Serological patterns of hepatitis B virus infection among people living with HIV in Ibadan, Nigeria

Hepatitis B virus (HBV) is a leading cause of liver pathology, which has remained a serious public health challenge in spite of the availability of hepatitis B vaccine discovered about 40 years ago. People living with human immunodeficiency virus (PLHIV) are more at risk of hepatic problems as liver complications appear and progresses faster, owing to their immunocompromised status. This study seeks to determine HBV exposure, serological pattern, and HBV susceptibility among PLHIV. One hundred and fifty PLHIV were enrolled for the study. About 5 mL of blood was collected, processed, and tested for markers of hepatitis B virus: HBsAg, anti-HBs, HBeAg, anti-HBe, and anti-HBc. Twenty-eight (18.7%) had at least one serological marker while 122 (81.3%) tested negative to all the markers. The prevalence of HBsAg in this study was 8.7%, anti-HBs prevalence was 10%, while HBeAg was 2.7%, anti-HBe 6.0%, and anti-HBc 6.7%. Higher HBsAg, HBeAg, and anti-HBc prevalence were observed among the male participants with 13.9%, 5.6%, and 13.9%, respectively, while the female participants had more anti-HBs and anti-HBe of 1.8% and 6.1%, respectively. Age group 51-60 years had the highest prevalence of HBsAg (17.7%), HBeAg (11.8%), and anti-HBe (11.8%) while age group 31-40 years had the highest prevalence of anti-HBs (14.8%) and anti-HBe (9.8%). This study revealed the different serologic patterns of HBV infection among PLHIV and that susceptibility to HBV infection among PLHIV is high.

Hepatitis B virus infection among Nigerian pediatric population

Hepatitis B infection has continued to be a growing global health concern in spite of the discovery and administration of hepatitis B vaccines over the years. The focus of this study was to evaluate the burden of this infection among asymptomatic pediatric population. Children, who visited the hospital between March and August 2018, were recruited into this study. Blood samples were collected after obtaining informed consent. The samples were processed and screened for HBsAg. Data were analyzed using chi-square statistic. Six (2.9%) of the 206 children in the study were positive for HBsAg. A hundred (48.5%) of the children were males and 106 (51.5%) were females in the ratio 1:1.1 (male to female). More male tested positive (4%) (4/96) than their female counterparts (1.9%) (2/104)(x² = 0.813; p = .367). Age group 13-18 years had the highest infection rate 6.6% (4/57), followed by age group 5-12 years with 3.8% (2/50). No HBV detection was recorded among those below the age of 5 years. Patients with no vaccination history had a higher HBV infection rate (4.2%) compared with those who had been vaccinated (1.1%) (x² = 1.164; p = .281). The study showed that HBV infection is of intermediate endemicity among the study population, a reflection of the endemic status of the infection in Nigeria. Vaccination effort among children should be sustained and intensified. We advocate for a more intensive public enlightenment on the infection especially among women of marriageable age.

Viral Hepatitis B Screening among Asymptomatic Patients of Liver Pathology in a Secondary Health-care Facility in Nigeria

Background: HBV infection is a serious ailment which damages the liver yet not well known and hence not given adequate attention. Many are infected but are not aware because they do not manifest any sign and symptom. Aim: The purpose of this study was therefore to evaluate the prevalence of HBsAg among asymptomatic hospital attendees. Study Design: A cross sectional study. Place and Duration of Study: St Mary’s Catholic Hospital, Ibadan, Nigeria, between November 2017 and August 2018. Methodology: 1328 consecutive patients who attended the hospital were enrolled into this study after obtaining their consent. Their blood samples were aseptically collected and assayed for HBsAg using conventional method. Results: A total of 1,328 participants were enrolled, out of which 421 (31.7%) were male and 907 (68.3%) were female with a gender ratio of 1:2.2 - male to female. 5.9% (25/421) of the males tested positive to HBsAg while 5.4% (49/907) of the females tested positive to HBsAg (p=0.692). Of the overall 1328 individuals screened, 5.6% tested positive to HBsAg. The age group with the highest prevalence of HBsAg were those between 51 and 60 years with 13.1% followed by 41 - 50 years (7.2%) while > 70 years had the lowest prevalence. Conclusion: This study showed that HBsAg infection is high among asymptomatic hospital attendees in Ibadan, Nigeria. More public sensitization and awareness programmes are strongly advocated for.

