Search

Zika virus (ZIKV) is one of the arboviruses implicated in febrile illness, microcephaly and other neurological disorders in babies whose mothers were infected during pregnancy. Information on ZIKV in Nigeria is limited. Hence, this study was aimed at investigating the seroprevalence of Zika virus among pregnant women in Lagos State. In a cross-sectional study, blood samples collected from 352 randomly selected pregnant women in four hospitals in Lagos State were separated and plasma analyzed using Zika virus IgG and IgM capture Enzyme-linked immunosorbent assay (Demeditec Diagnostics, Germany). The optical densities were read using Precision Microplate reader (Molecular devices) and cut-off calculated according to manufacturer’s guide. Parameters and symptoms such as history of fever, rashes on the body, exposure to mosquito were extracted from the questionnaire and analyzed. IgM seropositive samples were screened for ZIKV RNA on RT-qPCR. Out of 352 samples screened, 7(2.0%) and 5(1.4%) of the pregnant women tested positive for IgG and IgM respectively. None tested positive for both IgG and IgM markers. Statistical analysis showed that there is no significant relationship between the symptoms analyzed in this study at 95% Confidence interval except conjunctivitis. None of the ZIKV IgM seropositive samples tested positive for ZIKV RNA on RT-qPCR. The results show that there is evidence of exposure to Zika virus among the population studied in Lagos, Nigeria. Also, the low level seroprevalence of the virus in the population studied indicates that there is lack of herd immunity of Zika virus infection in Lagos, Nigeria.

Biosafety is an important issue globally, as a line of defence that protects health personnel, public and the environment from exposure to hazardous agents. Most developing nations have weak health systems and consequently weak biosafety. Engaging in an external quality program such as an accreditation process will help build capacity and competence in all areas. The Centre for Human Virology and Genomics (CHVG) laboratory of the Nigerian Institute of Medical Research, Lagos, Nigeria started its biosafety program in compliance to international standards stipulated by ISO 15189:2012, in its journey towards laboratory accreditation. Accreditation is widely used to attest for laboratory competence. In the quest for laboratory accreditation, several processes were implemented to ensure compliance, one of which was biosafety. Simple remedial actions and policies that have worked in other climes were applied over a 10-year period in the CHVG laboratory. A significant drop in nonconforming incidences and laboratory accidents was seen while biosafety audits showed improvement in safety practices. Keywords: Biosafety, Infection control, audit French Title: Mise en œuvre de la biosécurité dans la lutte contre les infections: un examen décennal La biosécurité est une question importante à l'échelle mondiale, en tant que ligne de défense qui protège le personnel de santé, le public et l'environnement de l'exposition à des agents dangereux. La plupart des pays en développement ont des systèmes de santé faibles et, par conséquent, une faible sécurité biologique. S'engager dans un programme de qualité externe tel qu'un processus d'accréditation aidera à renforcer les capacités et les compétences dans tous les domaines. Le laboratoire du Centre de virologie humaine et de génomique (CHVG) de l'Institut nigérian de recherche médicale de Lagos, au Nigéria, a commencé son programme de biosécurité conformément aux normes internationales stipulées par ISO 15189: 2012, dans son parcours vers l'accréditation des laboratoires. L'accréditation est largement utilisée pour attester la compétence du laboratoire. Dans la recherche de l'accréditation des laboratoires, plusieurs processus ont été mis en œuvre pour assurer la conformité, dont l'un était la biosécurité. Des mesures correctives simples et des politiques qui ont fonctionné sous d'autres climats ont été appliquées sur une période de 10 ans dans le laboratoire du CHVG. Une baisse significative des incidents non conformes et des accidents de laboratoire a été observée tandis que les audits de biosécurité ont montré une amélioration des pratiques de sécurité. Mots clés: Biosécurité, Contrôle des infections, audit

