Risk factors and seroprevalence of hepatitis C virus antibody among blood donors in Lagos.

AIMS AND OBJECTIVES: This study was undertaken (i) to determine the seroprevalence of antibodies to Hepatitis C virus (anti -HCV) among blood donors (ii) to document the incidence of known risk factors for HCV infection among blood donors. PATIENTS AND METHODS: This is a cross sectional prospective study among apparently normal blood donors. Subjects were recruited from three different hospitals in Lagos metropolis. All recruited donors were evaluated for HCV infection- associated risk factors by questionnaire interviews. Sera samples from recruited donors were tested for anti-HCV using third generation Murex (Murex Biotech, South Africa) and fourth generation Dialab Enzyme Linked Immunosorbent Assay (ELISA) kits (Dialab. Austria). RESULTS: A total of three hundred and thirty four blood donors were screened, of which seven (2.1 %) were positive for anti-HCV. The blood donors comprised 15 (4.5 %) females and 319 (95.5 %) males. There was an association between anti-HCV positivity and history of multiple sex partners and previous sexually transmitted infections (X2-15.9; p < 0.05) Majority of blood donors were family replacement 317 (94.9 %) with anti-HCV prevalence of 2.2 % (7/317) while 5.1 % (17/334) were voluntary non remunerated with anti-HCV prevalence of 0% (p >0.05) CONCLUSION: Prevalence of anti-HCV among blood donors in Lagos (2.1%) is low as in most previous reports from Nigeria and some other parts of Africa.

Aetiology of bacteraemia among adult AIDS patients attending Lagos University Teaching Hospital (LUTH), Lagos, Nigeria.

BACKGROUND: Bacteraemia is a relatively common event in HIV-infected patients, especially in late infection. Studies in Africa have shown that more than 23% of AIDS patients have bacteraemia but there is paucity of data from Nigeria. METHODS: Blood samples from 67 consecutive patients with AIDS attending the Lagos University Teaching Hospital between April and August 2000 were cultured. Temperature, ESR, Full blood count, and where possible CD4 counts were obtained. Socio-demographic details were also recorded. Thirty apparently healthy people were randomly selected from a low-risk population to act as non-AIDS controls. The Oxoid Signal Blood Culture System was used to investigate bacteraemia. Antibiotic sensitivity tests were carried out on all isolates. RESULTS: Twenty-two (33%) of the 67 AIDS patients were culture positive. Non-typhoidal Salmonella spp (45.5%), coagulase-negative staphylococci (22.7%) and Staphylococcus aureus (18.2%) were most commonly isolated. One isolate each of Klebsiella pneumoniae, Pseudomonas aeruginosa and Bacillus spp were identified. All bacteraemic patients had temperatures above 38 degrees C and white blood cell counts ranged between 2,700-13,500/mm(3). There was a high rate of antibiotic resistance particularly to chloramphenicol, tetracyclines, cotrimoxazole and beta-lactam antibiotics. However, most isolates were still susceptible to gentamicin and the fluoroquinolones. There was no significant difference in the socio-demographics of the bacteraemic AIDS and non-bacteraemic AIDS patients. CONCLUSION: Salmonella spp. were the most common aetiological agent of bacteraemia among AIDS patients seen at the Lagos University Teaching Hospital (LUTH), Nigeria. A high temperature was a pointer to the presence of bactaeraemia while total white blood cell counts were not useful. It is recommended that blood culture should be done for AIDS patients with elevated temperature irrespective of the total white blood cell count.

Malignant lymphomas in Jos, Nigeria: a ten-year study.

