Risk Factors and Sero-Prevalence of Hepatitis C Virus Antibody among Undergraduate Students of Federal University of Technology, Owerri

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1 Futo Journal Series (FUTOJNLS) e-issn : p-issn : Volume-4, Issue-1, pp Research Paper July 2018 Risk Factors and Sero-Prevalence of Hepatitis C Virus Antibody among Undergraduate Students of Federal University of Technology, Owerri Abstract *Obi R. K 1, Shenge J. A 2, Chikwendu C. I 1, Amadi E. S 1 and Ogbulie J. N 1 1 Department of Microbiology, Federal University of Technology, Owerri, P.M.B. 1526, Owerri, Imo State, Nigeria. 2 Department of Virology, College of Medicine, University of Ibadan, Oyo State, Nigeria *Corresponding Author s robert.obi@futo.edu.ng Hepatitis C virus infection is a major global health problem. It occurs among people of all ages, genders, races and world regions. This study was conducted to determine the prevalence of hepatitis C virus antibody (anti-hcv), among a healthy university undergraduate population in South-Eastern Nigeria. All tests were done using rapid anti- HCV test kit by Dia Pro Diagnostic Bioprobes, Italy. A total of 100 students, aged between 15 and 32, were included in the study. There were equal number of males and females. Structured questionnaires were administered to obtain information on socio-demographic and clinical data, as well as potential risk factors that might be associated with HCV. Of the 100 students, 12(12%) were positive with 10% of the males and 14.4% of the females positive for the anti-hcv. Age-group years had the highest prevalence of anti -HCV (23.3%), followed by age-group years with 14.3% prevalence rate. None of the subjects in age-groups and tested positive. The prevalence of Hepatitis C Virus is indeed high among the young healthy undergraduate population in Federal University of Technology, Owerri, South - Eastern Nigeria. Keywords: Antibody, Females, Hepatitis C Virus, Infection, Males, Prevalence. 1. Introduction Hepatitis C virus (HCV) is an important blood-borne, hepatotrophic pathogen that causes a serious health problem, affecting more than 185 million people globally (Mora, Adams, Kleithermes, Dugas, Balagubramanian, Sandhu, Nde, Small, Jose, Scanglione, & Layden, 2016). Infection with HCV can lead to progressive liver disease such as cirrhosis and hepatocellular carcinoma (HCC) in chronically-infected persons (Heim, 2013). Globally, it is the major cause of chronic liver disease (Shepard, Finelli & Alter, 2005), responsible for most liver transplantations (Dhawan, 2016). The incidence and prevalence of HCV infections vary in the general population and geographically too. 326 Obi et al., Risk Factors and

