EPIDEMIOLOGICAL STUDY OF UROGENITAL SCHISTOSOMIASIS IN APPARENTLY HEALTHY AND HIVINFECTED FEMALES IN JOS, PLATEAU STATE, NIGERIA
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Abstract
This study is aimed at determining the status, prevalence and significance of female urogenital schistosomiasis (FUGS) in schistosomiasis endemic population at risk of HIV transmission in Jos, Plateau State. Epidemiological circumstances that predisposed individuals to urogenital schistosomiasis and HIV in Jos Plateau State, was investigated. FUGS was determined from parasitological and immunological techniques. Circulating cathodic (worm) antigen (CCA) was used as an additional immunodiagnostic tool to measure the worm burden of the study population. Commercial ELISA was used to determine HIV status while CCA and cytokine plasma levels were used to assess pathology and determine indices of FUGS. Immunological studies to provide evidence of FUGS morbidity, to establish the presence of immunopathology and other markers of FUGS were carried out using important regulatory T - cells and cytokines involved in cellular and humoral immune response. The physical nature and chemistry profile of study subjects were determined for urinary tract pathology, using urinalysis test strips. Data analyses, using expressive percentage, parametric and non-parametric tests were used to assess the significance of varied observations. Two Way analysis of variance was used for multiple comparisons while regression for linear relationships, were applied appropriately. Observations were confirmed significant at p = 0.05 in SPSS version 15.1 and all statistics; while Optical Density values were transformed by ELISA LogIt 2005 software. One thousand, two hundred and forty-five (1245) females were screened for S. haematobium. Urogenital schistosomiasis was confirmed in 265 (26.3%), in 11-20 year olds (28.3%) accounting for the highest infections (p < 0.05). HIV infection was 27(6.8%) and (9.4%) in 21-30 year olds. Students accounted for most infection (39.7%). Only 5.3% urinary schistosomiasis/HIV co-infections were recorded. Economic activities including, irrigation agriculture and domestic chores accounted for most water contacts (64.8%). About 70.9 % (381) presented with indices of FUGS pathology, including: blood, nitrate, xv protein, leucocyte in >45% of positive persons. Worm burden (from CCA level) was as high as 127 (67.8%; p > 0.05) among study groups. About 79.3% schistosomiasis and HIV infected groups expressed high level of IFN-γ (5-fold, p < 0.05). Tumor necrosis factoralpha (TNF-α) revealed elevation in 58.0% of the schistosomiasis, HIV and HIV/schistosomiasis co-infected subjects (p<0.05). Schistosomiasis infected group had a 7-fold plasma TNF compared to only a 2-fold elevation obtained in co-infected subjects. Interleukin (IL) - 4 presented more irregular interaction with a 42.3 fold elevation observed in HIV infected group, compared to 23.1 and 15.3-fold elevations recorded for single and co-infections. In all, changes in cytokines were marked with a general inconsistency across all groups. This demonstrates FUGS, HIV associated immunopathology and inflammatory reaction to Schistosoma infection. Rises in the levels of inflammatory cytokines (IFN-γ, TNF-α, IL-4) in schistosomiasis and HIV infection append to schistosomiasis morbidity via up-regulation of immunopathology of schistosomiasis and HIV replication, thus contributing to cytokine disorder. Results confirmed high FUGS and inflammatory cytokines; whose presence may constitute a significant risk factor in HIV acquisition and pathogenesis in Jos and perhaps north central Nigeria. It is hoped that this knowledge on urogenital schistosomiasis and HIV will rekindle public health interest and help to highlight the need for curbing the risk of these diseases. It is also hoped that it will emphasize the urgent need for the provision of safe water, sanitary facilities in endemic Nigerian communities.
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