Long term outcomes of highly active antiretroviral therapy in HIV infected Nigerians and those co-infected with hepatitis B and C viruses

Background: HIV co-infection with hepatitis B (HBV) and/or hepatitis C virus (HCV) is common, largely due to shared routes of transmission, but paucity of data exists for long term treatment outcomes of HIV infected patients, and those co-infected with HBV and HCV despite the high burden in Nigeria. The aim of study was to describe the longterm treatment outcomes in HIV infected Nigerians and to assess the effect of HBV and HCV co-infections on longterm response to antiretroviral therapy (ART).Methodology: This was a retrospective study of HIV infected adults (> 18 years old) consecutively initiating ART between July 2004 and December 2007, who were followed up for 7 years (2011 and 2014). HBV and HCV infections were diagnosed by detection of serum hepatitis B surface antigen (HBsAg) and HCV antibody (HCVAb) respectively. HIV viral load and CD4 count were monitored 3-monthly after initiating ART, and treatment outcomes based on these were compared between patients with HIV mono-infection, HIV/HBV, HIV/HCV and HIV/HBV/HCV co-infections. Clinical and laboratory data of the patients were abstracted from the medical databases, FileMaker Pro, v 10, entered into Microsoft Excel, and analyzed using SPSS version 20.0.Results: A total of 2,800 adults were evaluated (median age of 35.5 years; 64.2% female), of whom 197 (7.0%) were co-infected with HBV, 53 (1.9%) with HCV, and 15 (0.5%) with HBV and HCV. During the 7-year period, 369 (13.2%) patients were lost to follow up. Immune reconstitution, measured by CD4 recovery, was lower in both HBV and HCV co-infections compared to HIV mono-infection, but this was not statistically significant (p>0.05). Median baseline HIV viral load was 4.63 log copies/ml for all groups, which decreased to undetectable level at a median time of 6 months and remained so for the study duration.Conclusion: This study revealed a higher virologic failure among HIV/HCV co-infected group compared to other groups. No immunological difference in ART treatment outcomes between HIV mono-infected and those co-infected with HBV and HCV after 7-year follow-up. Gradual rise in CD4 was found to be an immunological evidence of the body’s recovery from HIV, buttressed by the drop in viral load over the 7-year period. Keywords: ART, HIV, HBV, HCV co-infection, long term outcomes   English title: Résultats à long terme du traitement antirétroviral hautement actif chez les Nigérians infectés par le VIH et ceux co-infectés par les virus des hépatites B et C Contexte: La co-infection par le VIH avec l'hépatite B (VHB) et/ou le virus de l'hépatite C (VHC) est courante, engrande partie en raison des voies de transmission partagées, mais il existe peu de données sur les résultats dutraitement à long terme des patients infectés par le VIH, et ceux co -infectés par le VHB et le VHC malgré le fardeau élevé au Nigéria. Le but de l'étude était de décrire les résultats du traitement à long terme chez les Nigérians infectés par le VIH et d'évaluer l'effet des co-infections par le VHB et le VHC sur la réponse à long terme au traitement antirétroviral (TAR).Méthodologie: Il s'agissait d'une étude rétrospective sur des adultes infectés par le VIH (>18 ans) ayant commencé un traitement antirétroviral consécutivement entre juillet 2004 et décembre 2007, suivis pendant 7 ans (2011 et 2014). Les infections par le VHB et le VHC ont été diagnostiquées par détection de l'antigène de surface sérique de l'hépatite B (AgHBs) et des anticorps anti-VHC (HCVAb) respectivement. La charge virale du VIH et la numération des CD4 ont été surveillées tous les trois mois après le début du TAR, et les résultats du traitement basés sur ceuxci ont été comparés entre les patients atteints de mono-infection VIH, VIH/VHB, VIH/VHC et VIH/VHB/VHC. Les données cliniques et de laboratoire des patients ont été extraites des bases de données médicales, FileMaker Pro, v 10, saisies dans Microsoft Excel et analysées à l'aide de SPSS version 20.0.Résultats: Un total de 2800 adultes ont été évalués (âge médian de 35,5 ans; 64,2% de femmes), dont 197 (7,0%) étaient co-infectés par le VHB, 53 (1,9%) par le VHC et 15 (0,5%) par le VHB et VHC. Au cours de la période de 7 ans, 369 (13,2%) patients ont été perdus de vue. La reconstitution immunitaire, mesurée par la récupération des CD4, était plus faible dans les co-infections par le VHB et le VHC que dans la mono-infection par le VIH, mais cela n'était pas statistiquement significatif (p>0,05). La charge virale VIH de base médiane était de 4,63 log copies / ml pour tous les groupes, ce qui a diminué à un niveau indétectable à une période médiane de 6 mois et le reste pendant toute la durée de l'étude.Conclusion: Cette étude a révélé un échec virologique plus élevé parmi le groupe co-infecté par le VIH / VHC par rapport aux autres groupes. Aucune différence immunologique dans les résultats du traitement TAR entre le VIH mono-infecté et ceux co-infectés par le VHB et le VHC après un suivi de 7 ans. L’augmentation progressive des CD4 s’est avérée être une preuve immunologique de la guérison du corps du VIH, étayée par la baisse de la charge virale au cours de la période de 7 ans. Mots clés: TAR, VIH, VHB, co-infection par le VHC, résultats à long terme     &nbsp

