Project – Hepatitis C virus among pregnant women living

CHAPTER ONE

INTRODUCTION

1.1 Backgroud to the study

Hepatitis C infection is an infection of the liver caused by the hepatitis C virus (HCV). HCV is one of several viruses that can cause hepatitis. ‘Hepatitis’ means inflammation of the liver(Ryan and Ray,2004).It is unrelated to the other common hepatitis viruses (for example, hepatitis A or hepatitis B). HCV is a member of thehepacivirus genus in the familyFlaviviridae. There are at least six distinctly different strains of the virus which have different genetic profiles (genotypes). In the U. S., genotype 1 is the most common form of HCV. Even within a single genotype there may be some variations (genotype 1a and 1b, for example). Genotyping is important to guide treatment because some viral genotype respond better to therapy than others (Wilkins et al. 2009).

According to Hepatitis C NSW (2010), here are some of the things that can happen once the body contract hepatitis C.

The body may deal with hepatitis C of its own accord and you may never get sick.About 25% of all people who contract hepatitis C will clear the infection (although this happen less commonly in people with HIV). For a range of reasons, hepatitis C infection is eradicated from the body in these people, usually within 12 months of having been infected.

Hepatitis C may remain present in the body. About three quarters of people who contract hepatitis C will be chronically infected. This means that they have detectable hepatitis C virus (measured by a PCR test) in their blood for a period of longer than twelve months. People in this group may be at risk of developing liver problems over time.

The genetic diversity of HCV is one reason that it has been difficult to develop an effective vaccine since the vaccine must protect against all genotypes. It is difficult for the human immune system to eliminate HCV from the body, and infection with HCV usually becomes chronic. Over decades, chronic infection with HCV damages the liver and can cause liver failure. Up to 85% of newly-infected people fail to eliminate the virus and become chronically infected. Infection is most commonly detected among people who are 40 to 60 years of age, reflecting the high rates of infection in the 1970s and 1980s. There are 8,000 to 10,000 deaths each year in the U.S. related to HCV infection. HCV infection is the leading cause of liver transplantation in the U.S and is a risk factor for liver cancer.

Most of the signs and symptoms of HCV infection relate to the liver. Less commonly, HCV infection causes conditions outside of the liver. Symptoms are generally mild and vague, including a decreased appetite, fatigue, nausea, fever. Headache, muscle or joint pains, and weigh loss.Hepatitis C after many years becomes the primary cause of cirrhosis and liver cancer. About 10–30% of people develop cirrhosis over 30 years (Meisel, et al. 1995).

HCV infection can cause the body to produce unusual antibodies called ‘cryoglobulins’. These cryoglobulins cause inflammation of the arteries (vasculitis) which may damage the skin, joints, and kidneys. In addition, these patients may develop Raynaud’s phenomenon in which the fingers and toes turn color (white, then purple, then red) and become painful at cold temperatures(Iannuzzella, and Vaglio, 2010).

Two skin conditions, lichen planus and porphyria cutaneatarda, have been associated with chronic infection with HCV. HCV also is associated with B-cell lymphoma, a cancer of the lymph system.

Doctors use various tests to determine if a person has hepatitis C. One type of test measures antibodies in the blood, indicating that a person been exposed to HCV; the two most common antibody tests are called ELISA and RIBA. Viral load tests measure how much HCV genetic material is present in the blood; the two most common viral load tests are called PCR and bDNA.

Who to test for hepatitis c virus

According to MMWR (1998) Persons who ever injected illegal drugs,

Persons who were ever on chronic (long-term) hemodialysis;

Persons with persistently abnormal alanine aminotransferase level

Persons who were notified that they received blood from a donor who later tested positive for HCV infection;

Persons who received a transfusion of blood or blood components and organ transplant before July 1992; and

Healthcare, emergency medical and public safety workers after needle sticks, or mucosal exposures to HCV-positive blood

Children born to HCV-positive women.

1.2 statement of the problem

Sexual and maternal to child transmission and household exposure are not listed among major factors of HCV transmission (obasi. 2016). The transmission of HCV from mother to child is estimated at 4–8%, but the transmission rate increases to 17–25% if the mother is also HIV infected. In sub-Saharan Africa the main factor of HCV prevalence is blood transfusions and unsterile injections. The prevalence of HCV infection among pregnant women was estimated between 1 and 8% worldwide. In the Arabian Peninsula and North African (Maghreb) region, HCV among pregnant women ranges from 8.6% in Egypt to less than 1% in Libya. In Nigeria, a study conducted among pregnant women found that the prevalence of HCV ranged between 1.4% for women aged between 20 and 35 years old and 11.1% for women aged less than 20 years old. In a systematic review and meta-analysis study published in 2015, conducted in 21 sub-Saharan African countries, found that the overall HCV prevalence among pregnant women in antenatal clinic was 3% and was 2% in the Central African region. The burden of HCV infection in the general population and among pregnant women is unknown in Rwanda. The objective of the current study in Nigeria was to determine the prevalence and factors associated with testing positive for anti-HCV among pregnant women attending antenatal care services.

1.3 OBJECTIVES

1. To determine the prevalence of hepatitis C virus in pregnant women attending ante-natal in UNTH Ituku-ozalla
2. 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

1.4 Research Question

1. What is the prevalence of hepatitis C virus in pregnant women attending ante-natal in UNTH Ituku-ozalla ?
2. What is the age distribution where the infection occurs most ?

iii. What is the prevalence of hepatitis virus in people living with HIV and AIDS attending UNTH Ituku-ozalla ?

1.5 significance of the study

HCV-infection is a public health burden among pregnant women in Rwanda. This will study provides a platform to inform policymakers and stakeholders the need to accelerate progress in treatment access and global prevention of HCV infections. Further advanced studies of HCV in this group and in the general population are needed to explore detection of Antigens and Antibodies and how they inform the diagnosis of acute and active HCV infections.

1.6 scope of study

This on hepatitis c virus among pregnant women people living with HIV/AIDS. The study will be carried among pregnant women Attending Clinic At Unth Itukuozalla

1.6 Definition of terms

Hepatitis C

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). Hepatitis C is spread through contact with blood from an infected person. Today, most people become infected with the hepatitis C virus by sharing needles or other equipment used to prepare and inject drugs.

HIV

HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). There is currently no effective cure. Once people get HIV, they have it for life. But with proper medical care, HIV can be controlled.

Pregnant woman

Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman’s womb.

Project – Hepatitis C virus among pregnant women living