Hepatitis C virus antibody in HIV-1 infected Ugandan mothers

Hepatitis C and blood transfusion among children attending the Sickle Cell Clinic at Mulago Hospital, Uganda

BACKGROUND

Hepatitis C virus (HCV) accounts for 90% of post-transfusion hepatitis. In Uganda, there has been limited research of prevalence of HCV among sickle cell anaemia (SS) patients, a group at risk for multiple transfusions.

OBJECTIVES

To establish prevalence of HCV infection and determine whether blood transfusion increases risk among SS patients.

METHODS

244 SS patients aged 1-18 years were recruited by consecutive sampling. Socio-demographic, clinical and transfusion history was collected. Clinical examination done and blood tested for HCV by MEIA.

RESULTS

244 children were recruited. Of these, 159 (65%) had a history of blood transfusion. Among the transfused, five patients were HCV positive. Four of these were over 12 years of age. Among patients with no history of transfusion, one patient aged 14 years was HCV positive. Risk of HCV was higher among the transfused OR 2.7(CI 0.31-24). Patients who received more than two units were more likely to be HCV positive (p=0.03).

CONCLUSIONS

HCV prevalence of 2.5% was low but higher than that reported by other investigators in Uganda. Blood transfusion was a major contributing factor in occurrence of HCV. Children who get repeated transfusions should be screened for Hepatitis C and screening of blood for HCV prior to transfusion would help reduce occurrence of the disease.

Risk Factors and Seroprevalence of Hepatitis C among Patients Hospitalized at Mulago Hospital, Uganda

The emergence of hepatitis C virus (HCV) and its associated sequelae in Africa is a cause for significant concern. Human immunodeficiency virus (HIV) positive patients are at an increased risk of contracting HCV infection due to similar risk factors and modes of transmission. We investigated the seroprevalence of hepatitis C in hospitalized HIV-positive and HIV-negative patients in Mulago Hospital, an academic hospital in Uganda. Blood samples were first tested for HCV antibodies, and positive tests were confirmed with HCV RNA PCR. We enrolled five hundred patients, half HIV-positive and half HIV negative. Overall, 13/500 patients (2.6%) tested positive for HCV antibodies. There was no difference in HCV antibody detection among HIV-positive and HIV-negative patients. Out of all risk factors examined, only an age greater than 50 years was associated with HCV infection. Traditional risk factors for concurrent HIV and HCV transmission, such as intravenous drug use, were exceedingly rare in Uganda. Only 3 of 13 patients with detectable HCV antibodies were confirmed by HCV RNA detection. This result concurs with recent studies noting poor performance of HCV antibody testing when using African sera. These tests should be validated in the local population before implementation.

Trends in the incidence of primary liver cancer in Central Uganda, 1960-1980 and 1991-2005

Primary liver cancer (PLC) incidence trends from Africa are unknown. Using Kampala Cancer Registry data from 1960 to 1980 and 1991 to 2005, we identified 771 PLCs. Although rates were stable among men, PLC incidence among women increased >50%. Investigations of viral hepatitis, aflatoxin, obesity, and human immunodeficiency virus (HIV) may help to explain the increasing incidence of hepatocellular carcinomas (HCCs).

Etiology of acute sporadic hepatitis in adults in Senegal and Tunisia

Markers for acute hepatitis A, B, C and E virus infections were examined in the sera of 72 patients suffering from acute hepatitis in Senegal and Tunisia. Hepatitis B was responsible for 36% and hepatitis C for 21% of the cases. Acute hepatitis A was not diagnosed. HEV infection was not observed in Senegal and represents only 4% of the acute hepatitis cases in Tunisia.

Hepatitis B and C in Juba, southern Sudan: results of a serosurvey

To compare the epidemiology of hepatitis B virus (HBV) with hepatitis C virus (HCV) in a southern Sudanese population, 666 out-patients attending 6 public clinics in the city of Juba were enrolled in a serosurvey. The average age of subjects was 16 years; 54% were female. Of the 651 samples tested for hepatitis B markers, HBsAg was found in 26% and anti-HBc in 67%. In contrast, only 21 (3%) of the 666 samples were positive for anti-HCV using a second generation immunoblot assay (RIBA-2). Seventeen (81%) of the 21 anti-HCV-positive subjects were positive for anti-HBc, compared to 66% (418/630) of subjects negative for anti-HCV (P = 0.07). None of the anti-HCV-positive subjects reported receiving a prior blood transfusion and only 5 subjects reported a history of jaundice. Nine of the 21 (43%) anti-HCV-positive subjects reported a history of scarification, compared to 23% (148/645) of anti-HCV-negative subjects (P = 0.01). Hepatitis B infection was also associated with scarification by univariate analysis. However, after adjustment for age a history of scarification was not significantly associated with hepatitis C infection, but it was with HBV infection (odds ratio = 1.5, 95% CI 1.0-2.5; P = 0.05). The findings of this study indicate that HCV infection is not highly endemic in this population and that the epidemiology of HCV differs from that of HBV.

