DETECTION OF HEPATITIS C AND HEPATITIS B VIRUS INFECTION AMONG PRISON INMATES AND PSYCHIATRIC PATIENTS IN KADUNA METROPOLIS, NIGERIA


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TABLE OF CONTENTS

Title page
Table of Contents
List of Abbreviations
Abstract

CHAPTER ONE
1.0       INTRODUCTION
1.2       Statement of the Research Problem
1.3       Justification
1.4       Aim
1.5       Specific Objectives

CHAPTER TWO
2.0       LITERATURE REVIEW
2.1       History of Hepatitis C Virus
2.2       Hepatitis C Virus
2.2.1    Modes of Transmission
2.2.2    Pathogenesis
2.2.3    Complications of HCV infection
2.2.4    Clinical Presentation
2.2.5    Epidemiology
2.2.6    Diagnosis
2.2.7    Treatment
2.2.8    Prevention and Control
2.3       The Hepatitis B Virus
2.3.1.   Replication
2.3.2    Transmission
2.3.3    Clinical Manifestation
2.3.4    Hepatitis B Virus Genotypes
2.3.5    Epidemiology of Hepatitis B Virus
2.3.6    Diagnosis of Hepatitis B Virus
2.3.7    Treatment
2.3.8    Prevention of Hepatitis B Infection
2.4       HCV/HBV Co-infection
2.5       Prison inmates and Psychiatric Patients
2.6       Review of Empirical Findings

CHAPTER THREE
3.0       MATERIALS AND METHOD
3.1       Study Area
3.2       Study Design
3.3       Study Population
3.4       Ethical Approval and Consent
3.5       Inclusion and Exclusion Criteria
3.6       Sample Size
3.7       Sample Collection
3.8       Sample Processing
3.9       Data Collection
3.10     Detection of HCV and HBV in Serum
3.10.1 ELISA Assay for Detection of Anti-HCV IgM and IgG
3.10.2 ELISA Procedure for Detection of IgM and IgG Antibodies
3.10.3 Interpretation of ELISA Results
3.10.4 Principle of Rapid Test for the Detection of Hepatitis B surface antigen
3.10.5 Hepatitis B surface antigen screening using Rapid Diagnostic Test Method
3.11     Detection of HCV RNA
3.11.1 HCV RNA Extraction
3.11.2 Reverse Transcription
3.11.3 Polymerase Chain Reaction
3.11.4 Agarose Gel Electrophoresis
3.12     Data Analysis

CHAPTER FOUR
4.0       RESULTS

CHAPTER FIVE
5.0       DISCUSSION
5.1       Prison Inmates
5.2       Psychiatric Patients

CHAPTER SIX
6.0       SUMMARY, CONCLUSION AND RECOMMENDATION
6.1       SUMMARY
6.2       CONCLUSION
6.3       RECOMMENDATIONS
REFERENCES
APPENDICES



ABSTRACT

There is high risk of contracting hepatitis B and C among individuals with psychotic disorders due to lifestyle factors and prisoners globally continue to demonstrate a higher prevalence of Hepatitis B and C than the general population. This study was aimed at determining the seroprevalence of HCV and HBV and to detect hepatitis C virus (HCV) among prison inmates and psychiatric patients in Kaduna Metropolis. A total of 276 (153 prison inmates and 123 psychiatric patients) serum samples were tested for anti-HCV and Hepatitis B surface antigen (HBsAg) using third generation Enzyme Linked Immunosorbent Assay (ELISA) and RDT method respectively. Hepatitis C virus genome was detected in ten (10) serum samples using reverse transcription polymerase chain reaction (RT-PCR). An overall anti-HCV IgM prevalence of 10.14% (28/276), anti- HCV IgG prevalence of 8.69% (24/276) and HBsAg prevalence of 6.15% (17/276) was established. A 0.36% (1/276) HCV/HBV co-infection rate was obtained. Among the inmates, an anti-HCV IgM and IgG prevalence of 10.45% (16/153) and 8.5% (13/153) respectively was obtained with a 9.2% (14/153) HBsAg prevalence. An HBsAg, anti-HCV IgM and anti-HCV IgG prevalence of 2.4% (3/123), 9.75% (12/123) and 8.9% (11/123) respectively was obtained among the psychiatric patients. The highest HCV antibody prevalence was obtained among the female subjects (14.1% for IgM and 8.4% for IgG). No female tested positive for HBsAg. Subjects aged ≥48 years had the highest HCV prevalence (28.9%: 13/45 for IgM and 31.1%: 14/45 for IgG) while those within age group 28-32 years had the highest HBsAg prevalence (11.7%: 7/60). Age was observed to be associated with HCV infection (p=0.00). Viremia was evaluated by amplifying conserved untranslated region of HCV genome and bands of 244bp were observed. There was no statistically significant association between the viral infections and demographics. Presence of tattoo/scarification and alcohol intake were statistically associated with HCV infection while clothes sharing was associated with HBsAg among the inmates. Hepatitis C virus infection was statistically associated with blood transfusion, alcohol intake, presence of tattoo/scarification, sexual experience and shaving equipment sharing among the psychiatric patients while HBsAg was associated with only clothes sharing. This study established the circulation of HBV and HCV among inmates and psychiatric patients in Kaduna State. These individuals should therefore be screened for these viruses for appropriate clinical management and effective prevention.




CHAPTER ONE


1.0                                                                     INTRODUCTION


Hepatitis C virus (HCV) is a small enveloped virus measuring 55-65nm in size. It is a positive sense single stranded RNA virus of the family Flaviviridae and genus Hepacivirus

(Kapoor et al., 2011). It is the causative agent of human hepatitis C infection, although it has been found to infect chimpanzees, dogs, horses, and rodents (Rogo, 2011; Burbelo et al., 2012; Kapoor et al., 2013; Quan et al., 2013). Hepatitis C virus particle is made up of an RNA core of genetic material, surrounded by an icosahedral protective protein. This is further encased in a lipid envelope derived from the host. The viral glycoproteins, E1 and E2 are embedded in the lipid envelope (De-Beeck et al., 2003; Igwe et al., 2010). Hepatitis C virus encodes a single polyprotein of 3010-3011 amino acids which is processed into structural and non-structural proteins (NS). This is made possible with the aid of cell signalases and viral proteases.


Hepatitis C genome consists of a single open reading frame (ORF) that is made up of 9600 nucleotide base long (Kato, 2000). The ORF possess highly conserved nontranslated regions (NTR) in its 5′ and 3′ ends. In the 5′ end, there is an internal ribosome entry site (IRES) which allows the RNA to bind to the ribosomes close to the codon to start codon of the ORF. Based on genetic differences between HCV isolates, the virus is classified into seven genotypes (1-7) (Nakano, 2011). These subtypes are further broken into quasi species based on genetic diversity (Christian, 1996) and high error rate on the part of the virus RNA dependent RNA polymerase. The entry of the virus into the host is as a result of complex interaction between virions and cell surface molecules (Zeisel et al., 2009............

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