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% 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 % 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 Total number HBV infection 257(54.3%) 123(50%) HCV infection 5(1.06%) 5(2.03%)

Results of Screening Exercise Total number of subjects 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:

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: 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:

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