Sero-Mapping of HBV, HCV, HSV2 and Syphilis Across Regions in Kenya

This study was funded by Internal Research Grants of the Kenya Medical Research Institute. We acknowledge support from director KEMRI and institutions that participated in this study. Abstract Hepatitis B and C,herpes Simplex Virus 2 and syphilis are important infections that share common modes of transmission. The global burden of these infections and their occurrence as co-infection of HIV in high risk population groups calls for more attention in control and management. While HIV has been a program priority disease in many low resource settings, hepatis B and C have not had as much attention. Yet there is substantial indication that transmission of hepatitis, herpes virus 2 and syphilis is on the increase. This study aimed at determining the prevalence of hepatitis B, hepatitis C, Herpes simples virus 2 and syphilis and their distribution across different regions in Kenya. Samples were collected from HIV positive study participants in 11 counties (out of total 47) distributed in 7 out of the 8 regions (provinces).A total of 1829 samples were tested for the 4 infections and their distribution analysised. Mapping of the infection was presented by study sites and regions . Overall prevalence of HSV2 was the highest (at 50%) followed by that of HBV (29%) and HCV and Syphilis (14% repectively). Majority of study participants (71%) had co-infections while the rest of the study participants (29%) had none of the four infections. Western and Nyanza regions of the country had higher prevalence of HBV (above 31%). Sero-prevalence of HCV across the regions ranged between 8 to 19 percent. Syphilis sero-prevalence was highest in western and Nyanza region (Range 18% to 26%) compared to other regions (4% to15%), the lowest prevalence was in Central region. Distribution of HSV2 indicated Nairobi was leading at 62%, Central at 48.5% and Rift Valley at 47.5%. Lowest prevalence of HSV2 was at eastern region with an average of 29%. There was significant relation between infections and study sites. Since routine testing for HBV, HCV and HSV is not readily available, there is need to develop a strategy for prevention and control of these infections. Integration of services would be an important consideration in this regard. Keywords: HBV, HCV, HSV, Syphilis, prevalence, co-infection, distribution DOI: 10.7176/JBAH/9-12-06 Publication date:June 30th 201

High prevalence of <i>Rickettsia africae</i> variants in <i>Amblyomma variegatum</i> ticks from domestic mammals in rural western Kenya: implications for human health

Tick-borne spotted fever group (SFG) rickettsioses are emerging human diseases caused by obligate intracellular Gram-negative bacteria of the genus Rickettsia. Despite being important causes of systemic febrile illnesses in travelers returning from sub-Saharan Africa, little is known about the reservoir hosts of these pathogens. We conducted surveys for rickettsiae in domestic animals and ticks in a rural setting in western Kenya. Of the 100 serum specimens tested from each species of domestic ruminant 43% of goats, 23% of sheep, and 1% of cattle had immunoglobulin G (IgG) antibodies to the SFG rickettsiae. None of these sera were positive for IgG against typhus group rickettsiae. We detected Rickettsia africae–genotype DNA in 92.6% of adult Amblyomma variegatum ticks collected from domestic ruminants, but found no evidence of the pathogen in blood specimens from cattle, goats, or sheep. Sequencing of a subset of 21 rickettsia-positive ticks revealed R. africae variants in 95.2% (20/21) of ticks tested. Our findings show a high prevalence of R. africae variants in A. variegatum ticks in western Kenya, which may represent a low disease risk for humans. This may provide a possible explanation for the lack of African tick-bite fever cases among febrile patients in Kenya

Effects of Mega Dose Micronutrient Supplementation On Serum Zinc, Retinol and Immune Status of Adult Males and Females Diagnosed with and Without HIV, Malaria and TB in Western Kenya – An Unpublished Perspective as at The Year 2004