Rifampicin-resistant tuberculosis among known HIV-infected patients in Oyo State, Nigeria

A major opportunistic infection among HIV-infected people is tuberculosis (TB). It accelerates the deadly progression of HIV which results in further decline in the patient's immune status and early death. More than 9 million people suffer from this debilitating coinfection worldwide. More worrisome is the fact that some patients now develop resistance to rifampicin, a first-line drug against TB. This study therefore aimed at determining the rifampicin-resistant TB prevalence rate among known HIV-positive patients in Oyo State. This cross-sectional study was performed by collecting suitable sputum samples from 397 known HIV patients who attended ART Clinic between January and December 2017. The samples were analyzed using the GeneXpert machine, a real-time polymerase chain reaction-based equipment. Of the total 397 tested, 172 (43.3%) were male while 225 (56.7%) were females. Fifty (12.6%) of the 397 known HIV patients tested positive to TB and 6 (12%) of the 50 were resistant to rifampicin. Four (2.3%) of the 172 males had rifampicin-resistant TB and 2 (0.9%) of the 225 females were resistant to rifampicin. Age group 31-40 years was the most affected with pulmonary TB while age group 10-20 years was the most affected with rifampicin-resistant TB. Six (1.5%) of the total 397 were rifampicin resistant. In conclusion, strict compliance with the infection control measures is strongly advocated for to prevent further transmission of Mycobacterium tuberculosis to people living with HIV most of whom have their immune system already weakened.

Serological profile of HBV infection among apparently healthy hospital attendees

Hepatitis B virus (HBV) infection has been rated 10th among the killer diseases. Occult HBV infection goes undetected with the widely used HBsAg screening in most hospital thereby encouraging progression into complications such as liver cirrhosis and hepatocellular carcinoma. This work therefore aimed at evaluating HBV serological profiles among the population of apparently healthy hospital attendees and their proportion of susceptibility to HBV infection. 239 participants were recruited for this study. Their blood samples were screened for the HBV markers - HBsAg, anti-HBs, HBeAg, anti-HBe, and anti-HBc. In conclusion, this work depicted various serological patterns of HBV infection among apparently healthy hospital attendees suggesting there are occult HBV infection and immune escape mutant in our population. It also showed that a huge number of the study population were susceptible to HBV infection.

Abundance of enterovirus C in RD-L20B cell culture-negative stool samples from acute flaccid paralysis cases in Nigeria is geographically defined

PURPOSE

We recently showed that enteroviruses (EVs) andenterovirus species C (EV-C) in particular were abundant in faecal samples from children who had been diagnosed with acute flaccid paralysis (AFP) in Nigeria but declared to be EV-free by the RD-L20B cell culture-based algorithm. In this study, we investigated whether this observed preponderance of EVs (and EV-Cs) in such samples varies by geographical region.

METHODOLOGY

One hundred and eight samples (i.e. 54 paired stool suspensions from 54 AFP cases) that had previously been confirmed to be negative for EVs by the WHO-recommended RD-L20B cell culture-based algorithm were analysed. The 108 samples were made into 54 pools (27 each from North-West and South-South Nigeria). All were subjected to RNA extraction, cDNA synthesis and the WHO-recommended semi-nested PCR assay and its modifications. All of the amplicons were sequenced, and the enteroviruses identified, using the enterovirus genotyping tool and phylogenetic analysis.

RESULTS

EVs were detected in 16 (29.63 %) of the 54 samples that were screened and successfully identified in 14 (25.93 %). Of these, 10 were from North-West and 4 were from South-South Nigeria. One (7.14 %), 2 (14.29 %) and 11 (78.57 %) of the strains detected were EV-A, EV-B and EV-C, respectively. The 10 strains from North-West Nigeria included 7 EV types, namely CV-A10, E29, CV-A13, CV-A17, CV-A19, CV-A24 and EV-C99. The four EV types recovered from South-South Nigeria were E31, CV-A1, EV-C99 and EV-C116.

CONCLUSION

The results of this study showed that the presence of EVs and consequently EV-Cs in AFP samples declared to be EV-free by the RD-L20B cell culture-based algorithm varies by geographical region in Nigeria.

High prevalence of HIV p24 antigen among HIV antibody negative prospective blood donors in Ile-Ife, Nigeria

Blood transfusion service centers in Nigeria screen donated blood for markers of HIV infection using antibody- (Ab) based rapid test and in some centers, positives are re-tested using Ab-based ELISA. Paucity of data exists on p24 antigen prevalence among HIV Ab-negative donors in Nigeria. This study aims at detecting HIV p24 antigen among prospective blood donors in Osun State, Nigeria. Prospective blood donors negative for HIV antibodies using Determine test kit were re-tested using BIORAD GENSCREEN Ultra Ag-Ab ELISA kit, a fourth-generation ELISA kit that detects HIV antibodies/p24 antigen. Of the 169 HIV Ab-negative prospective donors, 10 (5.9%) were positive for HIV p24 antigen and 70% (7/10) of them were in the age range 18-30 years. Results of this study show that blood transfusion is still one of the major routes of HIV transmission in Nigeria and a higher proportion is among youth. Inclusion of p24 antigen testing into the blood donor screening will help reduce transfusion associated HIV in Nigeria if Nucleic Acid Testing (NAT) of all blood donor samples is not affordable; also, HIV enlightenment programs tailored toward youth may help reduce this rate among donors since more young people donate blood in low/middle-income countries than in high-income countries.

