Virology
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Item INCIDENCE OF HEPATITIS C VIRUS INFECTION IN A SEMI-URBAN COMMUNITY OF SOUTHWESTERN NIGERIA(2014-11) BAKAREY, A. S.Hepatitis C Virus (HCV) infection is an important cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma. Its epidemiology has been well described in developed countries. In Nigeria, previous studies on the virus were hospital-based or point prevalence from which the burden of HCV cannot be accurately determined. A population-based prospective study was therefore designed to assess the burden of HCV infection in a semi-urban community in southwestern Nigeria. A cohort of 490 purposively recruited consenting participants in Saki, a border town in Nigeria were enrolled and followed up for nine years (2003-2012). Blood samples were collected and tested for the presence of HCV antibodies using the ELISA technique from each participant at baseline, one year, 2 years and 9th year. The participants included 299 male and 191 female members of two occupational groups, auto-mechanics (n=236) and fashion designers (n=254) with age range of 15 to 65 years (median age=26years). A structured questionnaire was administered to capture information on awareness of HCV infection as well as predisposing factors including sharing of sharp objects, transfusion of blood and blood product, polygamy and multiple sexual partnership. The cohort was continuously provided education on prevention of sexually transmitted diseases and blood borne pathogens during the follow-up period. Data were analysed using descriptive statistics and ANOVA at p=0.05. Incidence of infection was reported as number of HCV cases/1000 person years. The rate of HCV infection at baseline was 8.4%. A total of 27 new cases of infection were identified in the cohort giving an overall incidence of 27.8 per 1000 person years. Incidence of HCV increased from first to the second (9.0 Vs 24.7 per 1000 person years) year but declined thereafter (11.3 per 1000 person years). Incidence of the infection increased with age and peaked among persons 45-54 years (34.5 and 38.5 per 1000 person years). The incidence was higher among male than female (21.2 Vs 14.5 per 1000 person years). Incidence in both male and female groups increased from first to second point but declined sharply thereafter. Incidence of HCV infection was higher among auto-mechanics (31.4 per 1000 person years), a male occupational group than fashion designers (23.9 per 1000 person years), a female dominated occupational group. Similarly, HCV incidence was higher in male (49.9 per 1000 person years) than female (14.6 per 1000 person years) members of the fashion designer group (Risk Ratio = 2.7, CI=1.32-5.87). The only significant risk factor identified was sharing of sharp objects (RR=2.4, CI=1.0-5.56, χ20.05:1=4.329, p=0.04). There was a substantial burden of HCV infection in the studied community. Sharing of sharp objects is a significant predisposing factor for HCV infection among the study populations. The high burden of the infection indicates the need for urgent implementation of measures to control HCV infection in Nigeria.Item Incidence and burden of respiratory syncytial virus infection in a community-based cohort o under-five years children in Nigeria.(2013) Odaibo, G. N.; Forbi, J. C.; Omotade, O. O.; Olaleye, D. O."Respiratory syncytial virus (RSV) is one of the most common causes of lower respiratory tract infection (LRI) in children under 5 years. Most of the available epidemiological information on RSV infection are from developed countries where denominator based studies have been done. We hereby describe our findings in a WHO sponsored study that estimated the incidence of the RSV infection in children in urban and rural communities in Nigeria. The study was designed as a prospective, population-based cohort of under-five children in an urban (Eleta) and a rural (Ijaiye) community in Oyo State, Nigeria. Nasopharyngeal wash was collected from each child with LRI into sterile plain 5mls tubes and transported daily to the laboratory on ice. An aliquot of each specimen was tested for presence of RSV antigen using an EIA and another aliquot inoculated into Hep2 cell line for virus isolation. Data analyses were performed using the EPIINFO version 6.0. Frequencies were compared using chi-square test at 95% confidential level and incidence reported as per 1000 child years. A total of 2,015 children were enrolled for the study among which 413 episode of LRI occurred. The overall incidence of RSV associated LRI during the 2 years of follow-up was 125/1000 child years. The incidence of RSV in Ijaye was 1.6 times (CI, 0.31 – 1.2) and 1.9 times (CI, 0.9 – 3.6) higher than that of Eleta in the first year and second year respectively. The highest incidence of RSV infection occurred among the age group 3-5 months in Eleta and the age group 9-11 months in Ijaiye. No gender