Baseline CD4+ T lymphocyte cell counts, hepatitis B and C viruses seropositivity in adults with Human Immunodeficiency Virus infection at a tertiary hospital in Nigeria

Abstract

Background: Ekiti State of Nigeria is known to have the lowest prevalence of HIV in Nigeria. University Teaching Hospital (UTH), Ado Ekiti was recently upgraded to serve as one of the three centres for HIV/AIDS referral, diagnosis and treatment in Ekiti State. We evaluated the baseline immunologic and biochemical parameters of patients presenting at the ART clinic of University Teaching Hospital, Ado Ekiti, Ekiti State. Methods: All HIV seropositive patients not yet on antiretroviral therapy, who presented at the ART Clinic within the study period had at the first visit to the clinic, their blood sample taken for CD4 cell counts estimation, HBsAg and anti-HCV screening, ALT, AST as well as hemoglobin estimation as part of the routine workup to assess their disease health status and need for antiretroviral therapy. Statistical significance was taken as p< 0.05. Results: A total of 273 patients comprising 79 (28.9%) males and 194 (71.1%) females were included in the study (F:M = 2.46: 1). The mean age of the study population was 36.21± 10.20 years with mean age of males (39.52 ± 9.95years) significantly higher than females (34.88 ± 10.02; p=0.001). The overall prevalence of HBsAg in the study population was 6.6% with a sex specific prevalence of 8.1% and 6% for males and females, respectively. No statistically significance difference in the mean serum alanine transaminase, serum aspartate transaminase, hemoglobin and CD4+ T-Lymphocytes cell count of those who had HBsAg negative status compared to those who had HBsAg positive status. Two (0.7%) of the patients had positive serum anti HCV antibodies. The CD4+ T-Lymphocytes cell count ranged between 5-1050 cells/µl with a mean of 286.19 ± 233.31 cells/µl. The majority of patients (71.8%) had a CD4+ T-Lymphocytes cell count < 350 cells/µl. Conclusion: At the time of presentation, majority of our patients had a CD4+ T-Lymphocytes cell count less than 350 cells/µl consistent with significant immune-suppression. More sustained and vigorous awareness campaigns still need to be done in Ekiti State to diagnose this disease early. There is also a need to accelerate the integration of hepatitis B virus screening and treatment programme into HIV/AIDS programme because of the morbidity and mortality implication of HBV and HIV co-infection.

Usefulness of Certain Clinical and Laboratory Parameters in Predicting Presence of HIV Infection in Adult HIV/AIDS Positive Patients in a Limited Resource Setting

“…The difference is statistically significant (p<0.001). This finding is in keeping with reports of HIV incidence in Nigeria (Nwokedi et al, 2007;Ajayi et al, 2009Ajayi et al, , 2011 and outside the country (UAC., 2003; Kilaru et al, 2004). Persons in the age range 20-50 might be predisposed because they represent the reproductive and productive age group of any society and thus sexually active.…”

“…This is similar to that observed in previous Nigerian studies where females tend to have lower values than males (Ramana et al, 2010;Ajayi et al, 2009Ajayi et al, , 2011. The reasons for this might be that the females attain sexual maturity earlier than the males and are likely to engage in sexual practices earlier than the male counterpart.…”

“…This finding is similar to report from northern Nigeria (this study site is in north central) with rates between 50-54% having CD4<200 at presentation. Late presentation is not peculiar to this environment alone as between 10-30% have been reported in the western world and higher in developing countries, largely because of limited access to health care and HIV treatment and issues associated with stigmatization (Sabin et al, 2004;Sepkowitz, 2006;Ajayi et al, 2011). Thus priority must be given to identifying HIV infected individual and starting treatment earlier in the course of their illness before they develop severe opportunistic infection.…”

Analysis of the immunologic status of a newly diagnosed HIV positive population in China

“…A study [ 13 ] carried out between January 2006 and December 2008 showed that 60.4% of the newly HIV diagnosed Moroccan patients had CD4 counts <200 cells/mm 3 when HIV diagnosis was confirmed. A similar investigation [ 14 ] conducted in Nigeria between January 2009 and March 2010 reported that 71.8% of the patients had a CD4 count <350 cells/mm 3 at HIV diagnosis. A study in USA in 2001 [ 15 ] showed that the mean CD4 count in HIV patients was 246 cells/mm 3 , and the median was 152 cells/mm 3 .…”

Epidemiological Distribution and Genotype Characterization of the Hepatitis C Virus Among HIV Patients in Kashan, Iran

“…The CD4+ T lymphocytes cell count ranged between 5 and 1050 cells/µL, with a mean of 286.19 ± 233.31 cells/µL. The majority of patients (71.8%) had a CD4+ T lymphocytes cell count < 350 cells/µL ( 41 ). In the study by Tremeau-Bravard et al, of the 443 HIV/AIDS positive individuals, ten patients were coinfected with the hepatitis C virus (2.3%).…”