Background: HIV co-infection with hepatitis B (HBV) and/or hepatitis C virus (HCV) is common, largely due to shared routes of transmission, but paucity of data exists for long term treatment outcomes of HIV infected patients, and those co-infected with HBV and HCV despite the high burden in Nigeria. The aim of study was to describe the longterm treatment outcomes in HIV infected Nigerians and to assess the effect of HBV and HCV co-infections on longterm response to antiretroviral therapy (ART).Methodology: This was a retrospective study of HIV infected adults (> 18 years old) consecutively initiating ART between July 2004 and December 2007, who were followed up for 7 years (2011 and 2014). HBV and HCV infections were diagnosed by detection of serum hepatitis B surface antigen (HBsAg) and HCV antibody (HCVAb) respectively. HIV viral load and CD4 count were monitored 3-monthly after initiating ART, and treatment outcomes based on these were compared between patients with HIV mono-infection, HIV/HBV, HIV/HCV and HIV/HBV/HCV co-infections. Clinical and laboratory data of the patients were abstracted from the medical databases, FileMaker Pro, v 10, entered into Microsoft Excel, and analyzed using SPSS version 20.0.Results: A total of 2,800 adults were evaluated (median age of 35.5 years; 64.2% female), of whom 197 (7.0%) were co-infected with HBV, 53 (1.9%) with HCV, and 15 (0.5%) with HBV and HCV. During the 7-year period, 369 (13.2%) patients were lost to follow up. Immune reconstitution, measured by CD4 recovery, was lower in both HBV and HCV co-infections compared to HIV mono-infection, but this was not statistically significant (p>0.05). Median baseline HIV viral load was 4.63 log copies/ml for all groups, which decreased to undetectable level at a median time of 6 months and remained so for the study duration.Conclusion: This study revealed a higher virologic failure among HIV/HCV co-infected group compared to other groups. No immunological difference in ART treatment outcomes between HIV mono-infected and those co-infected with HBV and HCV after 7-year follow-up. Gradual rise in CD4 was found to be an immunological evidence of the body’s recovery from HIV, buttressed by the drop in viral load over the 7-year period. Keywords: ART, HIV, HBV, HCV co-infection, long term outcomes English title: Résultats à long terme du traitement antirétroviral hautement actif chez les Nigérians infectés par le VIH et ceux co-infectés par les virus des hépatites B et C Contexte: La co-infection par le VIH avec l'hépatite B (VHB) et/ou le virus de l'hépatite C (VHC) est courante, engrande partie en raison des voies de transmission partagées, mais il existe peu de données sur les résultats dutraitement à long terme des patients infectés par le VIH, et ceux co -infectés par le VHB et le VHC malgré le fardeau élevé au Nigéria. Le but de l'étude était de décrire les résultats du traitement à long terme chez les Nigérians infectés par le VIH et d'évaluer l'effet des co-infections par le VHB et le VHC sur la réponse à long terme au traitement antirétroviral (TAR).Méthodologie: Il s'agissait d'une étude rétrospective sur des adultes infectés par le VIH (>18 ans) ayant commencé un traitement antirétroviral consécutivement entre juillet 2004 et décembre 2007, suivis pendant 7 ans (2011 et 2014). Les infections par le VHB et le VHC ont été diagnostiquées par détection de l'antigène de surface sérique de l'hépatite B (AgHBs) et des anticorps anti-VHC (HCVAb) respectivement. La charge virale du VIH et la numération des CD4 ont été surveillées tous les trois mois après le début du TAR, et les résultats du traitement basés sur ceuxci ont été comparés entre les patients atteints de mono-infection VIH, VIH/VHB, VIH/VHC et VIH/VHB/VHC. Les données cliniques et de laboratoire des patients ont été extraites des bases de données médicales, FileMaker Pro, v 10, saisies dans Microsoft Excel et analysées à l'aide de SPSS version 20.0.Résultats: Un total de 2800 adultes ont été évalués (âge médian de 35,5 ans; 64,2% de femmes), dont 197 (7,0%) étaient co-infectés par le VHB, 53 (1,9%) par le VHC et 15 (0,5%) par le VHB et VHC. Au cours de la période de 7 ans, 369 (13,2%) patients ont été perdus de vue. La reconstitution immunitaire, mesurée par la récupération des CD4, était plus faible dans les co-infections par le VHB et le VHC que dans la mono-infection par le VIH, mais cela n'était pas statistiquement significatif (p>0,05). La charge virale VIH de base médiane était de 4,63 log copies / ml pour tous les groupes, ce qui a diminué à un niveau indétectable à une période médiane de 6 mois et le reste pendant toute la durée de l'étude.Conclusion: Cette étude a révélé un échec virologique plus élevé parmi le groupe co-infecté par le VIH / VHC par rapport aux autres groupes. Aucune différence immunologique dans les résultats du traitement TAR entre le VIH mono-infecté et ceux co-infectés par le VHB et le VHC après un suivi de 7 ans. L’augmentation progressive des CD4 s’est avérée être une preuve immunologique de la guérison du corps du VIH, étayée par la baisse de la charge virale au cours de la période de 7 ans. Mots clés: TAR, VIH, VHB, co-infection par le VHC, résultats à long terme

