Human Immunodeficiency Virus (HIV) infection an uprising case in Porto Novo?

Abstract

Aims: To study and monitor the HIV prevalence within a time period in Porto Novo municipality.

Materials and Methods: A total of 947 blood samples were tested for HIV-1 and HIV-2 using Determine and Bioline techniques between 2005 to 2008 or for 42 months aged 18 to 70 years.

Results: Six samples (2.8%) were HIV positive for the men category, four samples were positive for HIV-1 while two were positive for HIV-2. In women category, Nine samples were positive for HIV making 1.2%, five samples were positive for HIV-1 and two samples each were positive for HIV-2 and HIV-1 + 2 respectively.

Conclusion: More education is needed to instruct and remind the population on preventive measures and this includes; the practice of safe sex using condoms, durex and keep faithful to only a partner

Keywords: HIV, Uprising, case, Porto Novo.

Corresponding Author: Peter Ubah Okeke

School of Sciences & Engineering

Atlantic International University Hawaii-USA.

Introduction

Human immunodeficiency virus (HIV) causes progressive impairment of the body"s cellular immune system, leading to increased susceptibility to infections and tumours and the fatal condition AIDS (acquired immunodeficiency syndrome). There are two main variants of the virus: HIV – 1 which causes most HIV infections and HIV – 2 which is found mainly in West Africa.

Aids was first recognized in the United States in 1980-1981 when homosexual men were found to have unusual infections and tumours suggesting and underlying deficiency in their cell – mediated immunity. When the recipients of some blood transfusions and people using intravenous drugs, like cocaine and heroin, developed similar problems, it became clear that AIDS was caused by an infectious agent.

However in 1983 – 1984, HIV was shown to be the cause of AIDS. Using special techniques HIV can be cultured, and when sought has been isolated from lymphocytes taken from persons with AIDS and those who are HIV antibody positive. Although evidence exists to show that HIV has been present in humans for 15-29 years, the exact origins of the virus in not yet know.

Infection with HIV is now global, with many of those infected being heterosexual young men and women living in developing countries. The world health organization has described the AIDS situation as a global health emergency which requires global collaboration and action.

Classification of HIV

HIV belongs to the family of viruses called retroviruses and subfamily lentiviruses.

Retroviruses are single-stranded RNA (ribonucleic acid) viruses that contain the enzyme reverse transcriptase. This enzyme is an RNA – directed DNA – polymerase that seems to possess ribonuclease activity. It enables the RNA of the virus to produce a DNA (deoxyribonucleic acid) copy of itself in order to become integrated and replicate in host cells.

Currently two genetically and immunologically distinct human immunodeficiency viruses are recognized as causing HIV disease and AIDS. They are:

•   HIV – 1

•   HIV – 2

Replication of HIV

HIV may infect any cell bearing CD4+ antigen receptor. Such cells are mainly the helper – inducer subsets of T – lymphocytes referred to as T4 lymphocytes. CD4+ antigen is also found on 5 – 10% of B – lymphocytes, 10 – 20% of tissue macrophages and up to 40% of circulating monocytes. It is thought that macrophages and monocytes are important reservoirs of HIV. Monocytes are able to carry the virus to various organs in the body such as the lungs and brain.

Epidemiology

HIV – 1 is responsible for most HIV infections in Western Europe, North America, Australia and New Zealand and throughout most of Sub-Saharan Africa.

HIV – 2 is currently found mainly in West Africa from Cape Verde islands to Benin with highest prevalence being in southern Senegal and Guinea Bissau. About equal frequencies of HIV – 1 and HIV – 2 can be found in Ghana, Nigeria, Cote d"Ivoire, Mali and Burkina-Faso.

Infections with HIV – 2 found outside of West Africa can usually be traced back to a West African contact. Though such contacts, HIV – 2 is thought to have been introduced into Angola, Mozambique and Brazil.

Both HIV – 1 and HIV – 2 are spread in the same way and both have the same consequences that are both cause AIDS. It appears that while about 50% of people infected with HIV – 1 will develop AIDS within about 7 – 8 years, the incubation time for HIV – 2 may be considerably longer and some infections may be less severe.

In developing countries, most of those infected with HIV – live in the cities. In general the prevalence of HIV is low in remote areas except where civil war, break up of families, and movements of the population have spread the virus into rural areas, for example in Mozambique and Uganda.

