Experience with Hepatitis B viral load testing in Nigeria

Background: Quantification of the viral burden is an important laboratory tool in the management of hepatitis B virus (HBV)-infected patients. However, widespread use of assays is still hampered by the high cost. Treatment reduces viral load to undetectable levels. HBV infected patients tend to have high HBV DNA levels, and severe liver disease.Objectives: This study was carried out to determine the pattern of HBV viral load levels of patients assessing management in Nigeria.Method: Variables included sociodemographics like age, sex, religion, income, educational background and residence. The COBAS Amplicor automated Analyzer (PCR based) was used to assay the virus quantitatively.Results: 594 patients were tested from 2008 to 2009. Statistical analysis was done using Epi info version 2002 and test of significance by Kruskal-Wallis. Mean age of the patients was 36.8 (ranging from 9 to 69) years. HBV viral titre ranged between 4,145 and 68,011,800 DNA copies/ml.Conclusion: There was a high occurrence of viral titre in the population studied. High viral load is a risk factor for hepatocellular carcinoma. A policy earmarked to combat this virus in Nigeria is hereby solicited.Key words: HBV infection, HBV DNA, Nigeriadoi: 10.4314/ajcem.v12i3.

Lipid profile of drug naive HIV patients in a tertiary health facility in Lagos, Nigeria

Aim: To determine the effect of HIV syndrome on lipid profile in a cohort of Nigerians.Objective: To determine the concentrations of total cholesterol (Tchol), triglyceride (TGL), high density lipoprotein (HDL), and low density lipoprotein (LDL) in HIV positive drug naive patients as against HIV negative people.Methods: This study examined the lipid profiles of 50 HIV positive individuals (test group), and 50 HIV negative individuals (control group) at the Human Virology Laboratory of Nigerian Institute of Medical Research (NIMR), Lagos, Nigeria. Informed consent was obtained and the Institutional Review Board (IRB) of NIMR approved the study. A questionnaire based assessment was provided for the individuals to complete, before 5 ml of blood was taken by venopuncture. Blood collected in plain tubes was centrifuged at 3500 rpm for 10 minutes and the serum obtained, used for the various lipid profile tests mentioned above.Statistical analysis on data from the questionnaire was done using Epi info 2000 (CDC).Results: The median lipid profile values for the control group were 168, 85, 99 and 58 mg/dl for Tchol, TGL, HDL and LDL respectively. Conversely, median lipid profile values for the HIV positive patients were 145, 98, 53, and 67 mg/dl for Tchol, TGL, HDL and LDL respectively. P values greater than 0.05 were taken to indicate an insignificant difference between the lipid profiles of the two groups.Conclusion: Based on results obtained, there were significant differences in the Tchol and HDL values between the two groups, indicating a possible effect of HIV on lipid profile for drug naive patients.Key words: lipid profile, HIV, TGL, HDL, LDL, Tchol

Selenium as adjunct to HAART in the management of HIV/Hepatitis B Virus coinfection: A Randomized open label study

Objective: Management of viral hepatitis in patients with HIV disease is quite challenging and  complex. With effective HIV treatment, people with HIV/HBV co-infection are living longer. HBV  epidemiologic surveys showed an inverse association between selenium (Se) level and regional cancer incidence, as well as viral infection. This study assessed effect of selenium as adjunct to HAART in management of HIV/HBV co-infection.Methods: A randomized open label study with participants allocated into three treatment groups: – HAART-only, Se-only and HAART-plus-Se. HIV viral load, HBV viral load, CD4 cell count, and alanine aminotransaminase (ALT), were analyzed at baseline and 18th month, analyzed using SPSS 5 v11. Ethical approval was obtained from Institute’s Ethical Review Board.Results: Sample size was 149 HIV/HBV patients. Rate of HBV clearance was higher among those on HAART-plus-Se at 18th month when compared with rate of clearance among those on HAART-only (p=0.046). CD4 count increment among HAARTplus- Se group compared with HAART-only group was higher (p=0.133), though not statistically significant. On comparison of baseline and 18th month ALT, there was significant decline for HAART-plus-Se (p=0.002) compared with HAART-only group.Conclusion: Selenium seems to have protective effect on liver cells; may be beneficial as adjunct to HAART in HIV/HBV management.Key words: HIV/HBV co-infection, Selenium adjunct, HAAR

