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Prevalence and Risk Factors for Development of Asymptomatic Bacteriuria Among HIV Positive Pregnant Women in Jos, Nigeria

Received: 7 June 2021     Accepted: 19 June 2021     Published: 25 June 2021
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Abstract

The Human Immunodeficiency Virus pandemic is negatively affecting the reproductive health of women in Nigeria. It is associated with increased morbidity and mortality, especially where secondary infections exist. Studies document that HIV positive women are prone to reproductive and urinary tract infections, and due to physiologic changes in pregnancy, there is higher incidence of urinary infections among pregnant women, with or without symptoms. This prospective cohort study investigates for asymptomatic bacteriuria in pregnancy among HIV seropositive women, to identify if HIV positivity confers additional risks for occurrence. We recruited 119 pregnant HIV positive women and 152 HIV negative controls from Jos University teaching hospital and Faith Alive hospital in Jos, Nigeria and screened for asymptomatic bacteriuria. Bacteriuria was confirmed when two separate urine samples, in the same woman, showed presence of 105 CFU/ml (100,000 organisms) of same species. Laboratory personnel performing tests were unaware of participants HIV status. Antibiotic sensitivity were determined and participants were followed-up/evaluated for features of pyelonephritis throughout antenatal care. Prevalence was determined and analysis to determine if HIV positivity conferred risks. There were 22 women with confirmed bacteriuria, with prevalence of 8.1% among all participants, with 9.4% (14) among HIV Negative cohort and 6.8% (8) of HIV positive women. HIV status, demography and previous pyelonephritis/UTI were not statistically associated with development of asymptomatic bacteriuria. Two women with medical conditions (Diabetes and Sickle cell disease) had confirmed bacteriuria, but numbers were insufficient to deduce an association. Staphylococcus aureus predominated (78.6%) among HIV negative, while for HIV positive women, Escherichia coli and Staphylococcus aureus each affected 44.4%. Antibiotic sensitivity favoured Cefuroxime in both HIV positive and negative women, but organisms were resistant to penicillins and Nitrofurantoin. Treatment was not possible because of antibiotics cost and/or unwillingness of participants to receive treatment for an asymptomatic condition. Analysis of the HIV positive cohort showed no further conferment of risk by CD4 counts, viral load, duration of HIV positivity, the anti-retroviral drug type/class or duration/adherence to ARVs. No woman with CD4 count >500 cells/mm3 developed asymptomatic bacteriuria but there was no statistical association. Similarly, women who had undetectable viral load had lower bacteriuria rates, while women with high viral load had higher rates of asymptomatic bacteriuria, but this was only significant when analysis was performed using the logarithm of viral load.

Published in Central African Journal of Public Health (Volume 7, Issue 4)
DOI 10.11648/j.cajph.20210704.14
Page(s) 170-181
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Asymptomatic Bacteriuria, Urine, Culture, Pregnancy, HIV Positive, Pyelonephritis, CD4 Count

References
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    Tinuade Abimbola Oyebode, Godwin Imade, Isichei Christian, Tolulope Afolaranmi, Halima Sule, et al. (2021). Prevalence and Risk Factors for Development of Asymptomatic Bacteriuria Among HIV Positive Pregnant Women in Jos, Nigeria. Central African Journal of Public Health, 7(4), 170-181. https://doi.org/10.11648/j.cajph.20210704.14

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    Tinuade Abimbola Oyebode; Godwin Imade; Isichei Christian; Tolulope Afolaranmi; Halima Sule, et al. Prevalence and Risk Factors for Development of Asymptomatic Bacteriuria Among HIV Positive Pregnant Women in Jos, Nigeria. Cent. Afr. J. Public Health 2021, 7(4), 170-181. doi: 10.11648/j.cajph.20210704.14

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    AMA Style

    Tinuade Abimbola Oyebode, Godwin Imade, Isichei Christian, Tolulope Afolaranmi, Halima Sule, et al. Prevalence and Risk Factors for Development of Asymptomatic Bacteriuria Among HIV Positive Pregnant Women in Jos, Nigeria. Cent Afr J Public Health. 2021;7(4):170-181. doi: 10.11648/j.cajph.20210704.14