One hundred-and-sixty-seven cases of malignant lymphomas (ML) diagnosed in the Jos University Teaching Hospital, Jos, Nigeria, over a ten-year period (1979-88) were reviewed. The overall incidence rate is 13.4 per 100,000 with a median age of 29 years and a male:female ratio of 3:1. Non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) represent 67.7 pc and 32.3 pc cases respectively. Low, intermediate and high grade NHLs account for 51.4 pc, 17.7 pc and 30.0 pc of cases respectively; the collective median age at presentation is 31 years and the male:female ratio is 2:1 (Follicular: 13.3 pc; diffuse 86.7 pc). The small lymphocytic lymphoma is the commonest NHL (38.1 pc); the small non-cleaved cell type (African Burkitt's lymphoma type) accounts for 24.7 pc with an incidence rate of 2.2 per 100,000 within the general population and a median age of 10 years. Hodgkin's disease (median age: 28 years) is the commonest form of ML exhibiting only a single peak in the 21-30 years range. The male:female ratio is 8:1 and histological types associated with poor prognosis predominate. The prevalent clinical presentations is with a painless peripheral lymphadenopathy, the cervical group of lymph nodes is often involved representing 55 pc and 67 pc of NHL and HD cases respectively. Burkitt's lymphoma present primarily as an abdomino-pelvic tumour (67.8 pc of cases). Primary extradonal presentation is seen in 90 pc of MLs, all of which are the NHL group with Burkitt's lymphoma accounting for 80 pc of all cases.

Seroprevalence study of HTLV-1 and HIV infection in blood donors and patients with lymphoid malignancies in Lagos, Nigeria.

OBJECTIVE: To document the seroprevalence of HTLV-1 and HIV in blood donors and in patients with lymphoma and leukaemia in Lagos metropolis. DESIGN: Cross sectional. SETTING: The Lagos University Teaching Hospital (LUTH) and General Hospital, Lagos (GH). SUBJECTS: 406 apparently healthy voluntary blood donors from the LUTH and GH and 30 patients [20 patients with histological diagnosis of Non-Hodgkin's Lymphoma (NHL) and 10 patients with diagnosis of Chronic Lymphocytic Leukaemia (CLL)] were recruited at LUTH. MAIN OUTCOME MEASURES: HTLV-1 and HIV-1 seroprevalence. RESULTS: Out of 406 donors, three (0.7%) were positive for HTLV-1 and 20 (4.9%) were positive for HIV-1. None of the 30 patients with NHL or CLL were positive for HTLV-1. Five of NHL patients were positive for HIV-1. CONCLUSION: HTLV-1 seroprevalence is low among Lagos donors. Routine screening of donors for this virus will not be cost effective. NHL is one of the AIDS related malignancies which has been documented in this study.

Management of HIV infection in Nigeria with zalcitabine in combination with saquinavir mesylate: preliminary findings.

The efficacy and safety of a combination therapy with two anti-retroviral drugs, zalcitabine (ddC) and saquinavir mesylate was evaluated in 24 adult Nigerian patients with HIV infection. The result of an interim analysis after a 6-month course of therapy is presented herein. Patients were given zalcitabine 2.25 mg and saquinavir 1800 mg per day. Efficacy was evaluated by improvement in the CD4 cell count and disappearance and/or resolution of clinical signs and symptoms from the patient baseline condition. Tolerability and safety were assessed by the occurrence of adverse event and monitoring of biochemical parameters such as alanine transaminase, alkaline phosphatase and total bilirubin. The haemogram profile of patients was also monitored. There was clinical improvement in 79.2% of the patients, a minimal increase in the CD4 cell count was observed and the incidence of adverse event was 40%. The haematological and biochemical profile of the patients were not significantly affected by treatment (p > 0.05). We therefore conclude that the drug cocktail comprising zalcitabine and saquinavir does posses good potentials for effective management of Nigerian patients with HIV infection. However, it is imperative and important to continue treatment with the drugs for a longer time in order to demonstrate sustained response.

Interferon alfa-2a (Roferon-A) monotherapy in chronic myelogenous leukemia: a pilot study in Nigerian patients in early chronic phase.

The efficacy and safety of interferon alfa-2a monotherapy was evaluated in seventeen Nigeria patients with chronic myelogenous leukaemia (CML). Male and female patients with a mean age of 34.5 +/- 10.6 years were recruited into the study. Interferon therapy was administered at a maintenance dose of 9 MIU daily for 12 months. Efficacy was evaluated by assessing both haematologic and cytogenetic response, tolerability by incidence of adverse events and safety by laboratory haematological and biochemical indices. At the end of 12 months of therapy 6 patients (54.4%) had complete haematologic remission whilst 3 patients (100% of those evaluated) showed partial cytogenetic remission. The incidence of adverse event was 70% and the monitored haematologic and biochemical indices were not adversely affected by treatment. In conclusion, the study clearly demonstrated a significant benefit of interferon alpha-2a in the management of Nigerian patients with CML. The changes in the haematological and cytogenetic profiles between baseline and term were significant (p < 0.05). However, it is imperative and important to encourage and continue monitoring of the responding and stabilized patients beyond 12 months in order to demonstrate sustained response. The drug was reasonably well tolerated, however life threatening pancytopenia may pose a major problem in certain cases.