Background: The world is currently experiencing a healthcare crisis caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Healthcare workers (HCWs) are at the forefront of controlling the spread of the disease; this response has resulted in a huge number of infections amongst HCWs and unfortunately some casualties. Infection prevention and control practices (IPC) are practical, proven methods that prevent avoidable harm to patients and protect health workers from contagious infection. This study was done to evaluate the effectiveness of IPC practices utilized in COVID-19 testing drive through facility in Lagos Nigeria. Method: The facility recruited 42 HCWs who were trained on IPC and use of Personal Protective Equipment (PPEs). Training on donning and doffing of PPEs, preparation of decontaminants and sample handling were done for relevant personnel. A daily log for monitoring COVID-19 symptoms was deployed to all HCWs; to help early detection of COVID-19 infection and prevent transmission amongst staff. Results: Of 42 personnel, 92.8% had a tertiary level of education while 71.4% had at least 5 years work experience. A total of 5 (11.9%) out of 42 HCWs were positive by week six of the study. All infected persons worked at the drive through centre. Most common symptom filled in the daily log tool was headache and fatigue. Conclusion: Despite all the measures introduced, 11.9% of HCWs became positive within 6 weeks, showing the highly infectious nature of the virus and the need to research into more effective measures in preventing the transmission of highly infectious pathogens to HCWs during outbreaks.

The present global pandemic triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has lingered for over a year in its devastating effects. Diagnosis of coronavirus disease 2019 (COVID-19) is currently established with a polymerase chain reaction (PCR) test by means of oropharyngeal-, nasopharyngeal-, anal-swabs, sputum and blood plasma. However, oral and nasal swabs are more commonly used. This study, therefore, assessed sensitivity and specificity of plasma as a diagnostic in comparison with a combination of oral and nasal swab samples, and the implications for blood transfusion. Oropharyngeal (OP) and nasopharyngeal (NP) swab samples were obtained from 125 individuals suspected to have COVID-19 and stored in viral transport medium (VTM) tubes. Ten millilitres of blood samples in EDTA were also obtained by venepuncture and spun to obtain plasma. Viral RNA was obtained from both swabs and plasma by manual extraction with Qiagen QIAamp viral RNA Mini Kit. Detection was done using a real time fluorescent RT-qPCR BGI kit, on a QuantStudio 3 real-time PCR instrument. Average age of study participants was 41 years, with 74 (59.2%) being male. Out of the 125 individuals tested for COVID-19, 75 (60%) were positive by OP/NP swab. However, only 6 (4.8%) had a positive plasma result for COVID-19 with median Ct value of 32.4. Sensitivity and specificity of RT-PCR SARS-CoV-2 test using plasma was 8% and 100% respectively. There was no false positive recorded, but 69 (55.2%) false negatives were obtained by plasma. SARS-CoV-2 viral RNA was detected, albeit low (4.8%) in plasma. Plasma is likely not a suitable biological sample to diagnose acute SARS-CoV-2 infection. The implication of transfusing blood in this era of COVID-19 needs further investigations.

Correspondence - No abstract available.

In an outbreak, effective detection of the aetiological agent(s) involved using molecular techniques is key to efficient diagnosis, early prevention and management of the spread. However, sequencing is necessary for mutation monitoring and tracking of clusters of transmission, development of diagnostics and for vaccines and drug development. Many sequencing methods are fast evolving to reduce test turn-around-time and to increase through-put compared to Sanger sequencing method; however, Sanger sequencing remains the gold standard for clinical research sequencing with its 99.99% accuracy This study sought to generate sequence data of SARS-CoV-2 using Sanger sequencing method and to characterize them for possible site(s) of mutations. About 30 pairs of primers were designed, synthesized, and optimized using endpoint PCR to generate amplicons for the full length of the virus. Cycle sequencing using BigDye Terminator v.3.1 and capillary gel electrophoresis on ABI 3130xl genetic analyser were performed according to the manufacturers’ instructions. The sequence data generated were assembled and analysed for variations using DNASTAR Lasergene 17 SeqMan Ultra. Total length of 29,760bp of SARS-CoV-2 was assembled from the sample analysed and deposited in GenBank with accession number: MT576584. Blast result of the sequence assembly shows a 99.97% identity with the reference sequence. Variations were noticed at positions: nt201, nt2997, nt14368, nt16535, nt20334, and nt28841-28843, which caused amino acid alterations at the S (aa614) and N (aa203-204) regions. The mutations observed at S and N-gene in this study may be indicative of a gradual changes in the genetic coding of the virus hence, the need for active surveillance of the viral genome.

