HIV infection among patients with pulmonary tuberculosis in Nigeria.

Respiratory problems like Pneumocystic carinni and Pulmonary tuberculosis (PTB) are among the common opportunistic infections in patients with HIV/AIDS. The risk of acquiring Mycobacterium tuberculosis in a community becomes greater with increase in the number of HIV positive persons with active tuberculosis. This study was carried out to determine the magnitude of HIV infection among PTB patients in different parts of Nigeria as part of the year 2000 national HIV surveillance programme. Blood samples were collected on blotting paper from a total of 2826 individuals attending TB clinics between 1st of September and 1st November, 2000. Samples were collected from patients with confirmed PTB from 12 states in the 6 geopolitical/health zone (2 states/zone) of Nigeria as part of high risk sentinel population groups. Samples were tested for the presence of HIV antibodies using commercial ELISA (Genescreen HIV-1/2, Sanofi Pasteur, Paris). All initially reactive samples were retested with a rapid EIA (Gene II, Sanofi Pasteur, Paris) according to the WHO recommendations (option II). HIV Prevalence in the states varied from 4.2% in Oyo to 35.1% in Benue States with a median prevalence of 17.0%. HIV Prevalence increased with age to a peak of 23.9% among PTB patients 30-39 years and then declined progressively to 12.8% among those 60 years and above. A relatively high HIV infection rate (13.8%) was found among the young adolescent age group 10-19 years. There was no significant difference in the rate among male and female PTB patients tested. Comparison with results of previous HIV sero-surveys shows a steady increase in HIV prevalence among PTB patients over the years. The high prevalence of HIV among young PTB patients aged 10-19 years in this study is worrisome and must be noted for intervention.

Clinico-epidemiological patterns of HIV infection in STD patients in Ibadan.

The HIV-seropositive subjects identified among the STD Clinic patients seen at a Special Treatment Clinic between 1989 and 1990 were studied to determine the epidemiological and clinical trends of HIV infection in these patients, and to demonstrate any association between the STDs and HIV- seropositivity. Thirty-seven out of the 581 patients investigated have been confirmed HIV-seropositive by Western bolt. The prevalence of HIV infection was 6.4%. Anti-HIV-1 antibody prevalence (3.6%) was higher than that of anti-HIV-2 antibody (2.8%). The age-range of the patients investigated was from 2 weeks to 49 years, and the HIV-seropositive cases were in the age-range 15-49 years, with peak incidence of HIV infection in the 21-30 years age-bracket. The male: female ratio of HIV-seropositive subjects was practically the same (1.01:1). HIV antibody-positive cases consisted of residents from towns in both Northern and Southern Nigeria. Only one of the HIV antibody-positive cases has developed clinical AIDS-progressive weight loss fourteen months after he was found positive for HIV antibody.

PIP: To identify epidemiologic and clinical patterns associated with human immunodeficiency virus (HIV) infection in sexually transmitted disease (STD) patients in Nigeria, serologic testing was performed on 581 men and women seen at Ibadan's Special Treatment Clinic during 1989-90. Of these, 37 (6.4%) were confirmed HIV-positive; 21 (3.6%) had HIV-1 antibodies and the remaining 16 (2.8%) had HIV-2 antibodies. Peak HIV incidence (24 cases, or 65%) was in the 21-30 year age group; the male to female ratio was 1.01 to 1.00. Presenting symptoms in HIV-positive cases included urethral discharge, vaginal discharge, dysuria, and genital ulcers. The prevalences of gonococcal infection, nonspecific urethritis and cervicitis, genital ulcer disease, and trichomoniasis were 27.0%, 18.9%, 16.2%, and 10.8%, respectively, among HIV-infected STD patients; none of the associations between specific STDs and HIV were statistically significant. Only 1 patient had developed clinical signs of acquired immunodeficiency syndrome (AIDS). The 6.4% prevalence rate detected among STD patients in this study was considered high since HIV is new to Nigeria (436 cases reported to date). Overall, these findings suggest that the AIDS epidemic is in an early stage in Nigeria and the major mode of HIV transmission is heterosexual sex. Routine HIV screening for high-risk groups in Nigeria, including STD patients, is recommended.

Incidence of dual presence of antibodies to HIV1 and HIV2 in seropositive cases seen in Ibadan, Nigeria.

Between July 1987 and December 1988, sera from 6,385 individuals were screened for HIV1 but only 1,861 of these samples were screened for HIV2. Majority of those screened for HIV infection (89.7%) were blood donors, 4.9% were international travellers/volunteers, 3.8% were patients (i.e. those with haematological malignancies, multiply transfused patients and those suspected of having HIV infections), and the rest (1.6%) were female sex workers. Screening for HIV1 antibody was done using Welcozyme anti-HTLV III (Wellcome Diagnostics, Dartford, England) or Elavia I (Diagnostics Pasteur, Marnes La Coquette, France). ELAVIA Ac-Ab-Ak II was used to detect HIV2. The confirmatory test employed was western blot, using LAV Blot I and LAV Blot II (Diagnostic Pasteur, Marnes La Coquette, France). The seroprevalence rate for HIV1 in the blood donors was 0.51% while that of HIV2 was 0.33%. The seroprevalence rates for HIV1 and HIV2 amongst the adult travellers were 1.64% and 0.55% respectively and the comparative rates in the multiply transfused patients (including those with haematological malignancies) were 1.23% each. All the HIV2 positive cases in this group had refractory anaemia. In those suspected of having HIV infection, the seroprevalence rate of HIV1 was 2.94% and no patient in this group had HIV2. Evidence of dual infection by HIV1 and HIV2 was obtained from 18.5% of the seropositive individuals. The dual infection rate in seropositive Nigerians is similar to that reported for some West African countries. We would strongly suggest that all blood samples for HIV tests in Nigerians should be screened for both HIV1 and HIV2. The two blood donors with evidence of dual infection could not be contacted due to fictitious addresses. The only patient with a dual infection has refractory anaemia and he is still being followed up but has not yet developed full-blown AIDs.

