Hepatitis C Virus Among Pregnant Women People Living With HIV/AIDs Attending Clinic at UNTH, Itukuozalla
Chapter One
OBJECTIVES OF THE STUDY
- To determine the prevalence of hepatitis C virus in pregnant women attending ante-natal in UNTH Ituku-ozalla
- To determine the age distribution where the infection occurs most
- To determine the prevalence of hepatitis virus in people living with HIV and AIDS attending UNTH Ituku-ozalla
CHAPTER TWO
LITERATURE REVIEW
Hepatitis C virus is a small (55-65 nm in size)enveloped single stranded positive sense RNA virus The hepatitis C virus particle consists of a core of genetic material (RNA), surrounded by an icosahedral protective shell of protein, and further encased in a lipid (fatty) envelope of cellular origin. Two viral envelope glycoproteins, E1 and E2, are embedded in the lipid envelope. It is a member of the hepacivirusgenus in the family flaviviridae (Rosen, 2011).
Mode of transmission and risk factors
According to Maheswari, and Thuluvath ( 2010) the primary method of transmission in the developed world is intravenous drug use (IDU), while in the developing world the main methods are blood transfusions and unsafe medical procedures. Hepatitis C virus is spread parentally, sexually (Bryan Ogeneh, 2004).
IDU is a major risk factor for hepatitis C in many parts of the world. Of 77 countries reviewed 25 including the United States were found to have prevalence of hepatitis C in the intravenous drug user population of between 60% and 80%(Xia, et al. 2008).
Transfusion of blood products or organ transplantation without HCV screening may carry significant risks of infection. The United States instituted universal screening in 1992 and the risk subsequently has decreased from one in 10,000 to 10,000,000 per unit of blood down from a risk of one in 200 units of blood (Day, 2009) .
Those who have experienced a needle stick injury from someone who was HCV positive have about a 1.8% chance of subsequently contracting the disease themselves, the risk is greater if the needle in question is hollow and the puncture wound is hollow.
Sexual practices that involve higher levels of trauma to the anogenital mucosa, such as anal penetrative sex, or that occur when there is a concurrent sexually transmitted infection, including HIV or genital ulceration, do present a risk (Tohme, 2010).
The United States government only recommends condom use to prevent hepatitis C transmission in those with multiple partners.
Tattooing is associated with two to threefold increased risk of hepatitis C. This can be due to either improperly sterilized equipment or contamination of the dyes being used. Tattoos or piercings performed either before the mid-1980s, “underground,” or nonprofessionally are of particular concern, since sterile techniques in such settings may be lacking (Jafari, 2010).
According to Lock, (2006), Personal-care items such as razors, toothbrushes, and manicuring or pedicuring equipment can be contaminated with blood. Sharing such items can potentially lead to exposure to HCV.
Vertical transmission of hepatitis C from an infected mother to her child occurs in less than 10% of pregnancies. It is not clear when during pregnancy transmission occurs, but it may occur both during gestation and at delivery (Lam, 2010).
A long labor is associated with a greater risk of transmission. There is no evidence that breast-feeding spreads HCV; however, to be cautious, an infected mother is advised to avoid breastfeeding if her nipples are cracked and bleeding, or her viral loads are high (Alter, 2006).
Pathogenesis of hepatitis C virus
Hepatitis C virus enters a susceptible host either directly through needle inoculation or transfusion of contaminated blood or inadvertently through breakage of a percutaneous barrier (as exemplified by sexual or perinatal transfusion) (Alter, 1997).
The virus then enters hepatocytes or other susceptible cells probably through a unique surface molecule as the viral receptor (Pileriet al. 1998).
After uptake, the virus uncoats and releases the genome to begin replication. The viral genome first serves as a template for the translation of polyprotein. The processed non-structural protein then form a complex with the genome and initiate synthesis of the negative strand which in turn function as the template for positive strand synthesis. The replication complex probably resides in a membraneous compartment in the cytoplasm. The RNA replicative intermediate matures and interact with the core and envelope proteins to assemble into a virion.
CHAPTER THREE
Materials
HCV test strip, centrifuge, timer, tourniquet, rack, syringe, cotton wool, test tube, EDTA bottle, gloves
Study Population
This study was a cross-sectional seroprevalence study involving pregnant women attending ante-natal and HIV patients attending the General out-patient clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla.
Sample collection
Venous blood (3 mls) was obtained from the participants and tested for antibody to HCV (anti-HCV) using hepatitis C virus one step rapid diagnostic test using the serum or plasma. The serum or plasma was separated from blood as soon as possible to avoid haemolysis.
Method
Serology
The test strip, serum or plasma specimen wasallowed to equilibrate to room temperature (15-30oc) prior to testing.
The pouch was brought to room temperature before opening it. The strip was removed from the sealed pouch and used as soon as possible
With arrows pointing towards the serum or plasma specimen, the strip was immerse vertically into the serum or plasma for at least 10-15 seconds.do not pass the maximum line on the strip when immersing it.
The strip was placed on a non-absorbent flat surface, start the timer and wait for the red line to appear. The resultshould be read at 10 minutes. Do not interpret the result after 20 minutes.
CHAPTER FOUR
RESULT
It was observed that out of 30 pregnant women (6.67%) tested positive for hepatitis C. as shown in table 4.1. 12 pregnant women in the age group 19-23 tested negative . In the age group 23-28 (9.09%) tested positive to HCV. In the age group 29-33(14.3%) tested positive to HCV.
Table 4.2 shows the sex distribution of HCV in PLWHA. A total of 20 patients were examined of which 7 were males and 13 females. (20%) of them were positive for HCV, (42.9%) of the male and (7.69%) of the female tested positive.
In table 4.3 a total of 7 males were examined for HCV and 42.9% tested positive. No sample was collected from the age group 20-24 and35-39. 2 samples were collected from the age group25-29 and (50%) of them tested positive.Five (5) samples were collected from the age group 30-34 and examined (40%) of them were positive.
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATION
DISCUSSION
The result showed that a total of 50 samples were collected; 30 from pregnant women and 20 from PLWHA. It was observed that the prevalence of hepatitis C virus was higher in those within the age range of 24-34 than in those within the age range of 19-23 and 38-40due to exposure to exposure to the risk factor of hepatitis C virus (Alter 1990).
It was also observed that (42%) of the men living with HIV and AIDS tested positive for HCV than the women (7.69%) because men are mostly infected than women due to men are likely to have risk factor for exposure to hepatitis C virus (alter 1990).
The prevalence of HCV is higher in PLWHA (20%) than in pregnant women (6.67%) and this can be due to reduced immunity and similar routes of transmission for HIV and HCV.
CONCLUSION
Though the prevalence of hepatitis C virus is high from this work, the infection has an adverse effect in all susceptible individual; men, women and children. Though there is no vaccination against this virus, medical management and ant-viral therapy should be employed to reduce or control this infection.
RECOMMENDATION
Since the prevalence of hepatitis C virus is high, it is recommended that Primary prevention activities such as screening and testing of blood, organ, tissue and semen donors can reduce the potential risk of HCV transmission from blood or blood component, intravenous drug use, multiple sex partners, tattooing.
Secondary prevention activities such as identifying HCV infected persons through diagnostic test, medical management and anti-viral therapy and providing appropriate medical follow-up and promoting healthy life styles and behavior can reduce risk for chronic infection.
Professional and public education; Health care emergency medical and public safety workers should be educated regarding the risk for contacting HCV.
Immunization against HCV is not available; therefore identifying persons at risk but not infected with HCV provides opportunity for counseling on how to reduce the risk of becoming infected.
REFERENCES
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