PREVALENCE OF HCV INFECTION AMONG HIV PATIENTS
ADMITTED AT MBARARA REGIONAL REFERRAL HOSPITAL
1. Background
Hepatitis C Virus (HCV) was first recognized in 1989 to be a cause of acute and chronic hepatitis
related to transfusion (1). HCV is the second major viral infection next to human
immunodeficiency virus (HIV) for more than two decades. This becomes a major public health
problem causing estimated annual deaths of 350,000 patients worldwide. Globally, an estimated
71 million people are chronically infected with HCV of which 5 million people are co-infected
with both HIV and HCV. The prevalence of HIV/HCV co-infection is higher in developing nations
which disproportionally varies geographically in sub-Saharan Africa from 0% to 22% (2 - 4).
HCV is associated with chronic liver disease leading to cirrhosis as well as hepatocellular
carcinoma; about 20% of patients with chronic HCV infection are more prone to develop cirrhosis
over an interval of 20 to 50 years (5-8). HIV/HCV coinfection is known to increase the incidence
of end-stage liver disease which is more severe in immunosuppressed patients infected with HIV
than those who have HCV infection alone as a result, HIV-infected individuals are at risk of being
coinfected with HCV (9-11). HIV suppresses the immune system of an infected host which creates
a conducive environment for HCV to lower viral clearance of HCV infection, increase levels of
HCV RNA in body fluid, aggravate progression of infection to HCV-related end-stage liver
disease, and increase risk and frequency of hepatotoxicity of antiretroviral treatment (ART).(12).
Studies have suggested appropriate management and monitoring are needed to improve the quality
of treatment and increase life expectancy of HIV-infected patients coinfected with HCV. Hence,
the magnitude and predisposing risk factors should be well investigated to design strategies and
take measures for reduction of such co-morbidities. Besides, all HIV patients should be routinely
tested for markers of HCV infection, and emphasis should be given towards the advantage of early
detection and therapy to reduce morbidity and mortality rate. Despite these facts, little attention is
given about HCV/HIV coinfections in Uganda, and the recent ART guidelines of the country
recommends only a liver function biochemical test, the alanine amino transferase (ALT) level test,
to identify liver-related complications among HIV patients rather than routine screening tests for
HCV (13-20).
2. Problem statement
Hepatitis C virus (HCV) infection is very dangerous due to the breakthrough of long-term
asymptomatic condition (21). HCV is strongly associated with human immunodeficiency virus
due to shared risk factors and mode of transmission. It is among of the leading cause of morbidity
and mortality among HIV patients. Acute HCV hepatitis in immunocompetent individuals is
generally asymptomatic, but when it comes to immunocompromised patients they tend to
experience lymphoplasmatic portal inflammation, interface hepatitis, necroinflammatory lobular
changes, moderately advanced fibrosis or rapid progression to fibrosis over a period of time (22).
Moreover, various routes of transmission have been involved such as exchange of blood or other
body fluids during injecting, drug use or tattooing practices using contaminated needles, and sexual
contact or through mother to child transmission (23-24). Despite the current global effort geared
towards elimination of HCV in Uganda, the burden of HCV infection among patients with HIV
remains unknown in Uganda (25). Due to inadequacy data on HCV prevalence in Mbarara
Regional Referral Hospital there is a need to study the prevalence of HCV infections among
patients with HIV and pinpoint the risks involved and how to limit or reduce HCV infections.
3. Rationale
HCV transmission can occur within health care and other settings such as hospitals, nursing homes,
adult homes, outpatient clinics, tattoo and piercing businesses. The use of universal/standard
precautions, proper disinfection and sterilization of equipment and other instruments will prevent
further transmission from occurring within these settings.
4. Research questions
i.
What is the proportion of HCV infection among patients with HIV admitted at MRRH?
ii.
What are the risk factors associated with HCV infection among patients with HIV
admitted at MRRH?
iii.
What are the socio-economic factors of HCV infected patients among patients with
HIV admitted at MRRH?
5. Objectives
5.1
Main objectives
The aim of this study is to determine the prevalence of HCV infection among patients with HIV
admitted at Mbarara Regional Referral Hospital in Uganda.
5.2
Specific objectives
a) To determine the proportion of HCV infection among patients with HIV admitted at
MRRH.
b) To determine risk factors associated with HCV infection among patients with HIV
admitted at MRRH.
c) To identify the socio-economic factors of HCV infected patients among patients with
HIV admitted at MRRH.
6. Methodology
6.1
Study Design and Setting
This will be a cross-sectional study which will involve HIV-infected adult patients admitted at
Mbarara Regional Referral Hospital at the time of study. Data collection will be done by using a
questionnaire.
6.2
Sample Size Determination and Sampling Technique
6.2.1 The following formula will be used for sample size determination:
n=Z2 x P(1−P)/e2,
Where n = the minimum sample size required, Z = (1.96) the significant value for 95% confidence
interval, P = (6.9%) (Freitas et al., 2014) the expected co infection of HCV and HIV patients,
and e= the margin of error (0.05).
n = 1.962 x 0.069 x (1-0.069)/0.052 = 99
The minimum sample size will be 99 HIV patients.
6.2.2 Sampling technique
The study will employ a convenient sampling technique in which all patients with HIV infection
will be included in this study
6.2.3 Inclusion criteria
All HIV infected patients admitted at Mbarara Regional Referral Hospital and those who will
consent to be involved in this study.
6.2.4 Exclusion criteria
All HIV infected patients admitted at MRRH who will be in critical medical condition
6.3
Data Analysis Procedure
Data generated will be checked for completeness and entered into Statistical Packages for Social
Science (SPSS) software for analysis. Moreover, a multivariate analysis will be computed to
identify factors that independently influence the occurrence of the dependent variable. For a
P value <0.05 with 95% confidence interval will be considered statistically significant.
