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Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
1
The Nexus Between Obesity and Leukemia Progression in HIV-Positive Individuals: A
Review
*Emmanuel Ifeanyi Obeagu1 and Getrude Uzoma Obeagu2
1Department of Medical Laboratory Science, Kampala International University, Uganda
2School of Nursing Science, Kampala International University, Uganda.
*Corresponding authour: Emmanuel Ifeanyi Obeagu, Department of Medical Laboratory Science,
Kampala International University, Uganda, emmanuelobeagu@yahoo.com, ORCID: 0000-0002-
4538-0161
Abstract
The coexistence of obesity, leukemia, and HIV infection presents a multifaceted challenge in
clinical management. This review aims to elucidate the intricate relationship between obesity and
leukemia progression in individuals living with HIV. Obesity, characterized by chronic low-grade
inflammation and metabolic dysregulation, influences leukemia progression through complex
mechanisms involving adipose tissue dysfunction, altered immune responses, and systemic
inflammation. Moreover, in HIV-positive individuals, the interplay between viral infection,
immune dysfunction, and oncogenesis further exacerbates the impact of obesity on leukemia
progression. Understanding these interactions is crucial for developing tailored therapeutic
strategies to improve clinical outcomes in this vulnerable population.
Keywords: Obesity, Leukemia, HIV, Progression, Adipose Tissue, Inflammation, Immune
Dysregulation
Introduction
The co-occurrence of obesity, leukemia, and HIV/AIDS represents a complex nexus of health
challenges that profoundly impact individual health outcomes and public health systems globally.
Obesity, a chronic condition characterized by excessive adipose tissue accumulation, is
Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
2
increasingly recognized as a significant risk factor for various malignancies, including leukemia.
Concurrently, individuals living with HIV/AIDS face a heightened risk of developing leukemia
due to the immunosuppressive effects of the virus and associated chronic inflammation.
Understanding the intricate interplay between these three conditions is paramount for elucidating
disease mechanisms and developing effective therapeutic strategies to improve clinical outcomes.
Obesity, beyond its role as a metabolic disorder, is now acknowledged as a state of chronic low-
grade inflammation, with adipose tissue serving as a dynamic endocrine organ secreting
adipokines, cytokines, and other bioactive molecules. This adipose tissue dysfunction creates a
pro-inflammatory microenvironment conducive to oncogenesis and tumor progression, including
leukemia. The dysregulated secretion of adipokines and cytokines, such as interleukin-6 (IL-6)
and tumor necrosis factor-alpha (TNF-α), contributes to systemic inflammation, insulin resistance,
and altered lipid metabolism, all of which foster leukemic cell survival and proliferation.1-40
In the context of HIV infection, the immune dysregulation and chronic inflammation associated
with the virus further exacerbate the impact of obesity on leukemia progression. HIV-induced
alterations in immune function, including CD4+ T-cell depletion and CD8+ T-cell expansion,
disrupt immune surveillance mechanisms, allowing for the persistence of oncogenic viruses and
leukemic transformation. Moreover, the dysregulation of cytokine networks in HIV/AIDS,
characterized by elevated levels of pro-inflammatory cytokines and impaired antitumor immune
responses, creates an environment conducive to leukemia development and progression.
Antiretroviral therapy (ART), while essential for suppressing HIV replication and restoring
immune function, may also influence leukemia progression through its immunomodulatory effects
and metabolic disturbances. Understanding the complex interactions between obesity, HIV
infection, and leukemia is crucial for optimizing treatment strategies and improving outcomes for
individuals living with these comorbidities. This review aims to explore the multifaceted
relationship between obesity and leukemia progression in HIV-positive individuals, providing
insights into the underlying mechanisms and therapeutic implications to guide future research and
clinical practice.41-70
Obesity and Leukemia Progression
Obesity, a multifaceted chronic condition characterized by excessive adipose tissue accumulation,
has emerged as a significant factor influencing the progression of leukemia, a hematological
malignancy characterized by abnormal proliferation of white blood cells. The relationship between
obesity and leukemia progression is complex and involves a myriad of interconnected mechanisms
spanning inflammation, metabolic dysregulation, and alterations in the bone marrow
microenvironment. Central to the interplay between obesity and leukemia progression is the
chronic low-grade inflammation characteristic of adipose tissue dysfunction. Adipose tissue serves
not only as an energy storage depot but also as an active endocrine organ, secreting a multitude of
bioactive molecules termed adipokines. Dysregulated secretion of adipokines, including pro-
inflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and
Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
3
leptin, alongside decreased levels of anti-inflammatory adiponectin, creates a pro-inflammatory
microenvironment conducive to leukemic cell survival and proliferation. Moreover, adipocytes
and stromal cells within the adipose tissue niche interact with leukemia cells, promoting their
migration, invasion, and resistance to chemotherapy-induced apoptosis.71-100
Metabolic dysregulation associated with obesity further contributes to leukemia progression
through altered lipid metabolism and insulin resistance. Elevated levels of circulating free fatty
acids and dyslipidemia can directly impact leukemic cell behavior and chemoresistance.
Additionally, insulin resistance and hyperinsulinemia, common features of obesity, have been
implicated in promoting leukemic cell growth and survival through activation of insulin-like
growth factor-1 (IGF-1) signaling pathways. The bone marrow microenvironment, essential for
hematopoiesis and leukemic cell homing, is profoundly influenced by obesity. Adipose tissue
expansion and adipocyte infiltration into the bone marrow disrupt the balance of hematopoietic
stem cell niches, favoring the expansion of leukemic stem cells and disease progression.
