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Nigerian Journal of Physiological Sciences
Physiological Society of Nigeria
ISSN: 0794-859X
Vol. 19, Num. 1-2, 2004, pp. 98-101
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Nigerian Journal of Physiological Sciences, Vol. 19, No. 1-2, June/Dec,
2004, pp.98-101
SEROPREVALENCE OF HIV INFECTION AMONG ORTHOPAEDIC AND PLASTIC SURGERY PATIENTS
IN ENUGU, NIGERIA - A SIX MONTH STUDY
R. O. NNELI*, F. C. AKPUAKA+, V.N.EGBUONU++, C.
OKWUONU++
*Departmens of Physiology, and +Department of Anatomy and Plastic
Surgery, College of Medicine and Health Sciences, Abia State University,
P.M.B.2000, Uturu. Nigeria ++ Immunologic Unit,
Department of Medical Laboratory Sciences, National Orthopaedic Hospital,
P.M.B. 01294, Enugu.
Received: May 30, 2004
Accepted: August 17, 2004
Code Number: np04017
Summary:
As the HIV pandemic continues to ravage every aspect of humanity,
there is a need to document its incidence and prevalence in various medical
subdivisions. This six-month study reports on the sero- prevalence of HIV
infection among orthopaedic and plastic surgery in- patients. Out of a total
of 121 patients
screened using Capillus test kit for HIV-1 / HIV-2, 10 patients were HIV
positive while 111 patients were HIV negative and this gave a seroprevalence
of 8.26
percent. Out of these, 73 plastic surgery patients were screened of which
6 patients or 8.22 percent were HIV positive. This shows that the prevalence
rates for both categories of patients were significantly higher than the
5.8
per cent national seroprevalence for HIV / AIDS. This raises a risk factor
for both surgeons and other patients undergoing elective procedures in these
two subdisciplines by contamination.
Key Words: HIV infection, seroprevalence, plastic, orthopaedic,
surgery,
Introduction
The incidence and prevalence of HIV infections among patients of various medical
specialties in Nigeria have been reported (Idigbe et al, 1994; Harry et
al, 1994, 1999; Anteyi et al, 1996; Angyo et al, 1998; 2000;
Emordi and Okafor, 1998; Mgbor and Okafor, 2002; Aghaji and Odoemene, 2002,
Otuonye et al, 2002; Nneli, 2003). Rankin(1993). Reported that blood
transfusion was a common prerequisite for major orthopaedic interventions such
as scoliosis, amputation surgery following trauma. Blood transfusion, an important
elective procedure demands that HIV screening should be carried out since it
has been identified as a major route of the virus transmission in sub-Saharan
Africa including Nigeria (Quinn et al, 1986; Anon.1987; Ola and Chikwem,
1991;Savant et al,1992;Harry et al,1993). The fact remains that needle
stick injuries perforate gloves and hence a possible means of transferring
infection either from the surgeon or the patients has been reported (Mingoli et
al, 1996). Also, surgeons are additionally exposed to contaminated fluids
from splashes, seepages, or penetrating injuries from instruments, bone fragments
or needles. Tokers et al (1992) cited an incidence of a patient who
was infected through a previous operation by an infected surgeon. There is
lack of established policies for the protection of surgeons and their patients
from HIV infection in spite of wearing goggles / gloves, aprons etc.. It has
been reported that surgical practice in Africa has become a neglected but important
means of spreading human immunodeficiency virus (HIV) (Africa Health, 2002).
Since patients for surgery can infect surgeons, it was necessary to ascertain
the seroprevalence rate of patients when they come for surgery and compare
with the national seroprevalence rate.
Subjects and Methods
Subjects
The study involved a total of 121 in patients made up of 63 for plastic
surgery elective procedures and 48 for orthopaedic surgery elective procedure
on admission at the National Orthopaedic Hospital, Enugu, Nigeria. This six
month study was carried out between January to June 2002.
Sample Collection
Blood samples were collected intravenously from each Patient for routine
HIV screening test done between 10.00 am 12.00 noon. Samples were collected
into glass test tubes containing EDTA. The samples were centrifuged at 17
r.p.m. and thereafter, the plasma / serum was employed for the screening test.
Each sample had an identification number or name assigned to it upon collection.