Transmission of HIV

HIV is present in semen, vaginal/cervical secretions and blood and these are the main vehicles by which the virus is transmitted. The virus may also be present in saliva, tears, Urine, breast milk, cerebrospinal fluid and infected discharges, but these are not the vehicles by which HIV is spread. Epidemiological facts do not support the idea that HIV is transmitted through water or food, sharing eating utensils, coughing or sneezing, toilets, swimming pools, insects bites, shaking hands or other casual contact, otherwise all age groups would be infected especially young children and elderly people.

There is therefore no public health reason for restricting HIV infected persons from employment, training, schooling or housing. There is no justification for taking any discriminatory measures based solely on the fact that a person is suspected or know to be seropositive

However, throughout the world, the group most affected are sexually active men and women in their 20s to 40s, reflecting the fact that HIV is predominantly sexually transmitted in developing countries the main routes of transmission are as fallows:

•  - Hetero or homo sexual intercourse

•  - mother to child transmission or vertical transmission

•  - Blood transfusion

•  - Dirty needles

•  - Contaminated objects used in circumcision in some parts of African

•  - Sexually transmitted diseases have higher risks of contamination.

Clinical features of HIV disease

Once infected with HIV, a person usually remains well for several years before developing problems. The person tends to become progressively ill as their immune system becomes increasingly damaged. Infection with HIV leads to severe immune suppression as the T4 lymphocytes are reduced in number and cease to perform their essential role in bringing about and regulating the body"s immune responses.

CLASSIFICATION OF HIV INFECTIONS

The Centre of Disease Control (CDC) in the United States has proposed the following classification system for people with HIV infection:

Group I – sero conversion illness

Group II – asymptomatic

Group III – persistent generalized lymphoadenopathy

Group IV – symptomatic HIV disease

GROUP I

Soon after becoming infected with HIV, a few people (10%) have a glandular fever-like illness with sore throat, skin rash, fever and enlarged lymph glands. This is called a seroconversion illness because it occurs at a time when the infected person is first making antibodies against HIV. Following this the person is described as being seropositive. The illness passes off after a few weeks and the person becomes asymptomatic.

GROUP II

Most people remain completely well after acquiring HIV and seroconverting. They can remain well for many years before developing AIDS but during this time they are infections.

GROUP III

Many HIV infected people, although otherwise well, develop generalized swelling of their lymph nodes, usually in the neck and under the arms. The lymph nodes are usually about 1-2 cm in diameter mobile and not tender.

GROUP IV

After a variable period of time, most people in groups I to III developed symptoms and signs due to HIV or its consequences and are then classified as belonging to Group IV. Most clinical problems are due to HIV causing a progressive decline in the bodies" immune responses, leading to opportunistic infections and some tumours. Sometimes HIV itself may cause damage to the body directly. Group IV includes those with AIDS or AIDS related complex.

Please note that following infections with HIV and before the appearance of circulating markers of infection, there is a "Window Period" of varying length, during which the infection becomes established. The window period is an important issue in blood screening as it is the period during, which screening tests will be unable to detect a potentially infectious donation. The window period could take up to 3 months.

The number of CD8+ lymphocytes increases and this helps to reverse the CD4+ to CD8+ ratio. A temporary drop in CD4+ cells is also observed, and an asymptomatic thrombocytopenia may occur during this phase. A viremia occurs but is cleared via the action of cytotoxic T – lymphocytes.

An asymptomatic phase or latent phase may last for months or years. The length of this phase is dependent on multiple factors including the dose of the virus, the route of the infection, the genetics of the host, and the immune response generated by the host. The clinical latency, described here is not associated with viral latency. The virus still continues to replicate in the lymphoreticular tissue.

Laboratory signs that immune activation is occurring include elevated levels of Beta-2 microglobulin neopterin and interleukin 2. The centre for disease control in Atlanta stated that adolescents and adults with HIV are classified as having AIDS if their CD4+ lymphocyte count is under 200 uL and or if their CD4+ T lymphocyte percentage is less than 14. In addition, HIV infected patients whose CD4+ count is less than 200 / uL who acquire certain infections diseases or malignancies are also classified as having AIDS.