Adipocyte-derived factors, including adipokines, extracellular vesicles, and fatty acids, modulate
signaling pathways involved in leukemic cell growth, survival, and chemoresistance. While the
precise mechanisms linking obesity and leukemia progression continue to be elucidated, the
clinical implications are clear. Obesity represents a modifiable risk factor that may influence
leukemia prognosis and treatment response. Therefore, interventions targeting obesity-associated
inflammation and metabolic dysregulation hold promise for improving outcomes in leukemia
patients, particularly those with comorbid obesity. Further research is warranted to explore the
intricate interplay between obesity and leukemia progression and to develop targeted therapeutic
strategies aimed at disrupting this detrimental association.101-140
Role of HIV Infection
The role of HIV infection in the progression of leukemia, particularly in the context of obesity,
adds another layer of complexity to the disease process. HIV/AIDS, a viral infection characterized
by progressive immunosuppression and chronic inflammation, significantly influences the
pathogenesis and clinical course of leukemia in affected individuals. One of the primary
mechanisms through which HIV infection contributes to leukemia progression is immune
dysregulation. The virus targets CD4+ T cells, leading to their depletion and impairing immune
surveillance mechanisms. This immune dysfunction compromises the host's ability to recognize
and eliminate malignant cells, allowing for the proliferation and dissemination of leukemic clones.
Furthermore, HIV-induced alterations in T-cell subsets, including an increase in CD8+ T cells and
a decrease in CD4+/CD8+ ratio, disrupt immune regulation and antitumor immunity, fostering a
microenvironment favorable for leukemia development and progression. Chronic inflammation
associated with HIV/AIDS further exacerbates leukemia progression by creating a pro-
inflammatory milieu that promotes leukemic cell survival and proliferation. HIV-infected
individuals often exhibit elevated levels of inflammatory cytokines, such as interleukin-6 (IL-6),
interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-α), which contribute to
Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
4
leukemogenesis and disease progression. Additionally, HIV-associated co-infections with
oncogenic viruses, such as Epstein-Barr virus (EBV) and human T-cell lymphotropic virus type 1
(HTLV-1), further increase the risk of leukemia development through viral oncogene expression
and immune evasion mechanisms. Antiretroviral therapy (ART), the cornerstone of HIV
management, has revolutionized the treatment landscape and significantly improved survival rates
among HIV-positive individuals. However, the impact of ART on leukemia progression remains
a subject of debate. While ART effectively suppresses viral replication and restores immune
function, certain antiretroviral drugs may exert direct or indirect effects on leukemic cells,
influencing disease progression and treatment outcomes. Additionally, metabolic side effects of
ART, such as dyslipidemia and insulin resistance, may further contribute to leukemia progression
in individuals with comorbid obesity.141-200
Conclusion
The convergence of obesity, HIV infection, and leukemia presents a multifaceted challenge in
clinical management, necessitating a comprehensive understanding of their complex interactions.
Obesity, characterized by chronic low-grade inflammation and metabolic dysregulation,
contributes to leukemia progression through adipose tissue dysfunction, altered immune responses,
and systemic inflammation. Similarly, HIV infection, with its immunosuppressive effects and
chronic inflammation, further exacerbates leukemia progression by impairing immune
surveillance mechanisms and creating a pro-inflammatory microenvironment conducive to
leukemogenesis.
The interplay between obesity, HIV infection, and leukemia underscores the importance of
personalized therapeutic approaches tailored to the specific needs of affected individuals. Targeted
interventions aimed at mitigating chronic inflammation, restoring immune function, and
addressing metabolic dysregulation hold promise for improving clinical outcomes in this
vulnerable population. Furthermore, elucidating the molecular mechanisms underlying these
interactions will facilitate the development of novel therapeutic strategies to disrupt the detrimental
association between obesity, HIV infection, and leukemia progression.
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HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
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Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
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Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
6
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Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
7
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Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
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Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
8
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HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
9
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50. Lionberger JM, Stirewalt DL. Gene expression changes in normal haematopoietic cells.
Best Practice & Research Clinical Haematology. 2009;22(2):249-269.
51. Obeagu EI, Nwosu DC. Adverse drug reactions in HIV/AIDS patients on highly active
antiretro viral therapy: a review of prevalence. Int. J. Curr. Res. Chem. Pharm. Sci.
2019;6(12):45-8.DOI: 10.22192/ijcrcps.2019.06.12.004
links/650aba1582f01628f0335795/Adverse-drug-reactions-in-HIV-AIDS-patients-on-
highly-active-antiretro-viral-therapy-a-review-of-prevalence.pdf.
52. Obeagu EI, Scott GY, Amekpor F, Obeagu GU. Implications of CD4/CD8 ratios in Human
Immunodeficiency Virus infections. Int. J. Curr. Res. Med. Sci. 2023;9(2):6-13.DOI:
10.22192/ijcrms.2023.09.02.002 links/645a4a462edb8e5f094ad37c/Implications-of-CD4-
CD8-ratios-in-Human-Immunodeficiency-Virus-infections.pdf.
53. Obeagu EI, Ochei KC, Okeke EI, Anode AC. Assessment of the level of haemoglobin and
erythropoietin in persons living with HIV in Umuahia. Int. J. Curr. Res. Med. Sci.
2016;2(4):29-33. links/5711c47508aeebe07c02496b/Assessment-of-the-level-of-
haemoglobin-and-erythropoietin-in-persons-living-with-HIV-in-Umuahia.pdf.
54. Ifeanyi OE, Obeagu GU. The Values of CD4 Count, among HIV Positive Patients in FMC
Owerri. Int. J. Curr. Microbiol. App. Sci. 2015;4(4):906-910.
Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
10
https://www.academia.edu/download/38320134/Obeagu_Emmanuel_Ifeanyi_and_Obeag
u__Getrude_Uzoma.EMMA2.pdf.