The Capillus test kit for HIV- 1 / HIV 2 (Trinity Biotech Plc., Wicklow,
Ireland) designed for human serum, plasma or whole blood was employed after
centrifugation. The latex reagent was
drawn up to 120ul in the dropper. Then, the reagent was dispensed on the edge
of the test sample, was mixed in the mixing well of the slide with the tip of
the pipette. A precallibrated pipette had a fresh disposable tip attached to
it and 10ul volume of the test or control was retrieved. The mixed reagents
were drawn to the flow channel and the reagent moved towards the viewing window
via capillary action. Samples with HIV 1 / HIV-2 specific antibodies caused
the antigen coated latex to aggregate. The capillary flow enhanced the binding
of specific antibodies to the latex and hence promoted aggregation. The reaction
was visually inspected when the latex
solution had reached the viewing window. Aggregation in the viewing window was
considered initially reactive, that is, positive. A smooth milky appearance was
considered non-reactive, that is, negative.
Results
Table 1 shows the result obtained from this study. A seroprevalence rate of
8.26 percent was observed for the total number of patients studied within this
period. The seroprevalence rate of 8.33 percent was obtained for HIV positive
orthopaedic patients. The seroprevalence rate for plastic surgery patients
was 8.22 percent. The monthly prevalence in this study is shown in Table 1
for each category. Table 2 shows a summary of the seroprevalence. One incidence
of HIV positive with pulmonary tuberculosis was observed in an orthopaedic
patient. Also, one incidence of HIV positive with infective hepatitis B positive
was observed in a plastic surgery patient.
Table 1: Seroprevalence rate of HIV infection among orthopaedic and plastic
surgery in patients in Enugu, Nigeria.
Patients
|
No. of HIV+
|
No. of HIV-
|
% Prevalence
|
Orthopaedic
|
4
|
44
|
8.33
|
Plastic
|
6
|
67
|
8.22
|
Total
|
10
|
111
|
8.26
|
Table 2: Summary of the seroprevalence rate of HIV infection among Orthopaedic
and plastid surgery in patients by months.
Orthopaedic Patients Plastic Patients
Months
|
HIV+
|
HIV-
|
% Prev.
|
HIV+
|
HIV-
|
% Prev.
|
January
|
0
|
0
|
0
|
0
|
3
|
0
|
February
|
0
|
3
|
0
|
0
|
6
|
0
|
March
|
1
|
8
|
11.1
|
1
|
10
|
9.09
|
April
|
1
|
9
|
10.0
|
2
|
21
|
8.7
|
May
|
1
|
11
|
8.3
|
3
|
14
|
17.6
|
June
|
1
|
13
|
7.1
|
0
|
13
|
0
|
Total
|
4
|
44
|
6
|
67
|
|
|
Discussion
The seroprevalence rate obtained in this study was higher than the national
seroprevalence rate of 5.8 percent (Federal Ministry of Health, 1999; 2001).
This high incidence corroborates the common observation in medical practice
that medical problems which bring patients to the hospital afford the opportunity
for the identification of underlying ailments like HIV infection detected herein.
It was in contrast to a cited trend in which HIV infected people prefer places
of alternative medicine (Ofoegbu, 1998). The seroprevalence of HIV among orthopaedic
and plastic surgery in patients was higher than those for HIV infection in
Tuberculosis(TB) patients which was 5.3 percent(Idigbe et al, 1994)
and 5.4 percent reported for ENT(Mgbor and Okafor(2002) while it was closely
related to those of medical wards admission which was 7.4 percent(Onwubere
and Ike,1999) and seroprevalence rate of 8.6 percent for pregnancy in Ondo
State (Akinbobola,2003). This rate was much lower than the rates of 35 45
percent of HIV positive obtained in Zambia for adult admissions for orthopaedic
related surgeries( Jellis and Regisford, (1990). Our result was
also lower than the 20 percent HIV eropositivity obtained from 1988 1993
for adult road accident victims in Zambia(Rankin, 1993). Since orthopaedic
and plastic surgery patients were not sick before admission into hospital,
their seroprevalence rate can be indicative of the population. So, this study
suggests that the national seroprevalence rate may be higher than 5.8 percent
reported by the Federal Ministry of Health. There is therefore the need for
caution. Some orthopaedic surgeons we interacted with in the course of this
study did not consider HIV / AIDS any serious threat to their lives nor to
their patients. We suggest that urgent precautionary measures should be enacted
by the relevant professional bodies to protect both the surgeons and patients
against potential risk during invasive surgical procedures.
Acknowledgement
We wish to thank immensely Dr. U. N. Enweani, Chairman of RET for granting
us the approval to carry out this study, and Mr. Ikechi of RET as well as the
Chief Medical laboratory Scientist for their assistance.
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© Physiological Society of Nigeria 2004
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