Seroprevalence of hepatitis B and C in maintenance dialysis in a public hospital in a developing country

Background. Patients with end-stage renal disease (ESRD) on maintenance dialysis are predisposed to hepatitis B virus (HBV) infection for a number of reasons. In a similar way, the prevalence of anti-hepatitis C virus (HCV) antibodies among patients on chronic haemodialysis and peritoneal dialysis is consistently higher than in healthy populations. There are few published data on these diseases in patients undergoing maintenance dialysis in sub-Saharan Africa.Objective. To determine the seroprevalence of HBV and HCV in patients on maintenance dialysis.Setting. Renal Unit, Kenyatta National Hospital, the largest public referral and teaching hospital in Kenya.Design. Cross-sectional descriptive study.Study population. All 100 patients on maintenance dialysis during the 9-month study period were evaluated.Method. The following information was obtained from all the patients: socio-demographic data, date of diagnosis of ESRD and commencement of dialysis and number of blood transfusions. Additionally, a history suggestive of hepatitis in spouses was looked for and physical examination for tattoos and other scars was carried out. Laboratory investigations included urea, electrolytes and serum creatinine liver enzymes, hepatitis B surface antigen (HBsAg), immunoglobulin M anti-hepatitis B core antibody (IgM anti-HBc), hepatitis Be antigen (HBeAg) and anti-HCV antibodies. Student's t-test was used to assess the significance of the data collected.Results. The results were expressed as mean (±SD). Fifty-seven males and 43 females were studied. Mean age was 44.3 ± 14.6 years. Ten patients (10%) had elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (> 40 U/l for both). HBsAg was found in 8 patients (8%) IgM anti-HBc in 2%, and HBeAg in none. Anti-HCV antibody was found in 5%. Six of the HBsAg-positive patients were on haemodialysis, the other 2 on continuous ambulatory peritoneal dialysis (CAPD). There was no coexistence of HBV and HCV markers. Longer duration of dialysis and the number of blood transfusions were associated with an increased seroprevalence of HBV and HCV.Conclusion. There is a low seroprevalence of HBV and HCV in our dialysis population. This should not lead to complaisance in screening for these potentially lethal complications

TUBERCULOSIS AND ORAL CANDIDA SPECIES SURVEILLANCE IN HIV INFECTED INDIVIDUALS IN NORTHERN KENYA, AND THE IMPLICATIONS ON TUBERCULIN SKIN TEST SCREENING FOR DOPT-P

Objective: To determine the pattern of opportunistic infections such as TB and Candida species in HIV infected patients in Northern Kenya.Design: Cross-sectional study.Setting: Five health facilities in Moyale (n=224), Mandera (n=121) and Turkana Kakuma; (n=83), Lopiding; (n=94) districts during different periods in 2003.Subjects: Five hundred and fifty two patients.Results: In total 94 (18%) patients were found to be HIV positive (Moyale=42, Mandera=13, Turkana; Kakuma=8, Lopiding=31). Only 65 of 94 HIV positive patients provided saliva samples. Of these, 11 (17%) were TB smear positive and 19 (29.2%) were colonized by oral Candida species. The Candida isolates were as follows; Co-infection of Candida species and TB (n=4), C. albicans only (n=12), C. tropicalis only (n=1), C. albicansand C. glabarata (n=l) and C. albicans, C. glabarata and C. tropicalis. co-infection (n=1).Conclusion: The findings provides an important insight into the differences in mucosal susceptibility to bacteria (TB) infection and fungal (Candida species) colonization during HIV immunosuppression, based on collected blood, sputum and saliva specimens. Further studies are needed to elucidate the comparative transmission dynamics and pathogeneticmechanisms of these opportunistic infections in different regions of Kenya. Such studies would improve the efficiency of directly observed preventive therapy programme (DOPT-P) whose implementation involves screening by tuberculin skin testing

