– Co-infection of Hiv And Hbv Among Pregnant Women Attending Ante-natal Care in Some Hospitals in Kaduna Metropolis, Nigeria –
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ABSTRACT
The transmission routes and some risk factors that are associated with human immunodeficiency virus (HIV) infection are also associated with hepatitis B virus (HBV) infection.
The HIV-infected pregnant cohort represents a unique population and infection with HBV is considered a public health problem worldwide.
This study was conducted to determine the sero-prevalence of HIV and HBV and co-infection of both viruses among pregnant women in Kaduna, Nigeria.
Eight hundred (800) pregnant women attending ante-natal care in four selected hospitals were recruited for this study.
Blood samples were collected and tested for presence of HIV antibodies and Hepatitis B surface antigen (HBsAg) using Determine HIV 1 and 2 rapid test kit and First Response antigen detection kits respectively.
The positive HIV blood were retested using Unigold and analyzed for CD4 counts, while positive HBsAg plasma was confirmed using ELISA and tested for various markers of hepatitis B virus.
TABLE OF CONTENTS
Cover Page – – – – – – – – – – i
Title Page – – – – – – – – – – ii
Declaration – – – – – – – – – – iii
Certification – – – – – – – – – – iv
Dedication – – – – – – – – – – v
Acknowledgements – – – – – – – – – vi
Abstract – – – – – – – – – – vii
Table of Contents – – – – – – – – – viii
List of Figures- – – – – – – – – – xiii
List of Tables – – – – – – – – – – xiv
List of Appendices – – – – – – – – xv
CHAPTER ONE
1.0 Introduction – – – – – – – – – 1
1.1 Statement of Research Problem – – – – – – – 4
1.2 Justification – – – – – – – – – 5
1.3 Aim – – – – – – – – – – 6
1.4 Specific Objectives – – – – – – – – 6
1.5 Research Questions – – – – – – – – 7
1.6 Research Hypothesis – – – – – – – – 7
CHAPTER TWO
2.0 Literature Review – – – – – – – – 8
2.1 Human Immunodeficiency Virus – – – – – – 8
2.1.1 History – – – – – – – – – – 8
2.1.2 Virology – – – – – – – – – 9
2.1.3 Immunology – – – – – – – – – 11
2.1.4 Epidemiology – – – – – – – – – 13
2.1.5 Transmission and Risk factors – – – – – – – 14
2.1.6 Pathology of HIV – – – – – – – – – 17
2.1.7 Replication and Gene expression – – – – – – 18
2.1.8 Replication of HIV – – – – – – – – 19
2.1.9 Pathogenesis of Untreated HIV Infection – – – – – 21
2.2.0 Diagnosis of HIV Infection – – – – – – – 27
2.2.1 Treatment of HIV Infection – – – – – – – 31
2.2.1.1 Overview of Antiretroviral Medication – – – – – 31
2.2.1.2 Initiating Treatment – – – – – – – – 32
2.2.1.3 Monitoring Antiretroviral Therapy – – – – – – 33
2.2.1.4 Changing Antiretroviral Therapy – – – – – – 35
2.2.1.5 Immune Modulators for HIV Treatment – – – – – 36
2.2.1.6 Prophylaxis against Opportunistic Infections – – – – 37
2.3 Hepatitis B Virus – – – – – – – – – 38
2.3.1 History – – – – – – – – – – 38
2.3.2 Virology – – – – – – – – – 38
2.3.3 Genome – – – – – – – – – – 39
2.3.4 Replication – – – – – – – – – 40
2.3.5 Serotypes and Genotypes – – – – – – – 40
2.3.6 Pathogenesis – – – – – – – – – 42
2.3.7 Transmission – – – – – – – – – 44
2.3.8 Epidemiology – – – – – – – – – 45
2.3.9 Clinical Manifestation – – – – – – – – 46
2.4.0 Diagnosis – – – – – – – – – 46
2.4.1 Prevention – – – – – – – – – 48
2.4.2 Treatment – – – – – – – – – 50
2.4.3 Prognosis – – – – – – – – – 51
2.4.4 Reactivation – – – – – – – – – 51
2.5 Hepatitis B and HIV Co-infection – – – – – – 52
2.5.1 Impact of HIV on the course of HBV Infection – – – – 53
2.5.2 Diagnosis of HBV in HIV Infection – – – – – – 54
2.5.3 Management of HBV in HIV Co-infected Individuals – – – – 55
2.5.4 Prevention of HBV Transmission – – – – – – 56
2.5.5 Hepatitis B Virus Therapy – – – – – – – 56
2.5.6 Indicators for Treatment of HBV in HIV Infection – – – – 56
