Prevalence of COVID–19/HIV-Positive Patients in an Isolation Center in Rivers State, Southern Nigeria.

By Owhonda G; Nnoka VN; Eli S; Ikenga VO; Wekere FCC; Emeghara GI; Tee GP (2022).

Greener Journal of Medical Sciences

Vol. 12(1), pp. 116-122, 2022

ISSN: 2276-7797

https://gjournals.org/GJMS

Prevalence of COVID–19/HIV-Positive Patients in an Isolation Center in Rivers State, Southern Nigeria.

Owhonda G¹; Nnoka VN²; Eli S³; Ikenga VO⁴; Wekere FCC¹; Emeghara GI⁵; Tee GP⁵

Department of community Medicine, Rivers State University.¹

Department of Pharmacology, Rivers State University.²

Mother, Baby and Adolescent Care Global Foundation.³

Department of Surgery, Rivers State University.⁴

Department of Human Physiology, Rivers State University.⁵

ARTICLE INFO

ABSTRACT

Article No.: 030922032

Type: Research

Full Text: PDF, HTML, EPUB, PHP

Background: COVID – 19 Infection/Human immunodeficiency Virus (HIV) co–infection is a double tragedy to those infected global. The reason is that those infected with HIV have reduced immunity and at greater risk of contacting COVID –19 infection resulting in higher mortality. The global prevalence of COVID-19 infected persons in people living with HIV (PLHIV) is 2%.

Aim: This study aims to determine the prevalence of admitted patients with COVID-19/HIV co-infection in an isolation center in Rivers State, South-South region of Nigeria.

Method: This was a 6 – months cross-sectional study of COVID – 19/HIV- positive patients at an isolation centre in Rivers State, Southern Nigeria. Polymerase Chain Reaction Test (PCR) was used to confirm those that were COVID-19 positive and HIV. Permission for the study was granted by the Director of Public Health, Rivers State Ministry of Health. The data was analysed with SPSS version 25.

Result: Three hundred and thirty five patients were recruited for the study all of which were COVID-19 positive. There were 105 (44.7) males and 130 (55.3) females. The mean age was 38.4 SD 13.2 and .231(98.3) HIV positive. There were 1Male positive for HIV and 3 Females positive for HIV.

Conclusion: The study revealed the prevalence of COVID – 19/HIV co-infection as 1.7%. Multi-disciplinary management should be instituted for better outcome. In addition, residents should be encouraged to accept COVID-19 vaccination for improved prognosis for those COVID – 19/HIV co-infection.

Accepted: 09/03/2022

Published: 25/03/2022

*Corresponding Author

Dr. Nnoka V. (MBBS)

E-mail: nnokaalentine@ yahoo.com

Phone: 08064843958

Keywords: Prevalence, COVID –19/HIV co-infection, Rivers State, Southern Nigeria.

INTRODUCTION

This study aims to determine the prevalence of admitted patients with COVID-19/HIV co-infection in an isolation center in Rivers State, South-South region of Nigeria. According to the National Agency for the Control of AIDS (NACA), Nigeria has a HIV prevalent rate of 1.4% while Rivers State has a HIV prevalence rate of 3.8% making it the 3^rd highest among all the states in the country³.

CORONA VIRUS DISEASE, 2019 (COVID-19).

Corona virus disease 2019 (COVID-19) is a disease that can be transmitted from person to person via inhalation of contaminated air droplets containing the virus and whose etiology is the severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), a novel virus. In December, 2019, the first known case of this disease was identified in Wuhan, China⁴. Since then, the coronavirus disease has resulted in a pandemic as almost all countries of the world have been affected one way or the other⁵.

When the virus was first identified in Wuhan, it was called the Wuhan coronavirus⁶. Since the new 2015 World Health Organization (WHO) guidelines avoids naming diseases according to geographical locations, or the group of people involved, so as to avoid stigmatization⁷, the virus was officially named SARS-CoV-2 and COVID-19 by the WHO in February, 2020⁸. CO represents corona, VI stands for virus, D stood for disease while 19 stands for the year the virus was discovered being 2019⁹.

