Prevalence of HepatitisB virus infections among HIV infected individuals in Nairobi, Kenya

Objectives: To determine the prevalence and characteristics of HBV infections among HIV infected individuals in Nairobi, KenyaDesign: A cross-sectional study.Setting: Kenya Medical Research Institute HBV Laboratory, Nairobi, KenyaSubjects: A total of four hundred HIV infected patients randomised from a Nairobi HIV comprehensive care centre between June and October 2015.Results: Of the 400 subjects screened; (27.75%) had HBV immunisation, (3%) had acute disease, (4.75%) were on recovery, (2.5%) were in chronic stage, (1.75%) were asymptomatic and (2.25%) had occult HBV. Statistical analysis showed that age andgender were not significantly associated with the risk of HBV or occult HBV infections.Conclusion: HIV/HBV co-infections is still >5.5% but the rates could be higher than reported here. Utility of HBV sero-markers especially in infection staging is therefore very important in disease diagnosis and surveillance

Switch from 200 to 350 CD4 baseline count: what it means to HIV care and treatment programs in Kenya

Introduction: With the increasing population of infected individuals in Africa and constrained resources for care and treatment, antiretroviralmanagement continues to be an important public health challenge. Since the announcement of World Health Organization recommendation andguidelines for initiation of antiretroviral Treatment at CD4 count below 350, many developing countries are adopting this strategy in their countryspecific guidelines to care and treatment of HIV and AIDS. Despite the benefits to these recommendations, what does this switch from 200 to 350CD4 count mean in antiretroviral treatment demand? Methods: A Multi-centre study involving 1376 patients in health care settings in Kenya. CD4count was carried out by flow cytometry among the HIV infected individuals in Kenya and results analyzed in view of the In-country and the newCD4 recommendation for initiation of antiretroviral treatment. Results: Across sites, 32% of the individual required antiretroviral at <200 CD4Baseline, 40% at <250 baseline count and 58% based on the new criteria of <350 CD4 Count. There were more female (68%) than Male(32%).Different from <200 and <250 CD4 baseline criteria, over 50% of all age groups required antiretroviral at 350 CD4 baseline. Age groupsbetween 41-62 led in demand for ART. Conclusion: With the new guidelines, demand for ARVs has more than doubled with variations notedwithin regions and age groups. As A result, HIV Care and Treatment Programs should prepare for this expansion for the benefits to be realized.Key words: CD4, New criteria, HIV, AIDS, care and treatment, ARV initiatio

Risk factors of virologic failure and slow response to art among HIV-infected children and adolescents in Nairobi

Background: Antiretroviral therapy (ART) in resource-limited settings is effective when backed up with adequate clinical, immunological, and virologic monitoring. Undetected, virologic failure results in increased HIV-1 drug resistance mutations (DRMs), morbidity and mortality, or the need for costly second-line and third-line ART.Objective: To evaluate the prevalence, patterns, and risk factors of virologic failure and slow response to ART, among children and adolescents in resource-limited settings in Nairobi, Kenya.Design: A Retrospective study.Setting: The 8 Lea Toto Programme (LTP) Clinics in Dagoretti, Dandora, Kangemi, Kariobangi, Kawangware, Kibera, Mukuru, and Zimmerman areas of Nairobi. Subjects: One hundred and forty-six HIV-infected children and adolescents aged 1 month to 19 years of the LTP in Nairobi Kenya. Medical and demographic data including, HIV-1 viral loads, information on adherence to ART, HIV-1 DRMs and other key determinants of virologic failure, collected over a period of 2 years, was used for this study.Results: A threshold of 1,000 HIV RNA copies/ml was used to determine treatment outcome. The virologic failure rates in this cohort were 43.8% after 6 months, 32.2% after 12 months, 28.8% after 18 months, and 24.0% after 24 months of first-line ART. Twelve (8.2%) of 146 children showed a slow response to ART: they initially failed ART at 12 months, but had treatment success after 18 to 24 months. The rates of virologic rebound were 4 (2.7%) after 18 months and 3 (2.1%) after 24 months of ART. Multivariate Cox proportional hazards regression revealed that children with suboptimal adherence to ART were 37 times more likely to experience virologic failure (P = 0.000003).Conclusions: This study showed that ART implementation in resource-limited settings is effective when regular virologic monitoring, adherence counselling, and HIV-DR testing are available. Secondly, adherence to ART is a strong predictor of treatment outcome for children and adolescents in resourcelimited settings. Therefore, methods of optimizing adherence levels should be explored and implemented

