1. HIV/AIDS in Africa: Could the story have been different in Nigeria?
Christopher K.O. Williams
Fred Hutchinson Cancer Research Center/University of Washington Center For AIDS Research,
Seattle, Washington, Etats-Unis,
Department of Hematology, College of Medicine, University of Ibadan, Ibadan, Nigeria
Abstract
Objectives and Methods
Discussion
The current high seroprevalence rate (SPR) for HIV in Subsaharan Africa stands in striking contrast with the low rates, even in individuals of high-risk lifestyle, observed in surveys of pre-pandemic period in certain locales. Human retroviral research in Nigeria dates back to 1983 with the description of the index case of adult T-cell leukaemia/lymphoma. Subsequent screening of normal blood donors, school children and patients with haematological disorders with first-generation ELISA and lymphocyte immunophenotyping techniques revealed HTLV-I SPR of 6.4%, 0.0% and 0.0%-13% respectively, as well as unexplained fatal cases of immunodeficiency and lymphadenopathy/dermatitis. A WHO sponsored survey of risk factors of retroviral infection carried out in parts of Nigeria from 1985 to 1986 involved assessment of lifestyle of members of 5 population groups by a detailed questionnaire. They included 237 normal blood donors (NBD), 46 female commercial sex workers (FCSW), 54 male-, 17 female celibates (MC/FC) and 42 sexually transmitted diseases (STD) clinic patients (STDCP), who were screened for HTLVs and HIVs by ELISA and Western blot (WB). HTLV-I SPR for NBD, FCSW, MC, FC and STDCP were 4.6%, 13%, 16.7%, 1.85% and 11.8%. Multivariate analysis revealed eastern Nigerian origin (ENO) (p= ), female sex (p=0.037) and female sex of ENO (p=0.0006) but not ethnicity (p=0.215) or polygamy (p=0.43) as risk factors for HTLV-I infection. Confirmation of HIV-1/2 SPR in the study group was not possible until the development in the 1990's of the recombinant enhanced "Singapore" HIV-1/2 WB, which identified 2 HIV-1, but 0 HIV-2 cases, thus yielding HIV-1 SPR of 0% for FCSW, MC, FC, STDCP, and ≈0.5%-1.0% in NBD nationally. Retrospective estimates indicates expected ≈ AIDS deaths in 1985/6 at the University College Hospital, the main health care unit of the region, ≈5 of which were clinically diagnosed. In addition to the educational challenges resulting in the knowledge gap (vis-à-vis the situation in developed countries) about HIV/AIDS, cultural and infrastructural challenges probably also contributed to the failure of averting the disastrous progression of the pandemic in areas where timely intervention might have been effective. Senegal was another locale where retroviral research program was in place prior to the HIV/AIDS crisis. The low Senegalese HIV SPR probably resulted from early recognition of the dangers of the new disease and the prevailing cultural millieu, in contrast to other West African locales. Recent Ugandan experiences indicate that a reversal of the pandemic is possible in Subsaharan Africa. Lessons learnt from failure to control HIV/AIDS could help in confronting emerging new health challenges, including AIDS associated malignancies, breast and lung cancer as well as other diseases of "westernization" and changing lifestyles in Africa.
Survey of Risk Factors For Retroviral Infection in Nigerians:
sponsored by the World Health Organization;
Purpose of the study: To evaluate the role of sexual behavior in the transmission of human retroviruses among Nigerians
Methods: enzyme-linked immunoabsorbent assay (ELISA) and an investigational Western blot,
a small survey of the seroprevalence of HTLV-I and HIV was conducted in 1985/86
All serological tests were done on frozen preserved serum samples at the Viral Epidemiology Branch, NCI, Bethesda, MD, US.
5 population groups with differing lifestyles and sexual behavior as assessed by a detailed questionnaire
Normal blood donors;
female commercial sex workers;
patients attending a sexually transmitted diseases (STD clinic);
Seminarians and Nuns (celibate for religious reasons).
Population of adult Nigerians in the period: about 48 million
~240, ,000 HIV seropositive adult Nigerians in ;
Assuming that the estimate of 1 AIDS death for every 20 HIV seropositive cases, there could have been
~12,000-24,000 AIDS deaths in Nigeria in
The University College Hospital, Ibadan, Nigeria, the pre-eminent medical facility in the country, had a catchment population of at least 20% of Nigeria (20 million) in
Expected AIDS death: 2,400 – 4,800
Observed cases with clinical/laboratory features of AIDS: ≈ 5
Reasons for detection failure:
Technological and infrastructural underdevelopment
Ineffective surveillance
Background
Results
Studies of human retroviral infections in Ibadan, Nigeria, jointly with the Viral Epidemiology Branch, National Cancer Institute (NCI), Bethesda, MD, USA,
19-yr old Nigerian with ATL diagnosed in Ibadan, Nigeria in early 1980’s, and believed to be the first such patient to be appropriately documented on the African continent
Conclusion
References
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