HIV point-of-care diagnostics: meeting the special needs of sub-Saharan Africa.

Sub-Saharan Africa, accounting for 70% of the 35 million people living with HIV worldwide, obviously carries the heaviest burden of the HIV epidemic. Moreover, the region's poor health system occasioned by limited resources and inadequate skilled clinical personnel usually makes decentralization of HIV care difficult. Therefore, quality diagnostics that are easy to use, inexpensive, and amenable for use at point of care (POC) are a dire necessity. Clearly, such diagnostics will significantly lessen the pressure on the existing over-stretched centralized HIV laboratory services. Thankfully, some POC diagnostics are already being validated, while others are in the pipeline. As POC test kits emerge, implementation hurdles should be envisaged and planned for. This review examines emerging HIV diagnostic platforms, HIV POC product pipelines, gaps, perceived POC implementation challenges, and general recommendations for quality care.

H3Africa: a tipping point for a revolution in bioinformatics, genomics and health research in Africa.

BACKGROUND: A multi-million dollar research initiative involving the National Institutes of Health (NIH), Wellcome Trust and African scientists has been launched. The initiative, referred to as H3Africa, is an acronym that stands for Human Heredity and Health in Africa. Here, we outline what this initiative is set to achieve and the latest commitments of the key players as at October 2013. FINDINGS: The initiative has so far been awarded over $74 million in research grants. During the first set of awards announced in 2012, the NIH granted $5 million a year for a period of five years, while the Wellcome Trust doled out at least $12 million over the period to the research consortium. This was in addition to Wellcome Trust's provision of administrative support, scientific consultation and advanced training, all in collaboration with the African Society for Human Genetics. In addition, during the second set of awards announced in October 2013, the NIH awarded to the laudable initiative 10 new grants of up to $17 million over the next four years. CONCLUSIONS: H3Africa is poised to transform the face of research in genomics, bioinformatics and health in Africa. The capacity of African scientists will be enhanced through training and the better research facilities that will be acquired. Research collaborations between Africa and the West will grow and all stakeholders, including the funding partners, African scientists, scientists across the globe, physicians and patients will be the eventual winners.

Computational biology and bioinformatics in Nigeria.

Over the past few decades, major advances in the field of molecular biology, coupled with advances in genomic technologies, have led to an explosive growth in the biological data generated by the scientific community. The critical need to process and analyze such a deluge of data and turn it into useful knowledge has caused bioinformatics to gain prominence and importance. Bioinformatics is an interdisciplinary research area that applies techniques, methodologies, and tools in computer and information science to solve biological problems. In Nigeria, bioinformatics has recently played a vital role in the advancement of biological sciences. As a developing country, the importance of bioinformatics is rapidly gaining acceptance, and bioinformatics groups comprised of biologists, computer scientists, and computer engineers are being constituted at Nigerian universities and research institutes. In this article, we present an overview of bioinformatics education and research in Nigeria. We also discuss professional societies and academic and research institutions that play central roles in advancing the discipline in Nigeria. Finally, we propose strategies that can bolster bioinformatics education and support from policy makers in Nigeria, with potential positive implications for other developing countries.

Absence of routine molecular testing and prevalence of HIV-2 infection in regions hardest-hit by HIV infection.

INTRODUCTION: Investigating the incidence and dynamics of HIV-2 and false-negative HIV test results in a highly sexually active population where frequent opportunities exist for acquiring and transmitting infections provides additional understanding of the epidemiology of the virus in Africa. METHODOLOGY: The HIV status of 900 active female sex workers (FSWs) was determined using two lateral flow rapid assays in series. The second rapid test device incorporates type-specific recombinant peptides that discriminate between HIV-1 and HIV-2 infection. HIV sero-negative samples were re-tested for HIV infection and their viral loads determined using the NucliSENS real-time nucleic acid sequence-based amplification (NASBA) platform. RESULTS: In total, 335 FSWs were determined to be HIV positive, the majority (227; 67.8%) of whom were between the ages of 20 and 30 years. Eighteen (5.4%) were found to have evidence of HIV-2 infection, 17 of whom were co-infected with HIV-1. Only one HIV-2 mono-infection was observed. Out of 565 HIV-negative individuals determined by serology, 11(1.9%; p > 0.05) were found to be HIV-1 positive when tested via the NASBA platform. CONCLUSION: False negative test results, HIV-2 infection, and complex transmission networks among FSWs may aid in fueling the HIV epidemic in the Nigerian population. These findings demonstrate the need to reevaluate the quality of HIV serological diagnostics, control services, and stress the need for widespread introduction of molecular testing among high-risk populations in the country.