Background: The role of micronutrients in management of HIV/AIDS, malaria and TB remains poorly understood worldwide. Objectives: To assess differences in mega dose nutritional management between HIV-seronegative and seropositive adult males and females diagnosed with HIV at Voluntary Testing and Counseling Centers (VCT) in Western Kenya. Methods: This was a randomized controlled study in which 90 subjects were recruited on the basis of an HIV-seropositive result from a voluntary and counseling center (VCT) using rapid HIV test kits. They were evaluated at baseline and every 4 weeks for 3 months to establish their clinical, biochemical and immunological status. After 12 weeks, 74 clients were still in the study, 9 were lost to follow-up while 7 had died. Of the 74 who completed the study, confirmation of baseline HIV status by ELIZA revealed that 63 were HIV-seropositive while 11 were HIV-seronegative despite losing spouses to HIV/AIDS. Correlations between parameters at baseline, during and after intervention were determined; Spearman’s Rho Coefficients indicating the level of significance. Group means were used to compare continuous data while categorical data was compared using Chi-Square. Results: Significant reductions in the clinical manifestation of disease were noted in the cohort after intervention for 12 weeks. Despite the large and different micronutrient dosages used between the two study arms, the only difference by arm of intervention was in the serum vitamin E level at 4 weeks which was much higher in arm 1 than it was in arm 2 of the study (p = 0.005). This might have been occasioned by the significant repletion of zinc in both arms, probably because use of citric acid in both arms improved zinc up-take from the supplements, food and/or reserves enabling other nutrients to be appropriately restored in both arms, these supporting the decision to pool the study arms and compare differences by HIV-seronegative and seropositive, notwithstanding the small sample sizes recruited but which nonetheless were our study limitation. Independent of the intervention arms, reduction of viral load by more than 0.5 log10 copies/ml correlated with higher baseline optical densities of HIV antibodies (P = 0.016) and higher baseline viral loads (p = 0.0001). A lower optical density of HIV antibodies at baseline correlated with higher serum zinc levels at 12 weeks (p = 0.008) and a lower Body Mass Index (BMI) at baseline (p = 0.029). Independent of the arm of study, a significant increase in CD4 cells counts post intervention correlated with lower baseline viral loads (p = 0.010), lower baseline NK cell counts (p = 0.007

Survey on prevalence and risk factors on HIV-1 among pregnant women in North-Rift, Kenya: a hospital based cross-sectional study conducted between 2005 and 2006

<p>Abstract</p> <p>Background</p> <p>The HIV/AIDS epidemic in Kenya is a major public-health problem. Estimating the prevalence of HIV in pregnant women provides essential information for an effective implementation of HIV/AIDS control measures and monitoring of HIV spread within a country. The objective of this study was to determine the prevalence of HIV infection, risk factors for HIV/AIDS and immunologic (lymphocyte profile) characteristics among pregnant women attending antenatal clinics in three district hospitals in North-Rift, Kenya.</p> <p>Methods</p> <p>Blood samples were collected from pregnant women attending antenatal clinics in three district hospitals (Kitale, Kapsabet and Nandi Hills) after informed consent and pre-test counseling. The samples were tested for HIV antibodies as per the guidelines laid down by Ministry of Health, Kenya. A structured pretested questionnaire was used to obtain demographic data. Lymphocyte subset counts were quantified by standard flow cytometry.</p> <p>Results</p> <p>Of the 4638 pregnant women tested, 309 (6.7%) were HIV seropositive. The majority (85.1%) of the antenatal attendees did not know their HIV status prior to visiting the clinic for antenatal care. The highest proportion of HIV infected women was in the age group 21–25 years (35.5%). The 31–35 age group had the highest (8.5%) HIV prevalence, while women aged more than 35 years had the lowest (2.5%).</p> <p>Women in a polygamous relationship were significantly more likely to be HIV infected as compared to those in a monogamous relationship (p = 0.000). The highest HIV prevalence (6.3%) was recorded among antenatal attendees who had attended secondary schools followed by those with primary and tertiary level of education (6% and 5% respectively). However, there was no significant relationship between HIV seropositivity and the level of education (p = 0.653 and p = 0.469 for secondary and tertiary respectively). The mean CD4 count was 466 cells/mm³(9–2000 cells/mm³). Those that had less than 200 cells/mm³accounted for 14% and only nine were on antiretroviral therapy.</p> <p>Conclusion</p> <p>Seroprevalence of HIV was found to be consistent with the reports from the national HIV sentinel surveys. Enumeration of T-lymphocyte (CD4/8) should be carried out routinely in the antenatal clinics for proper timing of initiation of antiretroviral therapy among HIV infected pregnant women.</p

High Prevalence of Rickettsia africae Variants in Amblyomma variegatum Ticks from Domestic Mammals in Rural Western Kenya: Implications for Human Health

Tick-borne spotted fever group (SFG) rickettsioses are emerging human diseases caused by obligate intracellular Gram-negative bacteria of the genus Rickettsia. Despite being important causes of systemic febrile illnesses in travelers returning from sub-Saharan Africa, little is known about the reservoir hosts of these pathogens. We conducted surveys for rickettsiae in domestic animals and ticks in a rural setting in western Kenya. Of the 100 serum specimens tested from each species of domestic ruminant 43% of goats, 23% of sheep, and 1% of cattle had immunoglobulin G (IgG) antibodies to the SFG rickettsiae. None of these sera were positive for IgG against typhus group rickettsiae. We detected Rickettsia africae–genotype DNA in 92.6% of adult Amblyomma variegatum ticks collected from domestic ruminants, but found no evidence of the pathogen in blood specimens from cattle, goats, or sheep. Sequencing of a subset of 21 rickettsia-positive ticks revealed R. africae variants in 95.2% (20/21) of ticks tested. Our findings show a high prevalence of R. africae variants in A. variegatum ticks in western Kenya, which may represent a low disease risk for humans. This may provide a possible explanation for the lack of African tick-bite fever cases among febrile patients in Kenya

