EPIDEMIOLOGY OF HEPATITIS B AND C VIRUS INFECTIONS AMONGST HIV PATEPIDEMIOLOGY OF HEPATITIS B AND C VIRUS INFECTIONS AMONGST HIV PATIENTS ON HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY IN SOUTHEASTERN NIGER

SOURCE:

Faculty: Biosences
Department: Applied Microbiology And Brewing

CONTRIBUTORS:

Okoli, C.S;
Nwobu, R.A.U;

ABSTRACT:

Hepatitis B virus (HBV) and Hepatitis C virus (HCV) co-infection is the leading cause of morbidity and mortality in HIV infected patients especially in developing countries. These have been shown to decrease the life expectancy in the HIV infected patients. Hence this study was designed to study the epidemiology of HBV, HCV and HBV/HCV co-infections in HIV patients attending Government Tertiary Hospitals in Southeast Nigeria. A cross-sectional study was conducted among 2,500 HIV patients on highly active antiretroviral therapy (HAART) attending Government Tertiary Hospitals in Ebonyi, Enugu, Abia, Imo and Anambra. The hospitals are Federal Teaching Hospital Abakaliki, Enugu State University Teaching Hospital, Federal Medical Centre Umuahia, Federal Medical Centre Owerri and Chukwuemeka Odumegwu Ojukwu University Teaching Hospital Awka respectively from February 2016 to November 2017. Socio¬-demographic and risk factors were collected using a structured questionnaire. Hepatitis B and C sero markers were detected using an Enzyme Linked Immunosorbent Assay (ELISA) while HBV and HCV genotypes were detected by Polymerase Chain Reaction (PCR). Reitman-Frankel colorimetric method was used in determining Alanine aminotransferase (ALT) and Aspartate Aminotransferase (AST) while Phenolphthalein monophosphate method was used in the determination of Alkaline Phosphatase (ALP). Haemocue Haemoglobin meter 301 was used to test for Haemoglobin and the cluster of differentiation T- lymphocytes class-4 (CD4+) levels were also determined using CD4 test count kit with Cyflow Counter. DNA and RNA were extracted using roche high pure viral nucleic acid kits and amplified by AB3130 Applied Biosystem Thermocycler. The results were analyzed using percentage frequency (%) and Statistical Package for Social Sciences (SPSS) software, version 20.0 and statistical significance was considered at P<0.05. Out of the 2,500 HIV patients sampled, 256 (10.2%), 175 (7.0 %) and 25 (1.0%) were positive for HBV infection, HCV infection and HBV/HCV co-infection, respectively. Enugu State showed the highest seroprevalence rate to hepatitis B virus surface antigen (HBsAg) with 62 (12.4%) and the least by Ebonyi State with seroprevalence rate of 42 (8.4%). In this study, 175(7.0%) were positive for Anti-HCV, the highest seroprevalence rate was recorded in Anambra and Enugu States with (10.0%) each and Imo State recorded the least seroprevalence (4.0%). The distribution of hepatitis B virus surface antigen showed that the age range of 31-40 years had the highest prevalence of 70 (17.5%) and the least prevalence was >70 years 6 (2.4%). Also, distribution of hepatitis C virus by age, 31 -40 years showed the highest prevalence of 70 (17.5%) and 51 -60 years showed the least prevalence of 15 (3.7%), but <10 years recorded 0.0%. Out of 1400 (56%) males and 1100 (44.0%) females 11.8% and 8.2% were sero positive to hepatitis B virus surface antigen (HBsAg) respectively, while 85 (6.1%) males and 90 (8.2%) females were positive to hepatitis C virus antibody. Associated risk factors and socio¬demographic parameters of HIV patients positive to HBV, HCV and HBV/HCV co-infections showed statistical significance (P<0.05), hence are significant risk factors. This study showed that P>0.05 is not statistically significant with regards to haematological and biochemical parameters except for CD4+ in HBV/HIV patients (P=0.000), also CD4+ and AST in HCV/HIV patients (P =0.000 and 0.006) and ALT in HBV/HCV/HIV patients (P=0.026) which showed statistical significance (P<0.05). DNA and RNA genotyping respectively showed hepatitis B with genotype E and genotype 2 for hepatitis C virus. Homology with consensus sequence of HBV genotype E were 99% and that of HCV genotype 2 were 96-98%. The findings show the importance of screening for hepatitis B and viruses in HIV infected individuals. HBV and HCV being a co-morbid infection and a threat were recorded in Eastern Nigeria; hence there is a need to give health education concerning transmission, risk factors and prevention of these viral infections. Government should create centers for the vaccination of populace.