6.4
Ethical Considerations
Ethical clearance will be sought from the research ethical committee of MUST University and
Mbarara Referral Hospital research committee. All information with regard to patients and other
generated data from patients will be confidential and umbers will be assigned to each of the
respondent and used during data scrutinization.
1. https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-12-S2-S2
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1415841/
3. https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecularbiology/hepatitis-c-virus
4. http://hepctrust.org.uk/about-hepatitis-c-virus. Accessed on 10/04/2023
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863002/
6. Takano, S.; Yokosuka, O.; Imazeki, F.; Tagawa, M.; Omata, M. Incidence of hepatocellular
carcinoma
in
chronic
hepatitis
B
and
C:
A
prospective
study
of
251
patients. Hepatology 1995, 21, 650–655. [PubMed]
7. Takayama, T.; Makuuchi, M. Segmental liver resections, present and future-caudate lobe
resection for liver tumours. Hepatogastroenterology 1998, 45, 20–23.
8. Llovet, J.M.; Ricci, S.; Mazzaferro, V.; Hilgard, P.; Gane, E.; Blanc, J.F.; de Oliveira, A.C.;
Santoro, A.; Raoul, J.L.; Forner, A.; et al. Sorafenib in advanced hepatocellular
carcinoma. N. Engl. J. Med. 2008, 359, 378–390.[PubMed]
9. A. H. Mohsen, P. Easterbrook, C. B. Taylor, and S. Norris, “Hepatitis C and HIV-1
coinfection,” Gut, vol. 51, no. 4, pp. 601–608, 2002.
10. World Health Organization, Fact Sheet of Hepatitis C, WHO, Geneva, Switzerland, 2020.
11. M. J. Alter, “Epidemiology of viral hepatitis and HIV co-infection,” Journal of
Hepatology, vol. 44, pp. 6–9, 2006.
12. Khalili M, &
Burman B (2013).
Liver
disease. Hammer G.D., & McPhee
S.J.(Eds.), Pathophysiology of Disease: An Introduction to Clinical Medicine, Seventh
Edition.
McGraw
Hill. https://accesspharmacy.mhmedical.com/Content.aspx?bookid=961&sectionid=5355
5695
13. Gedefie A, Adamu A, Alemayehu E, Kassa Y, Belete MA. Hepatitis C Virus Infection
among HIV-Infected Patients Attending Dessie Referral Hospital, Northeastern Ethiopia.
Int J Microbiol. 2021 Jan 22;2021:6675851. doi: 10.1155/2021/6675851. PMID:
33552160; PMCID: PMC7846398.
14. Zaltron S., Spinetti A., Biasi L., Baiguera C., Castelli F. Chronic HCV infection:
epidemiology
and
clinical
relevance. BMC
doi: 10.1186/1471-2334-12-s2-s2. [PMC
free
Infectious
Disease. 2012;12(S2)
article] [PubMed] [CrossRef] [Google
Scholar]
15. Mohsen A. H., Easterbrook P., Taylor C. B., Norris S. Hepatitis C and HIV-1
coinfection. Gut. 2002;51(4):601–608.
doi: 10.1136/gut.51.4.601. [PMC
free
article] [PubMed] [CrossRef] [Google Scholar]
16. World Health Organization. Fact Sheet of Hepatitis C. Geneva, Switzerland: WHO;
2020. [Google Scholar]
17. Alter M. J. Epidemiology of viral hepatitis and HIV co-infection. Journal of
Hepatology. 2006;44:6–9.
[CrossRef] [Google Scholar]
doi: 10.1016/j.jhep.2005.11.004. [PubMed]
18. Barth R. E., Huijgen Q., Taljaard J., Hoepelman A. I. Hepatitis B/C and HIV in SubSaharan Africa: an association between highly prevalent infectious diseases. A systematic
review and meta-analysis. International Journal of Infectious Disease. 2010;14:1024–
1031. doi: 10.1016/j.ijid.2010.06.013. [PubMed] [CrossRef] [Google Scholar]
19. Lauer G. M., Walker B. D. Hepatitis C virus infection. New England Journal of
Medicine. 2001;345(1):41–52.
doi: 10.1056/nejm200107053450107. [PubMed]
[CrossRef] [Google Scholar]
20. Bruno R., Sacchi P., Puoti M., et al. Pathogenesis of liver damage in HCV–HIV
patients. AIDS Reviews. 2008;10:15–24. [PubMed] [Google Scholar]
21. Bastos JCS et al World J Gastroenterol 2016; 22(28): 6393-6401)
22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146761/
23. Alter M. Hepatitis C virus infection in the United States. J Hepatol 1999;31(Suppl 1):88–
91.
24. https://www.pnas.org/doi/full/10.1073/pnas.0703039104
25. Joan Nankya-Mutyoba, Betty S. Apica, Grace Otekat, Dorothy B. Kyeyune, Lourita
Nakyagaba, Joletta Nabunje, Mary Nakafeero, Emmanuel Seremba, Ponsiano Ocama,
Hepatitis C in Uganda: Identification of infected blood donors for micro-elimination,
Journal of Virus Eradication,Volume 7, Issue 2,2021,100041,ISSN 2055-6640,
https://doi.org/10.1016
/j.jve.2021.100041.(https://www.sciencedirect.com/science/article/pii/S20556640210001
45)
26. (https://www.health.ny.gov/diseases/communicable/hepatitis/strategic/background_ration
ale_hepatitis_c.htm)