Hepatitis C virus among Nigerian patients with HIV infection--论文代写范文精选

丙型肝炎病毒(HCV)是一种威胁生命的病毒，感染肝脏的传播主要通过受感染的血液和血液制品。十五年后发现HCV慢性肝病的主要原因,丙肝病毒感染的自然历史的知识仍然是有限的。全世界大约1.7亿人长期感染病毒。

Abstract
Nigeria belongs to the group of countries highly endemic for viral hepatitis; unfortunately information on the prevalence of hepatitis C amongst patients with HIV in Nigeria is very scarce. This hospital-based investigation was conducted at two major hospitals in Jos, Nigeria from June 2002 through May 2003. Serum samples from 490 confirmed HIV infected patients were assayed for the presence of antibodies to HCV, using a third generation enzyme linked immunosorbent assay. Twenty eight (5.7%; 95% CI 3.66-7.76%) of the patients had antibodies to HCV. The prevalence of HCV antibodies was higher among the males (7.5%; 95% CI 3.83-11.09%) than the females (4.5%; 95% CI 2.10-6.88%). Statistical analysis showed no significant difference (χ2 = 1.917, df =1, p=0.05). Individuals of the age group 41-50 years had the highest prevalence of HCV antibodies (15.4%; 95% CI. 7.37-23.29%), followed by those of age group 31-40 years (7.4%; 95%, CI 3.70- 11.20%). A significant difference was observed in the association between age and prevalence of HCV antibodies (χ2 = 24.151, df = 4, p =0.05). Early diagnosis of HCV in people with HIV infection is advocated to reduce risk of HCV related advanced liver disease. 
Key Words: Hepatitis C virus, HIV, Nigeria

Introduction 
The hepatitis C virus (HCV) is a life threatening viral infection of the liver transmitted primarily through infected blood and blood products. Fifteen years after the discovery of the HCV as a major cause of chronic liver disease (1), knowledge of the natural history of the HCV infection is still limited.(2) Approximately 170 million people worldwide are chronically infected with the virus and the infection is often described as "silent" because people may be infected for 10 to 30 years and not exhibit symptoms.(3) 

Co-infection with human immunodeficiency virus (HIV) and the HCV is a growing public health concern. Both infections are spread in similar ways, notably through shared use of needles to inject drugs and sexual activity and most studies have shown that HIV infection leads to a more aggressive hepatitis C and a higher risk of liver damage.(4) Natural history studies with HIV-HCV co-infection have also shown more rapid progression of liver disease, and end stage liver disease due to hepatitis C is now a leading cause of death in HIV-infected patients.(5) Nigeria belongs to the group of countries highly endemic for viral hepatitis. In fact about 75% of the Nigerian population is likely to have been exposed to the hepatitis viruses at one time or the other in their life and about 7% of these will die from its complications.(6) Prior to the advent of HIV/AIDS in Nigeria, there was lack of enforcement of regulations guiding blood transfusion in many localities; this enhanced indiscriminate blood transfusion practices and the dominance of commercial donors among blood donors. In addition, there was also high patronage of patent medicine stores or some other substandard settings for treatment of ailments where unsterilized sharps were often used.(7) Available data showed that the prevalence of hepatitis C virus among local commercial blood donors in Nigeria ranged from 12.3-14.0%.(6, 8) Although a more recent study among patients with sickle cell anemia in Lagos Nigeria indicated a 5.0% anti-HCV prevalence.(9)

Materials and Methods 
Study Area The study was conducted from June 2002 through May 2003 in Jos-Plateau located in an area covering about 9,400km2 of the crystalline complex in central Nigeria. Its average elevation is about 1,250m above mean sea level and has an average annual rainfall of 1500mm and atmospheric temperature ranging from 120C- 310C. The area is known to have the most conducive weather in Nigeria and is said to be a tourist haven. Consequently, large numbers of people from many other parts of the country and foreigners alike have been attracted to the area purely to exploit its economic viability. Jos-Plateau and other parts of central Nigeria are reported to have the highest prevalence of sexually transmitted diseases (STDs) particularly HIVinfection.(7,12)

Discussion 
In HIV infected patients, co-infection with HCV has been associated with a reduced survival rate.(13) The increased risk of HCV related advanced liver diseases in people with HIV infection makes early HCV diagnosis a priority.(14) Unfortunately this has not been given its desired attention in the Nigerian health care delivery system, largely due to the dearth of information on HCV-HIV co-infection. In this study therefore, we have unequivocally established the existence of HCV infection in HIV-infected Nigerian patients. Our result showed a somewhat lower sero-prevelance (5.7%) compared to those reported in HIV infected patients in Brazil (36.2%) (15), Greece (13.8%) (16), Australia (13.1%) (17) and USA/Europe (35% ).(18) The reason for this outcome is not far fetched. It has been established that the overwhelming risk factor for HCV infection in almost all studies, is a history of illicit injection drug use.(15,18,19) 

This habit, though very efficient in HCV transmission is a rare occurrence amongst the Nigerian HCV infected patients studied. Most cases of the HCV infection in this study may have resulted from blood transfusion as 60.7% (17 out of 28) of the HCV infected individuals had history of blood transfusion. Multiple sexual partnership, a habit very common amongst the study population, may also have had a contributory role in the prevalence of HCV observed in this study although the sexual transmission of HCV appears to be very inefficient and sexual behavior is usually considered of secondary importance in determining the risk of HCV infection.(15,20) Analysis of the sex-related sero-prevelance of HCV amongst the HIV infected patients showed that the males were more infected than the females, though more of the HIV infected females reported to hospitals for medical attention than the males. 

The reason for higher frequency of HCV infection amongst the males was not immediately apparent and besides no statistically significant association was observed. However the prevalence of viral hepatitis is reported to be higher in male Nigerians than the females (10,11), probably due to the higher frequency of exposure to infected blood and blood products by the male folks as a result of occupation and social behavior.(6) A number of studies in different transmission groups have confirmed that age is a co-factor for disease susceptibility and progression.(21) Our findings indicated that the HIV infected individuals in their fifth decade of life had the highest HCV infection. Also there was a significant difference statistically. The reason for this is somewhat obscure from this study. Further studies on the dynamics of and epidemiology of HCV-HIV co-infection in Nigeria are advocated and could help to explain the trend. In conclusion, it is pertinent to state that one of the major drawbacks in this study was our inability to employ confirmatory assays such as the HCV recombinant immunoblot assay or the HCV-RNA assay. However we have confidence in the capacity of the HCV antibody assay to detect over 95% of HCV infected cases.(20,22) This study has contributed baseline data and provided insights in HCV and HIV co-infection in Nigeria. This would undoubtedly serve as a basis for further studies on this topic.(report代写)

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