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Screening for hepatitis C among HIV positive patients at Mulago hospital in Uganda
1Makerere University College of Health Sciences, School of Medicine, Department of Internal Medicine, Gastroenterology Division, Kampala, Uganda.
Insights
Routine hepatitis C virus (HCV) screening is not recommended for all HIV-positive patients in resource-limited settings due to low prevalence. Testing should be reserved for patients showing signs of liver disease.
Area of Science:
- Infectious Diseases
- Hepatology
- Public Health
Background:
- International guidelines recommend hepatitis C virus (HCV) screening for HIV-positive patients.
- Resource limitations in countries like Uganda necessitate adapting these guidelines.
- Prevalence of HCV in HIV-positive individuals and testing costs are key considerations.
Purpose of the Study:
- To determine the prevalence of HCV among HIV-positive patients in Uganda.
- To inform resource allocation for HCV screening in resource-limited healthcare settings.
Main Methods:
- A cross-sectional study was conducted with HIV-positive outpatients at Mulago hospital.
- Anti-HCV Enzyme Immuno Assay (Roche Diagnostics) was used for HCV screening.
Main Results:
- 122 HIV-positive patients were enrolled between October 2003 and February 2004.
- The estimated HCV prevalence was 3.3%, with 4 out of 122 patients testing positive.
- The majority of participants were female (66.4%), with a mean age of 33.9 years.
Conclusions:
- Low HCV prevalence in this study suggests routine screening is not cost-effective in resource-limited settings.
- HCV screening should be targeted towards HIV-positive patients exhibiting symptoms of liver disease.
- This approach optimizes resource utilization while identifying potential HCV cases.
Background:
In industrialized countries with more resources, it is recommended that HIV infected patients should be screened for hepatitis C virus (HCV) on entry into the health care system. Implementation of these guidelines in a country like Uganda with limited resources requires some modification after taking into account the prevailing circumstances. These include the prevalence of HCV in HIV positive patients and the cost of HCV testing.
Objective:
The objective of the study was to estimate the prevalence of HCV in HIV positive patients.
Methods:
This was a cross sectional study among HIV positive outpatients in Mulago hospital. HCV screening was done using anti-HCV Enzyme Immuno Assay (Roche Diagnostics)
Results:
Between October 2003 and February 2004, one hundred and twenty two HIV positive patients were enrolled into the study with a mean age of 33.9 years. There were more females 81 (66.4%) than males. Only 4 patients had anti-HCV, giving an estimated HCV prevalence of 3.3%.
Conclusion:
In view of the low HCV prevalence found in our study and similar studies and considering the high cost of HCV screening, routine HCV testing cannot be recommended among all HIV positive patients in our health care settings with limited resources. We recommend that HCV screening be limited to investigating HIV positive patients with features suggestive of liver disease in order to identify HCV as a possible cause.
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