre-existing immunity in shaping the epidemiology of COVID-19 in Africa.Methods: Plasma collected from Senegalese female sex workers prior to the COVID-19 pandemic was screened for SARS-CoV-2 and human coronavirus (hCoV) antibodies by virion immunoblots. For antibody-reactive plasma, paired peripheral blood mononuclear cells were stimulated by fusion proteins and IFN-γ cellular responses were assessed via ELISPOT.Results: We observed substantial levels of pre-existing cross-reactive immunity to SARS-CoV-2, stemming from prior exposure to seasonal hCoVs. Our antibody analysis revealed a 23.5% (47/200) seroprevalence rate against SARS-CoV-2 nucleocapsid (N). These samples were then probed for antibodies against hCoV spike (S) and/or N antigens; 85.1% (40/47), 70.2% (33/47), and 95.7% (45/47) were antibody reactive against hCoV-229E, hCoV-OC43, or hCoV-HKU1, respectively. Our analysis of cellular responses also demonstrated cross-reactivity to SARS-CoV-2 with 80.0% (36/45) and 82.2% (37/45) showing IFN-γ responses against S and N, respectively. A unique pre-pandemic subject had cross-reactive SARS-CoV-2 S antibodies with detectable neutralization and cross-reactive cellular responses.Conclusion: These findings suggest that prior hCoV exposure may induce cross-reactive adaptive immunity, potentially contributing to protection against COVID-19. Our study provides unique data on the dynamics of hCoV and SARS-CoV-2 immunity in Senegal and underscores the importance of understanding the role of pre-existing immunity in shaping COVID-19 outcomes globally.

While research involving pregnant women with HIV has largely focused on the antepartum and intrapartum periods, few studies in Nigeria have examined the clinical outcomes of these women postpartum. This study aimed to evaluate antiretroviral therapy retention, adherence, and viral suppression among postpartum women in Nigeria. This retrospective clinical data analysis included women with a delivery record at the antenatal HIV clinic at Jos University Teaching Hospital between 2013 and 2017. Descriptive statistics quantified proportions retained, adherent (≥95% medication possession ratio), and virally suppressed up to 24 months postpartum. Among 1535 included women, 1497 met the triple antiretroviral therapy eligibility criteria. At 24 months, 1342 (89.6%) women remained in care, 51 (3.4%) reported transferring, and 104 (7.0%) were lost to follow-up. The proportion of patients with ≥95% medication possession ratio decreased from 79.0% to 69.1% over the 24 months. Viral suppression among those with results was 88.7% at 24 months, but <62% of those retained had viral load results at each time point. In multiple logistic regression, predictors of loss to follow-up included having a more recent HIV diagnosis, higher gravidity, fewer antenatal care visits, and a non-hospital delivery. Predictors of viral non-suppression included poorer adherence, unsuppressed/missing baseline viral load, lower baseline CD4+ T-cell count, and higher gravidity. Loss to follow-up rates were lower and antiretroviral therapy adherence rates similar among postpartum women at our study hospital compared with other sub-Saharan countries. Longer follow-up time and inclusion of multiple facilities for a nationally representative sample would be beneficial in future studies.

The COVID-19 pandemic had a severe impact globally, yet African populations exhibited unexpectedly lower rates of severe disease and mortality. We investigated the potential role of pre-existing immunity in shaping the epidemiology of COVID-19 in Africa. Leveraging paired plasma and peripheral blood mononuclear cells collected from Senegalese female sex workers prior to the COVID-19 pandemic, we observed substantial levels of pre-existing cross-reactive immunity to SARS-CoV-2, stemming from prior exposure to seasonal human coronaviruses (hCoVs). Our antibody analysis revealed a 23.5% (47/200) seroprevalence rate against SARS-CoV-2 nucleocapsid (N). Of these SARS-CoV-2 N-reactives, 85.1% (40/47), 44.7% (21/47), and 95.7% (45/47) showed antibody reactivity against hCoV-229E or hCoV-OC43 spike (S) and/or N or hCoV-HKU1 S. Our analysis of cellular responses also demonstrated cross-reactivity to SARS-CoV-2 with 82.2% (37/45) and 84.4% (38/45) showing IFN-γ responses against S and N, respectively. These findings suggest that prior hCoV exposure may induce cross-reactive adaptive immunity, potentially contributing to protection against COVID-19. A unique pre-pandemic subject had cross-reactive SARS-CoV-2 S antibodies with detectable neutralization and cellular responses. Our study provides unique insights into the dynamics of hCoV and SARS-CoV-2 immunity in West African populations and underscores the importance of understanding the role of pre-existing immunity in shaping COVID-19 outcomes globally.

While research involving pregnant women with HIV has largely focused on the antepartum and intrapartum periods, few studies in Nigeria have examined the clinical outcomes of these women postpartum. This study aimed to evaluate antiretroviral therapy retention, adherence, and viral suppression among postpartum women in Nigeria. This retrospective clinical data analysis included women with a delivery record at the antenatal HIV clinic at Jos University Teaching Hospital between 2013 and 2017. Descriptive statistics quantified proportions retained, adherent (≥95% medication possession ratio), and virally suppressed up to 24 months postpartum. Among 1535 included women, 1497 met the triple antiretroviral therapy eligibility criteria. At 24 months, 1342 (89.6%) women remained in care, 51 (3.4%) reported transferring, and 104 (7.0%) were lost to follow-up. The proportion of patients with ≥95% medication possession ratio decreased from 79.0% to 69.1% over the 24 months. Viral suppression among those with results was 88.7% at 24 months, but <62% of those retained had viral load results at each time point. In multiple logistic regression, predictors of loss to follow-up included having a more recent HIV diagnosis, higher gravidity, fewer antenatal care visits, and a non-hospital delivery. Predictors of viral non-suppression included poorer adherence, unsuppressed/missing baseline viral load, lower baseline CD4+ T-cell count, and higher gravidity. Loss to follow-up rates were lower and antiretroviral therapy adherence rates similar among postpartum women at our study hospital compared with other sub-Saharan countries. Longer follow-up time and inclusion of multiple facilities for a nationally representative sample would be beneficial in future studies.