Dr Gbolahan Ajibola, MBBS, MPH - Botswana-Harvard AIDS Institute Partnership

Dr Gbolahan Ajibola

MBBS, MPH

Botswana-Harvard AIDS Institute Partnership

Gaborone, Gaborone | Botswana

ORCID logohttps://orcid.org/0000-0002-5408-4823

Dr Gbolahan Ajibola, MBBS, MPH - Botswana-Harvard AIDS Institute Partnership

Dr Gbolahan Ajibola

MBBS, MPH

Introduction

Primary Affiliation: Botswana-Harvard AIDS Institute Partnership - Gaborone, Gaborone , Botswana

Education

Dec 2012
University of Liverpool
MPH
Oct 2004
College of Medicine, University of Lagos, Nigeria
MB; BS

Experience

Feb 2012
Study Coordinator

Publications

17Publications

314Reads

53Profile Views

1PubMed Central Citations

Drug resistance after cessation of efavirenz-based antiretroviral treatment started in pregnancy

Ajibola G, Maruapula D, Rowley C, et al. Drug resistance after cessation of efavirenz-based antiretroviral treatment started in pregnancy. S Afr J HIV Med. 2020;21(1), a1023. https://doi.org/10.4102/sajhivmed.v21i1.1023

Southern African Journal of HIV Medicine

Background: To reduce risk of antiretroviral resistance when stopping efavirenz (EFV)-based antiretroviral treatment (ART), staggered discontinuation of antiretrovirals (an NRTI tail) is recommended. However, no data directly support this recommendation. Objectives: We evaluated the prevalence of HIV drug resistance mutations in pregnant women living with HIV who stopped efavirenz (EFV)/emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) postpartum. Method: In accordance with the prevailing Botswana HIV guidelines at the time, women with pre-treatment CD4 > 350 cells/mm3 , initiated EFV/FTC/TDF in pregnancy and stopped ART at 6 weeks postpartum if formula feeding, or 6 weeks after weaning. A 7-day tail of FTC/TDF was recommended per Botswana guidelines. HIV-1 RNA and genotypic resistance testing (bulk sequencing) were performed on samples obtained 4–6 weeks after stopping EFV. Stanford HIV Drug Resistance Database was used to identify major mutations. Results: From April 2014 to May 2015, 74 women who had stopped EFV/FTC/TDF enrolled, with median nadir CD4 of 571 cells/mm3 . The median time from cessation of EFV to sample draw for genotyping was 5 weeks (range: 3–13 weeks). Thirty-two (43%) women received a 1-week tail of FTC/TDF after stopping EFV. HIV-1 RNA was available from delivery in 70 (95%) women, 58 (83%) of whom had undetectable delivery HIV-1 RNA (< 40 copies/mL). HIV-1 RNA was available for 71 women at the time of genotyping, 45 (63%) of whom had HIV-1 RNA < 40 copies/mL. Thirty-five (47%) of 74 samples yielded a genotype result, and four (11%) had a major drug resistance mutation: two with K103N and two with V106M. All four resistance mutations occurred among women who did not receive an FTC/TDF tail (4/42, 10%), whereas no mutations occurred among 18 genotyped women who had received a 1-week FTC/TDF tail (p = 0.053). Conclusions: Viral rebound was slow following cessation of EFV/FTC/TDF in the postpartum period. Use of an FTC/TDF tail after stopping EFV was associated with the lower prevalence of subsequent NNRTI drug resistance mutation. Keywords: drug resistance; resistance mutations; HIV; antiretroviral treatment; Botswana. 

View Article
January 2020

HIV Exposure and Formula Feeding Predict Under-2 Mortality in HIV-Uninfected Children, Botswana.

J Pediatr 2018 12 11;203:68-75.e2. Epub 2018 Oct 11.

Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA; Harvard Medical School, Boston, MA; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpeds.2018.08.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252117PMC
December 2018
137 Reads
3.790 Impact Factor

Effect of co-trimoxazole on mortality in HIV-exposed but uninfected children in Botswana (the Mpepu Study): a double-blind, randomised, placebo-controlled trial

http://dx.doi.org/10.1016/S2214-109X(17)30143-2

Lancet

Background Co-trimoxazole prophylaxis reduces mortality among HIV-infected children, but efficacy in HIV-exposed but uninfected (HEU) children in a non-malarial, low-breastfeeding setting with a low risk of mother-to-child transmission of HIV is unclear. Methods HEU children in Botswana were randomly assigned to receive co-trimoxazole (100 mg/20 mg once daily until age 6 months and 200 mg/40 mg once daily thereafter) or placebo from age 14–34 days to age 15 months. Mothers chose whether to breastfeed or formula feed their children. Breastfed children were randomly assigned to breastfeeding for 6 months (Botswana guidelines) or 12 months (WHO guidelines). The primary outcome, analysed by a modified intention-to-treat approach, was cumulative child mortality from treatment assignment to age 18 months. We also assessed HIV-free survival by duration of breastfeeding. This trial is registered with ClinicalTrials.gov, number NCT01229761. Findings From June 7, 2011, to April 2, 2015, 2848 HEU children were randomly assigned to receive co-trimoxazole (n=1423) or placebo (n=1425). The data and safety monitoring board stopped the study early because of a low likelihood of benefit with co-trimoxazole. Only 153 (5%) children were lost to follow-up (76 in the co-trimoxazole group and 77 in the placebo group), and 2053 (72%) received treatment continuously to age 15 months, death, or study closure. Mortality after the start of study treatment was similar in the two study groups: 30 children died in the co-trimoxazole group, compared with 34 in the placebo group (estimated mortality at 18 months 2·4% vs 2·6%; difference −0·2%, 95% CI −1·5 to 1·0, p=0·70). We saw no difference in hospital admissions between groups (12·5% in the co-trimoxazole group vs 17·4% in the placebo group, p=0·19) or grade 3–4 clinical adverse events (16·5% vs 18·4%, p=0·18). Grade 3–4 anaemia did not differ between groups (8·1% vs 8·3%, p=0·93), but grade 3–4 neutropenia was more frequent in the co-trimoxazole group than in the placebo group (8·1% vs 5·8%, p=0·03). More co-trimoxazole resistance in commensal Escherichia coli isolated from stool samples was seen in children aged 3 or 6 months in the co-trimoxazole group than in the placebo group (p=0·001 and p=0·01, respectively). 572 (20%) children were breastfed. HIV infection and mortality did not differ significantly by duration of breastfeeding (3·9% for 6 months vs 1·9% for 12 months, p=0·21). Interpretation Prophylactic co-trimoxazole seems to offer no survival benefit among HEU children in non-malarial, low-breastfeeding areas with a low risk of mother-to-child transmission of HIV.

View Article
April 2017
7 Reads

High Sensitivity and Specificity of the Cepheid Xpert® HIV-1 Qualitative Point-of-Care Test among Newborns in Botswana.

doi: 10.1097/QAI.0000000000001384

Journal of Acquired immune deficiency syndrome

BACKGROUND: HIV point-of-care (POC) testing allows for early infant HIV diagnosis and treatment, but POC accuracy at birth and in the setting of antiretroviral prophylaxis for the prevention of mother-to-child HIV transmission (MTCT) is unknown. METHODS: We evaluated the Cepheid Xpert® HIV-1 Qual POC test against the Roche Taqman HIV-1 PCR platform using dried blood spots from 15 HIV-infected and 75 HIV-exposed uninfected newborns. These infants were screened for HIV at <96 hours of life at 5 hospital maternity wards in Botswana; all infants received post-exposure antiretroviral prophylaxis (PEP) and most mothers received 3-drug antiretroviral therapy in pregnancy and at delivery. RESULTS: Fourteen of 15 PCR positive samples tested positive by Cepheid POC, yielding a sensitivity of 93.3% (95%CI: 68.1-99.8%). Baseline viral load among positive infants ranged from <40 to >10,000,000 copies/ml, with a median of 2,403 copies/mL. The HIV RNA for the infant with false negative POC testing was 1,661 copies/mL. Of note, two infants with low HIV RNA (< 40 copies/mL and 272 copies/ml) were correctly identified as HIV positive by Cepheid POC. All of the 75 PCR-negative samples tested negative by Cepheid POC, yielding a specificity of 100% (95% CI: 96.1 -100%). DISCUSSION: Our study demonstrates high sensitivity and specificity for the Cepheid POC assay in the first week of life despite early infection and antiretroviral prophylaxis. This platform may be a useful approach for adding early infant HIV diagnosis to current testing programs.