Status of human immunodeficiency virus patients

The CD4+ count, viral load and the presence of immune activation markers can be used to predict the progression of the disease. An abrupt or gradual decline in the CD4+ count usually indicates that clinical disease will follow.

Approximately 87% of patients who have a CD4+ count of less than 200/uL developed AIDS within 3 years. Where as patients whose counts are between 200 and 480 convert to AIDS at about a 46% rate within 3 years. Finally those patients with a CD4+ count above 500/uL developed AIDS at a 16% rate for the some time period.

Plasma viremia has also been directly linked to clinical stages. In acute primary infection the viral load rises to about 5 x 106 virions/mL and then drops back to 8 x 104 / virions/mL during the asymptomatic stage. The viral load rises to 3.5 x 105 virions/mL during the early symptomatic stage and continues to climb to about 2.5 x 106 virions/mL when AIDS is diagnosed.

Viral load and CD4+ cell counts are used to monitor the effectiveness of antiviral therapy. Combinations of various drugs including nucleoside analogs, protease inhibitors and non nucleoside analogs are administrated to the patient. Often the viral load decreases in about 2 weeks and if the treatment is successful the maximal effect should occur by 6 months. The viral load level at the 6 month point is referred to as the set point.

The patient should then be monitored for viral load every 3 to 4 months. If the viral load rises above the set point, the patient should be switched to a new combination of drugs.

An indirect method to measure virus productions is to monitor immune activation markers. Increases of B2 micro globulin in plasma or increases in neopterin in the urine correlate with the degree of lymphocyte activation and also indicate progression to disease in HIV patients.

Materials and method

A total of 947 blood samples were collected at random from individuals apparently healthy and from suspected patients mainly adults(18 to 70 years) for a period of 42 month (2005 to 2008). A 2 cc of blood samples were collected into a BD vacutainer tubes and after centrifugation, plasma samples were obtained for the HIV 1 and HIV 2 testing.

MATERIALS

A complete test kit of determine HIV 1 and HIV 2 was used for this test, and a kit of Bioline standard diagnostics SD HIV1 and HIV2 and Automatic pipette calibrated from 5 to 50ul.

METHOD

The manufacturers instruction was completely followed in both tests (Determine and Subsequent Bioline) and positive and inconclusive samples were confirmed by the ELISA test kits (Enzyme linked immunosorbent Assay)- at the hospital of Dr.Baptista De Sousa in SãoVicente Cape Verde, Sensitivity and specificity are important characteristics which describe the accuracy of HIV antibody assay results, in this study, the assay used was 99% sensitive, this is crucial because samples containing HIV antibody at low level was not missed and due to its high specificity, sera not containing HIV antibody was correctly detected as HIV negative.

METHOD TEST DETERMINE

•  1. Remove the protective foil cover from each test.

•  2. For serum or plasma samples, apply 50µL of the sample using precision pipette to the sample pad marked by the arrow symbol.

•  3. Wait for a minimum of 15 minutes (up to 60 minutes).

•  4. Read the results.

QUALITY CONTROL

To ensure assay validity, a procedural control is incorporated in the device and is labelled CONTROL. If the control bar does not turn red by assay completion, the test result is invalid and the sample be retested.

BIOLINE TEST

1. Remove the test device from foil pouch; place it on a flat, dry surface (using a capillary pipette)

2. Add 10µL of plasma or serum specimen into the sample well labelled (S).

3. Add 4 drops (about 120µL) of assay diluents into sample well (S).

4. As the test begins to work, you will see purple color move across the result window in the centre of the test device.

5. Read results and control in 5 to 20 minutes. Please do not read results after 20 minutes, reading too late can give false results.

Results and discussion

Table 1: Presents the summary of all events occurred during the project work of 42 months (2005 to 2008) in Porto novo field work.

Table 2: Presents a graphical representation during the 42 months field research work in Porto Novo.

Discussion and conclusion

A total of 947 samples were tested for a period of about 42 months, a total of 218 samples were men while 729 samples were women. However, among the men tested, 6 men were recorded laboratorial as HIV positive making a percentage of 2.8% of the samples tested. Out of the positive samples, two were clinically presenting generalized dermatitis while one was venereal disease research laboratory (VDRL) screening tested positive with a clinical features of syphilis, one person positive for HIV-1 was presenting exclusive weight loss. And the rest HIV positive were apparently healthy persons without any clinical features and did not know that they were infected.