Effect of Plasmodium falciparum malaria on plasma fibrinopeptide-A (FpA) concentration.

Plasma Fibrinopeptide-A (FpA) concentrations were determined using Enzyme-linked Immunosorbent Assay (ELISA) in patients with acute Plasmodium falciparum malaria infection and in 30 healthy controls. The mean FpA levels of the malaria patients were significantly raised (p < 0.001). The patients' FpA level correlated positively with malaria parasitaemia, but negatively with plasma fibrinogen concentration. A week after commencement of chloroquine therapy and subsequent disappearance of malaria parasites from the thick blood films, the patients' FpA levels decreased significantly from pre-treatment values. It is suggested that the elevated FpA and reduced plasma fibrinogen levels in the patients probably indicate a more widespread existence of overt coagulation defect in acute malaria infection.

Sexually transmitted diseases in Ibadan in the 1990's: HIV infection--an additional dimension.

Five hundred and fifty-one patients attending the Special Treatment Clinic (STC) of the University College Hospital, Ibadan, between January 1989 and July 1990 were investigated for the common sexually transmitted diseases to determine the current relative prevalence rates of these infections. The patients were also investigated for human immunodeficiency virus (HIV) infection. Of the 551 patients, 384 (69.9%) were diagnosed as having sexually transmitted diseases. The most frequent STDs were gonococcal infections, non-specific urethritis and cervicitis and the genital ulcer diseases (GUDs) with prevalence rates 25.6%, 17.8% and 12% respectively. In addition to the common STDs, HIV infection was detected in 28 (5.1%) patients. Both HIV-1 and HIV-2 were detected as follows: HIV-1 in 16 (2.9%) patients and HIV-2 in 12 (2.2%) patients. All but one of the HIV-seropositive patients also had concurrent sexually transmitted diseases.

HIV seropositivity in Nigerians with lymphoproliferative malignancies.

One hundred and four Nigerians with lymphoproliferative malignancies were tested for antibodies to human immunodeficiency virus types 1 and 2 (HIV-1 and 2). All the patients with high grade lymphomas in this series were seronegative for HIV-1 and 2. Only 1 of the 104 patients had antibody to HIV-1 and none had antibody to HIV-2. Although the single positive result would suggest a higher HIV-1 seropositivity rate among the patients compared with the general Nigerian population, it should be interpreted with caution. This preliminary data emphasizes the need for an urgent countrywide study of the problem among this category of patients in Nigeria in view of the low prevalence rate of HIV-1 and 2 in the country.

PIP: Several workers have reported an association between lymphoproliferative malignancies and HIV infection. The revised diagnostic criteria for AIDS which include HIV-seropositivity in patients with Non-Hodgkin's lymphoma of the small, noncleaved, immunoblastic and large cell types are consistent with the observed relationship between HIV infection and lymphoproliferative malignancies. Following this revised definition, it was deemed necessary to determine the prevalence of HIV infection among the patients with lymphoproliferative malignancies seen in the University College Hospital, Ibadan, Nigeria. 104 newly-diagnosed Nigerian patients with lymphoproliferative malignancies seen at the hospital between December 1986 to May 1990 were tested for antibodies to HIV-1 and HIV-2. One patient was HIV-1-seropositive and none were HIV-2-seropositive. All patients with high-grade lymphomas were seronegative for both viruses. These preliminary data indicate the urgent need for a countrywide study designed to learn more about the relationship between HIV infection and lymphoid malignancies in Nigeria. The authors stress that while Burkitt's lymphoma coexisting with HIV-seropositivity is currently taken as diagnostic of AIDS, it is important to establish that the viral infection was acquired before the tumor developed in each patient. This observation is important due to the commonality of Burkitt's lymphoma in Nigeria where some hospitals are still unable to screen blood for HIV before transfusion.

Effects of haemoglobin electrophoretic pattern and seasonal changes on urine concentration in young adult Nigerian males.

Renal concentrating capacity has been measured in healthy young adult Nigerian males with normal (AA) and abnormal (AS) haemoglobin types in both the dry and the wet seasons after 13 to 15 hours hydropenia respectively. The results show that, in the dry season, urine osmolality values in AA subjects are similar to those observed in Caucasians. They further confirm that renal concentrating capacity is impaired in persons with the S gene, and emphasize the limitations of the specific gravity test as a measure of renal concentrating capacity. In healthy AA subjects, the urine osmolality during the wet season is significantly less than in the dry season, even after longer periods of hydropenia. AS subjects, on the other hand, exhibit no seasonal variation in renal concentrating capacity.