The fibrinolytic enzyme system in pregnancy in Nigerians.

Results of a detailed study of the fibrinolytic enzyme system in pregnant and non-pregnant Nigerians are reported. It was observed that plasma plasminogen, alpha 1-antitrypsin, and alpha 2-macroglobulin were significantly increased in pregnancy (P less than 0.001) in comparison with the non-pregnant state. Fibrinogen was also increased but at a level of P less than 0.01. A prolonged euglobulin clot lysis time was also observed (P less than 0.001). There was no significant difference in the mean values of platelet count in the two groups. These findings indicate that Nigerian women in pregnancy show physiological changes in haemostasis identical to those reported in Caucasians.

Spectrum of clinical diseases in HIV-infected adults at the Lagos University Teaching Hospital: a five-year experience [1992-1996].

The study was conducted to document the spectrum of clinical diseases in HIV infected patients at the Lagos University Teaching Hospital (LUTH) over a period of five years: 1992-1996. Patients with symptoms suggestive of HIV infection in both in and out-patients at LUTH were studied. Their blood specimens were screened for HIV infection using enzyme immunosorbent assay (EIA) technique and positive results were confirmed by western blotting techniques. The following were documented: risk factors, clinical history and physical findings. Of the 5,010 patients screened in a five-year period, 759 (15.15%) were found to be HIV positive. Of these 759 patients, 406 (53.5%) were young adults in their third decade (20-30 years). Heterosexual intercourse was the major risk factor in these patients (76%). Progressive loss of weight occurred in 77.8%, prolonged fever in 73%, chronic cough in 50%, painless lymphadenopathy in 40%, chronic diarrhoea in 35%, Kaposi's sarcoma in 0.52% and non-Hodgkin's lymphoma in 0.65%. It appears the scourge of AIDS has eventually hit Nigeria. There is the need for reinvigoration of preventive efforts but some energy has to be channeled towards patient care.

Evaluation of saliva-based diagnostic test kit for routine detection of antibodies to HIV.

The study was carried out to determine the reliability of a saliva based test kit for routine detection of HIV antibodies. 150 paired plasma and saliva samples were collected from 50 patients who were known to be positive for HIV-I and 100 others whose HIV serostatus were previously unknown. All the plasma samples were tested for HIV antibodies using Novopath Immunoblot Technique (as the gold standard), Wellcozyme (Murex) ELISA, Latex Agglutination Test (Capillus) and SeroCard Kit. The saliva samples were screened for HIV antibodies using SalivaCard Test Kit. All the 50 known positive patients tested positive when retested with immunoblot and 9 of 100 whose serostatus were unknown also tested positive giving a total of 59 positive results and 91 negative results. Of the 59 positive results, 59, 57, 58 and 47 were correctly identified as true positives by Wellcozyme, Capillus, SeroCard and SalivaCard respectively. Of the 91 negatives, 90, 91, 90 and 85 were correctly identified as true negatives respectively. Sensitivities in the same order were 100%, 97%, 98.3% and 79.7% whilst specificities were 98.9%, 100%, 98.9% and 97.8%. Whereas evaluation parameters for Wellcozyme, Capillus and SeroCard test kits met the criteria for licensure of a test kit as a routine test method for HIV antibody detection, the SalivaCard values fell far short of the stipulated criteria. The Sensitivity, Test Efficiency and Positive Predictive Values of 79.7%, 88% and 67.8% respectively obtained for SalivaCard are too low and the test kit cannot be recommended for routine use as HIV antibody detection kit.

Efficacy and safety of enoxaparin, a low molecular weight heparin in the prevention of deep vein thrombosis in Nigerian patients after orthopaedic surgery.

