Journal of Medicinal Plants Research Vol. 5(25), pp. 6102-6104, 9 November, 2011 Available online at http://www.academicjournals.

org/JMPR ISSN 1996-0875 2011 Academic Journals DOI: 10.5897/JMPR11.307

Short Communication

Prevalence of Hepatitis C virus (HCV) in Gadap Town Karachi, Pakistan

Asif Iqbal1, M. Akram1*, Hasan Ali2, Naveed Akhtar3, Saeed Ur Rashid Nazir4, Irshad Ahmad3, Asim Awan1 and H. M. Asif3
Faculty of Eastern Medicine, Hamdard University Karachi, Pakistan. Department of Biochemistry, Bahria Medical College, Karachi, Pakistan. 3 Faculty of Pharmacy and Alternative Medicine, The Islamia University of Bahawalpur, Pakistan. 4 Faculty of Pharmacy, University of Sargodha, Pakistan.
2 1

Accepted 23 September, 2011

Hepatitis C has been increasing day by day due to unsafe and unsterilized use of injections and razor in rural areas. The present study was conducted to determine the frequency of Hepatitis C and Hepatitis B in Gadap Town Karachi, Pakistan. 600 hundred subjects were enrolled. 47% were females and 53% were males. Mean ages of females was 25 years and mean age of male was 24 years. In Gadap Town, 5% was anti HCV reactive. Risk factor for transmission of Hepatitis C virus (HCV) was unsterilized syringes and razor use in this area. Key words: Hepatitis C virus (HCV), injections, Pakistan. INTRODUCTION Hepatitis C virus (HCV) is a single- stranded RNA virus arranged into structural and non- structural regions. There are six subtype based on differences in the nonstructural region. Only types I, II and III are seen in Europe and type IV occurs in the Far East. Immunogenic peptides have been derived from these regions for use in HCV assays and are becoming increasingly sensitive. The concentration of viral antigens in the blood is very low. Hepatitis C virus is increasing rapidly in developing countries (Alter, 1997). Study on prevalence of HCV in remote areas of Pakistan is not enough (Bari et al., 2001). HCV is the most cause of cirrhosis and associated symptoms like ascitis. Incidence rate of Hepatitis C varies. It is difficult to calculate exact incidence rate of Hepatitis C due latent nature of the disease prior to clinical presentation. Prevalence rates across the world have changed as well with more countries aware of transfusion-related Hepatitis C and more and more evidence supporting intravenous drug use as the leading risk factor of spread of the virus. In present study, prevalence of HCV has been evaluated and risk factor has been identified (Agboatwalla et al., 1994). HCV caused 90% of post-transfusion hepatitis before serological tests that allowed the screening of blood donors (Sulaiman and Julitasari, 1995). Intravenous drug abusers are at high risk of HCV infection (Hagan et al., 2002). Incubation period averages 6 to 7 weeks. More than 85% of cases lead to chronic hepatitis. Cirrhosis develops in 20 to 30% within 5 to 30 years and about 15% develop hepatocellular carcinoma. Male patients and people acquiring infection over 40 years have more rapid development of fibrosis. Hepatitis C may be a pathogenic factor in glomerulonephritis, autoimmune thyroiditis, idiopathic pulmonary fibrosis and probably lymphoma. The predominant role of blood transfusion and injection drug use in the transmission of HCV has consistently been reported worldwide (Wasley and Alter, 2000). Epidemiology HCV was identified in 1988 and was responsible for 70 to 90% of posttransfusion hepatitis in all countries where blood was tested for HBV markers. Since the screening of HCV in donor blood was introduced, this incidence has fallen to 4%. In the UK, I: 1800 samples of donated blood

*Corresponding author. E-mail: makram_0451@yahoo.com. Tel: 92-021-6440083. Fax: 92-021-6440079.