Detection and typing of Human Papillomavirus in urine from patients attending a sexually transmitted infections clinic in Nairobi County, Kenya

Human papillomavirus (HPV) is a common sexually transmitted infection (STI) that has been etiologically linked to cervical cancer. Different types of samples can be used for cervical screening, including Pap test or biopsy and Liquid Based Cytology, visual inspection using acetic acid or Lugol’s iodine, and HPV testing. These methods are invasive. The use of urine as an alternative specimen may be more widely accepted since it is non-invasive and the sample is readily available. The study aimed at detecting and genotyping HPV in urine from patients attending a sexually transmitted infections clinic in Nairobi County. It also aimed at assessing the factors associated with HPV infection. In this cross-sectional study, a structured ‘risk factor’ questionnaire was administered and HPV from urine specimen was genotyped using the L1 gene. Phylogenetic and molecular evolutionary analyses were conducted. Bivariate analysis and Pearson’s chi square (χ2) tests were used to determine the association between HPV infection and factors associated with HPV. A total of 222 adults (45 males and 177 females) aged 18-49 years were recruited. The prevalence of HPV among males and females was 22.2% (10/45) and 32.8% (58/177) respectively. The prevalence of high-risk types among males and females was 25% (1/4) and 27.5% (11/40) respectively. The high risk HPV genotypes detected among females were: HPV-16 (10%), -66 (7.5%), and -70 (7.5%) while low risk types were HPV 6 (27.5%), followed by -81 (25%), -83 (10%), -11 (7.5%), and -54 (2.5%) respectively. The prevalence of low risk types among males and females was 75% (3/4) and 72.5% (29/40) respectively. The prevalent low-risk HPV type detected in males was HPV type 6 (75%) while HPV-58 (25%) was the only high risk type in males. History of sexually transmitted infections was significantly associated with HPV infection among females (P=0.002). There was also significant association between marital status among males (p=0.046), how often one had used the contraceptives among females (p=0.038) and HPV genotypes at bivariate level. The results indicate high HPV prevalence, high risk and low risk HPVs could be detected in urine from the two populations. Therefore; molecular testing of HPV on urine samples is a method that utilizes a non-invasive technique that may increase screening coverage as it is easy to obtain. Key words: urine, Human papillomavirus, HPV genotypes, PCR, cervical cancer

HIV non-B subtype distribution: emerging trends and risk factors for imported and local infections newly diagnosed in South Australia

Monitoring HIV subtype distribution is important for understanding transmission dynamics. Subtype B has historically been dominant in Australia, but in recent years new clades have appeared. Since 2000, clade data have been collected as part of HIV surveillance in South Australia. The aim of this study was to evaluate the prevalence of and risk factors for HIV-1 non-B subtypes. The study population was composed of newly diagnosed, genotyped HIV subjects in South Australia between 2000 and 2010. We analyzed time trends and subtype patterns in this cohort; notification data were aggregated into three time periods (2000–2003, 2004–2006, and 2007–2010). Main outcome measures were number of new non-B infections by year, exposure route, and other demographic characteristics. There were 513 new HIV diagnoses; 425 had information on subtype. The majority (262/425) were in men who have sex with men (MSM), predominantly subtype B and acquired in Australia. Infections acquired in Australia decreased from 77% (2000–2003) to 64% (2007–2010) ( p = 0.007) and correspondingly the proportion of subtype B declined from 85% to 68% ( p = 0.002). Non-B infections were predominantly (83%) heterosexual contacts, mostly acquired overseas (74%). The majority (68%) of non-B patients were born outside of Australia. There was a non-significant increase from 1.6% to 4.2% in the proportion of locally transmitted non-B cases (p = 0.3). Three non-B subtypes and two circulating recombinant forms (CRFs) were identified: CRF_AE (n = 41), C (n = 36), CRF_AG (n = 13), A (n = 9), and D (n = 2). There has been a substantial increase over the past decade in diagnosed non-B infections, primarily through cases acquired overseas

