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State of Hepatitis C- The Nigeria Experience Ghana 12 th August, 2013

State of Hepatitis C- The Nigeria Experience Ghana 12 th August, 2013. Dr. Adegboyega Akere Lecturer/Consultant Physician & Gastroenterologist University of Ibadan/University College Hospital, Ibadan, Nigeria. Incidence & Prevalence. Worldwide prevalence is 3% North America – 0.4%-1.1%

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State of Hepatitis C- The Nigeria Experience Ghana 12 th August, 2013

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  1. State of Hepatitis C- The Nigeria ExperienceGhana 12th August, 2013 Dr. Adegboyega Akere Lecturer/Consultant Physician & Gastroenterologist University of Ibadan/University College Hospital, Ibadan, Nigeria

  2. Incidence & Prevalence • Worldwide prevalence is 3% • North America – 0.4%-1.1% • North Africa – 9.6%-13.6% • Egypt has the highest prevalence worldwide 9-50%

  3. Prevalence in Nigeria • Prevalence among local blood donors in Nigeria ranges from 12.3-14.0% • Inyama et al in Jos found a prevalence of 5.7% among 490 Nigerians with HIV infection • A prevalence of 5.0% was observed among sickle cell anaemia patients in Lagos • Adewole et al in Abuja found a prevalence of 2.3% among 260 HIV patients

  4. Olokoba et al in Ilorin found a prevalence of 9.3% among 280 patients with DM • Pennap et al in Keffi among 113 apparently healthy local community, found a prevalence of 13.2% • Chukwurah et al in Enugu found a prevalence of 7.6% among 1280 blood donors • Alao et al in Makurdi found a prevalence of 5.4% among 1400 blood donors over 1 year period

  5. Laraba et al in Maiduguri in a study of 90 patients with CLD and 85 controls reported a prevalence of 14.4% and 2.4% respectively • Nwokediuko et al in Enugu found a prevalence of 14.1% and 3.7% among 191 diabetics and 134 controls respectively • Adegoke et al at Ile-Ife reported a prevalence of 0.8% and 2.2% among 115 diabetics and 2013 controls respectively • Balogun et al in Ibadan found a prevalence of 0% and 1.1% among diabetics and controls respectively

  6. Out-patients of the Gastroenterology Clinic UCH, Ibadan 2012 2013 • Total number 473 246 • HBV infection 257(54.3%) 123(50%) • HCV infection 5(1.06%) 5(2.03%)

  7. Results of Screening Exercise • Total number of subjects - 305 • HBsAg - 16 (5.25%) • AntiHCV - 1 (0.33%)

  8. Modes of Transmission

  9. Risk Factors for HCV infection Risk Factors Cases (N=90) Controls (N=90) • Previous blood transfusion 14 (15.6%) 18 (20.0%) • Previous surgical procedure 27 (30.0%) 25 (27.8%) • Tattooing 33 (36.7%) 27 (30.0%) • Illicit self-injection 12 (13.3%) 14 (15.6%) • Multiple sexual partners 6 (6.7%) 0 • Exposure to jaundiced subject 13 (14.4%) 14 (15.0%) • Dental extraction 32 (35.6%) 22 (24.4%) • Scarification 66 (73.3%) 53 (58.9%) • Ear piercing 47 (52.2%) 37 (41.1%) • Circumcision 42 (46.7%) 39 (43.3%) • Uvulectomy (by native doctors) 4 (4.4%) 12 (13.3%) Balogun et al. Low Prevalence of Hepatitis-C Viral Seropositivity among Patients with Type-2 Diabetes Mellitus in a Tertiary Hospital. Journal of the National Medical Association 2006;98:1805-08

  10. HCV Genotypes

  11. Global Distribution of HCV Genotypes

  12. Global Distribution of HCV Genotypes

  13. HCV Genotypes in Nigeria • Oni et al reported at least two major genotypes(1&4) in Nigeria Oni AO,et al. Genotypes of hepatitis C virus in Nigeria. J Med Virol.1996;49:178-86 • In a study conducted in two rural remote communities in North Central Nigeria (n=519), a prevalence of 15% was reported and the genotypes are: genotype 1(85%), genotype 2 (15%) Forbi JC, et al. Epidemic history of hepatitis C virus infection in two remote communities in Nigeria, West Africa. Journal of General Virology 2012;93:1410-21

  14. Investigations • HBsAg, HIV • Liver Function Tests • Abdominal USS • HCV RNA Assay • HCV Genotype • Full Blood Count

  15. Challenges of Managing HCV Infection • Poor knowledge of the importance of the infection by patients and some doctors • Practice by quacks who take advantage of patients • Equipments for further investigation of patients are not widely available • High cost of tests • High cost of drugs • High cost of managing side effects from the drugs

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