As at the 10^th of February, 2022, there has being a total of 402,044,502 confirmed coronavirus cases with about 5,770,023 related deaths worldwide⁸.

In Nigeria, as at 11^th of February, 2022, there has being a total of 253,923 confirmed cases with 3,139 COVID-19 related deaths. Out of this figures, Rivers State with a population of over 5,198,716 (2006 census) has had about 16,499 confirmed cases with a total of 154 corona virus related deaths¹⁰.

Signs and Symptoms

Symptoms may vary from asymptomatic infection to mild, moderate or severe. They may include any combination of fever, cough, catarrh, muscle or joint pain, fatigue, loss of smell, loss of taste, headache, and difficulty in breathing. Shock, respiratory failure or multi organ dysfunction can also occur. About 81% of symptomatic persons develop only mild to moderate symptoms; only about 14% end up with severe symptoms like difficulty in breathing while only 5% suffer from life threatening symptoms like shock, respiratory collapse or multiorgan failure. Time of exposure to symptom onset is usually between 4-5days on the average¹¹.

Pathophysiology

The virus first enters the host through the target host cell receptor. SARS-CoV-2 is primarily made up of four structural glycoproteins namely spike, envelop, membrane and nucleocapsid¹². Several works have been published all pointing to human angiotensin converting enzyme 2 (ACE2) as a receptor that allows the entry of SARS-CoV-2^13,14. Apart from the lungs, ACE2 can also be expressed in the small intestine, heart, testis, kidneys, adipose tissue and thyroid gland which may mean that in conditions of a high viral load, SARS-CoV2 could also infect cells of other organ system.^2-4 The virus enters the host cell through binding of the viral and host cell membrane.^1-3

Host Defense against SARS-CoV-2

In the initial phase of infection, lung cells, epithelial cells of the bronchi and nasal cavity are targeted by Corona virus with the aid of its spike protein which attaches to ACE2¹⁵. Uptake of the virus is enhanced by trans-membrane serene protease 2 (TMPRSS2) which is present in the host cell. This is achieved via the cleavage of ACE2 and the activation of the viral spike protein which is responsible for the COVID-19 viral entry into the cells of the host^15,16. As it is with some other viruses that affects the respiratory system, TMPRSS2 and ACE2 are expressed in cells like the alveolar epithelial type 2 pneumocytes¹⁷. Marked depletion of lymphocytes may result from COVID-19 infection following destruction of T-cells¹⁸. This could also result from inflammatory responses elicited by the virus (both natural and acquired immune responses) which hampers the formation of lymphocytes and promotes the programmed cell death of lymphocytes^15,18.

Following continuous replication of the virus in the later phase of the infection, the integrity of the epithelial barrier is compromised¹⁹. COVID-19 attacks the capillary endothelial cells of the lungs, enhancing the inflammatory response with entry of neutrophils and monocytes. Viral sepsis can ensue leading to multi-organ failure^15,20.

Diagnosis and laboratory findings

A provisional diagnosis of SARS-CoV-2 can be made using symptoms alone, however, this will have to be confirmed with the help of a reverse transcription polymerase chain reaction (RT-PCR) of secretions containing the virus or some other forms of nucleic acid testing²¹. Laboratory investigations like a full blood count (FBC), C-reactive protein (CRP) radiological investigations like chest radiographs, CT scans of the chest can also aid diagnosis especially in individuals with a high index of suspicion²².

Laboratory findings may include an increase in lactate dehydrogenase, alanine amino-transferase, aspartate amino transaminase and C-reactive protein¹⁵. A decrease in the number of Lymphocyte count (absolute lymphocyte count ˂ 1.0 × 10⁹/L) is also a very common finding^15,17.

Clinical management and Treatment

Management of COVID-19 infection includes prevention and control of infection, supportive measures like oxygen supplementation and mechanical ventilation as indicated (CDC).

New drugs have being developed for the treatment of COVID-19 infection while there has been evaluation of some already existing drugs. For example, Remdesivir is a drug that has been approved by the U.S Food and Drug Administration for the treatment of COVID-19 infection.

Chloroquine/hydroxychloroquine compounds have previously been used to treat SARS-CoV-2 patients as this drug inhibit entry of the virus into host cell and also cause endocytosis of the virus invitro; however studies have not shown much benefits^15,23.