CD4T LYMPHOCYTE SUBSETS AND DISEASE MANIFESTATION IN CHILDREN WITH AND WITHOUT HIV BORN TO HIV-1 INFECTED MOTHERS

ABSTRACTObjective: To understand the natural history of HIV-1 infection in children in termsof evolution of childhood clinical manifestations versus the immune status, we prospectivelystudied children with and without maternally transmitted HIV-1 infection born tomothers infected with HIV-1 for two years between March 1998 and March 2000.Design: A prospective cohort study.Setting: An institutional children’s home.Subjects: Fifty nine children (26 males and 33 females) with and without maternallytransmitted HIV-1 infection born to mothers infected with HIV-1 and adopted ininstitutional children home.Methods: HIV-1 status of children under nine months was confirmed by polymerasechain reaction(PCR). ELISA for HIV-1 antibody in serum/plasma was used to confirmHIV-infection status for children aged £18 months. Children were visited every threemonths between March and June 2000. At every visit blood was collected for total whitecell count, haemoglobin and CD4+ and CD8+ T cell counts. The institutional doctorroutinely examined children and treated all ailments. Clinical data were recorded.Measures: HIV-DNA, anti-HIV antibodies, total white blood count, total T cell counts,CD4 and CD8 T cell subset counts, frequency of childhood manifestations of infection.Results: The children were aged between 4.5 and 13 years. The baseline haematologicaland immunological profiles (mean, mode) were: HIV-1 sero-converters (WBC 7151,7150;HB 11.6, 12.0; CD4+ 686, 795; CD8+ 2168, 1507) and HIV-1 de-seroconverters (mean,mode) were: (WBC 8386, 7150; HB 11.7, 12.8; CD4+ 735, 795; CD8+ 2168, 1507). Thecommonest causes of illnesses among the HIV-1 children were URTI (85.3%), TB(56.1%),pneumonia (56.2%), tonsillitis (34.1%), parotiditis (28%) and acute otitis media (25%).The distribution of clinical manifestations was similar between the two categories ofchildren, except URTI, whose prevalence was significantly increased among HIV-1infected children (p-value=0.006). Among the HIV-1 infected children, only TB,parotiditis, and acute otitis media (AOM) were significantly associated with decreasedCD4+ T cell count (p<0.05) resulting from HIV infection.Conclusions: HIV infection in children predisposes them to common childhood infectionsthat can be used as markers of immune decline. TB, AOM, URTI may be early indicatorsof suspicion that would enable selective screening for HIV infection in children

Prevalence of hepatitis c virus and its genotypes among a cohort of drug users in Kenya

Background: Prevalence of hepatitis C virus and that of its main genotypes varies between the worlds geographic regions. The risk factors for infection with HCV include blood transfusion, tattoing and injecting drug use.Objectives: To examine the prevalence of HCV and determine its main genotypes among a cohort of drug users in Kenya.Design: A laboratory based study.Setting: Hepatitis research laboratory in the Centre for Virus Research at the Kenya Medical Research Institute, Nairobi.Subjects: Three hundred and fourteen male and 19 female intravenous and non-intravenous drug users aged between 15-55 years.Results: Seventy four (22.2%) out of 333 samples tested positive for anti-HCV. Sixty nine out of the 74 serum samples were assayed for HCV RNA and 38 (55.5%) were positive. The RNA positive samples were further subjected to sequencing and 19 (73%) of the samples were classified asgenotype la, while seven (27%) samples were classified as genotype 4. Genotypes 2, 3, 5 and 6 were not identified in this study.Conclusions: These results demonstrate a high HCV infection prevalence among this cohort of drug users (22.2 %) as compared to that of the general population, which is estimated to be 0.2- 0.9%. The study also confirms the presence of at least two major genotypes among Kenyan drugusers (genotypes 1 and 4)

CD4T Lymphocyte subsets and disease manifestation in children with and without HIV born to HIV-1 infected mothers

Objective:To understand the natural history of HIV-1 infection in children in terms of evolution of childhood clinical manifestations versus the immune status, we prospectively studied children with and without maternally transmitted HIV-1 infection born to mothers infected with HIV-1 for two years between March 1998 and March 2000. Design:A prospective cohort study. Setting:An institutional children's home. Subjects:Fifty nine children (26 males and 33 females) with and without maternally transmitted HIV-1 infection born to mothers infected with HIV-1 and adopted in institutional children home. Methods:HIV-1 status of children under nine months was confirmed by polymerase chain reaction (PCR). ELISA for HIV-1 antibody in serum/plasma was used to confirm HIV-infection status for children aged £18 months. Children were visited every three months between March and June 2000. At every visit blood was collected for total white cell count, haemoglobin and CD4+ and CD8+ T cell counts. The institutional doctor routinely examined children and treated all ailments. Clinical data were recorded. Measures: HIV-DNA, anti-HIV antibodies, total white blood count, total T cell counts, CD4 and CD8 T cell subset counts, frequency of childhood manifestations of infection. Results:The children were aged between 4.5 and 13 years. The baseline haematological and immunological profiles (mean, mode) were: HIV-1 sero-converters (WBC 7151,7150; HB 11.6, 12.0; CD4+ 686, 795; CD8+ 2168, 1507) and HIV-1 de-seroconverters (mean, mode) were: (WBC 8386, 7150; HB 11.7, 12.8; CD4+ 735, 795; CD8+ 2168, 1507). The commonest causes of illnesses among the HIV-1 children were URTI (85.3%), TB(56.1%), pneumonia (56.2%), tonsillitis (34.1%), parotiditis (28%) and acute otitis media (25%). The distribution of clinical manifestations was similar between the two categories of children, except URTI, whose prevalence was significantly increased among HIV-1 infected children (p-value=0.006). Among the HIV-1 infected children, only TB, parotiditis, and acute otitis media (AOM) were significantly associated with decreased CD4+ T cell count (

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

The past 2 years, during which waves of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants swept the globe, have starkly highlighted health disparities across nations. Tegally et al. show how the coordinated efforts of talented African scientists have in a short time made great contributions to pandemic surveillance and data gathering. Their efforts and initiatives have provided early warning that has likely benefited wealthier countries more than their own. Genomic surveillance identified the emergence of the highly transmissible Beta and Omicron variants and now the appearance of Omicron sublineages in Africa. However, it is imperative that technology transfer for diagnostics and vaccines, as well the logistic wherewithal to produce and deploy them, match the data-gathering effort