View Article
March 2017
11 Reads

Detecting congenital malformations - Lessons learned from the Mpepu study, Botswana

https://doi.org/10.1371/journal.pone.0173800

PLOSone

Introduction A large and increasing number of HIV-infected women are conceiving on antiretroviral treatment (ART). While most antiretrovirals are considered safe in pregnancy, monitoring for rare pregnancy and infant adverse outcomes is warranted. Methods We conducted a retrospective secondary analysis nested within a clinical trial of infant cotrimoxazole vs. placebo prophylaxis in Botswana (the Mpepu Study). Infants were examined at birth, and at least every 3 months through 18 months of age. Abnormal physical findings and diagnostic testing revealing malformations were documented. Post hoc, a geneticist classified all reported malformations based on available documentation. Structural malformations with surgical, medical or cosmetic importance were classified as major malformations. We present a descriptive analysis of identified malformations. Results Between 2011 and 2014, 2,933 HIV-infected women who enrolled in the Mpepu study delivered 2,971 live-born infants. Study staff conducted 2,944 (99%) newborn exams. One thousand eighty-eight (38%) women were taking ART at conception; 1,147 (40%) started ART during pregnancy; 442 (15%) received zidovudine monotherapy; and 223 (7%) received no antiretroviral during pregnancy. Of 33 reported anomalies, 25 (76%) met congenital malformations criteria, 10 (30%) were classified as major malformations, 4 (40%) of which were identified after the birth exam. Discussion Our results highlight the importance of staff training on identification of congenital malformations, programmatic monitoring beyond the birth examination and the value of geneticist involvement in the malformations classification process in resource-limited settings. These elements will be important to fully define antiretroviral drug safety in pregnancy. Significance Surveillance systems for monitoring the safety of antiretroviral use during pregnancy among HIV-infected women in resource-limited setting are lacking. The World Health Organization’s published programmatic recommendations for such surveillance systems represents the gold standard. We employed data from a clinical trial in Botswana, a country with a generalized HIV epidemic and high antiretroviral uptake by HIV-infected women, to highlight practical opportunities to strengthen congenital malformation surveillance systems in these settings where over 1 million HIV infected pregnant women reside. Trial registration Clinical Trials.gov NCT01229761

View Article
March 2017
6 Reads

[Biochemical studies on camomile components/III. In vitro studies about the antipeptic activity of (--)-alpha-bisabolol (author's transl)].

Authors:
O Isaac K Thiemer

Arzneimittelforschung 1975 Sep;25(9):1352-4

View Article

Download full-text PDF

Source
September 1975
10 Reads
0.507 Impact Factor

Top co-authors

Shahin Lockman
Shahin Lockman

Brigham and Women's Hospital

11
Sikhulile Moyo
Sikhulile Moyo

Harvard School of Public Health

9
Joseph Makhema
Joseph Makhema

Harvard School of Public Health

8
Roger Shapiro
Roger Shapiro

Harvard School of Public Health

7
Oganne Batlang
Oganne Batlang

Botswana Harvard AIDS Institute Partnership

6
Jean Leidner
Jean Leidner

Massachusetts General Hospital

6
Daniel R Kuritzkes
Daniel R Kuritzkes

Brigham and Women's Hospital

5
Michael D Hughes
Michael D Hughes

Harvard School of Public Health

5
Maureen Sakoi
Maureen Sakoi

Botswana-Harvard AIDS Institute Partnership

5