Dexamethaxone and statins (anti-inflammatory agents) are other drugs that have reduced hospital stay and severity of symptoms in patients with SARS-CoV-2¹⁵.

Monoclonal antibodies that targets any of interleukin-1, interferon gamma, or interleukin-6 serves as anti-inflammatory agents, preventing organ damage in SARS-CoV-2 infection.

Immunomodulatory therapies like Anakira, Ruxolitinib and anti-coagulants like heparin have been tried with varying efficacies¹⁵.

Prevention

COVID-19 Preventive measures include wearing of face mask, social distancing, reduction in outdoor exposures, regular washing of hands with soap and water, use of hand sanitizers, avoiding contact with the eyes, mouth or nose, respiratory etiquette and vaccination²⁴.

Human immunodeficiency virus

Human Immunodeficiency virus (HIV) is a blood borne virus of the Retroviridae family and Lentivirus genus. The virus is said to have originated in Central Africa from chimpanzee²⁵. HIV has slowly spread across Africa and into other parts of the world. In the long run, HIV can cause acquired immunodeficiency syndrome (AIDS) which is characterized by depression of the immune system which makes way for opportunistic infections and certain cancers²⁶.

According to the W.H.O, prior to 2021, there were about 37.7 million people infected with HIV worldwide and over two thirds are within the African continent. In 2020 alone, not less than 680,000 lost their lives following HIV-related causes with about 1.5 million new cases (WHO)²⁷.

There are two species of HIV – HIV-1 and HIV-2, each one containing several subtypes. HIV is usually transmitted through sexual intercourse, sharing of needles and sharps, infected blood and blood products, mother to child transmission (MTCT) which can occur during the process of delivery or breastfeeding.

Pathophysiology

HIV infects cells that participate in immune functions such as the T lymphocytes especially the CD4 T cells, dendritic cells and macrophages²⁸. As a result of the infection with the virus, CD4 T cells are depleted by a number of ways including but not limited to direct destruction by CD8 cytotoxic cells of CD4 T cells that has been infected, apoptosis of bystander cells that are uninfected etc^29,30. Following the depletion of CD4 T lymphocytes, a threshold level will be reached when cell mediated immunity will be lost with antecedent susceptibility of the host to various types of opportunistic infections eventually giving rise to full blown AIDS.

Diagnosis

An initial diagnosis of HIV can be made using an enzyme-linked immunosorbent assay (ELISA) which can be confirmed using any of western blot technique, Immunoflorescence assay (IFA) or a polymerase chain reaction (PCR).

Signs and symptoms

The signs and symptoms of HIV infection depends on the stage of the disease. In the early phase of infection, there could be seroconversion (typically within the first 2-4 weeks of infection) which presents with flu-like symptoms like fever, chills, generalized rashes, malaise, muscle aches, generalized lymphadenopathy.

Acquired immunodeficiency syndrome (AIDS) presents as a severe, recurrent and sometimes lethal opportunistic infections and malignancies.

Treatment

At present, there is no cure for HIV infection and current treatment modalities only aims to suppress replication of the virus within the host allowing the individuals immune system to recover and resume its role in the fight against opportunistic infections and certain cancers²⁷.

Current treatment regimen consists of a combination of three or more antiretroviral (ARV) drugs.

Prevention

Preventive measures of HIV infection includes use of condoms, routine screening for HIV and other sexually transmitted diseases, prevention of mother to child transmission (MTCT) of HIV, Post exposure prophylaxis (PEP) with ARV.

