Studies on the Prevalence of Hepatitis C Virus Infection in Diabetic Patients.

doi:10.21203/rs.2.13403/v1

Download PDF

Research article

Studies on the Prevalence of Hepatitis C Virus Infection in Diabetic Patients.

https://doi.org/10.21203/rs.2.13403/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 09 Sep, 2020

Read the published version in BMC Infectious Diseases →

You are reading this older preprint version

Read the latest preprint version →

Background: Hepatitis C virus (HCV) infection and type 2 diabetes mellitus (T2DM) are two major public health problems associated with increasing complications and mortality rates worldwide. The objective of this study to evaluate the prevalence of hepatitis C virus (HCV) infection in diabetic patients and to investigate the influence of several epidemiological and clinical factors on HCV infection.

Method: A total number of one hundred and eighty diabetic patients were recruited for this study. Consented subjects made up of 71(39.4%) males and 109(60.56%) females were recruited for the study. Structured questionnaires were administered to the consented participants to obtain relevant data. Sera samples were assayed for antibodies to HCV using an enzyme linked immunosorbent assay [Inteco Diagnostic Limited]. ELISA technique.

Result: Overall prevalence of HCV infection among diabetes patients assayed was 13.3%. Out of which 8(11.3%) was obtained from the male subjects compared to 16 (14.7%) seropositivity recorded for the female subjects (P = 0.511; P > 0.05). Considering age distribution, Subjects aged 41-50 years recorded, 9 (22.5%) positivity (P= 0.238; P>0.05).Considering educational status of subjects screened, 22 (14.9%) positivity was rescored among subjects who have attained tertiary status of education.( P = 0.574;P>0.05).Risk factors considered showed that, 7 (18.9%) seropositive subject were alcoholic consumers(P value = 0.2621;P>0.05) while 5 (8.9%) recorded history of sharing sharp objects P= 0.2427;P>0.05).

Conclusion: Our study shows a slightly higher prevalence of hepatitis C infection in type 2 diabetics. This call for urgent routine screening exercise among diabetic patients for HCV infection. This study also emphasizes the need for public enlightenment of the association between HCV infection and T2DM, to avert possible complications among diabetic patients. Keywords: HCV, Type 2 diabetes mellitus (T2DM), Patients

Infectious Diseases

HCV

Type 2 diabetes mellitus (T2DM)

Patients

Hepatitis is the inflammation of the liver as a result of viral infection which can either be acute or chronic, symptomatic or asymptomatic (1). This viral infection can lead to liver damage due to various causes such as heavy intake of alcohol, toxin ingestion and certain suppressive medical conditions (2).Hepatitis C virus (HCV) infection is a public health concern affecting more than 170 million people worldwide (3)(4). HCV is a positive, single-stranded RNA virus in the Flaviviridae family. HCV is most efficiently transmitted through transfusion of infected blood, transplantation of infected organs, mother-to-child transmission during childbirth and interaction with infected blood or body fluids of an infected person(5). Most cases of Liver transplant mainly occurs as a result of HCV infection progressing to chronic infections.(6).

Hepatitis C virus (HCV) has been identified as one of the leading causes of chronic liver disease with serious sequel as the end stage of cirrhosis and liver cancer(7).Hepatitis C has clearly been demonstrated to be a precipitating factor for diabetes but only in patients with risk factors to develop such. People with hepatitis C virus (HCV) infection appear to be at increased risk of developing type 2 diabetes(8). Diabetes mellitus is a chronic disease of metabolism causing abnormal glucose homeostasis(9).

Diabetes Mellitus, commonly referred to as diabetes is an impairment in which the body is unable to process glucose leading to reduction in the blood sugar level. Diabetes is characterized by high blood glucose level (hyperglycemia) with problems of fat, protein, and carbohydrate metabolism due to the body’s inability to secrete/act on insulin over a long period(10). Diabetic status of individuals are divided into two; namely Type 1 diabetes which occurs mostly in children and adolescents and Type 2 diabetes which occurs mostly in adults, (11).