preponderance in the incidence of RSV was observed. This study provided for the first time, a denominator based prevalence and incidence of RSV at the community level in Nigeria. The rates of RSV among under-five children in rural and urban communities in Nigeria are high."Item Pattern of HIV-1 drug resistance among adults on ART in Nigeria(2013) Odaibo, G. N.; Okonkwo, P.; Adewole, I. F.; Olaleye, D. O.Background: The development of anitiretroviral drug resistance may limit the benefit of antiretroviral therapy. Therefore the need to closely monitor these mutations, especially the use of ART is increasing. This study was therefore designed to determine the ARV drug resistance pattern among ART na?ve and expose individuals attending a PEPFAR supported by antiretroviral clinic in Nigeria. Methodology: The study participants included patients attending the PEPFAR supported by University College Hospital (UCH), Ibadan ART clinic who have been on HIV treatment for at least one year with consecutive viral load of over 2000 copies/ml as well some ART Na?ve individuals with high (>50,000 copies/ml) baseline viral level attending the hospital for pre-ART assessment. Blood sample was collected from each individual for CD4 enumeration, viral load level determination and DNA sequencing for genotypic typing. Antiretroviral drug resistance mutations (DRM) were determined by using the Viroseq software and drug mutations generated by using a combination of Viroseq and Stanford algorithm. DRM were classified as major or minor mutations based on the June 2013 Stanford DR database. Results: The most common major NRTI, NNRTI and PI mutation were D67N (33.3%), Y181C (16.7%) and M46L/I (55.6%) respectively. Lamivudine (3TC) and emtricitabine (FTC); nevirapine (NVP) and nelfinavir (NFV) were the most common NRTI, NNRTI, and PI drugs to which the virus in the infected individuals developed resistance. Isolates from 4 patients were resistant to triple drug class, including at least one NRTI, NNRTI and a PI. Only one (4.8%) of the isolates from drug Na?ve individuals had major DRM that conferred resistance to any drug. Conclusion: Demonstration of high rates of antiretroviral DRM among patients on 1st and 2nd line ART and the presence of DRM in drug Na?ve individuals in this study show the importance of surveillance for resistance to ARV in line with the magnitude of scaling up of treatment program in the country.Item Laboratory profile of HIV-1 and dual HIV-1/HIV-2 associaed acquired immunodeficiency sydrome in Nigeria(2013) Odaibo, G. N.; Olaleye, D. O." Background: HIV-2 is comparatively less pathogenic with slow progression of infection to clinical disease and consequently there is less of information on the occurrence of HIV-2 associated disease than HIV-1. We hereby describe some laboratory profiles of individuals presenting with HIV-2 and dual HIV-1/2 related AIDS at the University College hospital in Ibadan over a period of seven years. Methodology: Blood samples from patients presenting with the AIDS defining illness at the University College Hospital, Ibadan, Nigeria were tested for antibodies to HIV-1/2 using rapid test devices or ELISA. Initially reactive samples were further tested by immunoblotting for differentiation into HIV-1 or HIV-2 or HIV-1/2 dual infection. Blood samples from individuals with confirmed infections were further analyzed for CD4 cell lymphocyte number, plasma HIV-1 RNA concentration, hematological and blood chemistry parameters. The data analysis was done using descriptive statistics and Levene-S test for equality of variance. Results: Thirty five patients, 18 and 17 with HIV-2 and dual HIV-1/2 infections respectively were identified during the period covered by this study (2005-2012). The median age of the patients was 48 years old (Range: 42 - 70 years old) and mean CD4 cell count of HIV-2 patients at enrollment was 324 (Range: 16 - 696) and 350 (Range 54 - 863) per microlitre of blood for patients with dual HIV-1/2 infection. HIV-1 RNA was not detected in the plasma of the 18 patients with serological HIV-2 infection but 2 (11.8%) of the 17 patients with dual HIV-1/2 serological profile had detectable HIV-1 RNA (1,287,275 copies/ml and 1,816,491 copies/ml). Conclusion: The results emphasize the need to consider HIV-2 infection in the investigation of patients presenting with the AIDS related illness but with negative HIV-1serology. The study also shows the importance of inclusion of multispot HIV-1 and 2 rapid tests for differentiating HIV-1 from HIV-2 infections in regions where both types of HIV circulate or epidemiologically indicated. "Item Hepatitis E virus infection in HIV positive ART naïve and experience individuals in Nigiera(2013) Odaibo, G. N.; Olaleye, D. O." Background: Studies have shown Hepatitis E Virus to be a causative agent of acute and chronic hepatitis in severely immunocompromised patients such as organ transplant