The objective was to determine the efficacy and safety of Enoxaparin as an antithrombotic agent in orthopaedic patients at risk for thromboembolism. 49 patients who had lower limb orthopaedic surgery were studied. They received subcutaneous Enoxaparin 40mg 12 hours before surgery and subsequently, daily for one week. Blood specimens were drawn at 2 and 12 hours after the first injection, and 24 hours after the fourth injection for anti Factor Xa assay. Specimens were also taken preoperatively, 1st, 5th and 7th post operative days (POD) for determination of Packed Cell Volume (PCV), Haemoglobin level, White Blood Cell (WBC) and Platelet Counts. The mean pre-treatment, 2, 12 and 24 hours anti Factor Xa clotting times were 14.5 +/- 0.8, 36.2 +/- 5.6, 30.6 +/- 9.8 and 25.8 +/- 9.3 seconds respectively. The changes were significant, P = 8.2 x 10(-12). The 2 and 24 hours clotting times corresponded to plasma heparin concentration level of 0.12 - 0.22U/ml read off from prepared Enoxaparin standardisation curve. Significant changes were observed in haemoglobin level, PCV, WBC and Platelet Counts when preoperative, 1st, 5th and 7th POD mean values were compared by Analysis of Variance--P < 0.01 in all cases. The study showed that Enoxaparin 40 mg daily caused hypocoagulation within prophylactic range of 0.12 - 0.22U/ml of heparin in the plasma. Changes in blood counts were within the limits expected post surgery.

HIV seroprevalence in emergency department patients: Lagos University Teaching Hospital, Lagos, 1999.

The emergency department patients represent a cross-section of the entire population and values of HIV seroprevalence in them have been used to assess the general trends of HIV surveillance in other countries. The objectives of this study is to determine 1. Whether seroprevalence of HIV antibodies in patients attending emergency departments could serve as a marker of prevalence of HIV antibody in the general population. 2. The degree of clinical suspicion or knowledge of the medical personnel to the status o the HIV seropositive patients is also evaluated. A total of 312 emergency department patients of Lagos University Teaching Hospital (LUTH) had their blood samples screened for antibodies against Human Immunodeficiency Virus (HIV) types I and II by ELISA based techniques: Immunocomb II HIV I & II Bispot Kits. Repeatedly reactive samples were confirmed by another ELISA based technique using Immunocomb I & II Combfirm kits. The attending medical doctor was asked whether there was any suspicion or knowledge that the patient being attended to, was HIV seropositive. The seroprevalence of HIV antibodies was 5.77% with no significant difference in sex incidence. The age groups 20-29 and 30-39 years were most affected. The seropositive nature of affected patients was unsuspected by medical personnel in 55.56% of the HIV antibodies seropositive patients. The Federal Ministry of Health in 2000, estimated the National prevalence rate of HIV to have been 5.4% in 1998. This figure is comparable to that obtained in this study and revalidates the fact that emergency department patients may be used for disease surveillance in the population. The seropositive status of majority of the HIV positive patients was unsuspected by the attending medical personnel. Thus, strict adherence to universal safety precautions is essential for all medical personnel. Post exposure prophylaxis should be made readily accessible to all medical personnel.

Absolute lymphocyte count as surrogate for CD4+ cell count in monitoring response to antiretroviral therapy.

The objective of the study is to determine whether Absolute Lymphocyte Count (ALC) can serve as a surrogate for CD4 T-lymphocyte Cell Count (CCC) in HIV infected Nigerians on Lamivudine/Zidovudine anti-retroviral therapy. 32 adult Nigerians infected with HIV were recruited into the study. They were assessed clinically and categorised into three clinical stages A, B and C according to CDC criteria. They all received lamivudine 150 mg b.d and Zidovodine 300 mg b.d for six months. Blood specimens were taken on enrollment and at four weekly intervals for paired ALC and CCC determination. ANOVA statistics was used to determine whether ALC and CCC (separately) change significantly with increasing duration of therapy. Paired ALC and CCC values were tested for correlation. Sensitivity and specificity of low ALC values in predicting low CCC values were also calculated. The 32 patients comprised 18 males and 14 females aged between 16 and 49 years. The mean age (SD) was 36.1 (+/-7.85) years. The mean ALC value rose from 2485/l and 2352/microl before commencement of therapy to 3026/microl and 3151/microl four weeks after for males and females respectively. These changes were not significant, P>0.05. No further changes were noted over the next 24 weeks. However, the mean CCC values increased from 233/microl before therapy through 339/microl at four weeks, 362/microl at eight weeks to 398/micro1 at 12 weeks. It then fluctuated between 372/microl and 310/microl for the remaining part of the study. These changes were not significant: F: ratio = 1.28 (df = 6,181), P>0.05. A weak but significant positive correlation was established between ALC and CCC. Correlation coefficient was 0.25, P<0.05. The sensitivity and specificity of ALC 2000/microl as a predictor of CCC 200/microl were 57% and 72% respectively. ALC correlates weakly with CCC in patients undergoing antiretroviral therapy and it may not serve as a perfect surrogate for CCC as a monitor of immunological response to therapy.