2 Hepatitis C virus is a spherical, enveloped single stranded hepatotropic RNA virus that belongs to the flaviviridae family (Sharma, 2010). Hepatitis C virus infection was originally known as a Non-A, non-b hepatitis, but was later identified as Hepatitis C virus in 1989, a transfusion-transmissible viral agent (Choo, Kuo, Weiner, Overby, Bradley & Hughton, 1989). Major risk factors are blood transfusion from unscreened blood donors, injection drug use, and health-care-related procedures. Other risk factors for infection are unprotected sexual intercourse, perinatal transmission, household with infected person, scarification marks, tattoos and incisions, etc. (WHO, 2012). HCV shares same route of transmission with Human Immunodeficiency Virus (HIV) and hepatitis B virus (HBV), a feature that has made HCV screening a must among HIV/HBV co-infected patients (Otegbayo, Taiwo, Akingbola, Odaibo, Adedapo, Penugonda, Adewole, Olaleye, Murphy, & Kanki, 2008). In Africa, the prevalence of HCV is not well documented, probably as a result of poor screening, misdiagnosis or under-reporting of cases (WHO, 2012). Due to the asymptomatic nature of HCV infection, many infected persons are not aware of their infection status, a serious risk factor for transmission of HCV infections; and majority of infected persons will become chronic with time, if they are not able to clear the virus (Alter, Kruszon-Moran & Nainan, 1999). Some studies in Nigeria have reported relatively increasing HCV prevalence, in a few major cities among some segments of the population (Ejiofor, Ibe & Emordi, 2009; Onakewhor & Okonofua, 2009). Further epidemiological studies are needed to understand better the trend in HCV infection among specific groups especially those at high risk of contracting the infection, in order to properly target therapy and management especially in areas where services are either costly or unavailable. There is no vaccine or post -exposure prophylaxis against HCV; hence the social and economic burden caused by HCV infection remains high and increasing in developing countries (Nwannadi, Alao, Bazuaye, Omoti & Halim, 2012). There appears to be considerable under-diagnosis of HCV infection among young people who are mostly at risk of infection owing to a number of risky activities they indulge in. This present study therefore, determined the sero-prevalence of HCV among undergraduate students of Federal University of Technology, Owerri, where incidence of HCV infection is poorly documented. 2. Materials and Methods 2.1. Study Design This is a cross-sectional seroprevalence study in which blood samples were collected from consenting male and female undergraduate students of Federal University of Technology, Owerri (FUTO) Study Site This study was carried out at the Federal University of Technology, Owerri, Imo State, South Eastern, Nigeria Study Population The study population included randomly selected 50 male and 50 female, students of FUTO, aged between 15 and 32 years. The purpose of the study was fully explained to them and their informed consent obtained prior to collection of samples. The specimen size was determined using the formula: 327 Obi et al., Risk Factors and

3 n = Z 2 pq d 2 where n = sample size, z = standard deviation (1.96), p = prevalence, q = 1-p and d = degrees of freedom (0.05), based on the most recent antihepatitis C virus antibodies prevalence done in Lagos (Ayolabi, Taiwo, Omilabu, Abebisi & Fatoba, 2006). The least number of specimens to be collected for the study was calculated to be 89; hence 100 specimens were collected Ethical consideration Ethical clearance was obtained from the Medical, Ethical and Scientific Research Committee of the School of Biological Sciences, Federal University of Technology, Owerri, before the commencement of study. Also, a consent form was given to each student after explanation, to obtain permission Inclusion and exclusion criteria Those excluded from the study included non-students and students who did not give consent to participate in the study. All consenting undergraduate students were enrolled for the study Administration of questionnaire A structured questionnaire was administered to the consenting students in order to obtain information on their socio-demographic and clinical data, and potential risk factors that might be associated with Hepatitis C infection Sample Collection Using a sterile syringe, 5 ml of blood was collected via vein puncture and transferred into plain vacutainer test tubes, properly labelled and transported on ice packs in a cold box to the Laboratory of the Department of Microbiology, FUTO. The blood samples were allowed to stand for 60 minutes to coagulate. The samples were then centrifuged at 3000 rpm for 5 minutes. The supernatant (serum) was transferred aseptically into 2 ml cryovial and stored at -20 C until tested. Samples were collected between October, and November, HCV Antibody Detection The serum samples were screened for the presence of HCV antibody using Dia Pro Diagnostic Bioprobes, Srl, Italy. The test was carried out based on manufacturer s instructions. Check value of the control or patient sample / extinction value of calibrator 3 = Ratio. The results were interpreted as described by the manufacturers kit insert. Ratio <0.9: was considered negative Ratio 0.9 to <1.1: was considered borderline Ratio 1.1: was considered positive 2.9. Statistical Analysis Paired T test was used to compare rate of HCV infection between male and female undergraduates of FUTO using GraphPad Prism software version 5.01 linear regressions (Graphpad Software Inc., U.S.A): P < 0.05 at 95% confidence interval was considered significant. 328 Obi et al., Risk Factors and