HBV Infection Among HIV-Infected Cohort and HIV-Negative Hospital Attendees in South Western Nigeria

BACKGROUND

Prevalence, association and probable mode of acquisition of HBV and HIV dual infections have not been fully explored. Thus, HBV intervention plan and services are sometimes exclusively targeted towards HIV-infected population. We investigated HBV infection among HIV-infected cohort in comparison with HIV-negative hospital attendees to ascertain dual infectivity pattern; thereby encouraging appropriate allotment of intervention services.

MATERIALS AND METHODS

A total of 349 (M=141; F=208; Mean=33.98 years; Range= 0.33-80 years) plasma specimens from two virus diagnostic laboratories in south-western Nigeria were analysed. These include 182 HIV-positive and 167 HIV-negative specimens from ART and GDV laboratories respectively. The specimens were initially screened for detectable HIV antigen/antibody, and subsequently HBsAg by ELISA technique.

RESULTS

Overall, HBsAg was detected in 20.92% (95% CI: 16.65-25.19%) of the patients. Also, 24.82% (95% CI: 17.69-31.95%) and 18.27% (95% CI: 13.02-23.52%) HBsAg positivity was recorded for males and females respectively. CHI square analysis showed no association (P=0.14) between gender and prevalence of HBsAg. Similarly, comparison of prevalence of HBsAg by age groups shows no significant difference (P=0.24). Overall, no significant difference (P=0.59) was observed in the prevalence of HBsAg among the HIV-infected cohort and HIV-negative hospital attendees.

CONCLUSIONS

Results of the study confirm endemicity and comparable rates of HBV infection independent of HIV-status.

PREVALENCE AND ASSOCIATED CHARACTERISTICS OF CYTOMEGALOVIRUS (CMV) IMMUNOGLOBULIN ANTIBODIES AMONG BLOOD DONORS AT A UNIVERSITY TEACHING HOSPITAL IN NIGERIA

BACKGROUND

The screening for cytomegalovirus (CMV) specific antibodies is not routine in our setting, thus the transfusion of blood portends high risk for susceptible individuals.

OBJECTIVE

To determine the prevalence of IgG and IgM specific antibodies and associated characteristics in blood donors seen at a referral teaching hospital in Nigeria.

DESIGN

Prospective, cross-sectional and descriptive study.

SETTING

Blood Bank and Serology Unit of the Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Nigeria.

SUBJECTS

One hundred and eighty four blood donors negative for human immunodeficiency virus, hepatitis B and C viruses and syphilis were assessed for their levels of CMV specific IgG and IgM antibodies (AccuDiagTM ELISA, DIAGNOSTIC AUTOMATION INC, USA) using the enzyme linked immunosorbent assay technique (ELISA).

RESULTS

Ninety six percent of the donors were males while those with secondary education and below (61.3%), unmarried (70%), artisans and unemployed including students (82.5%) were in the majority. The prevalence of CMV IgG and IgM antibodies were 97.4% and 52.6%, while CMV IgG antibody range from 94.7% to 100% in all types of donation. All female donors (3.8%) were positive for IgG and IgM antibodies. The level of education of the donors predicts IgM antibody positivity, those with secondary education or less are more likely than others to be positive (p < 0.05; X2 = 15.98). Linear logistic regression showed that male donors and those in the artisan group are more likely to be positive for IgM antibody (p < 0.05).

CONCLUSION

The prevalence of CMV antibodies is very high (IgG = 97.4%; IgM = 52.6%) in our setting. Donors with low educational status and artisans are more likely to be IgM positive. Therefore, a more stringent donor selection, adoption of leukodepleted blood and blood products for uninfected patients especially the immuno-compromised and adoption of a national policy on CMV infected blood is advocated.

Hepatitis B core IgM antibody (anti-HBcIgM) among hepatitis B surface antigen (HBsAg) negative blood donors in Nigeria

BACKGROUND

Transfusion associated Hepatitis B virus (TAHBV) continues to be a major problem despite mandatory screening for Hepatitis B surface Antigen (HBsAg). Presence of HBsAg is the common method for detecting hepatitis B infection. Unfortunately, this marker is not detected during the window period of the infection. Nigeria being a developing country cannot afford DNA testing of all collected units of blood which serve as the only possibility of achieving zero risk of transfusion associated HBV. Five different serological makers of hepatitis B virus (HBV) infection were therefore assessed to evaluate the reliability of using HBsAg marker alone in diagnosis of HBV infection among blood donors and to detect the serological evidence of the infection at the window period. This will preclude the possibility of transmitting hepatitis B through transfusion of Hepatitis B surface antigen (HBsAg) negative blood in Nigeria.