The first case of COVID-19 in Nigeria was recorded on February 27, 2020, being an imported case by an Italian expatriate, to the country. Since then, there has been steady increase in the number of cases. However, the number of cases in Nigeria is low in comparison to cases reported by other countries with similar large populations, despite the poor health system prevailing in the country. This has been mainly attributed to the low testing capacity in Nigeria among other factors. Therefore, there is a need for innovative ways to increase the number of persons testing for COVID-19. The aim of the study was to pilot a nasopharyngeal swab self-sample collection model that would help increase COVID-19 testing while ensuring minimal person-to-person contact being experienced at the testing center. 216 participants took part in this study which was carried out at the Nigerian Institute of Medical Research between June and July 2020. Amongst the 216 participants, 174 tested negatives for both self-collected samples and samples collected by Professionals, 30 tested positive for both arms, with discrepancies occurring in 6 samples where the self-collected samples were positive while the ones collected by the professionals were negative. The same occurred in another set of 6 samples with the self-collected samples being negative and the professional—collected sample coming out positive, with a sensitivity of 83.3% and a specificity of 96.7%. The results of the interrater analysis are Kappa = 0.800 (95% CI, 0.690 to 0.910) which implies an outstanding agreement between the two COVID-19 sampling methods. Furthermore, since p< 0.001 Kappa (k) coefficient is statistically different from zero, our findings have shown that self-collected samples can be reliable in the diagnosis of COVID-19.

INTRODUCTION: Heightened surveillance of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) 2019 outbreak in Wuhan, China activated several collaborative laboratory drills on its detection by health institutions in Nigeria. We hereby detail the laboratory detection and confirmation of the novel SARS-CoV-2 virus of the index case imported into Nigeria. METHODS: viral RNA from sputum sample of the index case was tested for SARS-CoV-2 envelope (E) and RNA dependent RNA polymerase (RdRp) genes using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Genetic analysis using a partial sequence of RdRp gene was used for laboratory confirmation, evolutionary inferences, and relatedness to previous strains of betacoronaviruses in Nigeria. RESULTS: both qRT-PCR for the E and RdRp genes indicated the presence of the SARS-CoV-2 RNA by showing cycle threshold (ct) values of 20.27 and 25.26 respectively. On successful completion of the sequencing run, data aligned with >98% similarity of the 2019 circulating strain of Coronavirus SARS-CoV-2. Evolutionary algorithms revealed that the sequence (RdRp gene) of the outbreak circulating strains were more conserved unlike previous coronavirus outbreaks. Data showed that some coronaviruses belonging to the BetaCoV genus had earlier been reported in bats and camels in Nigeria indicating the possibility of sero-protection in exposed populations. CONCLUSIONS: pre-laboratory drills prompted early diagnosis and confirmation of SARS-CoV-2 index case in Nigeria initiating rapid case-definition, contact tracing, and successful epidemiological management of the outbreak. Rapid sequencing of the viral genome during strategic points of the outbreak curve and making libraries of new variants for improved vaccine development are recommended.

Introduction Hepatitis C Virus (HCV) is highly infectious with no currently available vaccine. Prior to treatment, it is recommended to confirm HCV infection with either quantitative or qualitative nucleic acid test. Access to these assays in Nigeria is limited but for effective management of patients, HCV viral load (VL) prior to therapy is required and genotype may be needed in some instances. This study aimed at reviewing the pattern of HCV viral load and genotype in the country, and its implication in patient management. Methods this was a retrospective study that involved data abstraction from an electronic database of an accredited laboratory between June 2013 and May 2017. De-linked data were abstracted from records of adult subjects with HCV VL and genotype results, these were analysed using Microsoft Excel 2010 and SPSS v20. Results within the study period, 346 subjects had baseline VL and 134 (38.7%) had genotype results available. Of these, 202/346 (58.4%) had detectable VL results with higher prevalence in males (64.7%) and ≥51years (42.5%) age group. The median VL among 202 subjects was 407,430 (IQR: 96,388 - 1,357,012) IU/mL. Distribution of genotypes showed that genotypes 1 and 4 had prevalence of 63.2% and 16.8% respectively. Conclusion genotypes 1 and 4 have the highest prevalence. A greater proportion of subjects had VL values ≤800,000 IU/mL, an indication that they are more likely to respond well to available antiviral therapy hence, access to these antivirals will greatly improve management of HCV infection in Nigeria.