CD4+ T lymphocyte reference values of immunocompetent subjects in an African university.

CD4(+) T cells play critical roles in the immune system and, being primary targets of HIV infection, they are used to measure disease progression and response to combination antiretroviral therapy (cART), alongside other parameters, in HIV/AIDS patients. The aim of this study was to determine the reference values of CD4(+) T cells in a student population that was HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) negative. After ethical clearance and informed consent, 500 subjects (mean age = 26 years) were recruited, of whom 56 (11.2%) had HIV, HBV or HCV and were excluded. Blood samples were collected from the remaining 444 subjects into vacutainer tubes and analysed using the BD FACScount cytometer according to the manufacturer's instructions. Of the 444 subjects, 266 (59.9%) were male and 178 (40.1%) were female. The mean (± standard deviation) CD4(+) T cell count was 987 cells/µL (± 336). The mean counts among males and females were 957 cells/µL (± 306) and 991 cells/µL (± 340), respectively. Values of CD4(+) T cells ranged from 651 cells/µL to 1705 cells/µL. Subjects with higher CD4(+) T Cells were more likely to be female than male. There was no direct correlation between CD4(+) T cell values and age of the participants. Our findings offer the first insight into the CD4(+) T cell reference values of a Nigerian student population and provide useful data that will guide future cART decisions and other immune-based therapies.

Parvovirus B19 antibodies and correlates of infection in pregnant women attending an antenatal clinic in central Nigeria.

Human parvovirus B19 infection is associated with spontaneous abortion, hydrops foetalis, intrauterine foetal death, erythema infectiosum (5th disease), aplastic crisis and acute symmetric polyarthropathy. However, data concerning Nigerian patients with B19 infection have not been published yet. The purpose of this study was to establish the prevalence of B19 IgG and IgM antibodies, including correlates of infection, among pregnant women attending an antenatal clinic in Nigeria. Subsequent to clearance from an ethical committee, blood samples were collected between August-November 2008 from 273 pregnant women between the ages of 15-40 years who have given their informed consent and completed self-administered questionnaires. Recombinant IgG and IgM enzyme linked immunosorbent assay kits (Demeditec Diagnostics, Germany) were used for the assays. Out of the 273 participants, 111 (40.7%) had either IgG or IgM antibodies. Out of these, 75 (27.5%) had IgG antibodies whereas 36 (13.2%) had IgM antibodies, and those aged 36-40 years had the highest prevalence of IgG antibodies. Significant determinants of infection (p < 0.05) included the receipt of a blood transfusion, occupation and the presence of a large number of children in the household. Our findings have important implications for transfusion and foeto-maternal health policy in Nigeria. Routine screening for B19 IgM antibodies and accompanying clinical management of positive cases should be made mandatory for all Nigerian blood donors and women of childbearing age.

Parvovirus B19 antibodies and correlates of infection in pregnant women attending an antenatal clinic in central Nigeria

Human parvovirus B19 infection is associated with spontaneous abortion, hydrops foetalis, intrauterine foetal death, erythema infectiosum (5th disease), aplastic crisis and acute symmetric polyarthropathy. However, data concerning Nigerian patients with B19 infection have not been published yet. The purpose of this study was to establish the prevalence of B19 IgG and IgM antibodies, including correlates of infection, among pregnant women attending an antenatal clinic in Nigeria. Subsequent to clearance from an ethical committee, blood samples were collected between August-November 2008 from 273 pregnant women between the ages of 15-40 years who have given their informed consent and completed self-administered questionnaires. Recombinant IgG and IgM enzyme linked immunosorbent assay kits (Demeditec Diagnostics, Germany) were used for the assays. Out of the 273 participants, 111 (40.7 percent) had either IgG or IgM antibodies. Out of these, 75 (27.5 percent) had IgG antibodies whereas 36 (13.2 percent) had IgM antibodies, and those aged 36-40 years had the highest prevalence of IgG antibodies. Significant determinants of infection (p < 0.05) included the receipt of a blood transfusion, occupation and the presence of a large number of children in the household. Our findings have important implications for transfusion and foeto-maternal health policy in Nigeria. Routine screening for B19 IgM antibodies and accompanying clinical management of positive cases should be made mandatory for all Nigerian blood donors and women of childbearing age.

Seroprevalence of herpes simplex virus type-2 among patients attending the Sexually Transmitted Infections Clinic in Jos, Nigeria.