HIV-1 subtype and viral tropism determination for evaluating antiretroviral therapy options: an analysis of archived Kenyan blood samples

<p>Abstract</p> <p>Background</p> <p>Infection with HIV-1 is characterized by genetic diversity such that specific viral subtypes are predominant in specific geographical areas. The genetic variation in HIV-1 <it>pol </it>and <it>env </it>genes is responsible for rapid development of resistance to current drugs. This variation has influenced disease progression among the infected and necessitated the search for alternative drugs with novel targets. Though successfully used in developed countries, these novel drugs are still limited in resource-poor countries. The aim of this study was to determine HIV-1 subtypes, recombination, dual infections and viral tropism of HIV-1 among Kenyan patients prior to widespread use of antiretroviral drugs.</p> <p>Methods</p> <p>Remnant blood samples from consenting sexually transmitted infection (STI) patients in Nairobi were collected between February and May 2001 and stored. Polymerase chain reaction and cloning of portions of HIV-1 <it>gag</it>, <it>pol </it>and <it>env </it>genes was carried out followed by automated DNA sequencing.</p> <p>Results</p> <p>Twenty HIV-1 positive samples (from 11 females and 9 males) were analyzed. The average age of males (32.5 years) and females (26.5 years) was significantly different (p value < 0.0001). Phylogenetic analysis revealed that 90% (18/20) were concordant HIV-1 subtypes: 12 were subtype A1; 2, A2; 3, D and 1, C. Two samples (10%) were discordant showing different subtypes in the three regions. Of 19 samples checked for co-receptor usage, 14 (73.7%) were chemokine co-receptor 5 (CCR5) variants while three (15.8%) were CXCR4 variants. Two had dual/mixed co-receptor use with X4 variants being minor population.</p> <p>Conclusion</p> <p>HIV-1 subtype A accounted for majority of the infections. Though perceived to be a high risk population, the prevalence of recombination in this sample was low with no dual infections detected. Genotypic co-receptor analysis showed that most patients harbored viruses that are predicted to use CCR5.</p

Sero-prevalence of human cytomegalovirus infection and predisposing factors among HIV infected patients attending comprehensive care clinic at Kenyatta National Hospital, Kenya

Background: Human Cytomegalovirus (hCMV) is one of the opportunistic infections in HIV patients. During an active infection it's a common cause of Pneumonia, retinitis, gastro-intestinal disease, and hepatitis. It is significantly associated as a HIV disease co-factor. It does quicken HIV acquisition, disease progression and high mortality and morbidity in HIV patients. Currently there is scanty data on this disease in Kenya leading to lack of recognition on the magnitude especially in HIV patients.Objective:To determine the sero-prevalence and predisposing factors associated with hCMV infection among HIV infected individuals attending comprehensive care clinic (CCC) at Kenyatta National Hospital, Nairobi County, Kenya.Design: A cross sectional study.Setting: Kenyatta National Hospital.Subjects: A total of 400 consenting patients were systematically sampled from HIV comprehensive clinic of Kenyatta National Hospital between July and August 2015Results: A total of 400 HIV-infected individuals who were 18 years and above with an average age of 42.73 (SD, 9.5) years were screened for CMV infections. Of these, 246(61.5%) were female and 154(38.5%) were male. Of 400,398 (99.0%) were hCMV IgG sero-positive, 32 (8.0%) were hCMV IgM sero-positive. Age group between 19 and 28 years [OR= 4.8 95% CI: (1.4-16.4); P=0.012], never been married [OR= 4.3 95% CI: (1.3-14.5); p=0.020], never had children [OR=3.2 95% CI: (1.2-8.5); p=0.022] and use of highly active anti-retroviral therapy (HAARn [OR=3.5 95% CI: (1.2-10.3); p=0.031]were found to be significantly associated with CMV sero-positivity in bivariate analysis. In multivariate analysis, bothCD4 (p &lt;0.001) and viral loads (p &lt;0.001) were found to be significantly associated with CMV sero-positivity.Conclusion: The 99.0% sero-prevalence of hCMV in the HIV patient's calls for routine screening for hCMV infections in order to prevent neurological clinical manifestations associated with CMV in HIV patients. Human cytomegalovirus preventive measures may be necessary to decrease mortality and morbidity associated with hCMV infections