COVID-19 and HIV co-infection

Consequent on the COVID-19 pandemic, there have been fears over the increased susceptibility to severe COVID-19 disease in people living with HIV (PLHIV) due to varying degrees of immunosuppression²⁷. Individuals with HIV infection who are not on ARV medications are said to be at even greater risk. However, when compared with other comorbidities like obesity, older age, severe asthma, diabetes mellitus, heart or respiratory diseases, HIV appears to be a lower risk factor for severe COVID-19 disease. People living with HIV who also have a heart or respiratory disease or who are elderly are also more likely to acquire COVID-19 with greater severity of the disease compared with those without these comorbidities (UNAIDS). A study by Karmen-Tuohy et al (2020) showed that HIV/COVID-19 co-infection does not have any significant impact on the duration of hospital stay, presentation or outcome when compared with individuals who are negative to HIV³¹. This was supported by another work done by Nagarakanti et al (2021) which also showed no difference in admission into the intensive care unit, need for mechanical ventilation or even mortality amongst individuals with HIV/COVID-19 co-infection (who were on admission) when compared with COVID-19 positive individuals without HIV infection³². It is pertinent that people living with HIV adhere strictly to all the preventive measures that have been put in place by the World Health Organization (WHO) in other to avoid acquiring the SARS-CoV-2.

Aim

To determine the prevalence of HIV infection amongst COVID - 19 positive patients at an isolation centre in, Southern Nigeria.

METHODOLOGY

This was a 6 – months cross-sectional study of HIV- COVID – 19 positive patients at an isolation centre in Rivers State, Southern Nigeria. HIV confirmatory kit was used to confirm those that were positive for HIV. Polymerase Chain Reaction Test was used to confirm those that were COVID-19 positive. Permission for the study was granted by the Director of Public Health, Rivers State Ministry of Health. The information was analysed using SPSS version 25.

RESULT

Table 1: COVID-19 and HIV Co-Infection

Variable	Number	Percentage
Sex
Female Male	105 130	44.7 55.3
Age
Mean 38.4	SD 13.2
Result (HIV)
Negative Positive	231 4	98.3 1.7

Mean age 38±13.2

Table 2: Prevalence of HIV Among COVID – 19 Patients (COVID – 19/HIV Co-Infection)

	RESULT		Total
SEX	NEGATIVE (%)	POSITIVE
Male	129 (99.2)	1(0.8)	130
Female	102 (97.1)	3(2.9)	105
Total	231 (98.3)	4(1.7)	235

Bar Chart of Male and Female Distribution of HIV- Positive Infections

DISCUSSION

Our study revealed the prevalence of HIV amongst COVID – 19 patients in an isolation center In southern Nigeria was 1.7% (table 1 and 2). This figure was lower than the global figure of 2%.³³ In the study conducted by Tope Oyelade et al. 33. The study showed that CIOVID – 19/ HIV Co – infection was highest amongst African population .³³ furthermore, the study revealed that HIV infection may be linked with increased COVID – 19 death.

In the research carried out by Algatitan JS et al in Spain showed that people living with HIV are most affected by COVID – 19 infection. ³⁴ In addition, the researchers showed that people giving with HIV were feeling threatened with high level of fear, anxiety and stress because of the possibility of being infected with another virus that could kill them. Although there are ongoing research about COVID – 19 / HIV Co – infection much is still unknown however early data revealed that people with HIV with a CD4 cell counts above 200 have the same risk for severe COVID – 19 as people without HIV. ³⁴ ^- ³⁶ However in, persons with HIV who have weaker immunity and are theoretically more vulnerable especially the elderly and with poorer health. ^3,7 It is combination of these variables age as immunity in HIV positive patients with COVID – 19 that put them at greater risk. ³⁴ for this reason it is important that people with HIV have adequate information, should not panic nor be over confident and should engage in positive health behavior especially optimal adherence to treatment. ³⁵

Our study showed that female infected with COVID – 19 / HIV co – infection when compared to males in the ratio 3 : 1; indicating that out of the 231 infected cases 3(2.9%) of the females had COVID – 19 / HIV co –infection compared to 1 (0.8%) males.

This was not actually in agreement with some studies which revealed that there is inconclusive studies or hypothesis whether females or males were more predisposed to COVID – 19/ HIV co-infection. ³³

CONCLUSION

The study revealed the prevalence of COVID – 19/HIV co-infection as 1.7%. Multi-disciplinary management should be instituted for better outcome. In addition, residents should be encouraged to accept COVID-19 vaccination for improved prognosis for those COVID – 19/HIV co-infection.

Funding:

There was no funding for the research work.

Ethical Consideration:

Permission for the study was granted from data collected by the office of the Director Public Health Department Rivers State Ministry of Health, Nigeria.

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