State of Hepatitis C- The Nigeria Experience

Ghana 12th August, 2013

Dr. Adegboyega AkereLecturer/Consultant Physician & Gastroenterologist

University of Ibadan/University College Hospital, Ibadan, Nigeria

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%

http://www.google.com.ng/url?sa=i&rct=j&q=world+wide+prevalence+of+hepatitis+C+infection&source=images&cd=&cad=rja&docid=1gR8GtE8yrewlM&tbnid=3EI8tlwQZUfYoM:&ved=0CAUQjRw&url=http%3A%2F%2Fudel.edu%2F~kdob%2FHCVepidemiology.html&ei=j9X_Ua7fCKGI0AXmr4CQCQ&bvm=bv.50165853,d.ZG4&psig=AFQjCNHlsgte7NQh2I9B8moEs9vE6lml-g&ust=1375805349221215

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

• 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

• 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

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%)

Results of Screening Exercise

• Total number of subjects - 305

• HBsAg - 16 (5.25%)

• AntiHCV - 1 (0.33%)

Modes of Transmission

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

HCV Genotypes

Global Distribution of HCV Genotypes

Global Distribution of HCV Genotypes

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

Investigations• HBsAg, HIV

• Liver Function Tests

• Abdominal USS

• HCV RNA Assay

• HCV Genotype

• Full Blood Count

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