Heme Mediated STAT3 Activation in Severe Malaria

The mortality of severe malaria [cerebral malaria (CM), severe malaria anemia (SMA), acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)] remains high despite the availability associated with adequate treatments. Recent studies in our laboratory and others have revealed a hitherto unknown correlation between chemokine CXCL10/CXCR3, Heme/HO-1 and STAT3 and cerebral malaria severity and mortality. Although Heme/HO-1 and CXCL10/CXCR3 interactions are directly involved in the pathogenesis of CM and fatal disease, the mechanism dictating how Heme/HO-1 and CXCL10/CXCR3 are expressed and regulated under these conditions is still unknown. We therefore tested the hypothesis that these factors share common signaling pathways and may be mutually regulated.We first clarified the roles of Heme/HO-1, CXCL10/CXCR3 and STAT3 in CM pathogenesis utilizing a well established experimental cerebral malaria mouse (ECM, P. berghei ANKA) model. Then, we further determined the mechanisms how STAT3 regulates HO-1 and CXCL10 as well as mutual regulation among them in CRL-2581, a murine endothelial cell line.The results demonstrate that (1) STAT3 is activated by P. berghei ANKA (PBA) infection in vivo and Heme in vitro. (2) Heme up-regulates HO-1 and CXCL10 production through STAT3 pathway, and regulates CXCL10 at the transcriptional level in vitro. (3) HO-1 transcription is positively regulated by CXCL10. (4) HO-1 regulates STAT3 signaling.Our data indicate that Heme/HO-1, CXCL10/CXCR3 and STAT3 molecules as well as related signaling pathways play very important roles in the pathogenesis of severe malaria. We conclude that these factors are mutually regulated and provide new opportunities to develop potential novel therapeutic targets that could be used to supplement traditional prophylactics and treatments for malaria and improve clinical outcomes while reducing malaria mortality. Our ultimate goal is to develop novel therapies targeting Heme or CXCL10-related biological signaling molecules associated with development of fatal malaria

Estimation Of Measles Sero-conversion in Children Vaccinated Against Measles in Edo State of Nigeria

A study of seroconversion of 115 children between 9 months to 5 years vaccinated against measles was conducted in Oriowon local government area of Edo State. This has to establish the immune status of the children against measles after immunisation. Haemagglutination inhibition technique was used. Prevaccination immune status was conducted and 89.6% of the children studied especially among the older ones between 2-5 years were found with protective measles antibody. The highest of the titre attained was 1.256. Exposure to endemic environment was attributed to this cause. In the postvaccination assessment of the immune status, 94.7% developed protective measles antibody with a minimum titre level of 1:16, while 5.27% was not protected against measles. Among the highly protected children, 84.9% had a titre range between 1.64 and 1.1024. The high measles antibody titre detected in the children before vaccination was thought could affect the measles vaccination, instead there was increase in measles antibody titre. This could indicate the potentiation of antibody development by the immunization. Children were observed to have been vaccinated at older age than the scheduled age of vaccination. This was attributed to the attitude of the mothers. Nigerian Quarterly Journal of Hospital Medicine Vol. 9, No. 2 (June 1999) pp. 169-17

BLOOD CHEMISTRY AND PLATELET SEROTONIN UPTAKE AS ALTERNATIVE METHOD OF TRACKING HIV/AIDS

A cross sectional study was conducted to investigate the blood chemistry and platelet serotonin uptake as alternative method of determining HIV disease stage in HIV/AIDS patients. Whole blood was taken from subjects at the Human Virology of the Nigerian Institute of Medical Research. Subjects were judged suitable for the various investigations by means of a questionnaire. The Genie II HIV diagnostic kit was used to confirm HIV positive status. HIV positive subjects were grouped in to two: those receiving antiretroviral therapy were referred to as the ARV group and those not on antiretroviral therapy were designated as non-ARV group. Each group was further sub-divided according to the Centers for Disease Control 1993 classification of HIV disease. HIV negative subjects must have been tested no later than two months to the sample collection date and must not lead a high-risk lifestyle. Serum was used to assay for blood chemistry activities with Randox analytical reagents. Blood platelets were prepared from one milliliter of whole blood and platelet serotonin uptake rates were determined. The serum glutamic-oxaloacetic transaminase (SGOT) of non-ARV subjects was the only blood chemistry parameter that showed any significant variation from normal (

OSMOTIC FRAGILITY AND Na+ -K++ ATPase ACTIVITY OF ERYTHROCYTES OF HIV/AIDS PATIENTS

A cross sectional study was carried out to investigate the osmotic fragility and Na+ -K+ ATPase activity of the erythrocytes of HIV/AIDS patients. Whole blood was taken from subjects at the Human Virology Laboratory of the Nigerian Institute of Medical Research. Subjects were judged suitable for the various investigations by means of a questionnaire. The Genie II HIV diagnostic kit was used to confirm HIV positive status. HIV positive subjects were grouped into two: those receiving anti-retroviral therapy were referred to as the ARV group and those not receiving antiretroviral therapy were designated as non-ARV group. Each group was further sub-divided according to the Centers for Disease Control 1993 classification of HIV disease. HIV negative subjects must have tested no later than two months to the sample collection date and must not lead a high-risk lifestyle. Twenty microliters of whole blood were used for the erythrocytes osmotic fragility assay. One milliliter of whole blood was used to prepare the erythrocyte ghost membrane for the Na+-K+ ATPase activity assay. The two HIV positive groups showed significant increase in percentage haemolysis under osmotic stress at 0.65% saline. The ARV group had an average percentage haemolysis of 2.56 ± 0.81% while the non-ARV group had an average of 3.19 ± 1.11% compared to an average of 0.83 ± 0.36% for the control group (p < 0.05). A pattern observed in the result was an increase in activity with increasing severity of the HIV/AIDS disease. Data from the present study indicate that the osmotic fragility of erythrocytes was significantly potentiated, while Na+-K+ ATPase activity was not significantly altered (p < 0.05) in HIV/AIDS disease. Key Words: Osmotic fragility, Na+ -K+ ATPase activity, erythrocytes, HIV/AIDS Afr. J. Clin. Exper. Microbiol. 2004; 5(2): 148 – 154