2.5.7 Treatment of HBV in the Setting of Antiretroviral Therapy – – – 57
2.5.8 Treatment of HBV in the Absence of Antiretroviral Therapy – – – 57
2.5.9 Hepatitis B Virus Medication – – – – – – – 58
2.6.0 Hepatitis B Virus Resistance – – – – – – – 60
2.6.1 Monitoring on Therapy – – – – – – – – 61
2.6.2 Hepato-cellular Carcinoma Screening – – – – – – 62
2.6.3 Immunization against HBV in HIV Infection – – – – – 63
CHAPTER THREE
3.0 Materials and Methods – – – – – – – – 64
3.1 Study Area – – – – – – – – – 64
3.2 Study Population – – – – – – – – – 64
3.3 Control – – – – – – – – – – 65
3.4 Ethical Approval – – – – – – – – – 65
3.5 Inclusion and Exclusion Criteria – – – – – – – 65
3.6 Sample Size – – – – – – – – – 65
3.7.1 Questionnaire Administration – – – – – – – 66
3.7.2 Specimen Collection – – – – – – – – 66
3.8 Analysis of Specimen for HIV – – – – – – – 66
3.8.1 HIV Screening using Determine – – – – – – 67
3.8.2 CD4+ Count Determination – – – – – – – 69
3.8.3 HBV Screening – – – – – – – – – 69
3.8.3.1 Antigen Detection Technique using the First Response HBsAg Card – 70
3.8.3.2 ELISA Assay – – – – – – – – – 70
3.8.4 Detection of Markers of HBV Infection – – – – – 72
3.9 Data Analysis – – – – – – – – – 72
CHAPTER FOUR
4.0 Results – – – – – – – – – – 74
CHAPTER FIVE
5.0 Discussion – – – – – – – – – 101
CHAPTER SIX
6.0 Conclusion and Recommendations – – – – – – 109
6.1 Conclusion – – – – – – – – – 109
6.2 Recommendations – – – – – – – – 109
6.3 Limitations of the Study – – – – – – – – 110
REFERENCES – – – – – – – – – 111
APPENDICES – – – – – – – – – 125
INTRODUCTION
Human immunodefficiency virus (HIV) types 1 and 2 are lentiviruses belonging to the family Retroviridae, and the etiologic agents of acquired immune defficiency syndrome (AIDS).
The acquired immune syndrome was first described in 1981, and HIV-1 was isolated by the end of 1983 (Brooks et al., 2010).
Human Immunodefficiency Virus attacks the body’s immune system. Normally, the immune system produces white blood cells and antibodies that attack viruses and bacteria.
The infection fighting cells are called T-cell lymphocytes. Months to years after a person is infected with HIV, the virus destroys all the T-cell lymphocytes.
This disables the immune system to defend the body against diseases and tumors. Various infections will be able to develop, these opportunistic infections take advantage of the body’s weakened immune system.
These infections which normally not cause severe or fatal health problems will eventually cause the death of the HIV patient (FMOH, 2010a).
Infection with Hepatitis B virus (HBV) is a widespread problem. Epidemiological survey showed that about 5% of the world populations are asymptomatic carriers (Omer, 1995).
Chronic HBV infection is a major cause of mortality and 50% of chronic carriers are expected to die from the disease due to liver cirrhosis or hepatocellular carcinoma (Omer,1995).
REFERENCES
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D. and Adewole, I. (2010).Adewole, O.O., Anteyi, E., Ajuwon, Z., Wada, I., Elegba, F., Ahmed, P., Betiku, Y., Okpe, A.,
Eze, S., Ogbeche, T. and Erhabor, G.E. (2009).Agboghoroma, C.O. (2005). Management of HIV in pregnancy: A clinical review. Tropical
Journal of Obstertric and Gynaecology, 22:65-73.Aghasadeghi, M.R., Bahramali, G., Sadat, S.M., Farahani, A., Mohraz, M., Davar Siadat, S.,
Mostafavi, E., Memarnejadian, A., Ardestani, M.S., Vahabpour, R., Saraji, A.A.
andDelbaz, S.A. (2011).Ali,S.H. and Ashraf, M.M. (2007). Prevalence of Hepatitis B infection in pregnant women in a
tertiary care hospital. Infectious Disease Journal of Pakistan, 16:35-38.Alter, M. (2003). Epidemiology and prevention of Hepatitis B. Seminars in Liver Disease. 23:
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