BACKGROUND: Infection with Herpes Simplex Virus Type-2 (HSV-2) is the primary cause of genital herpes and the most common cause of genital ulcer disease (GUD) worldwide.  There is little information on the prevalence of HSV-2 in Nigeria. METHODOLOGY: Specimens were collected from 162 volunteers attending Jos University Teaching Hospital and tested for HSV-2 antibodies using HSV-2 Type specific IgG EIA test kit (Globalemed LLC Alexandria VA, USA). Data were analyzed using SPSS version 13.0. P values ≤ 0.05 were considered significant number. RESULTS: Out of the 162 individuals tested, 141 (87.0%) were HSV-2 positive. Infected individuals were more likely to be male than female (92.8% versus 86.4%; P > 0.05). There were high rates of infection in all age groups, and the prevalence increased with age. However, multivariate logistic regression analysis showed that HSV-2 prevalence was not significantly associated with increasing age, sex, marital status, occupation, educational status, and number of sex partners (P > 0.05). CONCLUSIONS: The results highlight the potential public health impact of HSV-2 in Nigeria where anti-HSV-2 testing is not generally performed in all populations, especially considering the risk of neonatal transmission and the attendant complications at birth.

Hepatitis B virus infections in apparently healthy urban Nigerians: data from pre-vaccination tests.

BACKGROUND: In spite of the availability of an effective vaccine since 1982 against hepatitis B, infection with hepatitis B virus (HBV), which is 50 to 100 times more infectious than HIV, still persists in most parts of the world with Nigeria being described as an endemic zone. We therefore set out to establish the prevalence of this infection and evaluate its relationship with age and gender in urban Nigerians. METHODOLOGY: During pre-vaccination tests, blood samples were collected by finger-prick and venepuncture from 1,891 subjects aged < or = 60 years, between 2008 and 2009 after having obtained informed consent and ethical clearance. Smart Check HBsAg (Globalemed, Cape Town, South Africa) and ShantestTM-HBsAg Elisa (Shantha Biotechnics Ltd, Hyderabad, India) were used for initial and confirmatory tests respectively. RESULTS: Of the 1,891 participants, 957 (50.6 %) were males and 934 (49.4%) were females. Overall 114 (6.0%) were positive, of whom 71 (7.4%) were males and 43 (4.6%) females. Those aged 21-30 years had the highest infection rate, and males were more likely to be infected with the virus than females (P > 0.05). CONCLUSIONS: Such a high prevalence of a vaccine-preventable infection questions the effectiveness of the Nigerian vaccination strategies. The Nigerian government hepatitis B vaccination programme, which hitherto is limited to the National Childhood Immunisation Programme, should include the adult population.

Urban-rural estimation of hepatitis C virus infection sero-prevalence in north Central Nigeria.

BACKGROUND/OBJECTIVE: The epidemiology of hepatitis C virus (HCV) infection has been partially described for at risk groups in urban communities in Nigeria. On the other hand, literature on the possible spread of the virus in rural Nigeria remains extremely scanty. The objective of this study was to estimate the prevalence of HCV in a rural and urban community in Nigeria. METHODS: Four hundred and twenty four (n = 424) plasma samples belonging to 238 rural inhabitants and 186 urban dwellers in North Central Nigeria were tested for anti-HCV markers using a third generation quantitative enzyme-linked immunosorbent assay (ELISA) that uses recombinant proteins and synthetic peptides derived from core and non-structural regions. RESULTS: 29(12.2%, CI = 0.17-0.86) of the rural samples and 5(2.7%, CI = 0.01-0.06) of urban samples were positive for HCV infection. The highest number of infections was in the 21-40 years age category. Our preliminary findings indicates that the number of HCV infection in rural was higher (p = 0.03) when compared with urban settings in Nigeria. CONCLUSION: Our results suggest a higher prevalence of HCV infection in rural than urban Nigeria in the region studied and possibly in Nigeria as a whole. HCV transmission is active in rural Nigeria and large scale studies to understand the dynamics of the infection are required so as to plan targeted preventive measures.

Evaluation of a recombinant DNA hepatitis B vaccine in a vaccinated Nigerian population.