55. Obeagu EI, Okeke EI, Anonde Andrew C. Evaluation of haemoglobin and iron profile
study among persons living with HIV in Umuahia, Abia state, Nigeria. Int. J. Curr. Res.
Biol. Med. 2016;1(2):1-5.
56. Ibebuike JE, Nwokike GI, Nwosu DC, Obeagu EI. A Retrospective Study on Human
Immune Deficiency Virus among Pregnant Women Attending Antenatal Clinic in Imo
State University Teaching Hospital. International Journal of Medical Science and Dental
Research, 2018; 1 (2):08-14.
https://www.ijmsdr.org/published%20paper/li1i2/A%20Retrospective%20Study%20on%
20Human%20Immune%20Deficiency%20Virus%20among%20Pregnant%20Women%2
0Attending%20Antenatal%20Clinic%20in%20Imo%20State%20University%20Teaching
%20Hospital.pdf.
57. Obeagu EI, Obarezi TN, Omeh YN, Okoro NK, Eze OB. Assessment of some
haematological and biochemical parametrs in HIV patients before receiving treatment in
Aba, Abia State, Nigeria. Res J Pharma Biol Chem Sci. 2014; 5:825-830.
58. Obeagu EI, Obarezi TN, Ogbuabor BN, Anaebo QB, Eze GC. Pattern of total white blood
cell and differential count values in HIV positive patients receiving treatment in Federal
Teaching Hospital Abakaliki, Ebonyi State, Nigeria. International Journal of Life Science,
Biotechnology and Pharama Research. 2014; 391:186-189.
59. Obeagu EI. A Review of Challenges and Coping Strategies Faced by HIV/AIDS
Discordant Couples. Madonna University journal of Medicine and Health Sciences. 2023;
3 (1): 7-12.
60. Oloro OH, Obeagu EI. A Systematic Review on Some Coagulation Profile in HIV
Infection. International Journal of Innovative and Applied Research. 2022;10(5):1-11.
61. Alvarez F, Fritz JH, Piccirillo CA. Pleiotropic effects of IL-33 on CD4+ T cell
differentiation and effector functions. Frontiers in immunology. 2019; 10:438556.
62. Chirumbolo S, Bjørklund G, Sboarina A, Vella A. The role of basophils as innate immune
regulatory cells in allergy and immunotherapy. Human vaccines & immunotherapeutics.
2018;14(4):815-831.
63. Nwosu DC, Obeagu EI, Nkwuocha BC, Nwanna CA, Nwanjo HU, Amadike JN, Ezemma
MC, Okpomeshine EA, Ozims SJ, Agu GC. Alterations in superoxide dismutiase, vitamins
C and E in HIV infected children in Umuahia, Abia state. International Journal of
Advanced Research in Biological Sciences. 2015;2(11):268-271.
64. Ifeanyi OE, Uzoma OG, Stella EI, Chinedum OK, Abum SC. Vitamin D and insulin
resistance in HIV sero positive individuals in Umudike. Int. J. Curr. Res. Med. Sci.
2018;4(2):104-108.
65. Ifeanyi OE, Leticia OI, Nwosu D, Chinedum OK. A Review on blood borne viral
infections: universal precautions. Int. J. Adv. Res. Biol. Sci. 2018;5(6):60-66.
Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
11
66. Nwovu AI, Ifeanyi OE, Uzoma OG, Nwebonyi NS. Occurrence of Some Blood Borne
Viral Infection and Adherence to Universal Precautions among Laboratory Staff in Federal
Teaching Hospital Abakaliki Ebonyi State. Arch Blood Transfus Disord. 2018;1(2).
67. Chinedu K, Takim AE, Obeagu EI, Chinazor UD, Eloghosa O, Ojong OE, Odunze U. HIV
and TB co-infection among patients who used Directly Observed Treatment Short-course
centres in Yenagoa, Nigeria. IOSR J Pharm Biol Sci. 2017;12(4):70-75.
68. Offie DC, Obeagu EI, Akueshi C, Njab JE, Ekanem EE, Dike PN, Oguh DN. Facilitators
and barriers to retention in HIV care among HIV infected MSM attending Community
Health Center Yaba, Lagos Nigeria. Journal of Pharmaceutical Research International.
2021;33(52B):10-19.
69. Obeagu EI, Obeagu GU, Ede MO, Odo EO, Buhari HA. Translation of HIV/AIDS
knowledge into behavior change among secondary school adolescents in Uganda: A
review. Medicine (Baltimore). 2023;102(49): e36599. doi:
10.1097/MD.0000000000036599. PMID: 38065920; PMCID: PMC10713174.
70. Anyiam AF, Arinze-Anyiam OC, Irondi EA, Obeagu EI. Distribution of ABO and rhesus
blood grouping with HIV infection among blood donors in Ekiti State Nigeria. Medicine
(Baltimore). 2023;102(47): e36342. doi: 10.1097/MD.0000000000036342. PMID:
38013335; PMCID: PMC10681551.
71. Echefu SN, Udosen JE, Akwiwu EC, Akpotuzor JO, Obeagu EI. Effect of Dolutegravir
regimen against other regimens on some hematological parameters, CD4 count and viral
load of people living with HIV infection in South Eastern Nigeria. Medicine (Baltimore).
2023;102(47): e35910. doi: 10.1097/MD.0000000000035910. PMID: 38013350; PMCID:
PMC10681510.
72. Opeyemi AA, Obeagu EI. Regulations of malaria in children with human
immunodeficiency virus infection: A review. Medicine (Baltimore). 2023;102(46):
e36166. doi: 10.1097/MD.0000000000036166. PMID: 37986340; PMCID:
PMC10659731.
