Prevalence of Human Immunodeficiency Virus and Hepatitis B Virus in Preoperative Patients: Potential Risk of Transmission to Health Professionals
The aim of present study was to determine the prevalence
of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) infections
in preoperative patients admitted for surgical procedures at the Lagos
University Teaching Hospital (LUTH), Lagos, Nigeria. Two hundred patients
(200 samples tested for HIV) and (100 samples tested for HBV) comprising
90 males (45%) and 110 females (55%) were recruited into the study. Sixty-eight
of the 200 patients (34%) were scheduled for emergency surgery (group
A) and 132 (66%) listed for elective surgery (group B). Seven (3.5%) of
the 200 patients tested positive for HIV-1 and 2 using the Well-coenzyme
method. Five (2.5%) and 2 (1%) of the 200 patients confirmed HIV-positive
were females and males respectively. Sixty-one percent of the 100 patients
tested for hepatitis B surface antigen were males and 39 (39%) females.
Eighteen percent of the 100 patients examined were positive for (HbsAg).
Ten percent of the 18 HBsAg-positive patients were males and 8 (8%) were
females. This study showed the prevalence rate of HIV and Hepatitis B
in preoperative patients at the Lagos University Teaching Hospital and
to some reflects the prevalence of HIV and HBV in the general population.
Both HIV and Hepatitis B Virus infections are endemic
in Nigeria and are important causes of morbidity and mortality (Mustapha
and Jibrin, 2004). Coinfection with HIV and HBV is a rapidly growing public
health concern (WHO, 2003). The sub-Saharan Africa has been most severely
affected by the HIV/AIDS pandemic with almost 9% of its adult population
living with HIV (WHO, 2003). The HIV epidemic in Nigeria has extended
beyond the commonly classified high-risk groups and is now common in the
general population with the adult prevalence rate at 5.8% in 2001 as reported
by Federal Ministry of Health, Nigeria (Anonymous, 2003). The report also
indicated that some parts of the country were worse affected than others
but no state is unaffected. All the states of Nigeria have general population
epidemics of over 1% with some areas having prevalence higher than 10%.
Furthermore, the infection cuts across both sexes and all age groups but
youths between the ages 20-29 years are more infected. Nigeria is classified
among the group of countries highly endemic for HBV infection. About 75%
of the Nigerian population is reportedly likely to have been exposed to
HBV at one time or the other in their life Sirisena et al. (2002).
Information is very scarce on the prevalence of HIV and
HBV in pre-operative patients in Nigeria. It should be noted that testing
for HIV and HBV infections is useful for epidemiological monitoring and
for public health planning. As a result of this dearth of information,
guidelines and other adequate information on the preventive and control
measures are essentially lacking in many settings in Nigeria. The objective
of the study therefore was to determine the prevalence of HIV and HBV
in pre-operative patients for epidemiological purpose and to prevent possible
transmission of these viruses to health workers.
MATERIALS AND METHODS
Study population: The subjects were patients admitted for surgery in the
different surgical wards of Lagos University Teaching Hospital (LUTH),
Nigeria. The patients were randomly selected and included males, females
and children of various ages. Verbal consent was obtained from each patient
and from the parents of under-aged patients before participating in the
Study design: Vene-puncture was carried out on all the patients
from the ante-cubital vein with minimal stasis and 10 mL of blood was
withdrawn. This was placed in plain sample tubes and allowed to clot.
Each tube of blood was accompanied by a requisition that included the
patients` given identity number (specifically for the study). A survey
form was designed that included patient demographic data and risk factor
information. All surgical staff and nurses were taught on how to ask questions
referable to risk factor and how to complete the forms. The research team
ensured that each patients` admission packet contained a survey form and
preaddressed envelop marked confidential. Information was obtained at
time of the admission examination. Completed forms were collected daily
and matched with blood samples. The sera were separated from cells and
stored frozen at -20°C and tested within 72 h.
Method of testing: Two samples were tested by an Enzyme-Linked Immuno-Sorbent
Assay (ELISA) technique, using Well-cozyme HIV-1 and 2 kits (Well-Cozyme
Diagnostics, Dartford, England). HbsAg test was carried out on 100 samples
using the slide method (HBV latex reagent, Abbott, USA) based on the ability
of latex particles coated with HbsAg specific antibodies to agglutinate
in the presence of Hepatitis B surface antigen. Positive samples with
ELISA were confirmed with Western blot test.
RESULTS AND DISCUSSION
In this study, a total of 200 patients were examined. Sixty eight
of the patients came in for emergency operations and 132 of the patients
were admitted for elective procedures. The results of this study are presented
in Table 1-4.