4 3. Results and Discussion Results showed that a total of 12% of the blood samples were positive for HCV antibody as shown in Table 1. The result also showed that the infection was more in the age group of (23.3%). The prevalence of HCV infection in FUTO was also seen to be higher in females (14.4%) than in males (10%) as shown on figure 1. The risk factors associated with HCV infection in FUTO as deduced from responses to the questionnaire, showed that the greatest risk factor were sexual intercourse and pedicure (35.3%). They were closely followed by blood transfusion and sharing of sharp objects (33.3%), with the least being barber clipper (21.9%). The result also showed that about 26.7% of the study population were ignorant of HCV infection, while 17.5% were unaware of their HCV status (Table 2). Table 1. Prevalence of HCV antibody among undergraduate students of FUTO based on age. Age interval Total screened HCV ve HCV +ve %+ve Total Obi et al., Risk Factors and

5 Rate of HCV antibody detection Males Females Undergraduate students of FUTO Fig. 1. Prevalence of HCV antibody detection among male and female students Table 2. Risk factors associated with HCV infection among the study participants Risk Factors Total screened HCV ve HCV +ve %+ve Blood transfusion (Yes) (No) Multiple sex partners (Yes) (No) Share of objects (Yes) (No) Barber clipper (Yes) (No) Pedicure (Yes) (No) Manicure (Yes) Obi et al., Risk Factors and

6 (No) HCV awareness (No) (Yes) HCV status (No) (Yes) This study determined the seroprevalence of HCV among apparently healthy students of Federal University of Technology, Owerri as 12% (Table 1). In the past, few seroprevalence studies have determined HCV infection rate in different cities and among different populations ranging from 4.7-5% in Ilorin, to % in Enugu, 11% in Ibadan to 20% in Benin (Ejiofor et al., 2009), mostly among children and adults (Ejiofor et al., 2008). The present result showed that students with highest prevalence belong in age group (23.3%), females (14.4%) and males (10%) (Fig.1). These are mostly adolescents and an active age group, where peer influence could enhance HCV exposure and infection. This finding has serious epidemiological implications and has revealed further, the burden of HCV in Nigeria. The high prevalence rate observed in this study is a pointer that HCV infection among the student population, not only in the study area but also its environs, and Nigeria entirely, needs urgent attention. Interestingly, these individuals look apparently healthy, asymptomatic and some (17.5 %) are unaware of their HCV infection status, while 26.7% were ignorant of HCV infection, buttressing the need for increased awareness in the study area and adjoining communities. The latter is characteristic of HCV infection and is a serious factor that drives HCV transmission and new infections in any population (WHO, 2012). Although among individuals with acute HCV infection, minority of cases can be symptomatic which can equally present a mild to moderate clinical development in association with fulminant hepatic failure (Farci, Alter & Shimoda, 1996). Associated risks factors also determined in this study were as shown in Table 2, with greatest risk factor shown as multiple sexual partners and pedicure (35.3%). Having multiple sex partners is an important risk factor for sexual transmission of HCV, a factor that has remained unresolved in relation to HCV infection over time (Bernstein, 2008). The high prevalence and associated risk factors among young university students is rather not surprising, in a setting where a huge percentage (26.7%) of screened population had never heard of HCV infection and 17.5% were ignorant of their infection status. This has equally reflected in the transmission of HCV through pedicure and manicure (found in this study as 29.4% in Table 2), which are common activities among mostly female students in tertiary institutions of learning. This further highlights the need for education of workers in salons and spa centers on the need to practice proper sterilization of their materials after each use. Blood transfusion and sharing of sharp objects each had a prevalence of 33.3%. HCV is a blood-borne pathogen which makes transfusion with improperly screened or unscreened blood and blood products a great risk for transmission of hepatitis C virus, as well as HIV, HBV and other viral hepatitis agents. HIV and HBV share same route and mode of transmission with HCV, hence have common risk factors (Otegbayo et al., 2008). Transfusion with unscreened blood has been reported as the common risk factor for HCV infection in developing countries including Nigeria (Isa, Hassan, Mamman, Bababdoko, 331 Obi et al., Risk Factors and

