AFRO-NETS> National Reference Laboratory for HIV/AIDS Research in Nigeria

[Shola Abolarinwa <timshola@yahoo.com>]

National Reference Laboratory for HIV/AIDS Research in Nigeria
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Source: AHILA <ahila-net@who.org>


The HIV/AIDS Laboratory of the Nigerian Institute of Medical Re-
search, (NIMR) Yaba, was recently upgraded to a Reference Laboratory 
for Basic, Applied and Operational Research on HIV/AIDS. The funds 
used for upgrading the facilities and other infrastructures were sup-
ported with a grant from by the Ford Foundation.

Upgrading of the facilities has been completed and the present labo-
ratory in the Institute will serve as National Reference Laboratory 
for HIV/AIDS Research in the country. The Laboratory was officially 
commissioned by the Honourable Minister of Health on the 20th of 
July, 2001.

A profile of the present Research Capacities of the
new specialised laboratories are reflected below:-
- Serology/Immunology Laboratory
- Haemathology Laboratory
- Clinical Chemistry Laboratory
- Microbiology Laboratory
- Virology Laboratory

The standard of the NIMR HIV/AIDS Reference Laboratory could compete 
with any such laboratory in other parts of the world. The laboratory 
has modern facilities and the necessary manpower to carry out tests 
on:

- Serology/Immunology: Screening for HIV antibodies using Rapid 
and ELISA and Western Blot techniques; Estimation of serum Immu-
noglobulin levels i.e. IgG, IgA, IgM; Estimation of response of lym-
phocytes to stimulation with mitogens such as PHA, Con-A, PWM; Auto-
mated estimation of CD4/CD8 cell levels and flow cytometry.

- Haematology: Measurement of up to twelve haematological parame-
ters such as Haemaglobin ; Packed Cell Volume (PCV), White Blood Cell 
Count (WBC); Differential Platelet Counts; Enythrocytw Sedimentation 
Rate (ESR); etc.

- Clinical Chemistry: Measurement of biochemical profiles includ-
ing serum proteins, liver function test; gammus GT; blood sugar; 
plasma lipids; serum cholesterol; uric acid; kidney function tests; 
cardiac emzymes, etc.

- Microbiology: Microscopy, culture and sensitivity tests; spe-
cial techniques in study of fungal, bacterial and other parasitic in-
fections.

- Virology: Measurement of viral antigen (P24), determination of 
viral load levels using PCR; HIV sub typing.

The new P3 facility in the Laboratory is apparently the only such fa-
cility presently in the country. Apart from carrying out research 
programmes, the laboratory also has adequate capacities for labora-
tory back-up service to most of the current HIV Control programmes in 
the country.

With the present laboratory, clinical samples, which hitherto would 
have been sent to laboratories outside the country, can now be han-
dled at the NIMR laboratory. The Institute is now positioned to co-
ordinate and gives the necessary lead on HIV/AIDS research in the 
country.


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NATURAL HISTORY OF HIV INFECTION IN NIGERIA 

Data on the pathogenesis of the Human Immunodeficiency Virus have in-
dicated that the virus can exist for prolonged periods in a latent or 
chronic form. Various studies have shown that progression from ini-
tial infection with HIV to clinical detectable immunologic abnormali-
ties and disease manifestations can take between 3-7 years or more. 
However, not all HIV infections progress to frank AIDS. After infec-
tion and seroconversion, subjects may develop prodromal AIDS, AIDS-
related complex (ARC) or persistent generalised lymphadenopathy.

The main causes of deaths in HIV-infected subjects with full-blown 
AIDS are some neoplasms, especially Kaposi sarcoma and a variety of 
opportunistic infections of microbiological aetiology. It has further 
been documented that the human, vital and environmental factors which 
determine transmission and disease progression rates differ from one 
country to another. Based on these, the clinical manifestations asso-
ciated with HIV infection differ from one geographical area to an-
other. These discrepancies may reflect under-reporting of certain 
conditions in some countries because of lack of diagnostic facili-
ties, they may also be caused by differences ion the microbiological 
environment. Tropical diseases may interact with HIV disease and po-
tentially modify the clinical spectrum of the disease in the tropics. 
Also there may be differences in the genetic susceptibility of the 
host in different communities. Differences in the quality of care may 
be responsible for the fact that certain HIV-related conditions may 
occur more frequently in Africa because adequate treatment for such 
conditions may often not be available. Finally, variation in HIV 
strains may cause diseases with different natural histories as was 
shown in some recent studies comparing the natural history of HIV-1 
and HIV-2 infections in Kinshasa.

Presently, very little information is available on the natural his-
tory of HIV infection in Nigeria. Reports have documented that the 
latent period between HIV infection and clinical manifestations in 
patients in Europe and America may take between 7-10 years. On the 
other hand, data from countries in sub-Saharan Africa (Congo-Kinshasa 
and Kenya) have documented latent period of infection of 2 years in 
some patients The pitfall however, about some of these findings is 
that most often the exact time of onset of infection is not known es-
pecially in the developing countries. Some of the patients may have 
been at the late periods of infection. The current weight of informa-
tion is suggesting that the latent period between infection and 
clinical manifestations may be shorter in the developing countries 
given for the current level of poverty in these countries. Presently 
there are no well-documented data between latent period of HIV infec-
tion and its manifestation in Nigerian subjects. This needs to be 
studied and documented and will therefore be one of the areas of fo-
cus in this proposed project.

The interesting and striking difference between the natural histories 
of HIV in Africa and United States or Europe is the short survival 
time of AIDS patients in Africa. This suggests that it is probably 
not the HIV disease itself that causes these high mortality rates in 
Africa but that patients die faster of HIV related opportunistic in-
fections because adequate medical care is not readily available or 
not within the reach of most patients in countries of sub-Saharan Af-
rican.

The proposed project will attempt to document at the national level, 
the profile of opportunistic infections on HIV morbidity and mortal-
ity will be examined. At the end of the project a clearer picture of 
the natural history of HIV infection in the country will have been 
documented. A study reported that the main opportunistic infections 
associated with HIV infection in Zaria, Northern Nigeria, included 
Mycobacteria tuberculosis infection (30%), acute bacterial infection 
(salmonella typhi, streptococcus pneumoniae and staphylococcus 
aureus) (25%). Candidiasis (14%) and Kaposi sarcoma (2%). Another re-
port incriminated strains of Nocardia asteroides. (7%) Histoplasma 
capsulatum, (3%) Cryptococcus neoformans (%) and Aspergillus lumiga-
tus (.5%) in addition to some of the organisms identified in Zaria, 
as playing important roles as associated respiratory opportunistic 
infections in HIV/AIDS patients in Lagos, Southern Nigeria.

It is clear that the range of these opportunistic infections in the 
country is likely to be wide. More urgent studies are therefore 
needed to look at the problem on a National level. This is with the 
view to properly mapping out the frequency and profile of these op-
portunistic infections in the various geographical areas of the coun-
try. This will help improve early diagnosis and prompt management of 
clinical manifestations and reduce early mortality in the various ar-
eas.

The HIV laboratory of NIMR has facilities to carry out a well articu-
lated national study in this area, however, most of the facilities 
currently on ground in the laboratory will have to be updated and im-
proved to cope with the kind of studies proposed in this project. The 
PCR presently available in the Institute is the 1st generation model. 
Third generation model will be imperative in this project to ensure 
more reliable and consistent results.


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