In the women category, a total of samples tested recorded 9 HIV positive laboratorial confirmed cases making a percentage of 1.2% of the women samples tested. Five women were positive for HIV-1, two women were positive for HIV-2 and also two others showed positive for both HIV-1 and HIV-2. A woman positive for HIV-1+2 was clinically presenting chronic diarrhoea of more than 2 months and a woman positive for HIV-2 was of risky sexual behaviour. The virulence of the human immunodeficiency strains have been reported to be different with HIV-1 being more virulent. The type of HIV at the increase in Porto Novo locality is HIV-1. In the men population tested, four men were positive for HIV-1 while in the women population tested, five women were positive also for HIV-1.

However in a study carried out in 1987 among sex workers in several Cape Verde islands recorded HIV prevalence at about 2% and another study carried out in urban areas of Praia in 1988 showed 1.4% HIV prevalence in age group 15 to 55 years. All these studies in the 1980s showed only HIV-2 (and no HIV-1 isolated)- United Nations study group on acquired immunodeficiency syndrome (UNAIDS) reported in African continent, country by country has published this work about the incidence of HIV infection in Cape Verde.

However the situation in Porto Novo is purely different from that of UNAIDS of the 1980s, because most of the population tested showed higher incidence of HIV-1 than HIV-2 and this could be due to the more competitive nature of Hiv-1 to that of Hiv-2 . A positive HIV test is neither diagnostic of AIDS nor any AIDS – related condition but only an indication of infection with the virus.

The percentage of patients with positive HIV antibody test who actually develop AIDS differs from one geographical area to another. Predisposing factors for progression to AIDS are poorly understood. They are thought to include malnutrition, overall health and constitution of the patient, individual genetically determined vulnerability to chronic HIV infections and the occurrence of other viral or serious infection which can hasten immune suppression particularly in high risk persons.

The anxiety of progression to AIDS causes a lot of stresses which may in it hasten the onset of AIDS, the Porto Novo experience showed that the infection of the pandemic virus is sub control and that the sexually active group aged 20 to 50 is more involved. In this study, persons tested has no history of past blood transfusion and toxic dependency or intravenous drug users and this showed that unprotected sex remains the route of most transmission of the deadly virus.

Conclusion

In conclusion, this work is for the purpose of monitoring the prevalence of HIV infection among Porto Novo inhabitants and as a vigilante screening for voluntary blood donors and persons who are healthy and also from patients presenting clinical signs and symptoms suggested by the physician as a watch out signs for HIV and or AIDS. Although there are many signs connected to HIV which is mostly noted such as chronic diarrhoea, sexually transmitted diseases (syphilis,chancroid,and gonorrhoea),fungal infections,meningitis,tuberculosis,pneumonia etc. The percentage recorded in this work follows almost what the UN-AIDS (1980) reported. The incidence of HIV-1 mostly seen now could be as a result of more competitive nature of Hiv-1 to that of Hiv-2. In Cape Verde, we could see that the HIV pandemic is under control because of various governmental and non-governmental programs aimed at reducing the infection and a percentage of 2.8%of men samples tested and that of 1.2%of women samples tested, in a total of 947 samples were not alarming. And in all there are nine tested positive for HIV-1,(four men and five women respectively).It takes a total dedication of all the officers of the health sector, government and the public to continue in this fight against the AIDS insurgence and laboratory should continue to be on the watch in testing of both apparently healthy and suspected persons. It is obvious that blood donors should be totally screened and accepting blood transfusion remains strict only on the last resort because blood accepted during the window period must be positive in the circulation of the patient no matter the result of the screening test conducted on such blood before transfusion. The young and the old should continue to practice safe sex and to remain faithful to only a sex partner and perform test of HIV on intended new partners. HIV testing must remain paramount to the candidate of marriage and the local court registry and churches should incorporate HIV screening tests as one of the factors for qualification of marriage, both partners must present the results of HIV testing from recognized laboratories or agencies. This will go a long way in preventing the pandemic virus from circulating.

However, governmental agencies should make provisions for easy access to sex education and incorporate same in schools and universities and durex or condom will be freely accessible to the public especially in African continent. Hotels receiving travelers must have the publicity of HIV/AIDS openly in public areas.

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Author:

Okeke Peter Ubah