There are documented evidences of health workers becoming
infected with HIV after contact from an infected patient (Wormser et
al., 1988; Anonymous, 1988a). Surgeons and operating room personnel
are among those most likely to come in contact with blood from patients
(Hagan et al., 1988). To decrease the risk of infection, operating
room personnel attempt to treat every patient as if they are infected
with HIV. It could be argued, however, that knowing preoperatively which
patient is infected with HIV could result in procedural and behavioural
modifications that could further decrease the risk of infection being
spread to a health care professional. Although some have recommended patient
screening preoperatively (Leen et al., 1989), others are of the
opinion that testing all patients for the presence of HIV infection is
not appropriate (Hagan et al., 1988; Bokhout, 1988). To asses the
potential risk of exposure of health personnel especially operating room
of Human Immunodeficiency Virus (HIV) in preoperative patients in
relation to age
of Human Immunodeficiency Virus (HIV) in preoperative patients according
to category of operations
of Hepatitis B virus in preoperative patients in relation to age
of HIV in relation to type of surgical procedures
|-: Negative, +: Positive
emergent and elective surgical procedures, a prospective
study was carried to primarily determine the prevalence of HIV and Hepatitis
B infection in patients undergoing emergency and elective surgery at the
Lagos University teaching Hospital.
The results obtained from this study showed a sero-prevalence
of 3.5% HIV and 18% HBV infection. According to Diettrich et al.
(1991), the indications and spectrum of HIV-associated with elective surgery
reflect those seen in the general surgical practices and were similar
to those seen in the general populace. Results of the current study showed
a higher incidence in the patients listed for elective surgery (2.5%)
and thus suggests that the sero-prevalence of HIV infection could be on
the increase in the general population, as reflected in the WHO report.
This could also imply that health care workers may be encountering more
of these apparently healthy individuals harbouring the HIV, thus, exposing
them to the potential risks of acquiring HIV and HBV infections. The HBsAg
sero-positivity of 18% among preoperative patients confirmed that, Lagos,
Nigeria is endemic for HBV infection. Present results were in conformity
with earlier reports from community and hospital-based studies in some
parts of Nigeria, which showed high prevalence of HBsAg ranging from 7.4-26%
Ekpo et al. (1995).
At least 18 health workers, without risk factors, have been reported
to contact HIV infection after a known exposure to an infected patient
in a hospital setting (Anonymous, 1988b). The total number of health workers
who have become infected is unknown but is certainly higher than the figure
reported in our study. Elsewhere, of those health workers reported to
have occupationally acquired HIV infection, most have a history of needle-stick
exposure (Wallace, 1988). There are instances, however, in which the infection
has apparently taken place after only skin contact with blood (Anonymous,
1988b). These reports are of particular concern to surgeons and health
workers in the operating room setting. Even though gowns and rubber gloves
impervious to blood are worn routinely, this by no means protects the
operating room personnel from contact with blood. Studies have demonstrated
that as many as 34.5% of gloves contain holes (Dodds et al., 1988;
Fell et al., 1988), making skin contact with blood during every
operative procedure almost certain for one of the health workers involved
in the surgical procedures. In addition, inadverted punctures of the gowns
and gloves and even the skin with needles, wires, scalpels and other sharp
instruments used routinely in the course of surgery, occurs during virtually
every operative procedure. Thus even though universal precautions are
practiced in every operating room, defects in equipment and breaks in
routine occur so frequently, even with the greatest of care taken, that
health workers are exposed to the potential risk of HIV and Hepatitis
infection during operating procedures that are performed on infected patients.
In Nigeria, there is no documented report of operating room personnel
that has been infected with HIV and Hepatitis but the fact that these
personnel are daily being exposed to HIV-infected patients is a great
concern of the potential risk of infection.
On the basis of the results of this study, it is
concluded that the prevalence of HIV in preoperative patients is low.
Also, the patients who are HIV positive can be identified by simple questions
that should be routinely asked on admission. There will however, a small
group of patients who are HIV positive, who may not be identified by admission
history and thus remain a risk for health workers, particularly in the
operating room setting. It is therefore, important for general precautions
to be strictly adhered to in the hospital and particularly in the operating
room setting. Further study with larger population size is recommended.
This study however, provides important information on the sero-prevalence
of HIV and HBV in preoperative patients at the hospital. This finding
agrees with the report of World Health Organization that the incidence
of HIV and HBV is on the increase in the general population in the country
and needs to be urgently addressed.
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