Browsing by Author "Adal, Melaku"

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    Characterization of Epidemiological Nutritional Immunological and Virological and Genetic Diversity Parameters in Hiv-Infected Individuals in Addis Ababa Ethiopia
    (Addis Ababa University, 2021-06-17) Adal, Melaku; Petros, Beyene (Professor)
    HIV prevalence in Addis Ababa is relatively high among the high risk population. The aim of the present study was to investigate epidemiological, nutritional, immunological, and virological factors and HIV-1 diversity in antiretroviral naïve HIV-infected adults in Addis Ababa. To optimize study site and participant selection, a sytematic review of the existing baseline information was done to determine the prevalence of HIV/AIDS, and the predisposing risk factors in Addis Ababa. Data relevant for the systematic review were collected from online databases. In addition, survey and surveillance reports, performance and project assessment findings were also collected and analysed. From February to August 2013, this cross-sectional study was conducted on samples of 594 HIV-1 infected ART-naïve adult study participants, from four hospitals in Addis Ababa. CD4+ T cell count, HIV RNA load, fasting serum glucose, hemoglobin, fasting serum triglyceride and total cholesterol concentrations were determined. HIV-1 RNA amplification and sequencing was performed on 60 plasma samples, and assembled using the iterative viral assembler method. REGA subtyping tool was used for scanning of recombination and subtyping. Prediction of coreceptor usage was performed using online tools and phylogenetic analysis done using MEGA. The Spearman correlation, chi-square, Mann-Whitney and Kruskal-Wallis, independent t tests; ANOVA and regression analyses were used for data analysis. The prevalence of HIV in Addis Ababa appears to have stabilized at around 3%, but was higher in MARPs. The prevalence of undernutrition, excess weight, obesity and hypercholesterolemia were 15.1%, 22.1%, 5.4% and 16.6%, respectively. The hypercholesterolemia prevalence was higher in females (18.9%) than in males (11.0%) (p < 0.05). The median CD4+ T cell count was 2 357 cells/mm3(IQR = 248-537). Detectable HIV RNA load of 4.23 ± 0.83 log copies/mLwas found for a sample of 500 study participants. Serum total cholesterol and CD4+ T cell count were significantly correlated with HIV RNA load (p <0.01). Having lower concentration of serum total cholesterol was an independent predictor of higher HIV RNA load (p <0.05). The immune status was better in females than males in the presence of higher serum total cholesterol (p<0.05). Genome sequencing of the HIV isolates identified 81.7% subtype C, 1.7% subtype A1, and 10% C/A1 and 5.0% C/A1/D recombinants. PhenoSeq results to determine coreceptor usage from the 50 genome sequences were 88.0% and 12.0% that correspond to R5 and CXCR4, respectively. Furthermore, subtypes HIV-1 C and A1; CRFs C/A1 and C/A1/D, and R5-viruses were dominant. Therefore, nutritional abnormalities in the ART naïve HIV-infected study participants indicate the need for targeted nutritional programs and regular lipid level monitoring as an integral part of HIV/AIDS care. The more than 14% WHO clinical stage III/IV patients detected among the study participants, categorized as ART naïve, showed the need to revise the patient care policy on ART-naïve status of HIV positive individuals. The study also indicated the need for further indepth studies on HIV-1 subtype diversity, CRFs and its phenotypic distribution for a better understanding of the epidemiology of HIV/AIDS. Such indepth characterization of HIV-1 sub-type diversity will be required for possible future use of maraviroc, the co-receptor antagonist, in HIV/AIDS treatment.
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