recipients and person with HIV infection. This study was designed to determine the burden of HEV infection among HIV positive individuals in Nigeria and the effect of HIV treatment on the burden of HEV infection among this group of patients. Methods: Aliquot of plasma samples collected for laboratory investigations such as CD4 enumeration, blood chemistry (AST, ALT, Creatine, Urea) were used to determine the presence of HEV IgG and IgM antibodies using commercially available ELISA. Samples analysed in the study were collected from 180 HIV positive individuals (90 ART naive and 90 ART experienced) attending the ART clinic at the University College Hospital, Ibadan, Nigeria. Results: Twenty two of the 180 (12.2%) samples were positive for either HEV IgG (20/180) or IgM (2/180). The rate of HEV IgG was higher among ART naive individuals and the two IgM positive persons were ART naive. There was no significant difference in the mean CD4 count and mean ALT between HEV seronegative and seropositive individuals (P = 0.8 and 0.2 respectively). Conclusions: The results of this study suggest the need to test for HEV infection in HIV positive individuals for the early diagnosis and proper management since HEV is known to be fulminant in the presence of underlying liver disease that is common among HIV infected persons. In addition, the use of ART may reduce the incidence of HEV infection in HIV positive persons. "Item High rate of non-detectable HIV-1 RNA among antiretroviral drug naïve HIV positive individuals in Nigeria(Libertas Academica Ltd, 2013) Odaibo, G.N; Adewole, I. F.; Olaleye, D. O.Plasma HIV-1 RNA concentration, or viral load, is an indication of the magnitude of virus replication and largely correlates with disease progression in an infected person. It is a very useful guide for initiation of therapy and monitoring of response to antiretro¬viral drugs. Although the majority of patients who are not on antiretroviral therapy (ART) have a high viral load, a small proportion of ART naive patients are known to maintain low levels or even undetectable viral load levels. In this study, we determined the rate of unde-tectable HIV-1 RNA among ART naive HIV positive patients who presented for treatment at the University College Hospital (UCH), Ibadan, Nigeria from 2005 to 2011. Baseline viral load and CD4 lymphocyte cell counts of 14,662 HIV positive drug naive individuals were determined using the Roche Amplicor version 1.5 and Partec easy count kit, respectively. The detection limits of the viral load assay are 400 copies/mL and 750,000 copies/mL for lower and upper levels, respectively. A total of 1,399 of the 14,662 (9.5%) HIV-1 positive drug naive individuals had undetectable viral load during the study period. In addition, the rate of non-detectable viral load increased over the years. The mean CD4 counts among HIV-1 infected individuals with detectable viral load (266 cells/μL; range = 1 to 2,699 cells/μL) was lower than in patients with undetectable viral load (557 cells/μL; range = 1 to 3,102 cells/μL). About 10% of HIV-1 infected persons in our study population had undetectable viral load using the Roche Amplicor version 1.5.Item Hepatitis B virus DNA in patients with HBsAg in south western Nigeria(Wiley Periodicals, Inc., 2012) Odaibo, G. N.; Ola, S. O.||Olaleye, O. D.There are about 400 million people with chronic hepatitis B virus (HBV) infection worldwide with a potential of adverse sequelae including hepatocellular carcinoma. Recent data have shown that the level of HBV DNA in serum or plasma of an infected person probably reflects more accurately the replicative activity of the virus and therefore may serve as a better maker for management of the infection. This study was designed to determine the rate of detection of HBV DNA in blood samples of patients with HBsAg positive in Nigeria in comparison with the HBe and anti-HBe used widely as serological markers of infectivity. Plasma samples from 105 patients with HBsAg positive were tested for the presence of HBeAg and anti-HBe using a commercial enzyme-linked immunosorbent assay while plasma HBV DNA was quantified using the COBAS Amplicor HBV Monitor assay. Of the 105 HBsAg samples, 17 (16.2%) and 85 (81%) were positive for HBeAg and anti-HBe, respectively, while 8 (7.6%) were negative for both HBeAg and anti-HBe. HBV DNA was detected in 86 (81.9%) of the samples, out of which 15 (18.1%) and 67 (80.7%) were positive for HBeAg and anti-HBe, respectively. HBV DNA was detected in 78.4% of the HBeAg negative samples and in all the eight samples that were negative for both HBeAg and anti-HBe. The implication of these findings in the management of patients with HBV infection is compelling.Item HIV infection among newly Daignosed TB patients in southwestern Nigeria: A multi-DOTS center study(Scientific Research, 2013) Odaibo, G. N.; Okonkwo, P.; Lawal, O. M.; Olaleye, D. O.Backgroud: The burden of TB and HIV