State of Hepatitis C- The Nigeria
Experience
Ghana 12th 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%
• North Africa – 9.6%-13.6%
• Egypt has the highest prevalence worldwide
9-50%
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)
• Previous blood transfusion 14 (15.6%)
• Previous surgical procedure 27 (30.0%)
• Tattooing
33 (36.7%)
• Illicit self-injection
12 (13.3%)
• Multiple sexual partners
6 (6.7%)
• Exposure to jaundiced subject 13 (14.4%)
• Dental extraction
32 (35.6%)
• Scarification
66 (73.3%)
• Ear piercing
47 (52.2%)
• Circumcision
42 (46.7%)
• Uvulectomy (by native doctors) 4 (4.4%)
Controls (N=90)
18 (20.0%)
25 (27.8%)
27 (30.0%)
14 (15.6%)
0
14 (15.0%)
22 (24.4%)
53 (58.9%)
37 (41.1%)
39 (43.3%)
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