73. Obeagu EI, Obeagu GU, Obiezu J, Ezeonwumelu C, Ogunnaya FU, Ngwoke AO, Emeka-
Obi OR,
74. Obeagu EI, Ubosi NI, Uzoma G. Storms and Struggles: Managing HIV Amid Natural
Disasters. Int. J. Curr. Res. Chem. Pharm. Sci. 2023;10(11):14-25.
75. Obeagu EI, Obeagu GU. Human Immunodeficiency Virus and tuberculosis infection: A
review of prevalence of associated factors. Int. J. Adv. Multidiscip. Res. 2023;10(10):56-
62.
76. Obeagu EI, Obeagu GU. Unmasking the Truth: Addressing Stigma in the Fight Against
HIV. Elite Journal of Public Health. 2024;2(1):8-22.
77. Obeagu EI, Obeagu GU, Okwuanaso CB. Optimizing Immune Health in HIV Patients
through Nutrition: A Review. Elite Journal of Immunology. 2024;2(1):14-33.
78. Obeagu EI, Obeagu GU. Utilization of immunological ratios in HIV: Implications for
monitoring and therapeutic strategies. Medicine. 2024;103(9): e37354.
Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
12
79. Obeagu EI, Obeagu GU. CD8 Dynamics in HIV Infection: A Synoptic Review. Elite
Journal of Immunology. 2024;2(1):1-3.
80. Obeagu EI, Obeagu GU. Implications of B Lymphocyte Dysfunction in HIV/AIDS. Elite
Journal of Immunology. 2024;2(1):34-46.
81. Obeagu EI, Obeagu GU. Maternal Influence on Infant Immunological Responses to HIV:
A Review. Elite Journal of Laboratory Medicine. 2024;2(1):46-58.
82. Obeagu EI, Obeagu GU. Understanding B Lymphocyte Functions in HIV Infection:
Implications for Immune Dysfunction and Therapeutic Strategies. Elite Journal of
Medicine. 2024;2(1):35-46.
83. Obeagu EI, Obeagu GU. Platelet-Driven Modulation of HIV: Unraveling Interactions and
Implications. Journal home page: http://www. journalijiar. com.;12(01).
84. Obeagu EI, Anyiam AF, Obeagu GU. Managing Hematological Complications in HIV:
Erythropoietin Considerations. Elite Journal of HIV. 2024;2(1):65-78.
85. Obeagu EI, Obeagu GU, Hauwa BA, Umar AI. Hematocrit Variations in HIV Patients Co-
infected with Malaria: A Comprehensive Review. Journal home page: http://www.
journalijiar. com.;12(01).
86. ObeaguEI AA, Obeagu GU. Synergistic Effects of Blood Transfusion and HIV in Children
Under 5 Years with Severe Malaria: A Review. Elite Journal of HIV. 2024;2(1):31-50.
87. Obeagu EI, Anyiam AF, Obeagu GU. Unveiling B Cell Mediated Immunity in HIV
Infection: Insights, Challenges, and Potential Therapeutic Avenues. Elite Journal of HIV.
2024;2(1):1-5.
88. Obeagu EI, Obeagu GU. Hematocrit Fluctuations in HIV Patients Co-infected with Malaria
Parasites: A Comprehensive Review. Int. J. Curr. Res. Med. Sci. 2024;10(1):25-36.
89. Obeagu EI, Obeagu GU. Transfusion Therapy in HIV: Risk Mitigation and Benefits for
Improved Patient Outcomes. Sciences. 2024;4(1):32-7.
90. Obeagu EI, Obeagu GU. Mental Health and Psychosocial Effects of natural disaster on
HIV Patients. Sciences. 2024;4(1):38-44.
91. Obeagu EI, Obeagu GU. Eosinophil-Associated Changes in Neonatal Thymic T
Regulatory Cell Populations in HIV-Infected Pregnancies. Elite Journal of Health Science.
2024;2(1):33-42.
92. Obeagu EI, Obeagu GU. Advances in Understanding the Impact of Blood Transfusion on
Anemia Resolution in HIV-Positive Children with Severe Malaria: A Comprehensive
Review. Elite Journal of Haematology. 2024;2(1):26-41.
93. Obeagu EI, Ayogu EE, Obeagu GU. Interactions between Blood Transfusion and
Antiretroviral Medications: Implications for Patient Care. Elite Journal of Medicine.
2024;2(2):104-15.
94. Obeagu EI, Obeagu GU. Maternal Eosinophilic Responses in HIV-Positive Pregnant
Women: Unraveling Immunological Dynamics for Improved Maternal-Fetal Health. Elite
Journal of Immunology. 2024;2(1):47-64.
95. Obeagu EI, Anyanwu CN, Obeagu GU. Challenges and Considerations in Managing Blood
Transfusion for Individuals with HIV. Elite Journal of HIV. 2024;2(2):1-7.
Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
13
96. Obeagu EI, Ubosi NI, Obeagu GU, Akram M. Early Infant Diagnosis: Key to Breaking the
Chain of HIV Transmission. Elite Journal of Public Health. 2024;2(1):52-61.
97. Obeagu EI, Obeagu GU. Understanding Hematocrit Fluctuations in HIV-Malaria
Coinfection for Improved Management. Elite Journal of Public Health. 2024;2(1):22-34.
98. Obeagu EI, Obeagu GU. The Impact of Erythropoietin on Preeclampsia in HIV-Positive
Women: A Review. Elite Journal of Nursing and Health Science. 2024;2(1):21-31.
99. Obeagu EI, Obeagu GU. Platelet Distribution Width (PDW) as a Prognostic Marker for
Anemia Severity in HIV Patients: A Comprehensive Review. Journal home page:
http://www. journalijiar. com.;12(01).
100. Obeagu EI, Obeagu GU. Neonatal Outcomes in Children Born to Mothers with
Severe Malaria, HIV, and Transfusion History: A Review. Elite Journal of Nursing and
Health Science. 2024;2(3):38-58.
