SOURCE:

Faculty: Biosences
Department: Applied Microbiology And Brewing

CONTRIBUTORS:

Nweke, R. N.
Oyeka, A. C.

ABSTRACT:

Coinfection with viral hepatitis caused by hepatitis B virus (HBV) and hepatitis C virus (HCV) are associated with severe liver damage and immunological complications among Human Immunodeficiency Virus (HIV) infected individuals. Syphilis is a sexually transmitted disease (STD) common among people living with HIV-AIDS (PLWHA).The genital sores caused by syphilis increases the risk of acquiring HIV. The aim of this study is to evaluate the patterns of cluster of differentiation T-lymphocytes class-4 (CD4) cells and liver enzymes and their correlation with prevalence of HBV, HCV and syphilis among HIV infected individuals. The study was carried out within sixteen months period (September, 2015 to December, 2016). Five hundred and two people living with Human Immunodeficiency Virus that gave their consent participated in the study. A questionnaire form was filled by each of the participants to assess their socio-demographic characters. The participants were randomly selected from those attending clinics at General Hospital Onitsha, General Hospital Ekwulobia and General Hospital Enugwu-Ukwu. The participants comprised 346 (68.9%) females and 156 (31.1 %) males in the ratio of 1:2.2 (male to female). Veinous blood samples collected from the participants were used to screen and confirm them positive to HIV and to perform HBsAg, anti-HCV and syphilis serological tests, liver enzymes: Glutamate pyruvate transaminase/Alanine amino transferase (GPT/ALT), Glutamate oxaloacetate transaminase/Aspartate amino transferase (GOT/AST) and Alkaline phosphatase (ALP) as well as CD4 cells count. The data were analysed using Statistical Package for Social Sciences (SPSS) software, version 21.0 and were all shown in the appendix. Statistical significant was considered at P ≤ 0.05. The seroprevalence of HIV only, HIV-HBV and HIV-HCV co-infections were 93.2%, 5.2% and 1.6% respectively while prevalence for both HIV-HBV-HCV and HIV-Syphilis were 0.0% in the study population. Age group 31-45 had the highest number, 246 (49.0%) of participants while age group 61 and above had the least 15(3.0%). Higher percentage of males were coinfected with HIV-HBV (males, 9.6% vs females, 3.2%) while higher percentage of females were coinfected with HIV-HCV (females, 2.0% vs males, 0.6%). Among the participants 24 (4.7%), 30 (6.0%) and 16 (3.2%) had elevated GPT (ALP), GOT (AST) and ALP respectively. Nine (1.8%) participants had both hepatitis B and elevated liver enzymes while only one (0.2%) participant coinfected with HIV-HCV had elevated liver enzymes. Five (1.0%) had hepatitis B and elevated GPT, 3 (0.6%) had hepatitis B and elevated GOT and 1 (0.2%) had hepatitis B and elevated ALP. The level of elevation of the liver enzymes were all moderate, whose liver enzyme values ranges from 60 to 100 for both GPT and GOT and 140 to 200 for ALP, except for one female participant that had severe hepatotoxicity (GPT and GOT higher than 100 IU/L and ALP more than 215 IU/L). Among the 502 participants, 293 (58.4%) were married, 162 (32.3%) were single while widowed and divorced were 39 (7.7%) and 8 (1.6%) respectively. Majority of the participants had secondary school certificate (334; 44.6%) or OND certificate and above (196; 39.0%). Students made up 31.3% of the participants while civil servants, Artisans and Business men/women made up 12.5%, 20.3% and 29.1% respectively. Among the participants; 399 (79.5%) were on Antiretroviral therapy (ART) while 103 (20.5%) were Non-ART. Four hundred and ten participants (81.7%) had CD4 count 200cells/μl of blood and above while 92 (18.3%) had CD4 count less than 200. All the age groups had higher number of their participants on ART and CD4 count up to 200cells/μl of blood and above. The mean CD4 count of the female participants was higher (546.8±18.8) than the males, (489.0±30.1) but the difference was not statistically significant. Also the mean CD4 count of participants coinfected with HIV-HBV was lower (494.9±81.3) than those negative to HBV (531.0 ±16.3) while the mean CD4 of participants coinfected with HIV-HCV was higher (673.4±13.7) than those negative to HCV (526.8±16.1).The statistical analysis showed that age and sex, both significantly affected the coinfection of HIV-HBV (P < 0.05) but were not significant in the coinfection of HIV-HCV (P > 0.05). The analysis also indicated that the age of a person living with HIV-AIDS did not significantly affect the CD4 and liver enzyme level. The GOT and ALP elevations significantly affected the CD4 cell count but GPT elevation had no significant effect on CD4 cell count though the mean CD4 count of those with elevated GPT was lower than those with normal GPT. Coinfection of HIV-HBV was also significantly affected by exposure to risk factors, while coinfection of HIV-HCV was not significantly affected by exposure to risk factors. The mean CD4 count of participants on ART was higher (552.1± 10.5) than those not on ART (446.3 ± 16.4). Also participants with elevated ALP had the least mean CD4 (256.5± 12.8), followed by those with elevated GOT (328 ± 13.4), then those with elevated GPT had mean CD4 count of 382.0 ± 18.1 while those without liver enzymes elevation had mean CD4 count of 561.0 ± 11.7. From this study, the mean CD4 count of those coinfected with HIV-HCV was higher than those with HIV only and some other researchers in the past recorded the same, the reason for this needs further research. The result of this research have shown that presence of HBV and elevated liver enzymes pose a great threat to the health of a person living with HIV-AIDS and should be monitored regularly.