infection is estimated to be about 512/100,000 and 3,000,000 people respectively. However, accurate data on TB/HIV co-morbidity in different parts of Nigeria were not available due to limited access to HIV Counseling and Testing (HCT) by individuals with TB infection. This study was designed to determine the true rate of HIV infection among newly diagnosed TB patients by providing comprehensive HCT services in 43 DOTS centers in Oyo State, Southwestern Nigeria. Methods: All patients meeting the case definition for TB suspects who presented at each of the 43 DOTS Centres were counselled and those who consented tested for presence of HIV antibodies using HIV 1/2 Determine, Unigold and Stat-Pak rapid test kits in a serial algorithm. Results: A total of 13,109 TB positive patients were enrolled for the study, out of which 1605 (12.3%) tested positive for HIV antibodies. HIV infection was higher among female (15.5%) than male (9.5%) TB patients (p < 0.05). The rates also varied among the age groups, ranging from 4.3% in the 10 - 19 years to 18.0% in the 40 - 49 years age group. A relatively high rate (10.5%) of HIV infection was found among children less than ten years of age. Conclusion: The results of this work show the true burden of TB/HIV in any region in Nigeria for the first time. Higher rate of TB/HIV co-infection among female patients and children are significant and important factors that should be considered in the planning of intervention measures in Nigeria and other TB and HIV endemic countries in Africa.Item Correlation of cag-A serological status with histological parameters of chronic gastritis among dyspeptic patients in south western Nigeria(2012) Oluwasola, A. O.; Otegbayo, J. A.; Ola, S.O.; Ebili, H. O.; Afplabi, A. O.; Odaibo, G. N."BACKGROUND:The aim of this study was to determine the sero-prevalence of Cag-A strains of Helicobacter pylori in both dyspeptic and non-dyspeptic individuals and also correlate the serological status of Gag-A strain of H. pylori with the various graded histological variables of chronic gastritis in the dyspeptic patients. METHODS:Using helicobacter p120 Cag-A enzyme linked immunosorbent assay, Cag-A serology test was carried out on 65 dyspeptic patients and 65 age and sex matched non-dyspeptic controls. The gastric biopsies of the patients were also histologically examined to ascertain the presence, nature and degree of the following histological variables of gastritis: colonisation by H. pylori; inflammation, intestinal metaplasia and mucosal atrophy. The CagA serological status was then correlated with the graded variables. RESULTS:A prevalence of 46.2% and 58.8% seropositivity for Cag-A strain of H. pylori was found among dyspeptic patients and control individuals respectively. Cag-A seropositive patients accounted for nine(81.8%) of the 11 cases with moderate to severe activity and 75% of both cases with mucosal atrophy and cases with intestinal metaplasia. CONCLUSION:Infection with Cag-A positive Helicobacter pylori was equally prevalent among both dyspeptic patients and control subjects studied. CagA seropositivity, however, appeared to be associated with higher inflammatory activity in the mucosa of patients with chronic gastritis and may be associated with intestinal metaplasia and mucosal atrophy in H. pylori-induced chronic gastritis."Item Hepatitis B and E viral infection among Nigerian healthcare workers(2012) Ola, S. O.; Odaibo, G. N.; Olaleye, O. D.; Ayoola, E. A."BACKGROUND:There is dearth of information on Hepatitis E virus (HEV) infection and its co-infection with HBV among Nigerian healthcare workers (HCWs). Hence, there is the need to determine the rate of HEV infection and its association with HBV among HCWs who are at greater risk of nosocomial infections. METHODOLOGY:Sera from 88 HCWs and 44 non-HCWs healthy adults as controls were tested for the presence of antibody to HEV (anti-HEV). The HCWs were also tested for HBsAg and antibody to Hepatitis B core antigen (anti-HBc) using commercially available ELISA kits. RESULTS:The prevalence of anti-HEV obtained among the HCWs and controls were 43% and 94% respectively (p<0.005) while those of HBsAg and anti-HBc in HCWs were respective 13% and 56%. Overall among HCWs, the prevalence of HBV infection was 65.9%, higher than HEV infection (p<0.005) with only anti-HBc greater among the male participants (p<0.005) while co-infection of HBV with HEV was 27.3%. HEV infection was least among the Paediatricians (18%) and highest among the Surgeons (55%) while HBV infection was similar in all the different occupational groups of HCWs (44-59%) except among the Gynecologists and Obstetricians (80%). CONCLUSION:Infection with HEV is high among Nigerian HCWs but lower than the rate among non-HCWs. It is also co-infected with HBV especially among the different groups of the HCWs and could occur with the diverse clinico-serological patterns of HBV infection."