METHODS

Between July and August 2009, 92 blood donors were enrolled for the study. The prevalence of 5 different markers of Hepatitis B virus infection was detected using Enzyme Linked Immunosorbent Assay (ELISA). Demographic factors were assessed during the study.

RESULTS

HBsAg and its antibody (anti-HBs) was detected in 18 (19.6%) and 14(15.2%) of the 92 blood donors respectively. Anti-HBc IgM was found in 12(13.0%) of the 92 blood donors while Hepatitis B envelope antigen (HBeAg) and its antibody (anti-HBe) were detected in 4(8.9%) and 12(26.7%) respectively from 45 donors sampled. HBeAg is a marker of high infectivity and appears after HBsAg. At least one serological marker was detected in 30(32.6%) of the blood donors. Five (5.4%) of the 92 donors had anti-HBc IgM as the only serological evidence of hepatitis B virus infection.

CONCLUSIONS

The result of this study shows that five donors have anti-HBcIgM as the only serological evidence of HBV infection. Inclusion of anti-HBcIgM in routine screening of blood donors in Nigeria should be encouraged. This is the first study to assess anti-HBcIgM in the country.

Reliability of testing and potential impact on HIV prevention in Nigeria

Several factors including variability of human immunodeficiency virus (HIV), laboratory facilities, cost and competence of personnel handling the tests are some of the important factors that affect accuracy and reliability of HIV testing in most parts of Africa. Recently investigators in Africa have observed that antibody detection assays based on antigens derived from HIV-1 subtype B show moderate to significantly lower sensitivity for detection of infection by various non-B subtypes. In this study, we evaluated the reliability of two EIA and 12 rapid HIV-1/2 test kits that are commercially available in Nigeria using the Western immunoblotting technique as reference. A panel of 100 sera from Western blot confirmed symptomatic or asymptomatic HIV-1 infected persons and 90 seronegative patients from those referred for testing in our laboratory were used for this study. Each sample was tested with two HIV-1/2 EIA, and 12 HIV-1/2 rapid test kits commercially available at one time or the other for HIV-1/2 testing in Nigeria. Overall, the sensitivity of the two EIA kits were 100% and 91.0% with specificity of 96.7% and 91.1% respectively. The sensitivity of the rapid test kits ranged from 88% to 98.0% with specificity of 92.2% to 100%. Further analysis showed significant variation in the sensitivity and specificity of the same kit based on whether an individual had asymptomatic or symptomatic infection The results of this study highlight the problem of diagnosis of HIV infections in Africa. It shows that the sensitivity of most of the rapid assays shall not be adequate for detection of early infection. The implications of possible misdiagnosis on the various intervention strategies that rely predominantly on correct HIV status of an individual are enormous. Thus, there is an urgent need for review of the current HIV testing assays or algorithms in Nigeria and other parts of Africa.

Neutralizing antibodies against poliovirus serotypes among children in southwest Nigeria

In May 1988, the World Health Assembly resolved to eradicate poliomyelitis globally by the year 2000. Despite the reported success in national immunization days, acute flaccid paralysis surveillance and accelerated efforts to meet the deadline including 'mopping-up' were executed in 1999 and subsequent years. Nigeria remains one of the major reservoirs for wild poliovirus transmission. Neutralizing antibody titre to the three poliovirus serotypes was determined among children from different communities in southwest of Nigeria, and analysed by age, gender and location. About 0.5-2 ml of blood sample was collected by venepuncture from each child. Aliquot of serum from each blood sample was inactivated prior to neutralization test by the beta method for poliovirus antibodies. A total of 347 (59.6 per cent) out of 500 and 82 children enrolled for the study had at least antibody titre of 1:8 against each of the three poliovirus serotypes. Immunity level to the three poliovirus serotypes increased with age and peaked in children aged 4-6 years. Seven (53.8 per cent) out of 13 unvaccinated children tested in the study had detectable neutralizing antibody to the three serotypes. Immunity pattern of P2 > P1 and P3 was observed but no correlation between gender and antibody to the poliovirus serotypes. The populations had 59.6 per cent herd immunity for the three poliovirus serotypes. In a country with high incidence of poliomyelitis this situation leaves a high number of non-immunized children at the risk of infection with one or more poliovirus serotypes.