101. Obeagu EI, Obeagu GU. Assessing Platelet Functionality in HIV Patients
Receiving Antiretroviral Therapy: Implications for Risk Assessment. Elite Journal of HIV.
2024;2(3):14-26.
102. Obeagu EI, Obeagu GU. Advancements in HIV Prevention: Africa's Trailblazing
Initiatives and Breakthroughs. Elite Journal of Public Health. 2024;2(1):52-63.
103. Obeagu EI, Obeagu GU. Maternal Influence on Infant Immunological Responses
to HIV: A Review. Elite Journal of Laboratory Medicine. 2024;2(1):46-58.
104. Obeagu EI, Obeagu GU. Counting Cells, Shaping Fates: CD4/CD8 Ratios in HIV.
Elite Journal of Scientific Research and Review. 2024;2(1):37-50.
105. Obeagu EI, Anyiam AF, Obeagu GU. Managing Hematological Complications in
HIV: Erythropoietin Considerations. Elite Journal of HIV. 2024;2(1):65-78.
106. Obeagu EI, Obeagu GU. Immune Modulation in HIV-Positive Neonates: Insights
and Implications for Clinical Management. Elite Journal of Nursing and Health Science.
2024;2(3):59-72.
107. Obeagu EI, Ayogu EE, Obeagu GU. Impact on Viral Load Dynamics:
Understanding the Interplay between Blood Transfusion and Antiretroviral Therapy in HIV
Management. Elite Journal of Nursing and Health Science. 2024;2(2):5-15.
108. Obeagu EI, Obeagu GU. Understanding B Lymphocyte Functions in HIV Infection:
Implications for Immune Dysfunction and Therapeutic Strategies. Elite Journal of
Medicine. 2024;2(1):35-46.
109. Obeagu EI, Anyanwu CN, Obeagu GU. Challenges and Considerations in
Managing Blood Transfusion for Individuals with HIV. Elite Journal of HIV. 2024;2(2):1-
7.
110. Obeagu EI, Obeagu GU. Understanding ART and Platelet Functionality:
Implications for HIV Patients. Elite Journal of HIV. 2024;2(2):60-73.
111. Obeagu EI, Obeagu GU. The Role of Blood Transfusion Strategies in HIV
Management: Current Insights and Future Directions. Elite Journal of Medicine.
2024;2(1):10-22.
Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
14
112. Obeagu EI, AmaezeAA O, Obeagu GU. B Cell Deficiency and Implications in HIV
Pathogenesis: Unraveling the Complex Interplay. Elite Journal of Nursing and Health
Science. 2024;2(2):33-46.
113. Obeagu EI, Obeagu GU. Eosinophil Dynamics in Pregnancy among Women Living
with HIV: A Comprehensive Review. Int. J. Curr. Res. Med. Sci. 2024;10(1):11-24.
114. Obeagu EI, Obeagu GU. Hematocrit Fluctuations in HIV Patients Co-infected with
Malaria Parasites: A Comprehensive Review. Int. J. Curr. Res. Med. Sci. 2024;10(1):25-
36.
115. Obeagu EI, Obeagu GU. Unveiling the Role of Innate Immune Activation in
Pediatric HIV: A Review. Elite Journal of Immunology. 2024;2(3):33-44.
116. Obeagu EI, Obeagu GU. Harnessing B Cell Responses for Personalized
Approaches in HIV Management. Elite Journal of Immunology. 2024;2(2):15-28.
117. Obeagu EI, Obeagu GU, Hauwa BA, Umar AI. Neutrophil Dynamics: Unveiling
Their Role in HIV Progression within Malaria Patients. Journal home page: http://www.
journalijiar. com.;12(01).
118. Obeagu EI, Obeagu GU, Hauwa BA, Umar AI. Hematocrit Variations in HIV
Patients Co-infected with Malaria: A Comprehensive Review. Journal home page:
http://www. journalijiar. com.;12(01).
119. Obeagu EI, Igwe MC, Obeagu GU. The Power of Unity: Collective Efforts in
Confronting HIV Stigma. Elite Journal of Public Health. 2024;2(3):22-36.
120. Obeagu EI, Anyiam AF, Obeagu GU. Managing Anemia in HIV through Blood
Transfusions: Clinical Considerations and Innovations. Elite Journal of HIV. 2024;2(1):16-
30.
121. Obeagu EI, Obeagu GU. Maternal Eosinophilic Responses in HIV-Positive
Pregnant Women: Unraveling Immunological Dynamics for Improved Maternal-Fetal
Health. Elite Journal of Immunology. 2024;2(1):47-64.
122. Obeagu EI, Obeagu GU. Platelet Aberrations in HIV Patients: Assessing Impacts
of ART. Elite Journal of Haematology, 2024; 2 (3).:10-24.
123. Obeagu EI, Obeagu GU. Hematological Changes Following Blood Transfusion in
Young Children with Severe Malaria and HIV: A Critical Review. Elite Journal of
Laboratory Medicine. 2024;2(1):33-45.
124. Obeagu EI, Anyiam AF, Obeagu GU. Erythropoietin Therapy in HIV-Infected
Individuals: A Critical Review. Elite Journal of HIV. 2024;2(1):51-64.
125. Obeagu EI, Ubosi NI, Obeagu GU, Obeagu AA. Nutritional Strategies for
Enhancing Immune Resilience in HIV: A Review. Int. J. Curr. Res. Chem. Pharm. Sci.
2024;11(2):41-51.
126. Obeagu EI, Obeagu GU. The Crucial Role of Erythropoietin in Managing Anemia
in HIV: A Review. Elite Journal of Scientific Research and Review. 2024;2(1):24-36.
