High levels of Zinc-α-2-Glycoprotein among Omani AIDS patients on combined antiretroviral therapy

OBJECTIVE

To investigate the levels of zinc-α-2-glycoprotein (ZAG) among Omani AIDS patients receiving combined antiretroviral therapy (cART).

METHODS

A total of 80 Omani AIDS patients (45 males and 35 females), average age of 36 years, who were receiving cART at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, were tested for the levels of ZAG. In addition, 80 healthy blood donors (46 males and 34 females), average age of 26 years, attending the SQUH Blood Bank, were tested in parallel as a control group. Measurement of the ZAG levels was performed using a competitive enzyme-linked immunosorbent assay and in accordance with the manufacturer's instructions.

RESULTS

The ZAG levels were found to be significantly higher among AIDS patients compared to the healthy individuals (P=0.033). A total of 56 (70%) of the AIDS patients were found to have higher levels of ZAG and 16 (20%) AIDS patients were found to have high ZAG levels, which are significantly (P>0.031) associated with weight loss.

CONCLUSIONS

ZAG levels are high among Omani AIDS patients on cART and this necessitates the measurement of ZAG on routine basis, as it is associated with weight loss.

Hepatitis B virus carrier rate, prevalence and susceptibility and impact of immunization program among households in the city of Taiz, Yemen

OBJECTIVE

To examine the carrier rate, prevalence and susceptibility to hepatitis B virus infection in the city of Taiz, Yemen.

METHODS

In a community-based household survey 521 subjects from 98 randomly selected households were enrolled. Carrier rate, prevalence and susceptibility of hepatitis B virus infection in the city of Taiz, Yemen were examined.

RESULTS

The median age of the subjects was 19 years (range <1-85 years), 219 (42.0%) of whom were males and 305 (58.0%) were females. The HBsAg carrier rate was 4.2% (22/521), the prevalence was 16.9% (88/521) and the susceptibility rate was 57.5% (287/499). Male vs female carrier rate, prevalence and susceptibility rate were comparable. Children (age ≤ 18 years) vs adults had carrier rates of 2.7% vs 5.7% (odds ratio=2.2) and a prevalence of 5.1% vs 28.4% (OR: 5.6). The carrier rate, prevalence and immunity to HBV among subjects who reported vaccination vs those unvaccinated was; 2.1% vs 5.5%, 11.3 vs 20.8% and 53.1% vs 18.8%. A proportion of 47.2% of subjects who aged ≤ 10 years had isolated anti-HBs. Of 142 of the cohort born after full implementation of vaccination program (age:≤ 9 years) 72 (50.7%) were immune and 70 (49.3%) were susceptible whereas of 357 subjects borne before program implementation (Age:≥ 10 years) 140 (39.2%) were immune and 217 (60.8%) were susceptible (p<0.02 (Pearson) OR: 1.6 CI=0.42-0.93).

CONCLUSIONS

An intermediate endimicity was identified in Taiz city. Vaccination reduced carrier rate prevalence and susceptibility among vaccinated subjects. The high rate of subjects with isolated anti- HBs together with the reduced susceptibility rate among the cohort born after inclusion of HBV vaccine to EPI reflects impact of the program. Improving vaccination coverage will further reduce susceptibility rate.

Prevalence of antibodies to measles and rubella in Sana’a, Yemen

Prevalence of antibodies to measles and rubella was tested in sera collected from 1368 subjects in urban and rural Sana'a. Overall, 11.7% had no antibodies to measles and 14.6% had no antibodies to rubella, despite the fact that measles but not rubella vaccine is included in the vaccination program in Yemen. Of 89 children <5 years of age 49 (55.1%) had no detectable antibodies to measles, demonstrating that supplementary measles immunization campaigns are required to prevent virus circulation. Assessment of measles immune status among infants in the first year of life is required to determine the optimum age for measles vaccination. Rubella vaccination should be considered with care in Yemen.

Prevalence of blood-borne viral hepatitis in different communities in Yemen

It is generally believed that hepatitis B (HBV) and C (HCV) viruses are highly prevalent in the Republic of Yemen. This study investigated the prevalence of HBV and HCV markers in 494 blood donors from Aden, 493 blood donors from Sana'a, 97 residents from an African ethnic minority in Sana'a and 99 residents of Soqotra Island. There were significant differences in the prevalence of HBV carriage (HBsAg: 6.7, 15, 19.6 and 26.3% respectively; P < 0.001); past HBV infection (anti-HBc: 17.4, 18.5, 30.9 and 59.6% respectively; P < 0.001); susceptibility to HBV (absence of HBV markers: 73.3, 61.9, 38.1 and 9.1% respectively; P < 0.001), infectivity of HBV carriers (HBV DNA: 51.5, 33.8, 52.6 and 65.4% respectively; P = 0.028) and HCV antibodies (RIBA confirmed or indeterminate: 0.6, 0.2, 5.2 and 5.1% respectively; P < 0.001). A significant difference in HBV carrier rate and a borderline significant difference in the prevalence of natural infection was observed between males and females in the African community (P = 0.02 and 0.06 respectively). In contrast, in Soqotra Island, there was no significant sex difference in HBV carrier rate but susceptibility was significantly more prevalent in males (P = 0.03). This study illustrates that significant difference in prevalence and epidemiology exists among different communities within the same country, reflecting political, geographical and social differences. Control strategies should take these differences into account.

Prevalence of rubella antibodies among schoolgirls in Sana'a, Republic of Yemen

To determine the prevalence of rubella antibodies and age of exposure to rubella among Yemeni schoolgirls, we studied the sera samples of 323 female students (age range 11-21 years; mean age 16.26 +/- 1.89 years) drawn from three schools in Sana'a. All samples were screened for rubella IgG antibodies using enzyme linked immunosorbent assay and, if negative, for IgM in order to exclude the possibility of recent exposure. Of 323 sera, 296 (91.64%) were positive for rubella IgG. All IgG negative sera were also IgM negative. Comparable antibody prevalence was observed in all age groups. The prevalence of rubella IgG among Yemeni schoolgirls is high, with most becoming immune between the ages of 11 and 21 years. Although the age of exposure seems to be < or = 13 years, further investigation is needed to confirm this.

Hepatitis G virus RNA and its relation to hepatitis C infection in adult haemophilic patients

The prevalence of hepatitis C virus (HCV) infection and hepatitis G virus (HGV) RNA were studied in 50 adult haemophilic patients who had received commercial clotting factors prior to 1980. HGV RNA was detectable in 6/ 50 patients (12%); 49/50 (98%) had antibody to HCV and 40/49 (82%) of these were viraemic with detectable HCV RNA; 5/6 patients with detectable HGV RNA had co-existing HCV infection and viraemia. The HGV PCR products from all six patients were directly sequenced and all were shown to be similar to that of HGV but more diverse from that of GB virus C. One patient who had persistent abnormal liver function tests had detectable HGV RNA but no evidence of hepatitis B or C. The presence of HGV RNA in the absence of hepatitis B and C infection indicates that this virus is capable of independent transmission. Independent response to interferon was demonstrated in one patient with co-infection who lost HGV but not HCV after interferon therapy.