Prevalence of Asymptomatic Chlamydia trachomatis Infection among HIV Positive Patients in Warri Metropolis, Delta State, Nigeria

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Ebhohimhen Edna Oare, Adejumo Babatunde I. Gabriel, Ibeh Isaiah Nnana, Ebhohimhen B. Osayetin

Medical Laboratory Science Department, University of Benin, Benin City, Nigeria.

Abdulkadir Usman Itakure

Department of Medical Laboratory Science, College of Health Sciences and Technology, Markafi, Kaduna State, Nigeria.

Dimkpa Uchechukwu

Physiology Department, Nnewi Campus, Nnamdi Azikiwe University, Awka, Nigeria

Oke Ojo Moses

Department of Medical Laboratory Science, College of Health Sciences and Technology, Akure, Ondo State, Nigeria.

Emmanuel Alaba Michael

Medical Laboratory Science Department, College of Health Sciences and Technology, Idah, Kogi State, Nigeria.

Fwogos Ishaku Jung

Abdulkadir Ramatu Lawal

Department of Medical Laboratory Science, College of Health Sciences and Technology, Zawan, Plateau State.

PathologyLaboratory, 44, Nigerian Army Reference Hospital, Kaduna, Kaduna State, Nigeria.

Uchuno Ashimedua Gregory

External Quality Assurance Department, Medical Laboratory Science Council of Nigeria, Abuja, Nigeria.

All correspondence to:

Email:babatunde.adejumo@uniben.edu, bigadejumo@yahoo.com,

Adejumo B.I.G., Medical Laboratory Sciences Department, University of Benin, Benin City, Nigeria

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ABSTRACT

Background: It is a known fact that chlamydia infection has caused a lot of economic and reproductive damage worldwide.

Aim: This work is aimed at determining the prevalence of asymptomatic Chlamydia trachomatis infection among the HIV positive individuals in Warri metropolis, Delta state, Nigeria.

Methods: A total number of 100 patients participated in this study (50 HIV positive males, 50 HIV positive females). 5 millilitre of blood was collected asceptically into a clean plain test tube and allowed to clot. The sample was centrifuged at 1500 rev/minute for 10 minutes. The serum was then separated and stored at -200C for 2 weeks prior analysis. HIV I and II were detected with Unigold and determine rapid test kits. Chlamydia trichomatis antibody was detected quanlitatively with immunocomb kit.

Result: The overall prevalence of frequency of Chlamydia trachomatis infection is 20%. Of the number infected with Chlamydia trachomatis, 7 (14% of total population) were males, while 13 (13%) were females. Data also shows lack of significant difference in CD4 count between the infected males and females (296.57 ± 37.18 for males; and 319.07± 28.91 for females respectively).

Conclusion: The prevalence of CT among the HIV patients is relatively high (20%) in the present study. This study therefore supports the need for regular STI screening in this vulnerable and high risk population since asymptomatic cases are common in the population.

Keywords: Chlamydia trachomatis, Infection, HIV, Warri, Nigeria

INTRODUCTION

Chlamydia infection is one of the most common sexually transmitted infection worldwide (1). Genital infections produced by C. trachomatis mainly affect women, who develop cervical infections and urethritis, and a substantial number has an asymptomatic course (2), (3), (4). The health cost due to the destructive clinical squeal caused by C. trachomatis infection is enormous (5). In adults, complications include infertility, pelvic inflammatory disease (PID), ectopic pregnancy, premature rupture of membranes, pre-term-birth, puerperal infections and facilitation of human immunodeficiency virus (HIV) type 1 transmission (6), (7). C. trachomatis frequently infects both sexually active and immuno-compromised individuals, such as HIV patients. Growing evidence indicates that active C. trachomatis

(CT) infection is an important risk factor facilitating sexual transmission of HIV infection, and several observed high rates of C. Trachomatis assumes significance in view of risk of HIV transmission and spread. For instance, Chlamydia trachomatis has been associated with increased genital HIV shedding that may increase HIV  transmissibility (8). The prevalence of C. trachomatis genital infections in women has been reported ranging from 0 to 37%, depending on the population studied and the techniques used (9), (10). In developed countries the prevalence rate of CT infection in HIV women is between 1-10% this figure is very low when compared to developing countries like Nigeria (11). Chlamydia also affects HIV positive men, but the prevalence in men is lower than that of women (12). Chlamydia infection in males manifests as urethritis in 15-55 per cent of the affected less than or equal to 35 years, occasionally epididymitis may be seen. Several risk factors play a role in this tendency: age under 25, family status, education, beginning of sexual activity and number of sexual partner among others (13). Another study also reported that all sexual/behavioral factors could potentially interplay for the acquisition of these infections (14). HIV-infected individuals affected by an STI have increased viral load in genital secretions (15); (16), thereby increasing considerably their potential of infectiousness and transmission. The control of these infections represents a unique opportunity to improve reproductive health of women living with HIV (17). Both ulcerative and non-ulcerative STIs increase the risk of HIV transmission by three to ten times, depending on the type and etiology of the STD.

So far, very little or no information has been documented on the prevalence of C. trachomatis and its co-infectivity with HIV in Warri metropolis; hence the justification for this study. We therefore aimed at determining the prevalence of asymptomatic chlamydia trachomatis infection among HIV positive patients in Warri metropolis, Delta State, Nigeria. In addition, we demonstrated whether there were sex differences in the prevalence of chlamydia trachomatis infection and mean CD4 count among the HIV positive patients.