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are positive for HCV antibodies; the prevalence may well be higher than this figure (Sultana et al., 2000). HCV is much more common in southern Europe and Japan than in the UK, and in Egyptian blood donors the prevalence is as high as 19%. It is transmitted by blood and blood products and it is postulated that 76% of hemophiliacs (Desenclos, 2000; Brandao and Costa, 2002). The most recent WHO estimate of the prevalence of HCV infection is 2%, representing 123 million people (Perz et al., 2004). Clinical features Symptoms are few in the acute phase with a mild flu-like illness and a rise in serum transferases. Less than 20% of patients develop jaundice and this is mild and selflimiting. Most patients will not be diagnosed until they present, extra hepatic manifestations are seen, including arthritis, agranulocytosis and aplastic anemia, as well as diffuse neurological problems. Rarely, fulminant hepatic failure occurs. At least 50% of patients go on to develop chronic liver disease. Histologically, a chronic hepatitis leading to a cirrhotic picture is seen. Cirrhosis develops in about 10 to 20% within 5 to 30 years and of these patients about 15% will develop hepatocellular carcinoma (Khattak et al., 2002) Diagnosis Diagnosis of hepatitis C is based on an enzyme immunoassay that detects antibodies to HCV. Anti-HCV is not protective, and in patients with acute or chronic hepatitis its presence in serum generally signifies that HCV is the cause (Hayashi et al., 1994). Limitations of the enzyme immunoassay include moderate sensitivity (false-negatives) for the diagnosis of acute hepatitis C early in the course and low specificity (false-positives) in some persons with elevated -globulin levels. In these situations, a diagnosis of hepatitis C may be confirmed by using an assay for HCV RNA. Occasional persons are found to have anti-HCV in serum, confirmed by a recombinant immunoblot assay (RIBA), without HCV RNA in serum, suggesting recovery from HCV infection in the past. Testing donated blood for HCV has helped reduce the risk of transfusionassociated hepatitis C from 10% in 1990 to about 1 case per 2 million units today (Haider et al., 1994). Prevention and treatment Major prevention problems persist in the developing countries. Many of them cannot afford the anti-HCV blood test kits, where the use of contaminated equipment for injection and other medical and dental procedures is widespread. Efforts are therefore, necessary to persuade the manufacturers of tests to lower the costs for

developing countries. Health education programmes are also needed to inform the general public and health care workers, about the risk of transmitting infection with the use of unsterile equipments. Surveillance on a global scale needs to be strengthened in order to improve medical knowledge of transmission of the virus (Chowdhury et al., 2003). Interferon is the only drug that has been found effective in the treatment of HCV infection. However treatment is very expensive-thousands of dollars for the drug aloneand must be administered by injection several times a week for several months. Moreover, some patients, experience serious side effects. Also, about half of the patients go into remission but 50% relapse when the treatment is stopped: only 25% is long term remission. Given its cost, only a minority of patients can afford it. Or are likely to be offered it. Studies involving less costly, orally administered drugs are continuing. But results so far have been disappointing. For a number of technical reasons, the development of a vaccine to prevent HCV infection is unlikely for many years (Luby et al., 1997).
MATERIALS AND METHODS Study area This study was carried out in Gadap Town Karachi, Pakistan. Objective This study was carried out to determine the frequency of HCV and identify risk factors for transmission of these infections in Gadap Town Karachi, Pakistan. Procedure Screening and evaluation of risk factors for HCV Antibody (AntiHCV) was done in Gadap Town Karachi Pakistan. In this study, subject above age of 10 years and all previously unscreened adults who were counseled and a written informed consent was obtained. All drug addicts by history were excluded. A structured information sheet regarding risk factors was filled and screening done by immunochromatography (ICT) kits. Blood samples were collected from individuals who volunteered to participate in the study after a counselling session. Demographic information about each participant was obtained by oral interview. Such information included sex and age. Sample collection Blood samples were collected by venepuncture. The arm of the individual was tied with a tourniquet and the position of the veins disinfected using cotton wool soaked in methylated spirit. Using a disposable sterile needle and 5 ml syringe for each participant, blood samples were collected from them. Each sample resultant supernatant (Plasma) was carefully decanted into a new labelled tube and stored at -29 C until ready for use. Statistical analysis The prevalence of HCV was determined from the proportion of

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seropositive individuals in the total population under consideration and expressed as a percentage. P values of < 0.05 were considered to be statistically significant.

