Early HIV infection among persons referred for malaria parasite testing in Nigeria

Abstract

Persons in the early stages of HIV infection are the major drivers of new infections. These individuals may also develop renal dysfunctions at this time. Nigeria, as other African countries, has one of the highest prevalence of newly diagnosed HIV infections. Despite this, limited information exists on early HIV detection in the continent. This may be related to difficulties in providing early HIV diagnosis and treatment. Patients referred for malaria testing may provide a unique opportunity for early HIV detection. In this study, a method for identifying early HIV-infected individuals was assessed. HIV-1 subtype and renal function biomarkers were also analyzed in these persons. To identify early HIV infection, over a period of 18 months blood samples were collected from persons referred by clinicians for malaria parasite tests in Nigeria. A total of 671 samples were collected and analyzed for HIV antigen/antibody and subtypes. 101 of these samples were categorized into one of four groups: early HIV, chronic HIV, malaria infection and control groups for renal function analysis. 29% of HIV infected individuals were at the early stages of infection. The predominant subtype detected was CRF02_AG (57.14%). The early HIV group had the highest mean serum creatinine (95 µmol/L) and urea (5.7 mmol/L) values across all groups with the difference significant at P < 0.05. There was no significant difference between the circulating subtype and the stage of HIV infection. Our results show the feasibility of screening persons referred for malaria tests for early HIV. This can be used to control new HIV infections in sub-Saharan Africa.

Early HIV infection is associated with reduced proportions of gamma delta T subsets as well as high creatinine and urea levels

“…The study participants gave written informed consent before their blood samples were collected. Seventeen individuals at the early stage of HIV‐1 infection (EHIV) were enrolled, out of which 10 were recruited from persons who presented for malaria parasite diagnosis as previously described . The others were recruited from prospective volunteer blood donors whose samples were reactive for early HIV‐1 infection defined by HIV‐1 DNA detection along with 4th generation HIV ELISA (detection of both antigen and antibody) positive and negative with 3rd generation HIV ELISA (detection of HIV antibody only).…”

“…Twenty‐three out of the 41 chronically HIV‐1 infected patients on therapy had undetectable viral load (LVL) as defined by HIV‐1 RNA copies per mL <20, while the remaining 18 patients in this group had detectable viral load (HVL) defined by HIV‐1 RNA copies per mL >150 after being on treatment for at least 2 years. HIV‐infected individuals in Nigeria as well as in most countries in Sub‐Saharan Africa are identified and recruited for treatment at the chronic stages of infection . The approximate time of HIV exposure for CHIV, HVL and LVL groups are not less than 2, 6 and 7 years, respectively.…”

“…Patients' were identified as early HIV infection if HIV‐1 DNA from their blood samples was detected as positive along with a 4th generation HIV ELISA that detects both antigen and antibody and negative with a 3rd generation HIV ELISA that detects only HIV antibody. Those patients with positive HIV‐1 DNA with both 4th and 3rd generation ELISA were classified as chronic HIV infections as previously described . Information and procedures regarding HIV diagnosis and monitoring have been previously described …”

“…Those patients with positive HIV‐1 DNA with both 4th and 3rd generation ELISA were classified as chronic HIV infections as previously described . Information and procedures regarding HIV diagnosis and monitoring have been previously described …”

“…Renal disease in HIV infection has been shown to be associated with systemic inflammation, immune activation and an impaired immune system . Our previous study and others showed that when HIV‐associated nephropathies are diagnosed before acute/early HIV seroconversion is identified, it presents with uraemia, high serum creatinine levels and proteinuria …”