Infant immunization coverage in difficult-to-reach area of Lagos metropolis

A retrospective survey of infant immunization coverage was conducted among 210 children aged 12 to 23 months in difficult-to-reach coastal suburb of Lagos, Nigeria. This was to assess immunization coverage for BCG, DPT, OPV and measles vaccination and to investigate reasons for failure to be immunized and evaluate the drop out rate as well as missed opportunities. An EPI cluster method was used. Questionnaires were administered with WHO cluster form for infant immunization. Recall history and card records of immunization were the tools used. The result showed that 82 (39%) of the 210 children assessed were not immunized, 84 (40%) were partially immunized and only 44 (21%) were fully immunized. At one year of age, only 21 (10%) of the children completed their immunization. Observation of the follow up of vaccination showed that 65.5% of 127 children who started BCG vaccination dropped out as at the time of receiving measles vaccination. Reasons advanced for failure to immunize or complete immunization of the children included obstacles in 47.7%, lack of information 40.7% and lack of motivation in 11.6%. These factors contributed to missed opportunities. Only 9 (11%) of 82 children not vaccinated against measles attributed non vaccination to illnesses. Lack of health facilities and the terrain that is difficult to reach contributed to low coverage. Also, low literacy level, poor maternal health education, poor socioeconomic status and poor advocacy to community leaders and lack of commitment of health workers contributed to low coverage. For immunization coverage to improve in this area, these factors must be addressed. Keywords: infant, immunization, coverage, antigens, advocacy African Journal of Clinical and Experimental Microbiology Vol. 6 (3) 2005: 227-23

Comparison of dynabeads and capcellia methods with facscount for the estimation of CD4 T-lymphocyte levels in HIV/AIDS patients in Lagos, Nigeria

Objective: To compare the efficacy of the Capcellia assay and the Dynabeads technique against the FACScount technique in the estimation of CD4 T-lymphocytes within a Nigerian setting. Design: Prospective study.Setting: Urban area in Nigeria. Subjects: Ninety seven subjects (51 HIV seronegative and 46 HIV seropositive adults)seen in the blood banks and two out patient clinics in Lagos within the study period. Main Outcome Measures: Dynadeads technique with a higher correlation coefficient is a feasible alternative to the FACScount method. Results: There was an overall correlation coefficient of r = 0.75 for CD4 cell counts as determined by the Dynabeads technique in comparison with the FACScount method. Also, an overall correlation coefficient of r = 0.17 for CD4 cell counts as determined by the Capcellia technique against the FACScount method. Conclusion: Dynabeads technique is simple to carry out and cheaper in terms of demand for human expertise and infrastructural requirements than the FACScounts. Therefore, it was recommended for use in the laboratory for monitoring of ARV therapy in Nigeria and any other resource poor country. East African Medical Journal Vol. 83(4) 2006: 105-11

Changes in Serum Proteins and Creatinine levels in HIV Infected Nigerians

Immune dysregulation in terms of hypergammaglobulinaemia and hypogammaglobulinaemia was part of definition of immunodeficiency that characterized AIDS. This results in either raised level of total plasma/serum protein or low level of plasma/serum protein depending on which component of immune dysregulation predominates. This study examined the level of total serum proteins and globulins in HIV infected Nigerians. 64 patients with HIV infection and 10 apparently healthy subjects were recruited from 3 hospitals in Lagos Metropolis. They were examined for the presence of TB and malaria. Serum total protein, albumin and creatinine levels were determined using commercially available kits while the globulin level was computed. Level of immunodeficiency was also determined by CD4+ cell count, using the FACS count method. Data obtained from the patients were compared with values obtained from 10 healthy controls; using appropriate statistical tests on EPI-INFO V 6.0. Results showed that hypergammaglobulinaemia is the major immune dysregulation found with globulin level of 7.4g/d1 as compared with 2.9g/d1 in healthy control though it was not statistically significant. Total serum protein was also higher in HIV infected patients than the controls. The serum globulin was found to correlate negatively with CD4 cell count (r = -0.28, P = 0.0067). Serum creatinine appears not to differ significantly between control and infected patients although the creatinine levels has a positive correlation to plasma globulin levels (r = 0.45, p = 0.001). In conclusion hypergammaglobulinaemia was found to be common in HIV infected Nigerians. This was associated with raised level of plasma creatinine. KEY WORDS: Serum proteins, Creatinine, Albumin, Globulin and HIV Nigerian Journal of Health and Biomedical Sciences Vol.3(2) 2004: 69-7