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  • @article{10.11648/j.cajph.20210704.14,
      author = {Tinuade Abimbola Oyebode and Godwin Imade and Isichei Christian and Tolulope Afolaranmi and Halima Sule and Jonah Musa and Solomon Sagay and Prosper Okonkwo and Demetrios Kyriacou and Chad Achenbach and Phyllis Kanki},
      title = {Prevalence and Risk Factors for Development of Asymptomatic Bacteriuria Among HIV Positive Pregnant Women in Jos, Nigeria},
      journal = {Central African Journal of Public Health},
      volume = {7},
      number = {4},
      pages = {170-181},
      doi = {10.11648/j.cajph.20210704.14},
      url = {https://doi.org/10.11648/j.cajph.20210704.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20210704.14},
      abstract = {The Human Immunodeficiency Virus pandemic is negatively affecting the reproductive health of women in Nigeria. It is associated with increased morbidity and mortality, especially where secondary infections exist. Studies document that HIV positive women are prone to reproductive and urinary tract infections, and due to physiologic changes in pregnancy, there is higher incidence of urinary infections among pregnant women, with or without symptoms. This prospective cohort study investigates for asymptomatic bacteriuria in pregnancy among HIV seropositive women, to identify if HIV positivity confers additional risks for occurrence. We recruited 119 pregnant HIV positive women and 152 HIV negative controls from Jos University teaching hospital and Faith Alive hospital in Jos, Nigeria and screened for asymptomatic bacteriuria. Bacteriuria was confirmed when two separate urine samples, in the same woman, showed presence of 105 CFU/ml (100,000 organisms) of same species. Laboratory personnel performing tests were unaware of participants HIV status. Antibiotic sensitivity were determined and participants were followed-up/evaluated for features of pyelonephritis throughout antenatal care. Prevalence was determined and analysis to determine if HIV positivity conferred risks. There were 22 women with confirmed bacteriuria, with prevalence of 8.1% among all participants, with 9.4% (14) among HIV Negative cohort and 6.8% (8) of HIV positive women. HIV status, demography and previous pyelonephritis/UTI were not statistically associated with development of asymptomatic bacteriuria. Two women with medical conditions (Diabetes and Sickle cell disease) had confirmed bacteriuria, but numbers were insufficient to deduce an association. Staphylococcus aureus predominated (78.6%) among HIV negative, while for HIV positive women, Escherichia coli and Staphylococcus aureus each affected 44.4%. Antibiotic sensitivity favoured Cefuroxime in both HIV positive and negative women, but organisms were resistant to penicillins and Nitrofurantoin. Treatment was not possible because of antibiotics cost and/or unwillingness of participants to receive treatment for an asymptomatic condition. Analysis of the HIV positive cohort showed no further conferment of risk by CD4 counts, viral load, duration of HIV positivity, the anti-retroviral drug type/class or duration/adherence to ARVs. No woman with CD4 count >500 cells/mm3 developed asymptomatic bacteriuria but there was no statistical association. Similarly, women who had undetectable viral load had lower bacteriuria rates, while women with high viral load had higher rates of asymptomatic bacteriuria, but this was only significant when analysis was performed using the logarithm of viral load.},
     year = {2021}
    }
    

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    T1  - Prevalence and Risk Factors for Development of Asymptomatic Bacteriuria Among HIV Positive Pregnant Women in Jos, Nigeria
    AU  - Tinuade Abimbola Oyebode
    AU  - Godwin Imade
    AU  - Isichei Christian
    AU  - Tolulope Afolaranmi
    AU  - Halima Sule
    AU  - Jonah Musa
    AU  - Solomon Sagay
    AU  - Prosper Okonkwo
    AU  - Demetrios Kyriacou
    AU  - Chad Achenbach
    AU  - Phyllis Kanki
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    DO  - 10.11648/j.cajph.20210704.14
    T2  - Central African Journal of Public Health
    JF  - Central African Journal of Public Health
    JO  - Central African Journal of Public Health
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    EP  - 181
    PB  - Science Publishing Group
    SN  - 2575-5781
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    AB  - The Human Immunodeficiency Virus pandemic is negatively affecting the reproductive health of women in Nigeria. It is associated with increased morbidity and mortality, especially where secondary infections exist. Studies document that HIV positive women are prone to reproductive and urinary tract infections, and due to physiologic changes in pregnancy, there is higher incidence of urinary infections among pregnant women, with or without symptoms. This prospective cohort study investigates for asymptomatic bacteriuria in pregnancy among HIV seropositive women, to identify if HIV positivity confers additional risks for occurrence. We recruited 119 pregnant HIV positive women and 152 HIV negative controls from Jos University teaching hospital and Faith Alive hospital in Jos, Nigeria and screened for asymptomatic bacteriuria. Bacteriuria was confirmed when two separate urine samples, in the same woman, showed presence of 105 CFU/ml (100,000 organisms) of same species. Laboratory personnel performing tests were unaware of participants HIV status. Antibiotic sensitivity were determined and participants were followed-up/evaluated for features of pyelonephritis throughout antenatal care. Prevalence was determined and analysis to determine if HIV positivity conferred risks. There were 22 women with confirmed bacteriuria, with prevalence of 8.1% among all participants, with 9.4% (14) among HIV Negative cohort and 6.8% (8) of HIV positive women. HIV status, demography and previous pyelonephritis/UTI were not statistically associated with development of asymptomatic bacteriuria. Two women with medical conditions (Diabetes and Sickle cell disease) had confirmed bacteriuria, but numbers were insufficient to deduce an association. Staphylococcus aureus predominated (78.6%) among HIV negative, while for HIV positive women, Escherichia coli and Staphylococcus aureus each affected 44.4%. Antibiotic sensitivity favoured Cefuroxime in both HIV positive and negative women, but organisms were resistant to penicillins and Nitrofurantoin. Treatment was not possible because of antibiotics cost and/or unwillingness of participants to receive treatment for an asymptomatic condition. Analysis of the HIV positive cohort showed no further conferment of risk by CD4 counts, viral load, duration of HIV positivity, the anti-retroviral drug type/class or duration/adherence to ARVs. No woman with CD4 count >500 cells/mm3 developed asymptomatic bacteriuria but there was no statistical association. Similarly, women who had undetectable viral load had lower bacteriuria rates, while women with high viral load had higher rates of asymptomatic bacteriuria, but this was only significant when analysis was performed using the logarithm of viral load.
    VL  - 7
    IS  - 4
    ER  - 

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Author Information
  • Faculty of Medical Sciences, University of Jos, Jos, Nigeria

  • Faculty of Medical Sciences, University of Jos, Jos, Nigeria

  • Faculty of Medical Sciences, University of Jos, Jos, Nigeria

  • Faculty of Medical Sciences, University of Jos, Jos, Nigeria

  • Faculty of Medical Sciences, University of Jos, Jos, Nigeria

  • Faculty of Medical Sciences, University of Jos, Jos, Nigeria

  • Faculty of Medical Sciences, University of Jos, Jos, Nigeria

  • AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria

  • Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, USA

  • Division of Infectious Diseases and Center for Global Health, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, USA

  • Infectious Diseases & Immunology, Harvard School of Public Health, Boston, USA

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