7 Muktar & Ahmed, 2010). Contrary to this statement, sexual transmission (multiple sex partners) and pedicure were the most common risk factors for HCV transmission in this study, probably because of peculiar characteristic of the study population. In view of this, an expansive study is needed to authenticate this fact. HCV transmission through the parenteral routes such as sharing sharp objects like injection drug use, needles and other body-piercing objects has been reported in several studies (CDC, 2012). In rural communities, where most people are not well educated about the spread of viral hepatitis, family members still share a lot of these risky sharp objects. A family member with HCV poses a serious risk to others (CDC, 2012). Hepatitis C virus has no prophylaxis or vaccine against infection anywhere in the world. It is very imperative that every segment of the society is properly educated through awareness campaigns on the transmission, prevention and diagnosis of viral hepatitis C infection. On the other hand, for individuals that are already exposed to HCV, there is need to do further investigations and follow up in established facilities, in order to receive optimal care where necessary. References Alter, M. J., Kruszon-Moran, D. & Nainan, O. V. (1999). The prevalence of hepatitis C virus infection in the United States, 1988 through New England Journal of Medicine; 341(8), Ayolabi, C.I., Taiwo, M. A., Omilabu, S. A., Abebisi, A. O. & Fatoba, O. M. (2006). Seroprevalence of hepatitis C virus among blood donors in Lagos, Nigeria. African Journal of Biotechnology 5 (20), Bernstein, D. (2008). Diagnosis and Management of Hepatitis C Available at: December Center for Disease Control and Prevention (2012). Hepatitis C. Online review Choo, O. L., Kuo, G., Weiner, A. J., Overby, L. R., Bradley, D. W. & Hughton, M. (1989). Isolation of cdna clone derived from a blood-borne non A, non B viral hepatitis genome. Science 244(4902), Dhawan, V. K. (2016). Hepatitis C. Medscape, Ejiofor, O. S., Ibe, B. C. & Emordi, I. J. (2009). Socio-demographic differences in distribution of hepatitis C virus among children with sickle cell anaemia in Enugu, Southeast, Nigeria. Open Journal of Medicine, 21, Farci, P., Alter, H. J. & Shimoda, A. (1996). Hepatitis C virus associated fulminant hepatic failure. New England Iournal of Medicine, 335, Heim, M. H. (2013). Innate immunity and HCV. Journal of Hepatology, Isa, A. H., Hassan, A., Mamman, A. I., Bababdoko, A. A., Muktar, H. M. & Ahmed, A. J. (2010). Seroprevalence of hepatitis C virus antibodies among blood donors in Ahmadu Bello University Teaching Hospital, Kaduna. African Journal of Clinical Experimental Microbioliogy, 11(2), Mora, N., Adams, W. H., Kleithermes, S., Dugas, L., Balagubramanian, N., Sandhu, J., Nde, H., Small, C., Jose, J., Scanglione, S. & Layden, J. E. (2016). A Synthesis of Hepatitis C prevalence estimate in Sub-Saharan Africa: , British Medical Council Infectious Diseases, 160, Obi et al., Risk Factors and

8 Nwannadi, I. A., Alao, O. O., Bazuaye, G. N., Omoti, C. E. & Halim, N. K. (2012). Seroprevalence of Hepatitis C Virus Antibody in Sickel Cell Anaemia patients in Benin-City, Nigeria. Gomal Journal of Medical Sciences., 10,1. Onakewhor, J. U. & Okonofua, F. E. (2009). Seroprevalence of Hepatitis c viral antibodies in pregnancy in a tertiary health facility in Nigeria. Niger J Clin Pract, 12, Otegbayo, J. A., Taiwo, B. O., Akingbola, T. S., Odaibo, G. N., Adedapo, K. S., Penugonda, S., Adewole, F. I., Olaleye, D. O., Murphy, R. & Kanki, P. (2008). Prevalence of hepatitis B and C Seropositivity in Nigerian Cohort of HIV-infected Patients. Annals of Hepatology, 7(2), Sharma, S. D. (2010). Hepatitis C virus: molecular biology & current therapeutic options. Indian Journal of Medical Research, 131, Shepard, C. W., Finelli, L. & Alter, M. J. (2005). Global Epidemiology of Hepatitis C infection. Lancet Infectious Diseases, 5, World Health Organization (2012). Viral Hepatitis Factsheet Obi et al., Risk Factors and