Otorhinolaryngological manifestations of HIV/AIDS in Lagos.

A prospective study was carried out at the Lagos University Teaching Hospital in Lagos. The aims were to determine the prevalence of otorhinolaryngological disease among patients who were HIV+ and or had clinical AIDS and to correlate the presence of ORL disease with the clinical state of HIV infection. The study was done between October 1998 and September 1999. A total of ninety-eight patients were studied. The age range of the patients was between 15 and 69 years with 83% of them being in the age group of 20-49 years. The results showed that while only 17% of the patients were referred because of ORL diseases, 80% of them actually had O.R.L./head and neck conditions. This difference of proportion is highly significant P = 0.000037. 160.20% of the patients had oral/pharyngeal lesions and 24.5% had identifiable otological disease. Hearing impairment was noted in 30.6% of the patients on pure tone audiometric assessment of which 26.5% were sensorineural. The correlation between O.R.L./head and neck manifestation and the CDC classification of HIV/AIDS infection did not reveal a definite pattern.

HIV infection in children.

PIP: The World Health Organization estimates that more than 1 million children are infected worldwide with HIV. With 1 in 40 adults in sub-Saharan Africa estimated to be infected with HIV, the scenario has already been painted for a grim future of HIV-infected infants borne to infected mothers. AIDS/HIV is indeed a global problem against which prevention and control strategies are urgently needed. Controlling the incidence of HIV infection among heterosexuals will allow control over the incidence of congenital and perinatal infection. Efforts must be made to reduce the use of blood transfusions in the management of anemia and health care workers must be taught how to use blood supplies and transfusions appropriately. Discussed are: the vertical transmission of HIV; blood transfusion and the use of contaminated needles; clinical manifestations of AIDS in children; HIV infection diagnosis in infants and children; the management of HIV-infected children; vaccination; prognosis; and major and minor signs of pediatric AIDS.^ieng

The Society for Women and AIDS in Africa: the experiences of a developing federation.

PIP: The Society for Women and AIDS in Africa (SWAA) promotes AIDS prevention (e.g. increasing awareness among African women) and strives to understand how AIDS disrupts their lives and those of their children, families, and communities. It has semiautonomous national branches in 27 countries and has held 4 annual meetings. The Sierra Leone branch has 50 members, both men and women. It has participated in various World AIDS Day activities with 7 youth groups, including preparing posters and performing drama and music. It has conducted a survey of sexual practices which found that many men had multiple partners. the Sierra Leone branch has hosted a 3-day training workshop for women's groups. It has targeted female religious leaders, other clergy, and the Rotary Club. Its chief constraints include lack of funding, civil unrest, lack of electricity, and unreliable postal services. Both the Sierra Leone and Nigeria national branches depend on volunteers. Members of the Nigeria branch represent professional women's groups. SWAA Nigeria has regional branches in 13 states. Some SWAA Nigeria activities have included interventions targeting female prostitutes in 3 states, training of trainers workshops for prostitutes, and educational materials development. It faces several obstacles, including sporadic and unreliable communications systems and insufficient finances. The main obstacle of SWAA at the federation level is lack of core funding, so it has sent a proposal to international and bilateral organizations requesting core funding which would then be used for internal planning and program development. The federation is planning a skills development training program.^ieng

Leg ulceration in sickle cell disease in Nigeria.

