The Prevalence of Hepatitis B and C Virus Infections among Liver Cirrhosis Patients at the Korle-Bu Teaching Hospital, Accra-Ghana

Abstract

Cirrhosis of the liver is an endstage chronic liver disease which is generally irreversible. About 75% of patients with posthepatitic cirrhosis have progressive disease despite supportive therapy and die within one to five years from serious complications such as variceal haemorrhage, hepatic encephalopathy or superimposed hepatocellular carcinoma. Records from the Pathology Department of the Korle-Bu Teaching Hospital, Accra-Ghana indicates that cirrhosis is the commonest liver disease leading to death through serious complications. Most studies done in other countries have indicated an association between liver cirrhosis and chronic hepatitis B and C infections, especially, where these viruses are endemic. In Ghana Hepatitis B virus infection is endemic with seroprevalence rate ranging from 6.7-15.6%. That of hepatitis C ranges between 2.8% and 5.4%. Although liver cirrhosis is the commonest liver disease causing death at the Korle-Bu Teaching Hospital, the role of hepatitis B and C virus infections have not been well established in Ghana. The study was therefore carried out to determine the seroprevalence and the roles of hepatitis B and C virus among liver cirrhosis patients at the Korle-Bu Teaching Hospital. To achieve the above objectives, a nested case-control study design was used. Seventy consenting patients (cases) clinically diagnosed with ultrasound support as liver cirrhosis were interviewed. To test the validity of the criteria used in diagnosing cirrhosis, autopsies were done on all the cases that died during the study period. For each case interviewed four consenting patients age (±5 yrs) and sex-matched who were on admission with non-hepatic disease and not jaundiced were chosen as controls. About 10ml of blood was taken from each subject and the serum separated into well labelled micro tubes for storage at -70°C till analysis. Once thawed, samples were analysed form hepatitis B surface antigen and anti-HCV by sensitive ELIZA test-kits. The results were analysed statistically using EPI-INFO 2000 at a 5% significance level. Of the 70 cases 18 died and autopsy done on all confirmed the diagnosis of cirrhosis morphologically indicating that the criteria used in the diagnosis of cirrhosis were together sensitive and specific. Thirty, out of the 70 cases studied were positive for hepatitis B surface antigen giving a prevalence rate of 42.8%. The rate among controls was 7.5% (21 out of 280 controls). Hepatitis B virus infection was significantly associated with cirrhosis (π2 = 56.078, P= 0.000). The odds ratio obtained 9.25 with 95% CI = 4.83-17.7, indicates that the risk of developing cirrhosis is about 9 fold increased in those with Hepatitis B infections than those without. The seroprevalence of antibodies to hepatitis C virus among liver cirrhosis patients was 7.1% (5 out of 70) and 3.6% (10 out of 280) among the controls. An odds ratio of 2.07 (95% CI=0.159-1.462) obtained shows that the chances of a chronic hepatitis C virus patient developing cirrhosis of the liver is about twice that of those without hepatitis C and this was not statistically significant (π21.717, P=0.189). Blood transfusion was found to be a significant means of transmitting Hepatitis B virus infection (P=0.043) but not a significant means of transmitting hepatitis C virus infection (P=0.33.). In conclusion, it is recommended that blood screening against these viruses must continue and that other important modes of transmitting both hepatitis B and C viruses be further investigated to enable appropriate preventive measures to be applied. Immunization against hepatitis B Virus infection must be encouraged not only for children but among the general population especially groups which are at risk.