Despite various challenges that hinder the implementation of high-tech molecular methods in resource-limited settings, we have been able to implement and achieve International Organization for Standardization 15189:2012 accreditation for genotypic HIV drug resistance testing in our facility. At the Center for Human Virology and Genomics, Nigerian Institute of Medical Research, Nigeria has recorded a high sequencing success rate and good quality sequence data. This was achieved by optimizing laboratory processes from 2008 to the current date. We have optimized sample preparation, RT-PCR, several post-PCR processes, and the cycle sequencing to improve the sensitivity of amplification even with limited plasma samples and low viral copy numbers. The optimized workflow maximizes output, minimizes reagent wastage, and achieves substantial cost savings without compromising the quality of the sequence data. Our performance at our last external quality assurance program is a testimonial to the efficiency of the workflow. For the 5-sample panel, each with 67-68 mutation points evaluated, we scored 100% for all 5 specimens. Our optimized laboratory workflow is thus documented to support laboratories and to help researchers achieve excellent results the first time and eliminate contamination while minimizing the wastage of costly sequencing reagents.

Background We identified a HIV-positive cohort in virologic failure (VF) who re-suppressed without drug switch. We characterized their drug resistance mutations (DRM) and adherence profiles to learn how to better manage HIV drug resistance. A retrospective cohort study utilizing clinical data and stored samples. Patients received ART at three Nigerian treatment centres. Plasma samples stored when they were in VF were genotyped. Result Of 126 patients with samples available, 57 were successfully genotyped. From ART initiation, the proportion of patients with adherence ≥90% increased steadily from 54% at first high viral load (VL) to 67% at confirmed VF, and 81% at time of re-suppressed VL. Sixteen (28%) patients had at least one DRM. Forty-six (81%) patients had full susceptibility to the three drugs in their first-line (1 L) regimen. Thirteen (23%) were resistant to at least one antiretroviral drug but three were resistant to drugs not used in Nigeria. Ten patients had resistance to their 1 L drug(s) and six were fully susceptible to the three drugs in the recommended second-line regimen. Conclusion This cohort had little drug resistance mutations. We conclude that if adherence is not assured, patients could exhibit virologic failure without having developed mutations associated with drug resistance.

The natural history of chronic hepatitis B virus (HBV) infection and the spectrum of diseases attributable to chronic hepatitis B are diverse. It is estimated that 15%-25% of chronic carriers will die from complications of progressive disease such as liver cirrhosis, hepatocellular carcinoma, and hepatic decompensation. The main aim of this study is to evaluate the serological and virological profile of patients with hepatitis B infection to enhance the evaluation of the natural history of viral hepatitis in an endemic population.Characteristics of hepatitis B surface antigen (HBsAg) patients (2010-2016) were extracted from the database of a reference laboratory in Lagos. These included serological tests for hepatitis B antigens (HBeAg, HBsAg), antibodies (anti-HBcIgM, anti-HBeAb) (DIA.PRO), and HBV DNA (Roche Diagnostics). SPSS version 20.0 was used for data analysis.Of the 1,983 patients, 1,252 were male and 731 female. HBeAg was detected in 8.0% (128/1,605) of the subjects, anti-HBe was positive in 90.0% (1,257/1,396), while HBcore subclass IgM antibody was detected in 12.6% (116/930). Detectable HBV DNA was identified in 1,781 (89%), with viral load exceeding 2,001 IU/mL in 712 (35.9%) subjects. HBV viral loads200,000 IU/mL were more frequently detected in HBeAg-positive compared with HBeAg-negative subjects (65.7% vs 4.9%, P0.0001).We have demonstrated the predominance of low replicative phase HBV infection and highlighted the importance of HBeAg-negative infections that may require antiviral therapy. HBeAg-positive infections occurred significantly in younger adults with new or acute infections. Our findings have implications for patient evaluation and planning of hepatitis treatment programs.

A key element in containing the spread of the SARS-CoV-2 infection is quality diagnostics which is affected by several factors. We now report the comparative performance of five real-time diagnostic assays. Nasopharyngeal swab samples were obtained from persons seeking a diagnosis for SARS-CoV-2 infection in Lagos, Nigeria. The comparison was performed on the same negative, low, and high-positive sample set, with viral RNA extracted using the Qiagen Viral RNA Kit. All five assays are one-step reverse transcriptase real-time PCR assays. Testing was done according to each assay’s manufacturer instructions for use using real-time PCR platforms. 63 samples were tested using the five qPCR assays, comprising of 15 negative samples, 15 positive samples (Ct = 16–30; one Ct = 35), and 33 samples with Tib MolBiol E-gene Ct value ranging from 36–41. All assays detected all high positive samples correctly. Three assays correctly identified all negative samples while two assays each failed to correctly identify one different negative sample. The consistent detection of positive samples at different Ct/Cq values gives an indication of when to repeat testing and/or establish more stringent in-house cut-off value. The varied performance of different diagnostic assays, mostly with emergency use approvals, for a novel virus is expected. Comparative assays’ performance reported may guide laboratories to determine both their repeat testing Ct/Cq range and/or cut-off value.

