Current Trends In The Management Of Sickle Cell Disease: An Overview

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Safety in the workplace: The burden and pattern of markers of Hepatitis B virus infection in routine blood samples in haematology laboratory at Irrua, Edo, Nigeria

Hepatitis B virus [HBV] infection is a worldwide problem resulting in many deaths yearly from cirrhosis and liver cancer. Regrettably also, healthcare workers get exposed to blood-borne pathogens, including hepatitis B virus at work. HBV infection in immuno-competent hosts results in acute fulminant illness which may be fatal, partially resolved to become chronic, or completely resolved. HBV immunization in the country cover neonates and health workers leaving many people uncovered. Lack of monitoring and confirmation of successful HBV immunization in heath workers reduces coverage in this group leaving many susceptible to HBV infection at work. We aimed to determine the magnitude of this risk for occupational exposure to HBV infection. We therefore analyzed sixty nine routine blood samples coming to our Haematology laboratory at Irrua, Edo, Nigeria, using the five parameter hepatitis B virus kit manufactured by Micropoint Diagnostics USA. Results showed that HBsAg, Ant-HBs, HBeAg, Anti-HBe and Anti-HBc were reactive in 11.6%, 23%, 1.4%, 7% and 7% of our study samples indicating that the burden of HBV infectivity is high. We recommend active monitoring and routine confirmation of successful HBV immunization in health workers with expansion of the program to cover more of our population.Keywords: Chronic HBV Infection, Occupational exposure, Immunization, Management of Chronic HBV infectio

Quality of care: Ensuring patient safety in blood transfusion in Irrua, Edo State Nigeria

Blood transfusion can be very beneficial and life saving to patients; though it carries with it the risk of Transfusion Transmissible Infections [TTIs] likes the Human Immuno deficiency Virus [HIV], Hepatitis B Virus [HBV], Hepatitis C Virus [HCV] and Syphilis. Unfortunately, many hospitals in Nigeria are unable to undertake adequate donor-blood screening for TTIs using the ELISA Technique, owing to lack of facilities, manpower and/or funding. As our center partners with the National Blood Transfusion Service [NBTS] for screening with ELISA, we set out to determine the prevalence of the TTIs among blood donors in order to underscore the desirability of optimal screening of blood and partnering with the NBTS to improve blood safety. Donor blood units were sent to the NBTS for rescreening with ELISA technique, after we had screened for the TTIs using rapid kits. We then reviewed the results of 613 donors over two years to determine the prevalence of TTIs among donors. Overall results showed that 86 (13.6%) was reactive for one or two of the TTIs: HIV 23(3.6%); HBV 41 (6.5%); HCV 17 (2.7%) and Syphilis 5(0.8%). Our findings suggest that screening donor blood with rapid kits only is froth with dangers to the patient; hence hospitals lacking the capacity to screen with ELISA should partner with the NBTS.Keywords: Blood Safety, ELISA Screening, Rapid Kit Screening, TTIs, NBT

Prevalence and burden of HBV co-infection among people living with HIV:A global systematic review and meta-analysis

