Hepatitis C virus infection in Ghana: time for action is now
Date
2018-03
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Abstract
Chronic hepatitis C virus (HCV) infection is a blood borne infection just like hepatitis B virus (HBV) and Human Immunodeficiency Virus (HIV) with a significant global health impact. Since the discovery of the HCV, several developments including a better understanding of the clinical epidemiology, availability of diagnostics and approval of newer therapies over the last decade have occurred and changed the frontiers of HCV management. Many nations now place HCV infection as a priority public health issue. In Ghana however, awareness, advocacy and treatment of HCV still plays a second fiddle to HBV and HIV. This must change and the time to act is now.
The WHO estimates there has been a decline in the in the number of persons living with chronic HCV infections from about 130–150million to about 80million currently.1 This decline is due partly to the fall in new infections since the discovery of the HCV virus in 1989. Ironically, deaths from HCV are on the increase.2 A large number of persons infected 30–60 years ago are now dying from HCV-related cirrhosis and hepatocellular carcinoma (HCC), as these complications often take decades to develop.2 This mortality trend is projected to continue for several more decades unless treatment is scaled up considerably.
In Ghana, the most recent estimates of HCV infection from a systematic review by Agyeman et al is 3%.3 Given that HCV transmission is highest amongst intravenous drug users, HIV infected individuals and homosexuals and that majority of the studies in that review were in low risk individuals; blood donors and pregnant women, this is likely an underestimation. Since HCV infection is clinically silent in majority of carriers until late, the true prevalence and the burden it imposes on the Ghanaian health care system is likely to remain unknown unless a comprehensive national screening policy is implemented.
Blankson et al reports that 1 in 14 cases of cirrhosis is caused by HCV in Ghana.4 Also, Yang et al, reports that HCC occurs at an early age in Sub-Saharan Africa including Ghana and HCV is an important cause.5 Therefore, it is most likely that HCV is afflicting mainly the workforce of Ghana. This should be a concern to all, and for stakeholders to commit to interventions that will tackle this disease.
In the absence of an HCV vaccine, treatment of infected individuals is a major intervention to control this menace. Pre-treatment evaluation includes determination of HCV viral load, HCV genotype and degree of liver fibrosis either via liver biopsy or fibroscan. These evaluations are expensive and often limit the initiation of treatment in Ghanaians.