Nigeria has one of the highest HIV burdens as well as mother-to-infant transmission rates in the world. A pilot program using polymerase chain reaction (PCR)-based testing of dried blood spot (DBS) specimens was implemented to enable early identification of HIV-infected infants and timely referral and linkage to care. From February 2007 to October 2008, whole blood was collected by finger prick to prepare DBS from infants < 18 months presenting in six public mother-and-child health facilities in Lagos, Nigeria. The DBS were tested using the Roche Amplicor HIV-1 DNA Test, v1.5. To monitor laboratory testing quality, all of the PCR-positive and 10% of the PCR-negative DBS were retested by the same method at another reference laboratory. Three hundred and sixty-five randomly selected infants were screened using HIV rapid tests (RT) according to the national algorithm and RT-negative and PCR-positive specimens were also tested using Genscreen enzyme-linked immunosorbent assay (EIA) (Bio-Rad, France). The turnaround time (TAT) from sample collection, testing, and dispatching of results from each health facility was monitored. A total of 1,273 infants with a median age of 12.6 weeks (1 day to 71.6 weeks) participated in the program and 280 (22.0%) were PCR positive. HIV transmission levels varied greatly in the different health facilities ranging from 7.1% to 38.4%. Infants aged 48 to 72 weeks had the highest level of PCR positivity (41.1%). All PCR-positive specimens were confirmed by retesting. The mean turnaround time from DBS collection to returning of the laboratory result to the health facilities was 25 days. Three infants were found to be HIV antibody negative by rapid tests but were positive by both PCR and the fourth generation EIA. The DBS-based PCR program accurately identified all of the HIV-infected infants. However, many programmatic challenges related to the laboratory and TAT were identified.

Objective: Management of viral hepatitis in patients with HIV disease is quite challenging and complex. With effective HIV treatment, people with HIV/HBV co-infection are living longer. HBV epidemiologic surveys showed an inverse association between selenium (Se) level and regional cancer incidence, as well as viral infection. This study assessed effect of selenium as adjunct to HAART in management of HIV/HBV co-infection. Methods : A randomized open label study with participants allocated into three treatment groups: – HAART-only, Se-only and HAART-plus-Se. HIV viral load, HBV viral load, CD4 cell count, and alanine aminotransaminase (ALT), were analyzed at baseline and 18th month, analyzed using SPSS 5 v11. Ethical approval was obtained from Institute’s Ethical Review Board. Results : Sample size was 149 HIV/HBV patients. Rate of HBV clearance was higher among those on HAART-plus-Se at 18th month when compared with rate of clearance among those on HAART-only (p=0.046). CD4 count increment among HAARTplus- Se group compared with HAART-only group was higher (p=0.133), though not statistically significant. On comparison of baseline and 18th month ALT, there was significant decline for HAART-plus-Se (p=0.002) compared with HAART-only group. Conclusion : Selenium seems to have protective effect on liver cells; may be beneficial as adjunct to HAART in HIV/HBV management. Key words : HIV/HBV co-infection, Selenium adjunct, HAART

Background Hepatitis B virus (HBV) transmission through blood transfusion is reduced by screening for hepatitis B surface antigen (HBsAg). However this method cannot detect the presence of occult hepatitis B virus infection. This study sought to determine the prevalence of occult hepatitis B virus infection among blood donors in Ile-Ife, Nigeria. For the first time in Nigeria we employed an automated real-time PCR- method to investigate the prevalence of occult HBV in blood donors. Methods Blood donors screened with HBsAg immunochromatographic rapid test kits at the blood transfusion units of two hospitals and found to be negative were recruited into the study. Questionnaires to elicit risk factors for HBV infection were administered and then 10 ml of blood was collected from each donor. Plasma samples obtained from these HBsAg negative blood donors were screened again for HBsAg using an enzyme-linked immunosorbent assay (ELISA) method, and those found negative were screened for the presence of total antibody to the HBV core antigen (anti-HBc) using ELISA method. Those positive to anti-HBc were then tested for HBV DNA, using an automated real-time PCR method. Results Five hundred and seven blood donors found HBsAg negative by immunochromatographic rapid test kits at both blood transfusion units, were tested for HBsAg using ELISA and 5 (1 %) were HBsAg positive. The 502 found negative were tested for anti-HBc and 354 (70.5 %) were found positive implying previous exposure to HBV and 19 (5.4 %) of the 354 anti-HBc positive had HBV DNA signifying occult HBV infection. No risk factors were found to be associated with the presence of HBV DNA among those who tested positive. Conclusion Occult HBV infection exists in blood donors in Ile-Ife, Nigeria and the use of HBsAg alone for screening prospective donors will not eliminate the risk of HBV transmission in blood transfusion or stem cell transplantation.