127. Obeagu EI, Obeagu GU. Impact of Maternal Eosinophils on Neonatal Immunity in
HIV-Exposed Infants: A Review. Elite Journal of Immunology. 2024;2(3):1-8.
Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
15
128. Obeagu EI, Anyiam AF, Obeagu GU. Unveiling B Cell Mediated Immunity in HIV
Infection: Insights, Challenges, and Potential Therapeutic Avenues. Elite Journal of HIV.
2024;2(1):1-5.
129. Obeagu EI, Obeagu GU. Anemia and Erythropoietin: Key Players in HIV Disease
Progression. Elite Journal of Haematology, 2024; 2 (3).:42-57.
130. Obeagu EI, Obeagu GU. Platelet Dysfunction in HIV Patients: Assessing ART
Risks. Elite Journal of Scientific Research and Review. 2024;2(1):1-6.
131. Obeagu EI, Ubosi NI, Obeagu GU, Akram M. Early Infant Diagnosis: Key to
Breaking the Chain of HIV Transmission. Elite Journal of Public Health. 2024;2(1):52-61.
132. Obeagu EI, Obeagu GU. Transfusion Therapy in HIV: Risk Mitigation and Benefits
for Improved Patient Outcomes. Sciences. 2024;4(1):32-7.
133. Obeagu EI, Obeagu GU. P-Selectin and Immune Activation in HIV: Clinical
Implications. Elite Journal of Health Science. 2024;2(2):16-29.
134. Obeagu EI, Obeagu GU. Mental Health and Psychosocial Effects of natural disaster
on HIV Patients. Sciences. 2024;4(1):38-44.
135. Obeagu EI, Obeagu GU. Optimizing Blood Transfusion Protocols for Breast
Cancer Patients Living with HIV: A Comprehensive Review. Elite Journal of Nursing and
Health Science. 2024;2(2):1-7.
136. Obeagu EI, Obeagu GU. Advances in Understanding the Impact of Blood
Transfusion on Anemia Resolution in HIV-Positive Children with Severe Malaria: A
Comprehensive Review. Elite Journal of Haematology. 2024;2(1):26-41.
137. Obeagu EI, Obeagu GU. Transfusion-Related Complications in Children Under 5
with Coexisting HIV and Severe Malaria: A Review. Int. J. Curr. Res. Chem. Pharm. Sci.
2024;11(2):9-19.
138. Obeagu EI, Obeagu GU. Impact of Blood Transfusion on Viral Load Dynamics in
HIV-Positive Neonates with Severe Malaria: A Review. Elite Journal of Scientific
Research and Review. 2024;2(1):42-60.
139. Obeagu EI, Ayogu EE, Obeagu GU. Interactions between Blood Transfusion and
Antiretroviral Medications: Implications for Patient Care. Elite Journal of Medicine.
2024;2(2):104-5.
140. Obeagu EI, Obeagu GU, Odo EO, Igwe MC, Ugwu OP, Alum EU, Racheal P.
Combatting Stigma: Essential Steps in Halting HIV Spread. IAA Journal of Applied
Sciences. 2024;11(1):22-9.
141. Obeagu EI, Obeagu GU. P-Selectin Expression in HIV-Associated Coagulopathy:
Implications for Treatment. Elite Journal of Haematology, 2024; 2 (3).:25-41.
142. Obeagu EI, Obeagu GU. Eosinophil-Associated Changes in Neonatal Thymic T
Regulatory Cell Populations in HIV-Infected Pregnancies. Elite Journal of Health Science.
2024;2(1):33-42.
143. Obeagu EI, Obeagu GU. Exploring the Role of L-selectin in HIV-related Immune
Exhaustion: Insights and Therapeutic Implications. Elite Journal of HIV. 2024;2(2):43-59.
Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
16
144. Obeagu EI. Erythropoietin and the Immune System: Relevance in HIV
Management. Elite Journal of Health Science. 2024;2(3):23-35.
145. Obeagu EI, Obeagu GU. The Impact of Erythropoietin on Preeclampsia in HIV-
Positive Women: A Review. Elite Journal of Nursing and Health Science. 2024;2(1):21-
31.
146. Obeagu EI, Obeagu GU. Unraveling the Role of Eosinophil Extracellular Traps
(EETs) in HIV-Infected Pregnant Women: A Review. Elite Journal of Nursing and Health
Science. 2024;2(3):84-99.
147. Obeagu EI, Obeagu GU. Hematologic Considerations in Breast Cancer Patients
with HIV: Insights into Blood Transfusion Strategies. Elite Journal of Health Science.
2024;2(2):20-35.
148. Obeagu EI, Obeagu GU. L-selectin and HIV-Induced Immune Cell Trafficking:
Implications for Pathogenesis and Therapeutic Strategies. Elite Journal of Laboratory
Medicine. 2024;2(2):30-46.
149. Obeagu EI, Obeagu GU. The Intricate Relationship Between Erythropoietin and
HIV-Induced Anemia: Unraveling Pathways for Therapeutic Insights. Int. J. Curr. Res.
Chem. Pharm. Sci. 2024;11(2):30-40.
150. Obeagu EI, Obeagu GU. The Role of L-selectin in Tuberculosis and HIV
Coinfection: Implications for Disease Diagnosis and Management. Elite Journal of Public
Health. 2024;2(1):35-51.
151. Kalu OA, Ukibe NR, Onyenekwe CC, Okoyeagu RC, Nnaemeka WS, Onyenekwe
AJ, Ukibe EG, Ukibe BC, Ukibe VE, Obeagu EI. Assessment of Serum Cystatin C,
Microalbumin Levels and Egfr in HIV Seropositive Individuals based on Age and Gender
in NAUTH, Nnewi, Nigeria. Elite Journal of Medicine. 2024;2(3):48-59.