Detection of human immunodeficiency virus among individuals presenting with febrile illness in Lagos, Nigeria

Introduction: The Human Immunodeficiency Virus (HIV) is the aetiological agent of Acquired Immunodeficiency Syndrome (AIDS), which is a chronic and potentially life-threatening condition. Fever is mostly associated with the early stage of virus replication known as acute HIV infection or  syndrome; as such, determination of HIV status during this critical period is a good means of improving clinical outcome in those infected. Thus, this study aimed to determine the prevalence of HIV among febrile individuals in Lagos, Nigeria.Materials and Methods: A cross sectional study of 250 febrile individuals attending General Hospitals at Isolo, Mushin and Surulere, Lagos, Nigeria. Analysis was carried out at the Virology Research Laboratory, Central Research Laboratory, College of Medicine of the University of Lagos from July to October 2017. Sample analysis was done according to the Nigerian National Testing Algorithm to determine HIV status using Enzyme Immunoassay (EIA) and data analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results: Out of the 250 febrile participants, 8 were positive for HIV, with an overall prevalence of 3.2%. Further analysis however showed that 90% of the HIV positive participants had four or more episodes of fever in a month. HIV infection was still majorly among the ages 15-24 and 25-34 for male and ages 25-34, 35-44 and 45-54 for females.Conclusion: This findings showed that different cohorts are significantly at risk of HIV infection. Hence, policies and all efforts to reduce the burden of HIV are paramount for a HIV free future for Nigeria.Keywords: Acute Retroviral Syndrome (ARS), Fever, Asymptomatic and  Enzyme–Linked Immunosorbent Assay (ELISA)

Co–infection of hepatitis B and C viruses among human immunodeficiency virus infected children in Lagos, Nigeria

Introduction: The co–infection of Human immunodeficiency virus (HIV), Hepatitis B and C viruses remains a public health problem particularly in resource limited setting like Nigeria. Studies on these co–infections have been done principally among adult and pregnant women with limited information on the pediatric population. The study aims at documenting the burden and the patterns of HIV/HBV, HIV/HCV and HIV/HBV/HCV co–infections in children in Lagos, Nigeria.Methods: A cross–sectional study carried out at the Virology Research Laboratory, College of Medicine of the University of Lagos between December 2008 and January 2014. A total of 393 confirmed HIV infected children aged between <1 to 15 years were screened from two tertiary health facilities; Lagos State University Teaching Hospital (LASUTH, n=272) and Lagos University Teaching Hospital (LUTH, n=121), Lagos. Plasma samples were screened for markers for HBV (HBsAg, HBeAg, HBeAb, HBcIgM) and HCV (anti–HCV) using a fourth generation enzyme–linked immunosorbent assay (DIA. PRO. Diagnostic Bioprobes Srl., Italy).Results: Out of the 393 samples analyzed, 40 (10.2%) were sero–positive for dual HIV/HBV co–infection, comprising 21 (52.5%) females and 19 (47.5%) males, while 15 (3.8%) had detectable antibodies to HCV consisting of 7 (46.7%) females and 8 (53.3%) males without any statistical significance. On the overall, two (0.5%) of the participants were seropositive for triple HIV, HBV and HCV co–infections. HIV/HBV co–infection was detected among all the age groups, whereas, HIV/HCV co–infection was not seen among children <1 to 5 years.Conclusion: This analysis confirmed a high prevalence of HBV, low prevalence of HCV and suggests that chronic hepatitis may be prevalent among our HIV–infected children. Thus, routine screening and early detections are therefore necessary for an appropriate treatment plan for children co–infected with HIV/HBV and or with HCV.Keywords: Human immunodeficiency virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), Co–infection and Enzyme–Linked Immunosorbent Assay (ELISA

Persistence of Ebola virus RNA in some body fluids of Ebola virus disease (EVD) survivors – the Nigerian experience