Introduction : Perinatal and horizontal transmission of Hepatitis B occur in areas of high endemicity as most infections are acquired in the first 5 years of life. Unless Hepatitis B and C infected pregnant women identified, and appropriate treatment provided, children born to these women are at high risk of chronic Hepatitis B (and C) virus infection. The objecive of this study was to determined the prevalence and the factors associated with Hepatitis B and C Virus infection in pregnant HIV positive Nigerians. Methods : A cross sectional study among HIV Positive pregnant women seen at a large PMTCT clinic in Lagos Nigeria. The women were screened for Hepatitis B and C Virus infection at enrollment. HIV viral load, CD4 count, liver transaminases and hemoglobin levels were also determined. Data were managed with SPSS for windows version. Ethical approval was obtained from the Institution?s Ethical Review Board. Results : Of the 2391 studied subjects, 101(4.2%) and 37(1.5%) respectively were seropositive for Hepatitis B and C Virus infection. Twowomen (0. 08%) had triple infections. blood transfusion, (cOR: 2.3; 95% CI:1.1 - 4.6), history of induced abortion (cOR:2. 2;95% CI:1.3 - 3.6), and elevated baseline ALT (cOR:2. 2; 95%CI:2. 2;4.2) were significantly associated with HBV. History of induced abortion was the only factor found to be associated with HIV/ HCV (cOR: 1.9;95%CI:1. 3-3.9). Conclusion : Hepatitis B Virus infection (4.2%) is relatively common in our environment and associated with induced abortion, blood transfusion and elevated baseline transaminase. Hepatitis C Virus infection (1.5%) is less common and associated with only history of induced abortion. Key words: Hepatitis B virus, Hepatitis C virus, HIV, pregnancy

Aim: To determine the effect of HIV syndrome on lipid profile in a cohort of Nigerians.Objective: To determine the concentrations of total cholesterol (Tchol), triglyceride (TGL), high density lipoprotein (HDL), and low density lipoprotein (LDL) in HIV positive drug naive patients as against HIV negative people.Methods: This study examined the lipid profiles of 50 HIV positive individuals (test group), and 50 HIV negative individuals (control group) at the Human Virology Laboratory of Nigerian Institute of Medical Research (NIMR), Lagos, Nigeria. Informed consent was obtained and the Institutional Review Board (IRB) of NIMR approved the study. A questionnaire based assessment was provided for the individuals to complete, before 5 ml of blood was taken by venopuncture. Blood collected in plain tubes was centrifuged at 3500 rpm for 10 minutes and the serum obtained, used for the various lipid profile tests mentioned above.Statistical analysis on data from the questionnaire was done using Epi info 2000 (CDC).Results: The median lipid profile values for the control group were 168, 85, 99 and 58 mg/dl for Tchol, TGL, HDL and LDL respectively. Conversely, median lipid profile values for the HIV positive patients were 145, 98, 53, and 67 mg/dl for Tchol, TGL, HDL and LDL respectively. P values greater than 0.05 were taken to indicate an insignificant difference between the lipid profiles of the two groups.Conclusion: Based on results obtained, there were significant differences in the Tchol and HDL values between the two groups, indicating a possible effect of HIV on lipid profile for drug naive patients.Key words: lipid profile, HIV, TGL, HDL, LDL, Tchol.

Background: The use of real-time Polymerase chain reaction (PCR) technology options is increasing in resource-limited settings because they are faster, improve assay sensitivity,have higher throughput, larger dynamic ranges and reduced rates of contamination. In 2010, UNAIDS ranked Nigeria as the second highest population of people living with HIV and AIDS (2.98 million people) in the world. Objective: The objective of this study was to compare the analytical performances of the Amplicor HIV-1 Monitor (version 1.5) and the COBAS Ampliprep/Taqman (version 2.0) usedin monitoring HIV disease progression in HIV-infected individuals. Method: In a cross-sectional study, HIV-1 RNA values obtained with the Amplicor HIV-1 monitor version 1.5 were compared with those of the COBAS/Ampliprep TaqMan HIV-1version 2.0 in a routine clinical setting. Between May and November 2011, 176 plasma samples collected were analysed in parallel using both techniques. Data analysis was done using statgraphics Centurion XVI and Medcalc version 12.0. Result: The correlation coefficient for the two assays was 0.83 and the level of agreement using a Bland–Altman plot was 94.2%. Conclusion : These findings suggest that the results from the two methods were comparable, hence the COBAS/Ampliprep Taqman version 2.0 is recommended for high-volume laboratories.