Globally, in 2017 35 million people were living with HIV (PLHIV) and 257 million had chronic HBV infection (HBsAg positive). The extent of HIV-HBsAg co-infection is unknown. We undertook a systematic review to estimate the global burden of HBsAg co-infection in PLHIV. We searched MEDLINE, Embase and other databases for published studies (2002-2018) measuring prevalence of HBsAg among PLHIV. The review was registered with PROSPERO (#CRD42019123388). Populations were categorized by HIV-exposure category. The global burden of co-infection was estimated by applying regional co-infection prevalence estimates to UNAIDS estimates of PLHIV. We conducted a meta-analysis to estimate the odds of HBsAg among PLHIV compared to HIV-negative individuals. We identified 506 estimates (475 studies) of HIV-HBsAg co-infection prevalence from 80/195 (41.0%) countries. Globally, the prevalence of HIV-HBsAg co-infection is 7.6% (IQR 5.6%-12.1%) in PLHIV, or 2.7 million HIV-HBsAg co-infections (IQR 2.0-4.2). The greatest burden (69% of cases; 1.9 million) is in sub-Saharan Africa. Globally, there was little difference in prevalence of HIV-HBsAg co-infection by population group (approximately 6%-7%), but it was slightly higher among people who inject drugs (11.8% IQR 6.0%-16.9%). Odds of HBsAg infection were 1.4 times higher among PLHIV compared to HIV-negative individuals. There is therefore, a high global burden of HIV-HBsAg co-infection, especially in sub-Saharan Africa. Key prevention strategies include infant HBV vaccination, including a timely birth-dose. Findings also highlight the importance of targeting PLHIV, especially high-risk groups for testing, catch-up HBV vaccination and other preventative interventions. The global scale-up of antiretroviral therapy (ART) for PLHIV using a tenofovir-based ART regimen provides an opportunity to simultaneously treat those with HBV co-infection, and in pregnant women to also reduce mother-to-child transmission of HBV alongside HIV

Donor blood procurement and the risk of transfusion transmissible viral infections in a tertiary health facility in South-South Nigeria

Background: Blood and blood products are scarce commodities. The demand often outweighs the supply. This study is directed at investigating the blood procurement sources and the risk of viral transfusion transmissible infection. Materials and Methods: The records of the blood transfusion unit of a tertiary health facility in south-south Nigeria were studied. The procurement and screening records from 1 January to 31 December 2009 were analyzed. Results: 7,552 donor records were analyzed, 6,931 were commercial donor and 621 replacement donors. 891 commercial donors were infected, 500 (7.2%) were HIV positive, 323 (4.7%) HBV positive, 42 (0.6%) had HIV and HBV co-infection, while 28 (0.4%) were HCV positive. Twenty-three replacement donors were infected, 16 (2.6%) were HIV positive, 6 (1%) were HBV positive, while 1 (0.2%) were HCV positive. None of the replacement donors had co-infection. The risk of infection was significantly higher with commercial donor procurement (X2=45.07, P<0.001, OD=3.845). Conclusion: Commercial blood donors are still the major source of blood to the hospital and they also have the highest prevalence of transfusion transmissible viral infections in this region thus constitute a major risk transmitting infections to potential recipients.Key words: Blood donors, procurement, transfusion transmissible infection

Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Syphilis Co-Infections among HIV Infected Patients at the University of Benin Teaching Hospital, Benin City

Background: Victims of HIV infection may suffer a co-infection with hepatitis B and C viruses that share similar mode of transmission. Syphilis, a major cause of Sexually Transmitted Infections, is known to predispose to the transmission of these infections. Aim: The objective of this study is to determine the seroprevalence of HBV, HCV and Syphilis co-infections with HIV. Methodology: It is a cross sectional study conducted at the University of Benin Teaching Hospital (UBTH) Benin City. Consecutive patients were sampled using an interviewer administered questionnaire after obtaining an informed consent. Venous blood sample was collected from each patient. HBsAg, Anti-HCV, was tested using one-step rapid test kits by Clinotech’s Diagnostics, Canada. Anti-Treponema pallidum testing was done using rapid test strip by Global Strip Reagents, USA and CD4+ count analyzed by Cyflow SL3 Green Germany. Results: A total of 320 patients were analyzed. Twenty eight (8.8%) had HBV co-infection,16 (5%) had HCV co-infection and 12 (3.8%) had syphilis co-infection with HIV. There was no significant difference in the mean CD4+ counts of patients with HBV, HCV and syphilis co-infections and those who were not co-infected as P values were 0.52, 0.52 and 0.75 respectively. Conclusion: There is a relatively high prevalence of HBV, HCV and Syphilis co-infection in this locality. The high prevalence, not related to CD4+ count, suggests that the co-infection is not an opportunistic event associated with Immunosuppresion of HIV disease. Keywords: Hepatitis B, Hepatitis C, Syphilis, Coinfection, Benin Cit