Quantification of Human Immunodeficiency Virus -1 Viral Load using Nucleic Acid Sequence-based Amplification (NASBA) in North Central Nigeria

Viral load (VL) quantification is considered an integral part of the standard care in human immunodeficiency virus (HIV) infected individuals but in Nigeria as in most of sub-SaharanAfrica, this has not reached themajority of patients. We report the first field application of the NucliSens EasyQ HIV-1 platform for the real time quantification of HIV-1 VL combining NASBAamplification and real time detection with molecular beacons among HIV-1 infected individuals in north central Nigeria where the predominant HIV-1 subtypes are CRF02_AGandG.CD4 countswere enumerated using a fluorescence-activated cell sorter system. Of one hundred and forty nine (n=149) plasma sample from patients with mean age of 32 years andmade up of 77males and 72 females, fifty {n = 50 (37.9%); 28males and 22 females}hadVLs below the lower detection limit (LDL=25 IU/ml) set by the assay while eighty- two {n = 82 (62.1%); 39 males and 43 females}hadVLlevels above the LDL. Furthermore, 13 of 82 (15.9%) patientswith viral loads above the LDL had VLs between 26-1000 IU/ml while 69 (84.1%) had VLs of 1001-2400000 IU/ml. 17 (11.4%) of the samples could not be analyzed due to poor viral amplification. Among individuals with both CD4 and VL results (n=56), those with CD4 of 1-418 cell/μl presented with higher VL usually above 45,000 IU/ml when comparedwith thosewithCD4 of over 500 cell/μl. Our findings highlight the pattern, usefulness and feasibility of VL quantification by NucliSens EasyQinmonitoringHIV-1 patients inNigeria.Keywords: HIV-1,Viral load quantitation,Nigeri

Inverted CD4+/CD8+ ratio associated with AIDS event and death in HIV- 1 infected individuals in Nasarawa State, Nigeria

The current guidelines for the use of antiretroviral therapy in Nigeria places emphasis on the use of CD4+ enumeration to take decision of initiating antiretroviral therapy and HIV disease monitoring. CD4+ counts are known to be inherently inconsistent and therefore could be misleading. This study was undertaken to analyze the CD4+/CD8+ ratio vis-à-vis CD4+ in HIV-1 infected individual in North Central Nigeria and to correlate these immunological parameters to AIDS event and death in relation to gender and age of patients.Cell counts were carried out using a Fluorescence Activated Cell Sorter (FACS) that quantifies CD4+ and CD8+ T lymphocytes as absolute numbers of lymphocytes per mL of blood and the CD4+/CD8+ T lymphocyte ratio recorded in an automated fashion.A total of 290 HIV-1 positive persons were enrolled for this study. The median CD4+/CD8+ ratio were 0.05, 0.27, 0.64 in patients with CD4+ counts of 350 respectively. CD4+/CD8+ of 0.05 and 0.27were corresponding predictors of AIDS-related event and death. Patients with >0.64 are predictive of better disease prognosis and low progression to AIDS. The CD4+/CD8+ were minimally higher in female patients with a median CD4+/CD8 ratio of 0.27. The age distribution of our patients at point of first entry was not found to influence CD4+/CD8+ ratios.These findings provide basic and critical CD4+/CD8+ cut-off values in predicting HIV disease progression and an alternative to absolute CD4+ counts at predicting the onset of HIV related disease. These data are useful to determine when intervention with antiretroviral therapy is needed and to determine the likelihood of virological failure