Among the countries highly endemic for viral hepatitis, Nigeria is found. Information on how triple infected persons (HIV, HBV, and HCV) fare on HAART in the country is lacking. Laboratory based investigation was carried out to assess the virological and immunological parameters of HIV-1 infected patients co-infected with Hepatitis B and C, accessing care at the Nigerian Institute of Medical Research. It was a case controlled study.The study aimed to compare the laboratory data of HIV-HBV-HCV patients seen between 2006 and 2009 with HIV-1 monoinfected patients in the same period, on HAART according to the national guideline and followed up for 12 months.Detection of Hepatitis B surface Antigen (HBsAg) and Hepatitis C Virus Antibody (HCVAb) were assayed using ELISA techniques (Bio Rad and DIA PRO respectively). The CD4 and HIV viral load were determined using the Cyflow Counter/Kits (Partec) and the Amplicor HIV-1 Monitor Test V1.5 (Roche) techniques respectively.Forty-one (0.4%) of the 10,214 HIV-1 patients seen during the period were co-infected with both HBV and HCV. Over the 12 month-period, median HIV-1 viral load and CD4 count reduced and increased respectively (12,205-200 RNA copies/mL; 210-430 cells/mL from baseline - 12th month), and for the HIV-1 monoinfected patients (36,794-200 RNA copies/mL [p=0.5485] and 206-347 cells/mL [p=0.7703] from baseline - 12th month).There seems to be no significant influence of hepatitis B and C in HIV infection on HAART judging by the CD4 and viral load profiles which were similar in the two groups.

Issues: Quality-management systems (QMS) are uncommon in clinical laboratories in Nigeria, and until recently, none of the nation’s 5 349 clinical laboratories have been able to attain the certifications necessary to begin the process of attaining international accreditation. Nigeria’s Human Virology Laboratory (HVL), however, began implementation of a QMS in 2006, and in 2008 it was determined that the laboratory conformed to the requirements of ISO 9001:2000 (now 2008), making it the first diagnostic laboratory to be certified in Nigeria. The HVL has now applied for the World Health Organization (WHO) accreditation preparedness scheme. The experience of the QMS implementation process and the lessons learned therein are shared here.Description: In 2005, two personnel from the HVL spent time studying quality systems in a certified clinical laboratory in Dakar, Senegal. Following this peer-to-peer technical assistance, several training sessions were undertaken by HVL staff, a baseline assessment was conducted, and processes were established. The HVL has monitored its quality indicators and conducted internal and external audits; these analyses (from 2007 to 2009) are presented herein.Lessons learned: Although there was improvement in the pre-analytical and analytical indicators analysed and although data-entry errors decreased in the post-analytical process, the delay in returning laboratory test results increased significantly. There were several factors identified as causes for this delay and all of these have now been addressed except for an identified need for automation of some high-volume assays (currently being negotiated). Internal and external audits showed a trend of increasing non-conformities which could be the result of personnel simply becoming lax over time. Application for laboratory accreditation, however, could provide the renewed vigour needed to correct these non-conformities.Recommendation: This experience shows that sustainability of the QMS at present is a cause for concern. However, the tiered system of accreditation being developed by WHO–Afro may act as a driving force to preserve the spirit of continual improvement.

Background: Quantification of the viral burden is an important laboratory tool in the management of hepatitis B virus (HBV)-infected patients. However, widespread use of assays is still hampered by the high cost. Treatment reduces viral load to undetectable levels. HBV infected patients tend to have high HBV DNA levels, and severe liver disease. Objectives: This study was carried out to determine the pattern of HBV viral load levels of patients assessing management in Nigeria. Method: Variables included sociodemographics like age, sex, religion, income, educational background and residence. The COBAS Amplicor automated Analyzer (PCR based) was used to assay the virus quantitatively. Results: 594 patients were tested from 2008 to 2009. Statistical analysis was done using Epi info version 2002 and test of significance by Kruskal-Wallis. Mean age of the patients was 36.8 (ranging from 9 to 69) years. HBV viral titre ranged between 4,145 and 68,011,800 DNA copies/ml. Conclusion: There was a high occurrence of viral titre in the population studied. High viral load is a risk factor for hepatocellular carcinoma. A policy earmarked to combat this virus in Nigeria is hereby solicited. Key words: HBV infection, HBV DNA, Nigeria doi: 10.4314/ajcem.v12i3.3