2.2 Materials and Methods

Study population

A total number of 100 HIV positive patients (50 males and

age-matched 50 females) participated in this study. They are all residents of Warri, Delta state, Nigeria and patients attending heart to heart (HIV) clinic at Central hospital,

Warri. Their ages ranged from 21 – 68 years (males, 40.0 ± 8.32 yrs and females, 37.46 ± 10.44 yrs; p = 0.58). Cases were defined as, patients who are already diagnosed

HIV/AIDS sero-positive, on antiretroviral therapy, and are not staged. Their status was equally confirmed using Determine and Unigold rapid test kits. Participants who were symptomatic or have history of trachomonas were excluded. The Ethics committee of Ministry of Health, Delta State approved this study. The personal consent of participants was sought after explaining the purpose of the research. A well-structured questionnaire was administered to every participant of this study.

Sample Collection and Processing

Five millilitres of blood was collected and dispensed into a plain container and transported to Medical Laboratory Department, University of Benin. The non anticoagulated blood was spun at 1500rpm for 10 minutes and the supernatant serum was separated into a separate sterile tubes. The serum was stored at -200C for up to 2 weeks prior to analysis for HIV status (using rapid Determine and Unigold rapid diagnostic kits), and Chlamydia trichomonas antibody (using lgG immunocomb kits).

 

2.3 Data analysis

Data was expressed as mean and standard deviation. Comparative analysis for continuous variables was done using independent sample t-test, while that of categorical variables was done using chi-square test. Statistical significance was set at p < 0.05. All statistics were done using IBM/SPSS software (version 20.0).

Figure 1. The incidence of active Chlamydia trachomatis infection compared between males and females

Figure 2. Mean CD4 count of both the CT infected and non-CT infected patients

Figure 3. The CD4 count of patients with active Chlamydia trachomatis infection compared
between males (n = 7) and females (n = 13).

RESULTS
Figure 1 shows the incidence of Chlamydia trachomatis infection among HIV infected patients. Data indicated that 20% of the HIV infected patients had Chlamydia trachomatis infection, while 80% were not infected. Table 1 shows the frequency distribution of the test for active Chlamydia trachomatis infection among HIV patients according to gender. Data indicated that 7% (n = 7) of the total population who tested positive for active Chlamydia trachomatis infection were males, while 13% (n = 13) were females. Of the 7 males that had active Chlamydia trachomatis infection, 14.28% (n = 1) tested strongly positive and weakly positive respectively. Of the 13 females that had active Chlamydia trachomatis infection, 38.46% (n =5) were strongly positive. Table 2 shows the incidence of active Chlamydia trachomatis infection according to age groups. Data indicate that those aged 31-40 years had highest incidence (45%) of Chlamydia trachomatis infection followed by age group 41-50 years. Patients with the least incidence (5%) of Chlamydia trachomatis infection are of age groups 51-60 and ≥61 years respectively.

Figure 1 shows the incidence of active Chlamydia trachomatis infection compared between males and females. Data indicated lack of significant difference (X2 = 1.80; p = 0.18) in the incidence of active Chlamydia trachomatis infection between male (35%)s and females (65%).

Figure 2 shows the mean CD4 count of both the CT infected and non-CT infected patients. Data shows that the non-CT infected patients had significantly greater mean CD4 counts compared with the CT infected patients (365.77 ± 6.67 vs. 311.20 ± 22.41; p = 0.002).

Figure 3 shows the CD4 count of patients with active Chlamydia trachomatis infection compared between males (296.57 ± 37.18) and females (319.07 ± 28.91). Independent sample t-test indicated lack of significant difference (p = 0.645) in CD4 count between males and females.

DISCUSSION
In this study, the overall prevalence of Chlamydia trachomatis infection in HIV patients was 20%. This is
higher when compared with previous reports from Rio de Janeiro (Brazil), Mombasa (Kenya) and Thailand where a prevalence of CT of 3%, 3.2% and 9.7%, respectively, was observed among HIV-infected women (18, 19, 20). The highest prevalence (45%, n = 9) of CT was observed among those aged 31-40 years. This is in contrast to the findings of (14), who noted the highest prevalence of Chlamydia trachomatis in age group of 25-29 years. Interestingly, after the age of 40 years, the prevalence of CT
declined with age. The prevalence of Chlamydia trachomatis infection has been shown to decline with age (21). According to research findings prevalence of Chlamydia trachomatis infection in female decreases after 30 years likely because the target cell for CT infection is the  columnar epithelia cells which is present in the ecto-cervix of young women. This columnar epithelia cell is replaced by squamous epithelium through the process of squamous metaplasia which occurs with age (22), (23) the present study demonstrated gender differences in the prevalence of C. trachomatis in asymptomatic HIV positive patients in Warri metropolis, with prevalence of 7% of total in male and 13% in female respectively. The prevalence of CT has also been previously reported to be lower in men compared to women (12). The present data for both genders are within the range (0 to 37%) of a previously reported prevalence in asymptomatic cervical infections (24), (10). Other studies in France and Spain reported prevalence rates of 7.1 among women presenting for routine gynecologic examination and 6.3% in general HIV patient population (25), (26). Another study by (27) reported an 18.3% prevalence rate of CT in HIV infected women. (28) And (26) reported similar results in recent studies. Furthermore, the non-CT infected patients had significantly greater mean CD4 counts compared with the CT infected patients. This is in agreement with a previous study by (29) who found low CD4 count (less than 500 cells/ml) in 48 out of the 60 HIV infected patients, however, it is not clear if the immune status of the present study patients were directly related to the C. trachomatis infection. Interestingly, among the CT infected patients, the CD4 count did not show gender difference.

Conclusion

The prevalence of CT among the HIV patients is relatively high (20%) in the present study. This study therefore supports the need for regular STI screening in this vulnerable and high risk population since asymptomatic cases are common in the population.

Acknowledgement

We acknowledge the Ministry of Health, Delta State for ethical approval, the Medical Director and staff of Central hospital Warri, and the participants within Warri metropolis of Delta state.

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