INTRODUCTION: Recombinant hepatitis B vaccine was introduced in 1986 and has gradually replaced the plasma-derived hepatitis B vaccine. No published data are available on the immunogenicity of hepatitis B vaccines in Nigerians. The current study aimed to evaluate protective sero-conversion rates after vaccination with Shanvac-B rDNA hepatitis B vaccine in Nigerian subjects between January and September 2009. METHODOLOGY:   After having obtained informed consent and ethical clearance, 2 mL of blood were aseptically collected from each participant aged ≤50 years, one month after the first, second and third doses of the vaccine. Sera were separated into cryovials and frozen at -21oC until analysed for the detection of the protective antibody titre induction. Protective antibody titre was defined as a titre of ≥10 mIU/mL. RESULTS: Of the 376 participants, 192 (51.1%) were males and 184 (48.9%) were females. A total of 144 subjects participated in the first-dose group, nine (6.3%) of whom developed protective antibody titre (8.3% of males and 4.2% of females). Of the 121 participants in the second-dose group, 108 (89.3%) developed protective antibody titre (98.3% of males and 80.3% of females), while of the 111 participants in the third-dose group, 100% protectively sero-converted. Males were more likely to develop protective antibody titre than females after the second dose (P < 0.05). CONCLUSION: This data provides additional evidence for the efficacy of Shanvac-B rDNA hepatitis B vaccine and the need to adhere to the recommended three-dose schedule to achieve full and lasting sero-protection among Nigerians.

Human immunonodeficiency virus, hepatitis B virus and hepatitis C virus: sero-prevalence, co-infection and risk factors among prison inmates in Nasarawa State, Nigeria.

BACKGROUND: Published data on HIV, HBV, and HCV in correctional facilities in Nigeria is scarce. We set out to establish the seroprevalence, co-infection, and risk factors for these infections for the first time among prison inmates in Nasarawa State, Nigeria. METHODOLOGY: In a cross-sectional study conducted between April and May, 2007, blood samples were collected from 300 male prisoners of a mean age of 29.2 years, in the state's four medium-security prisons (overall population: 587). Prior to the study, ethical clearance and informed consent were obtained and structured questionnaires were administered. Samples were analyzed for HIV, HBsAg, and HCV using anti-HIV 1+2-EIA-avicenna, Shantest-HBsAg ELISA, and anti-HCV-EIA-avicenna, respectively. Specimens initially reactive for HIV were retested with vironostika microelisa. Data were analyzed using SPSS version 13.0. P values < or = 0.05 were considered significant. RESULTS: Of the 300 subjects, 54 (18.0 %), 69 (23.0 %), and 37 (12.3 %) tested positive for HIV, HBV, and HCV, respectively. Co-infections were eight (2.7 %) for HIV/HBV and two (0.7 %) for HBV/HCV. Those aged 21-26 years were more likely to be infected with HIV and HBV, while those aged 33-38 years had the highest HCV infection. Associated risk factors included duration in prison, previous incarceration (for HIV, HBV and HCV), intra-prison anal sex, multiple sex partners (for HIV and HBV), ignorance of transmission modes, blood transfusion, and alcohol consumption (for HBV and HCV). No inmate injected drugs. CONCLUSIONS: The overall outcome represents the need for prison-focused intervention initiatives in Nigeria. Injected drug use is an unlikely major transmission mode among Nigerian inmates.

Human immunonodeficiency virus, hepatitis B virus and hepatitis C virus: sero-prevalence, co-infection and risk factors among prison inmates in Nasarawa State, Nigeria

Background: Published data on HIV; HBV; and HCV in correctional facilities in Nigeria is scarce. We set out to establish the seroprevalence; co-infection; and risk factors for these infections for the first time among prison inmates in Nasarawa State; Nigeria. Methodology: In a cross-sectional study conducted between April and May; 2007; blood samples were collected from 300 male prisoners of a mean age of 29.2 years; in the state's four medium-security prisons (overall population: 587). Prior to the study; ethical clearance and informed consent were obtained and structured questionnaires were administered. Samples were analyzed for HIV; HBsAg; and HCV using anti-HIV 1 +2-EIA- avicenna; ShantestTM-HBsAg ELISA; and anti-HCV-EIA-avicenna; respectively. Specimens initially reactive for HIV were retested with vironostika microelisa. Data were analyzed using SPSS version 13.0. P values = 0.05 were considered significant. Results: Of the 300 subjects; 54 (18.0); 69 (23.0); and 37 (12.3) tested positive for HIV; HBV; and HCV; respectively. Co-infections were eight (2.7) for HIV/HBV and two (0.7) for HBV/HCV. Those aged 21-26 years were more likely to be infected with HIV and HBV; while those aged 33-38 years had the highest HCV infection. Associated risk factors included duration in prison; previous incarceration (for HIV; HBV and HCV); intra-prison anal sex; multiple sex partners (for HIV and HBV); ignorance of transmission modes; blood transfusion; and alcohol consumption (for HBV and HCV). No inmate injected drugs. Conclusions: The overall outcome represents the need for prison-focused intervention initiatives in Nigeria. Injected drug use is an unlikely major transmission mode among Nigerian inmates