FACULTY OF BASIC MEDICAL SCIENCES
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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 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."Item HIV-1 drug resistant mutations in chronically infected teatment naïve individuals in the pre-ARV era in Nigeria.(2012) Odaibo, G. N.; Ola, S. O.; Landerz, M.; Dietrich, U.; Olaleye, D. O.In Nigeria the Federal Government rolled out antiretroviral drugs for the management of HIV infection in year 2002. This study was carried out to determine the circulating antiviral drug mutations among ARV naïve patients with chronic HIV infection during the pre-ARV roll out era in the country. DNA was extracted from stored whole blood samples collected from 75 HIV positive patients attending the Medical outpatient clinic between December 1996 and November 2001. The Reverse transcriptase (RT) and the protease (PR) regions of the viral genome were amplified by nested PCR and then sequenced by cycle sequencing and analyzed using the ABI 3100 DNA sequencer to determine the mutations associated with protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI). Ten of the 64 (15.6%) samples with positive PCR had mutations for PR inhibitors (PI) including R8D, I 15V, G16E, M36I, M46L, L63P and H69K, while 5 of 63 harbored RT inhibitor (NRTI/NNRTI); V179I, A98T, V179E and A98S. Detection ofARV drug resistant mutations when ARV was not known to be in use in Nigeria calls for caution in the interpretation of drug resistance profile of HIV-1 from infected persons on treatment ARVs in the country.Item Genital ulcer diseases among HIV_infected female commercial sex workers in Ibadan, Nigeria(2011) Fayemiwo, S. A.; Odaibo, G. N.; Oni, A. A.; Ajayi, A. A. AWe evaluated the prevalence and association of Genital Ulcer Diseases (GUDs) among HIV-1 infected female commercial sex workers (FCSWs) in Ibadan, Nigeria. A total of 250 FCSWs from brothels in Ibadan were tested for presence of antibodies to HIV and Syphilis. Pelvic examinations for signs of sexually transmitted infections (STIs) were carried out on the subjects. Endocervical and high vaginal swabs were collected from each of the subjects to establish laboratory diagnosis of STIs. Their age ranged from 15 to 55 years (Mean = 25.8 yrs; SD = 3.74). Majority (246/250) were Nigerians, while 1.6% were from neighboring West African countries. Sixty four (25.6%) of the subjects were positive for HIV-1 while seven (2.8%) had dual HIV-1/2 infection. Analysis of the STIs showed that 49 (19.6%) of the CSWs had GUDs. Herpes genitalis was the commonest GUDs as it occurred in 25 (10%) of the subjects. Other STIs identified were chancroid (5.6%), syphilis (4.0%) and lymphogranuloma venerum (LGV) (4%). Sixteen (64.0%) of the CSWs with herpes genitalis had HIV-1 infection. The risk ratio of herpes genitalis for HIV acquisition was 3.0 (95% CI: 2.0 - 4.4). Syphilis and chancroid were also found tobe significantly associated with increased risk of HIV infection (p < 0.0001). The adjusted odd ratios for Herpes genitalis, chancroid, and syphilis were 3.7 (1-13.0, p < 0.05), 19.8 (2.7-13.0, p < 0.05) and 19.1 (1-231.0, p < 0.05) respectively. There is need to educate FCSWs continually to adopt safer sexual behaviours, seek early diagnosis and treatment of GUDs to reduce their risk of transmitting HIV infection.