Prevalence of antibodies to hepatitis C virus among patients with leprosy in several African countries and the Yemen

The prevalence of anti-HCV was determined in 1,309 leprosy patients and a control group of 1,469 subjects from 6 sub-Saharan African countries and the Yemen. Sera found positive by an initial second generation ELISA were subjected to 3 additional confirmatory tests. The anti-HCV prevalence in leprosy patients (7.1%) was significantly higher than in the control group (2.6%). HCV seroprevalence increased with age in both the control and leprosy groups. No statistically significant difference could be found between anti-HCV prevalence and the several clinical forms of leprosy among patients. The results of this study indicate a high degree of exposure or chronic carriage of hepatitis C among leprosy patients.

Low risk of sexual transmission of hepatitis C virus in Somalia

The prevalence in Somalia of antibody to hepatitis C virus (anti-HCV) was determined in a survey of 236 female prostitutes, 80 sexually transmitted disease (STD) clinic patients, 79 male soldiers, and 43 tuberculosis patients. Of 98 (22%) serum samples repeatedly anti-HCV reactive by first and second generation enzyme-linked immunosorbent assay kits, only 8 (1.8%) were anti-HCV positive by immunoblot assay (RIBA-2). Anti-HCV seropositivity by immunoblot assay was not associated with any risk group or with positive syphilis serology (found in 18% of subjects) or antibody to human immunodeficiency virus 1 (in 1.4% of subjects). These data indicate that sexual transmission of hepatitis C virus is not common in Somalia among sexually active populations, including female prostitutes and other groups at high risk of STDs and the acquired immune deficiency syndrome.

Hepatitis C virus infection in different populations in Cameroon

We tested serum samples collected in an urban setting (Yaounde) and in a rural area (Manyemen) for the presence of antibody to hepatitis C virus (HCV) (anti-HCV). Screening was done by second-generation ELISA and confirmation with second-generation RIBA. In Yaounde, anti-HCV was found in 12.5% of patients with febrile jaundice (95% CL 3.8-21.2), 5.5% of pregnant women (95% CL 3.3-7.3), 0% of children below 4 years of age, 31% of sickle cell patients (95% CL 20.2-41.8%), 1.6% of medical students (95% CL 0-4.7%) and 15.4% of prostitutes (95% CL 8.5-22.3). Only HBsAg-negative sera were tested for anti-HCV, except sera originating from subjects with febrile jaundice. In Manyemen, anti-HCV was detected in 6.4% of blood donors, 6.0% of pregnant women, 5.3% of HIV-positive subjects, 7.3% of RPR-positive and 3.9% of RPR-negative subjects. There was an increase in antibody prevalence with age. We conclude that HCV infection is common in Cameroon and that it is transmitted mainly by blood transfusion and probably by sexual activity.

Immunodominant regions within the hepatitis C virus core and putative matrix proteins

The complete amino acid sequences of hepatitis C virus (HCV) core (residues 1 to 115) and putative matrix (residues 116 to 190) proteins were synthesized as 18-residue-long peptides with an 8-amino-acid overlap. The peptides were assayed with 50 human serum samples with antibodies to HCV (anti-HCV) and 46 serum samples without anti-HCV, as determined by several commercial assays. Immunodominant regions were defined within residues 1 to 18, 11 to 28, 21 to 38, 51 to 68, and 101 to 118. The peptides that covered these regions were recognized by 40 of 50 (80%), 42 of 50 (84%), 36 of 50 (72%), 34 of 48 (68%), and 36 of 48 (72%) of the anti-HCV positive serum samples, respectively. Two anti-HCV negative serum samples were each repeatedly reactive with one peptide, but both were found to be negative by confirmatory anti-HCV assays. Four serum samples that were confirmed to be positive for anti-HCV in commercial assays did not recognize any of the peptides that cover the HCV core-matrix regions. Ninety-two percent of anti-HCV-positive serum samples reacted with a combination of peptides covering residues 1 to 18 and 11 to 28. Testing of peptides that contain the reported genotypic variations of the HCV core within the regions at residues 1 to 18, 51 to 68, and 101 to 118 showed that a change from Thr-110 to Asn-110 decreased the reactivities of eight serum samples. In conclusion, we found that human antibodies to the HCV core-matrix protein(s) are mainly directed to linear determinants and can easily be reproduced by using short synthetic peptides. We also found that such antibodies develop in more than 90% of HCV-infected people.

Seroprevalence of hepatitis C antibody in Peru

The prevalence in Peru of antibody to hepatitis C virus (anti-HCV) was determined in a survey of populations living in the northern jungle region and in groups at high risk of parenterally and sexually transmitted diseases. All sera were initially screened for anti-HCV using commercial first and second generation ELISAs; repeatedly reactive sera were further verified with a second generation immunoblot assay. Serum samples were also tested by ELISA for HBsAg, anti-HBs, and anti-HBc. None of 2,111 sera obtained in the survey of jungle residents was positive for anti-HCV by immunoblot assay. Twelve of 16 HIV-1 antibody positive hemophiliacs, one of 103 HIV-1 antibody positive homosexuals, and three of 602 HIV-1 negative registered female prostitutes were positive for anti-HCV. A high prevalence of total markers of hepatitis B infection was found in all subjects, especially in older subjects and groups at high risk of parenterally and sexually transmitted diseases. The findings of this study indicate that seropositivity for hepatitis C virus antibody is uncommon in Peru except in high risk groups and suggest that the epidemiology of hepatitis C differs substantially from hepatitis B.