152. Obeagu EI, Obeagu GU. Understanding Immune Cell Trafficking in Tuberculosis-
HIV Coinfection: The Role of L-selectin Pathways. Elite Journal of Immunology.
2024;2(2):43-59.
153. Obeagu EI, Obeagu GU. Eosinophilic Changes in Placental Tissues of HIV-
Positive Pregnant Women: A Review. Elite Journal of Laboratory Medicine. 2024;2(1):14-
32.
154. Obeagu EI, Obeagu GU. P-Selectin and Platelet Activation in HIV: Implications
for Antiviral Therapy. Elite Journal of Scientific Research and Review. 2024;2(1):17-41.
155. Obeagu EI, Obeagu GU. Strength in Unity: Building Support Networks for HIV
Patients in Uganda. Elite Journal of Medicine. 2024;2(1):1-6.
156. Obeagu EI, GU EE. Understanding the Intersection of Highly Active Antiretroviral
Therapy and Platelets in HIV Patients: A Review. Elite Journal of Haematology, 2024; 2
(3).:111-7.
157. Obeagu EI, Obeagu GU. Anemia in HIV: The Role of Erythropoietin in Disease
Progression. Elite Journal of Haematology, 2024; 2(4): 51-67
158. Obeagu EI, Obeagu GU. ART and Platelet Dynamics: Assessing Implications
for HIV Patient Care. Elite Journal of Haematology, 2024; 2(4): 68-85
Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
17
159. Obeagu EI, Obeagu GU. Impact of Breastfeeding on Infant Immune Responses in
the Context of HIV. Elite Journal of Nursing and Health Science, 2024; 2(4):23-39
160. Obeagu EI, Obeagu GU. HIV-Induced Immune Exhaustion in Neonates: A Review
of Mechanisms and Implications. Elite Journal of Immunology, 2024; 2(3): 45-61
161. Obeagu EI, Obeagu GU. Immunodeficiency and Immune Reconstitution in
Pediatric HIV: Mechanisms, Challenges, and Therapeutic Strategies. Elite Journal of
Immunology, 2024; 2(3): 62-79
162. Obeagu EI, Obeagu GU. Hematological Consequences of Erythropoietin in HIV:
Clinical Implications. Elite Journal of Haematology, 2024; 2(4): 86-104
163. Obeagu EI, Obeagu GU. GATA-1 and Hematopoietic Stem Cell Dysfunction in
HIV-Related Hematological Malignancies: A Review. Elite Journal of Haematology,
2024; 2(4): 105-122
164. Obeagu EI, Obeagu GU. Exploration of Intricate Relationship between GATA-1
and Anemia in HIV. Elite Journal of Haematology, 2024; 2(4): 123-140
165. Obeagu EI, Obeagu GU. GATA-1 and Immune Dysregulation in HIV/AIDS:
Implications for Therapy. Elite Journal of HIV, 2024; 2(3): 69-85
166. Obeagu EI, Obeagu GU. The Role of GATA-1 in Erythropoietin Response and
Resistance in HIV/AIDS. Elite Journal of HIV, 2024; 2(4): 1-17
167. Obeagu EI, Obeagu GU. Understanding the Role of GATA-1 in T-Cell
Development in the Context of HIV Infection. Elite Journal of HIV, 2024; 2(4): 18-34
168. Obeagu EI, Obeagu GU. Programmed Cell Death Protein 1 (PD-1) Pathway
Modulation in HIV/AIDS: From Bench to Bedside. Elite Journal of HIV, 2024; 2(4): 35-
53
169. Obeagu EI, Obeagu GU. Programmed Cell Death Protein 1 (PD-1) and Immune
Checkpoint Inhibitors in HIV-Related Lymphomas: Current Insights and Future
Directions. Elite Journal of Immunology, 2024; 2(4): 1-17
170. Obeagu EI, Obeagu, GU. Programmed Cell Death Protein 1 (PD-1) Signaling in
HIV-Associated Cardiovascular Disease: Mechanisms and Therapeutic Implications. Elite
Journal of Scientific Research and Review, 2024; 2(1): 61-77
171. Obeagu EI, Obeagu, GU. Cytotoxic T-Lymphocyte-Associated Protein 4 (CTLA-
4) Blockade and HIV-Associated Kaposi Sarcoma: A Promising Therapeutic Strategy.
Elite Journal of Scientific Research and Review, 2024; 2(1): 78-94
172. Obeagu EI, Obeagu GU. The Impact of Cytotoxic T-Lymphocyte-Associated
Protein 4 (CTLA-4) Genetic Variations on HIV Susceptibility and Progression. Elite
Journal of Immunology, 2024; 2(4): 18-35
173. Obeagu EI, Obeagu, GU. Antacid Use in HIV Patients: Implications for Drug
Absorption, Metabolism, and Adverse Effects. Elite Journal of Scientific Research and
Review, 2024; 2(3): 1-19
174. Obeagu EI, Obeagu GU. Erythropoietin Signaling and its Implications in HIV-
Related Anemia: A Comprehensive Review. Elite Journal of HIV, 2024; 2(4): 54-71
Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
18
175. Obeagu EI, Obeagu, GU. The Role of GATA-1 in Megakaryocyte Function and
Platelet Production During HIV Infection: A Review. Elite Journal of Scientific Research
and Review, 2024; 2(3): 20-36
176. Obeagu EI, Obeagu GU. GATA-1 and Bone Marrow Failure Syndromes in the
Context of HIV Infection: A Review of Molecular Mechanisms and Therapeutic
Implications. Elite Journal of Laboratory Medicine, 2024; 2(3): 39-56
177. Obeagu EI, Obeagu GU. GATA-1 Mutations and Their Association with HIV-
Associated Hematological Disorders: A Review. Elite Journal of Health Science, 2024;
2(4): 7-23
178. Obeagu EI, Obeagu GU. GATA-1 and Hematopoietic Stem Cell Maintenance in
HIV: Mechanisms and Implications. Elite Journal of Health Science, 2024; 2(4): 24-40
179. Obeagu EI, Obeagu GU. GATA-1 Regulation of Erythroid Progenitor Cell
Differentiation in HIV/AIDS: Molecular Insights and Therapeutic Implications. Elite
Journal of Haematology, 2024; 2(4): 141-159
180. Obeagu EI, Obeagu GU. Role of GATA-1 in Megakaryopoiesis and
Thrombopoiesis During HIV Infection: Molecular Insights and Therapeutic Implications.