Leg ulceration was found in only 14 of 834 (1.7%) sickle cell patients seen in a Lagos Hospital. Ulcers were seen only in patients above the age of 12 years in whom the prevalence was 5.4%. Affected males outnumbered females 6 to 1. The aetiology was traumatic in 12 patients, spontaneous in three and due to furuncle in one. The commonest sites were around the ankles. Ulceration was not commoner in patients with low socioeconomic status. The simplest forms of aseptic treatment resulted in as variable a healing time as more complex forms of treatment, but a high recurrence rate of ulceration (71.4%) was the major problem. There remains no acceptable reason for the lower prevalence of leg ulceration in Africans with sickle cell disease, but the role of zinc in susceptibility to the ulcers deserves further investigation.

Submandibular chronic sialadenitis presenting with alcohol-induced pain.

A 32 year old man with alcohol-induced pain over a right submandibular swelling is described. Excision biopsy of this swelling revealed chronic sialadenitis and the symptoms promptly ceased following this excision. We speculate on the possible pathophysiological mechanism.

Antibodies to human immunodeficiency virus (HTLV-III/LAV) in people from Lagos and Cross River States of Nigeria.

Using enzyme-linked immunosorbent assay (ELISA) and confirmatory immunoprecipitation tests, sera from 640 Nigerians from Lagos and Cross River States were examined for antibodies against HIV. These comprised 570 blood donors and their family members, 56 patients with various haematological conditions and 14 patients with acute Plasmodium falciparum infection. None of the sera was positive for HTLV-III/LAV antibodies by immunoprecipitation, although 12 (1.9%) sera were positive by ELISA.

Seroprevalence of HIV-1, HIV-2, and HIV-1 group O in Nigeria: evidence for a growing increase of HIV infection.

To determine current data on HIV infection and to further confirm the presence of HIV-1 group O infection in Nigeria, 2300 samples from five states were tested for the presence of HIV antibody. A convenience sampling was obtained from pregnant women, tuberculosis (TB) patients, commercial sex workers (CSWs), blood donors, patients with sexually transmitted diseases (STDs), patients with skin diseases, male clients of CSWs, outpatients suspected to have AIDS, truck drivers, and community dwellers. With the exception of pregnant women, the HIV prevalences in all these groups were high: 60.6% in CSWs, 16.2% in TB patients, 7.7% in blood donors in some states, and 16% in the rural area of Kano State. Male clients of CSWs, truck drivers, and STD patients had prevalences of 7.8%, 8.6%, and 21.2%, respectively. Regional differences in relation to HIV prevalences were observed; HIV-2 and most of the HIV-1/2 infections were found in the southern states of Nigeria. Higher HIV prevalences were observed in the north-northeast in pregnant women, TB patients, and CSWs, but for blood donors, higher rates were seen in the southeast-southwest. One asymptomatic 50-year-old woman, a community dweller in Kano, was identified to be HIV-1 group O-positive. Compared with data from national surveillance studies in 1991/1992 and 1993/1994, a substantial increase in HIV infection was observed. Our results show a growing incidence of HIV infection in Nigeria and suggest the presence of a rural HIV epidemic. The identification of HIV-1 group O in Kano shows that this virus strain is geographically widespread in Nigeria.

PIP: To obtain current data on HIV infection in Nigeria by population group, a seroanalysis of 2300 samples from 5 states (Lagos, Cross River, Borno, Kano, and Jugawa) was conducted during March-May 1996. The sample included commercial sex workers, pregnant women, tuberculosis patients, blood donors, patients with sexually transmitted diseases (STDs), patients with skin diseases, male clients of commercial sex workers, outpatients suspected to have AIDS, truck drivers, and community residents. Overall HIV prevalence was 40.7%. With the exception of pregnant women (1.7%), HIV prevalence was high in all subgroups: 60.6% in commercial sex workers, 21.2% in STD patients, 16.2% in tuberculosis patients, and 16.0% in rural areas of Kano state. The majority of HIV-positive women were 21-30 years of age, while HIV-infected men were primarily over 40 years of age. Compared with data from national seroprevalence studies conducted during 1991-92 and 1993-94, this study confirms a substantial recent increase in HIV infection in Nigeria. Of the 330 antibody-positive specimens, HIV-1 was the predominant infection in 315; there were 3 cases of HIV-2 and 12 cases involving dual HIV-1/2 infection. Only 1 serum sample was positive for HIV-1 group O antibodies. The high HIV prevalence detected among commercial sex workers indicates the potential for rapid diffusion of HIV to the general population.