RESULTS Hepatitis C is quite prevalent in both developing and developed countries. Therefore, the global mortality and morbidity related to chronic Hepatitis C poses a serious threat to public health around the globe. In present study, 600 hundred subjects were enrolled. 47% were females and 53% were males. Mean ages of females was 25 years and mean age of male was 24 years. In Gadap town 5% was anti HCV reactive. Risk factor for transmission of HCV was unsterized syringes and razor use in this area. Conclusion Hepatitis C viruses constitute a major public health problem because of the morbidity and mortality associated with the acute and chronic consequences of the infection. HCV cases have been increasing rapidly in rural areas. Most common cause for transmission of this infection may be unsterilized injection and razor use in rural areas. This can be controlled by awareness programs about HCV transmission in rural areas. The prevention of HCV infection can be achieved by blood screening for HCV before donation, avoiding sharing needles or any injecting equipment and following safe sexual practices.
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Alter MJ (1997). The epidemiology of acute and chronic hepatitis. Clin. Liver Dis., 1: 559-568. Bari A, Akhtar S, Rahbar MH, Luby SP (2001). Risk factors for hepatitis C virus infection in male adults in Rawalpindi-Islamabad, Pakistan. Trop. Med. Int. Health, 6: 732-738. Brandao AB, Costa FS (2002). Risk factors for hepatitis C virus infection among blood donors in southern Brazil: a case-control study. BMC Gastroenterol., 2: 18. Chowdhury A, Santra A, Chaudhuri S (2003). Hepatitis C virus infection in the general population: a community-based study in West Bengal, India. Hepatology, 37: 802-09. Desenclos JC (2000). Epidemiology of hepatitis C. Pract. Rev., 50: 1066-1070. Haider Z, Khan AA, Rehman K, Janjua MI, Iqbal J, Chishti MA, Qayyum A, Hasnain S, Shahzad A (1994). Sero-diagnosis for viral hepatitis in 93 patients admitted with acute hepatitis in three different teaching hospitals in Lahore. J. Pak. Med. Assoc., 44: 182-184. Hayashi J, Nakashima K, Yoshimura E, Hirata M, Maeda Y, Kashiwagi S (1994). Detection of HCV RNA in subjects with antibody to hepatitis C virus among the general population of Fukuoka. Jpn J. Gastroenterol., 29: 147-151. Khattak MF, Salamat N, Bhatti FA, Qureshi TZ (2002). Seroprevalence of hepatitis B, C and HIV in blood donors in northern Pakistan. J. Pak. Med. Assoc., 52: 398-402. Luby SP, Qamruddin K, Shah AA (1997). The relationship between therapeutic injections and high prevalence of hepatitis C infection in Hafizabad, Pakistan. Epidemiol. Infect., 119: 349-356. Perz JF, Farrington LA, Pecoraro C, Hutin YJF, Armstrong GL (2004). nd Estimated global prevalence of hepatitis C virus infection. 42 Annual Meeting of the Infectious Diseases Society of America; Boston, MA, USA. Sulaiman HA, Julitasari SA (1995). Prevalence of Hepatitis B and C viruses in healthy Indonesian blood donors. Trans. R. Soc. Trop. Med. Hyg., 89: 167-170. Sultana N, Qazilbash AA, Bari A (2000). Prevalence of anti-hepatitis C antibodies in patients with liver disease. Pak. Armed Forces Med. J., 50: 9-13. Wasley A, Alter MJ (2000). Epidemiology of hepatitis C; geographic differences and temporal trends. Semin. Liver Dis., 20: 1-16.