Elite Journal of Nursing and Health Science, 2024; 2(4):40-59
181. Obeagu EI, Obeagu GU. GATA-1 as a Modulator of Immune Responses in HIV-
Infected Individuals: Implications for Disease Pathogenesis and Therapeutic Interventions.
Elite Journal of Laboratory Medicine, 2024; 2(3): 57-74
182. Obeagu EI, Obeagu GU. GATA-1 and Inflammatory Signaling Pathways in HIV-
Related Hematological Disorders: Mechanisms and Therapeutic Implications. Elite Journal
of Health Science, 2024; 2(3):27-44
183. Obeagu EI, Obeagu GU. GATA-1 and Coagulation Cascade Regulation in HIV-
Associated Hematological Complications: Mechanisms and Therapeutic Implications.
Elite Journal of Health Science, 2024; 2(3):45-63
184. Obeagu EI, Obeagu GU. GATA-1 and HIV-Associated Myelodysplastic
Syndromes: Pathogenesis and Treatment Strategies. Elite Journal of Medicine, 2024; 2(4):
1-18
185. Obeagu EI, Obeagu GU. GATA-1 and Hematopoietic Stem Cell Quiescence in
HIV: Implications for Therapy. Elite Journal of Medicine, 2024; 2(4): 19-36
186. Obeagu EI, Onuoha EC, Hallie EF. GATA-1 Regulation of Coagulation Pathways
in HIV-Associated Deep Venous Thrombosis: Molecular Insights and Therapeutic
Implications. Elite Journal of Haematology, 2024; 2(4): 160-179
187. Obeagu EI, Onuoha EC, Hallie EF. Impact of L-selectin on Immune Cell
Trafficking in Tuberculosis and HIV Coinfection: A Review. Elite Journal of Immunology,
2024; 2(4): 54-72
188. Obeagu EI, Onuoha EC. L-Selectin in Tuberculosis-HIV Coinfection: Linking
Immune Cell Trafficking to Disease Pathogenesis. Elite Journal of Laboratory Medicine,
2024; 2(4): 7-25
Elite Journal of Haematology. Volume 2 issue 4(2024), Pp. 180-198
https://epjournals.com/journals/EJH
Citation: Obeagu EI, Obeagu GU. The Nexus Between Obesity and Leukemia Progression in
HIV-Positive Individuals: A Review. Elite Journal of Haematology, 2024; 2(4): 180-198
19
189. Obeagu EI, Obeagu GU. L-selectin and HIV-Induced Immune Cell Trafficking:
Implications for Pathogenesis and Therapeutic Strategies. Elite Journal of Laboratory
Medicine. 2024;2(2):30-46.
190. Obeagu EI, Obeagu GU. Exploring the Role of L-selectin in HIV-related Immune
Exhaustion: Insights and Therapeutic Implications. Elite Journal of HIV. 2024;2(2):43-59.
191. Obeagu EI, Obeagu GU. Understanding Immune Cell Trafficking in Tuberculosis-
HIV Coinfection: The Role of L-selectin Pathways. Elite Journal of Immunology.
2024;2(2):43-59.
192. Obeagu EI, Obeagu GU. P-Selectin and Immune Activation in HIV: Clinical
Management Strategies. Elite Journal of Immunology. 2024;2(2):29-42.
193. Obeagu EI, Obeagu GU. The Role of L-selectin in Tuberculosis and HIV
Coinfection: Implications for Disease Diagnosis and Management. Elite Journal of Public
Health. 2024;2(1):35-51.
194. Obeagu EI, Obeagu GU. P-Selectin and Platelet Activation in HIV: Implications
for Antiviral Therapy. Elite Journal of Scientific Research and Review. 2024;2(1):17-41.
195. Obeagu EI, Obeagu GU. P-Selectin Expression in HIV-Associated Coagulopathy:
Implications for Treatment. Elite Journal of Haematology, 2024; 2 (3).:25-41.
196. Obeagu EI, Onuoha EC. Modulation of L-selectin Expression in Tuberculosis-HIV
Coinfection: Implications for Disease Control. Elite Journal of Public Health, 2024; 2 (4):
56-74
197. Obeagu EI, Onuoha EC. L-selectin in Tuberculosis-HIV Coinfection: Linking
Immune Activation to Disease Outcome. Elite Journal of Health Science, 2024; 2(4): 41-
58
198. Obeagu EI, Obeagu GU. Role of L-selectin in Tuberculosis-HIV Coinfection:
Implications for Immune Activation and Dysfunction. Elite Journal of HIV, 2024; 2(4):
72-90
199. Obeagu EI, Obeagu GU. A Roadmap for Reducing HIV Transmission from Mother
to Child: Strategies, Challenges, and Future Directions. Elite Journal of HIV, 2024; 2(4):
91-109
200. Obeagu EI, Onuoha EC. From Awareness to Action: Recommendations for HIV-
Positive Pregnant Women. Elite Journal of Public Health, 2024; 2 (4): 75-93