CD26/dipeptidyl peptidase IV (CD26/DPPIV) is highly expressed in peripheral blood of HIV-1 exposed uninfected Female sex workers

<p>Abstract</p> <p>Background</p> <p>Design of effective vaccines against the human immunodeficiency virus (HIV-1) continues to present formidable challenges. However, individuals who are exposed HIV-1 but do not get infected may reveal correlates of protection that may inform on effective vaccine design. A preliminary gene expression analysis of HIV resistant female sex workers (HIV-R) suggested a high expression CD26/DPPIV gene. Previous studies have indicated an anti-HIV effect of high CD26/DPPIV expressing cells in vitro. Similarly, high CD26/DPPIV protein levels in vivo have been shown to be a risk factor for type 2 diabetes. We carried out a study to confirm if the high CD26/DPPIV gene expression among the HIV-R were concordant with high blood protein levels and its correlation with clinical type 2 diabetes and other perturbations in the insulin signaling pathway.</p> <p>Results</p> <p>A quantitative CD26/DPPIV plasma analysis from 100 HIV-R, 100 HIV infected (HIV +) and 100 HIV negative controls (HIV Neg) showed a significantly elevated CD26/DPPIV concentration among the HIV-R group (mean 1315 ng/ml) than the HIV Neg (910 ng/ml) and HIV + (870 ng/ml, p < 0.001). Similarly a FACs analysis of cell associated DPPIV (CD26) revealed a higher CD26/DPPIV expression on CD4+ T-cells derived from HIV-R than from the HIV+ (90.30% vs 80.90 p = 0.002) and HIV Neg controls (90.30% vs 82.30 p < 0.001) respectively. A further comparison of the mean fluorescent intensity (MFI) of CD26/DPPIV expression showed a higher DPP4 MFI on HIV-R CD4+ T cells (median 118 vs 91 for HIV-Neg, p = 0.0003). An evaluation for hyperglycemia, did not confirm Type 2 diabetes but an impaired fasting glucose condition (5.775 mmol/L). A follow-up quantitative PCR analysis of the insulin signaling pathway genes showed a down expression of NFκB, a central mediator of the immune response and activator of HIV-1 transcription.</p> <p>Conclusion</p> <p>HIV resistant sex workers have a high expression of CD26/DPPIV in tandem with lowered immune activation markers. This may suggest a novel role for CD26/DPPIV in protection against HIV infection in vivo.</p

PGF2α Synthase-Like Proteins are Expressed in Promastigotes of Old World Leishmania Species but not in New World Species

Background: Leishmaniasis is a disease caused by protozoan parasites of the genus Leishmania and spread by the bite of infected sand fly species. The disease is characterized by an increase in prostaglandin production in the host. PGF2α is among the prostaglandins that are synthesized by Leishmania sp. Objectives: To compare the expression profiles of PGF2α synthase-like proteins in Old and New World species of Leishmania so as to provide insight into the role of these proteins. Methodology: To detect gene expression at transcription level, polymerase chain reaction was carried out using L. major PGF2α synthase gene specific primers and cDNA from L. major, L. donovani, L. tropica, L. amazonensis, L. braziliensis, L. mexicana and L. chagasi promastigotes. To detect expression at translation level, total protein from promastigotes of the above parasites was analyzed on a Western blot using T. brucei-specific rabbit anti-PGF2α synthase polyclonal antibodies. Results: At the transcription level, PGF2α synthase gene expression was detected in Old World species L. major, L. donovani and L. tropica, but was absent in the New World  L. amazonensis and L. mexicana. It was expressed at low levels in the New World L. chagasi. Western blot analysis confirmed the presence of PGF2α synthase - like proteins in Old World and not in New World species. Discussion: These findings suggest that New World Leishmania may have evolved new ortholog genes to produce PGF2α. Alternatively, the ancestral PGF2α synthase gene may be present in the New World species but has mutated or been lost due to speciation during evolution. Key words: Prostaglandins; PGF2α synthase; Leishmani

Prevalence and Incidence of HIV Infection among Fishermen along Lake Victoria Beaches in Kisumu County, Kenya

Viette Pierre. Position systématique et appareil stridulant de Pemphigostola synemonistis Strand, de Madagascar [Lep. Noctuidae]. In: Bulletin de la Société entomologique de France, volume 60 (9-10), Novembre-décembre 1955. pp. 176-179