Introduction: Ebola virus (EBOV) has been shown to persist in some body fluids of Ebola Virus Disease (EVD) survivors with implication for future transmission particularly in Nigeria where EVD was experienced for the first time in 2014. Thus, this paper was aimed at providing information on the duration of persistence of EBOV in Nigeria. Materials and Methods: Ten consenting EVD survivors were enrolled. Baseline specimens; urine and semen (males), urine and high vaginal swab (HVS) (females) were obtained within one month after discharge from the Ebola Treatment Centre (ETC) and subsequently every fortnight. Samples were analyzed using quantitative Real-Star Filovirus Screen RT-PCR kit 1.0 at the National Reference Laboratory in Lagos.Results: Ten EVD survivors comprising 4 (40%) males and 6 (60%) females with age ranges of 28 to >33 years (mean age: 33.0 ± 6.9 years) were evaluated. EBOV RNA was not detected in the urine of all the participants and HVS from the females. However, EBOV RNA was detected in the semen of all 4 (100%) male participants at baseline, and at 2 months after discharge from the ETC. Two men were still positive for EBOV RNA 4 months after discharge from the ETC despite persistent negative vireamia. Conclusions: Our data confirm that a negative viremia in the convalescent period is not predictive of the absence of the virus in semen. Despite an early clearance of the virus from the urine and HVS, there was persistence of EBOV RNA in semen of male survivors 4 months after recovery

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Efficacy of HIV PCR techniques to diagnose HIV in infants born to HIV infected mothers at LASUTH

Background: There  has  been so many difficulties encountered in the diagnosis of HIV infection in infants <18 months of age born to HIV-infected mother. In these infants, definitive diagnosis can only be carried out by antigen based techniques which are expensive and not widely available in developing countries.Objective: To generate information on the rate of mother to child transmission in Nigeria and to compare the efficacies of both the HIV-1 RNA and HIV-1 DNA PCR techniques in the diagnosis of this infections in infants.Method: Ninety (90) whole blood samples were obtained from 45 HIV positive mothers and 45 infants born to these mothers from the Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos. The presence of HIV was determined using the Amplicor HIV-1 DNA test and an in- house RNAPCR method.Results:  All  the  infants  were  HIV  antibody  positive, however, only 5 infants were positive by HIV-1 DNA PCR, indicating an 11% rate of transmission from HIV positive mothers. Among the 5 infants positive by the DNA PCR, only 4 were positive for the in-house RNAPCR.Conclusion: The 11% transmission rate recorded in this study was similar to that from mothers’ who had Nevirapine ART interventions and both the HIV-1 DNA test and the in- house RNA PCR tests were sensitive and specific in the diagnosis  of  infection  in  infants,  depending  on  the level/state of HIV infection in infants.Keywords: HIV Diagnosis, MTCT, PCR Technique

Laboratory Diagnosis of Novel Coronavirus Disease 2019 (COVID-19): A Review

A spate of pneumonia cases caused by A novel Coronavirus called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was observed in Wuhan, Hubei province of China in late 2019. The outbreak termed COVID-19 has spread rapidly almost throughout the world with a case fatality of approximately 6.9%. The disease spreads by droplet infection from person to person. Early diagnosis is the key for prompt management of cases and control of the spread of the virus. Currently, real-time reverse transcription polymerase chain reaction (rRT- PCR) for the detection of unique sequences of the viral genome is the gold standard for COVID-19 testing where the N, E, S and RdRp (RNA-dependent RNA polymerase) genes are targeted using upper and lower respiratory tract specimens. The rRT-PCR is labor intensive, severely constraining the capacity for quick turnaround time (TAT) from sample collection to results transmission particularly in resource limited settings. Consequently, laboratory testing of suspected cases might be characterized by long wait periods. The exponential increase in demand for tests, coupled with inherent shortage or scarcity of laboratory resources dictates the need to provide for all that is required for effective diagnosis in the laboratory. Also, whether other materials, such as blood, urine, stools, saliva and throat washing, will become valid alternatives has not been unequivocally defined so far. The development and availability of serological assays and point of care molecular testing assays are potentially viable opportunity for purposes of diagnostics and epidemiologic surveillance, although more information is needed on accuracy and reliability of these portable immunoassays as non has been licensed for use in the country according to the Nigerian Centre for Disease Control (NCDC). Majority (80%) of these infections remains asymptomatic and are the major drivers of the spread of the infection around the world. With the perception of our experiences in recent months, it is clear that COVID-19 may have come to stay and we might be living together with this virus for quite a long time. Thus, our level of surveillance (using laboratory testing) and responsiveness against the emergence over burdened local outbreaks must be maintained at the highest possible levels with mitigation strategies to limit the spread of the disease