Viral load, CD4+ T-lymphocyte counts and antibody titres in HIV-1 infected untreated children in Kenya; implication for immunodeficiency and AIDS progression.

BACKGROUND: There are limited reports on HIV-1 RNA load, CD4+ T-lymphocytes and antibody responses in relation to disease progression in HIV-1 infected untreated children in Africa. METHODS: To describe the relationships between these parameters, we conducted a longitudinal cohort study involving 51 perinatally HIV-1 infected children aged between 1 and 13 years. HIV status was determined by ELISA and confirmed by western blot and PCR. Antibodies were quantified by limiting dilution ELISA, plasma HIV-1 RNA load by RT-PCR and CD4+ T-lymphocytes by FACSCount. RESULTS: Asymptomatic and symptomatic disease had, respectively, a rise in median HIV-1 RNA load from 1,195 to 132,543 and from 42,962 to 1,109,281 copies/ml in children below 6 years. The increase in viral load was 10-fold higher for asymptomatic compared to other categories and 2-fold faster for children less than 6 years than those above. Similarly, symptomatic children below 6 years had initial median CD4+ T-lymphocyte counts of 647 (22%) cells/muL, declining to 378 (20%) while those above 6 years had initial values of below 335 (15%) but which increased to 428 (17%). Median viral load correlated significantly with median CD4+ T-lymphocyte percentage in children above 6 years (p=0.026) but not below. CONCLUSIONS: Viral load is lower in older than younger children and correlates significantly with percentage CD4+ T-lymphocytes. Survival by HIV-1 infected children requires a competent immune response early in infection to counter the rapidly replicating virus. Interventions aimed at boosting the naïve immune system may prolong survival in these children.

Seroprevalence of simian immunodeficiency virus in wild and captive born Sykes' monkeys (Cercopithecus mitis) in Kenya.

BACKGROUND: The Sykes' monkey and related forms (Cercopithecus mitis) make up an abundant, widespread and morphologically diverse species complex in eastern Africa that naturally harbors a distinct simian immunodeficiency virus (SIVsyk). We carried out a retrospective serological survey of SIV infection from both wild and captive Sykes' monkeys from Kenya. We compared two commercially available, cross-reactive ELISA tests using HIV antigens with a novel SIVsyk antigen-specific Western blot assay and analyzed the data by origin, subspecies, age and sex. RESULTS: The SIVsyk antigen-specific Western blot assay detected more serum samples as positive than either of the cross-reactive ELISA assays. Using this assay, we found that seroprevalence is higher than previously reported, but extremely variable in wild populations (from 0.0 to 90.9%). Females were infected more often than males in both wild and captive populations. Seropositive infants were common. However, no seropositive juveniles were identified. CONCLUSION: We have developed a specific and sensitive Western blot assay for anti-SIVsyk antibody detection. Sykes' monkeys are commonly infected with SIVsyk, but with extremely variable prevalence in the wild. Higher infection prevalence in females suggests predominantly sexual transmission. High infection prevalence in infants, but none in juveniles, suggests maternal antibodies, but little or no vertical transmission.

Evaluation of HIV ELISA diagnostic kit developed at the Institute of Primate Research, Nairobi, Kenya.

The first diagnostic kits utilizing the enzyme-linked immunosorbent assay (ELISA) technique were developed in mid-eighties, and since then, this technique has become an increasingly important tool for screening multiple samples of blood or serum for presence of antibodies to various infectious pathogens, especially human immunodeficiency virus (HIV) in blood banks. However, most of the commercial diagnostic kits currently available in the market are too expensive, hence not easily affordable in most Diagnostic Laboratories. We designed an ELISA kit for diagnosis of HIV and compared it with some of the commercial kits. We used blood samples from the blood bank at the National Public Health Laboratory Services (NPHLS) in Nairobi and from patients referred to the Kenya Medical Research Institute (KEMRI) for HIV screening. Two commercial kits were used, Wellcozyme HIV Recombinant kit and Recombigen (env & gag) HIV-1 EIA kit. Out of 1350 samples tested by Recombigen (env & gag) HIV-1 EIA kit, 419 (31.0% ) were positive while 421 (31.2% ) samples were positive by Wellcozyme HIV Recombinant kit. Our ELISA kit detected a total of 431 positive samples out of 1350 (31.9% ), which was almost identical to the results from the other kits. Our kit was nearly identical in terms of sensitivity and specificity to the other two commercial kits used in this study. Thus our ELISA system, which is much cheaper than the commercial kits currently available in the market, offers a more affordable system for routine HIV tests.