Knobler, et al. (2000) reports an increase in DM type–2 before the development of advanced liver cirrhosis(12). Previous Research found that, after excluding chronic hepatitis C patients who received previous interferon treatment, higher fibrotic stages in liver histology and family history of DM were closely associated with higher prevalence of DM and impaired fasting glucose in patients with chronic hepatitis C(13). HCV infection and type 2 diabetes mellitus are two chronic conditions which contribute to a significant morbidity and mortality. A higher prevalence of type 2 diabetes mellitus has been observed in the developed world (2% to 9.4%) in patients with HCV infection than in those with other forms of chronic hepatitis(14,15)

Type 2 diabetes is a debilitating disease condition, while the co-infection of type 2 diabetes and HCV has been established to worsen this condition, hence it has become very necessary for a screening exercise to determine the prevalence rate of HCV among diabetic patients at our location of study, so as to increase awareness of the populace and health practitioners on the dangers of the co-infectious state of this virus with diabetes.

Study area and population:

The study was conducted at the Federal Teaching Hospital Ido-Ekiti which is a tertiary health institution. The study population comprised of randomly selected confirmed Diabetic patients attending the outpatient department of the Teaching Hospital.

Ethical permit and consent:

A proposal of the project was submitted to the Ethical Review Committee of the Federal Teaching Hospital Ido-Ekiti. Where ethical permit was sought for and obtained with protocol number: ERC/2018/02/27/103B.

Inclusion and Exclusion criteria:

Individuals confirmed for type 2 diabetes mellitus diabetes were recruited for the study. Persons who showed no interest in the study and are not diabetic were excluded from the study.

Questionnaire and sample size:

The sample size used in this research work was obtained from One–Hundred and eighty (180) volunteers, while those recruited were informed about the study and their consents obtained. Well-structured questionnaires were used to collect demographic data and other pertinent information.

Sample collection and processing:

Three-Five (3–5) mL of blood was collected from each diabetic patient aseptically. Blood samples were allowed to clot at room temperature undisturbed, thereafter Sera obtained were dispensed into a clean, dry cryovial and stored at –20ºC prior use. The sera were screened for antibodies to HCV using ELISA kits (Fortress Diagnostic Limited). Standard procedures were strictly adhered during the assay process.

Data analysis:

Filled questionnaires were crosschecked manually for correct data entry. The data were analyzed using the SPSS software package, Chi-square test was used to compare several Variables while the critical level for statistical significance was set at p = 5% (0.05).

Sample processing:

Sera samples obtained were screened for HCV antibodies using ELISA technique according to the manufactures manual. Serum ALT was also assayed for, following the procedure detailed out in the kit used. Hepatitis C ELISA and ALT kits were stored in the refrigerator at 4ºC prior to use. Serum samples were analyzed at Landmark University Medical Laboratory.

The total sera samples screened comprises of 71 (39.4%) Males and 109 (60.56%) Females (Table 4). The age distribution of the subjects analyzed for the test ranged from 0–20, 21–30, 31–40, 41–50, 51–60 and 60–100 years. Of the 180 serum samples analyzed for HCV, 24 (13.3%) samples tested positive while 156 (86.7%) samples tested negative (Table 4.1). Of the total positive samples, 8 (4.4%) were obtained from the Male diabetic patients while the female subjects recorded 16 (8.9%) positivity for HCV.

TABLE 1: Total number of sera samples assayed.

TABLE 2: Distribution of Hepatitis C Virus based on Gender

Figure 1: Distribution of Hepatitis C Virus according to Gender

TABLE 3: Distribution of Hepatitis C Virus According To Age.

Figure 2: Distribution of Hepatitis C Virus according to Age

TABLE 4: Distribution of Hepatitis C Virus According To Marital Status

Figure 3: Distribution of Hepatitis C Virus according to marital status

TABLE 5: Distribution of Hepatitis C Virus According To Educational Background

Figure 4: Distribution of Hepatitis C Virus according to Educational background.

TABLE 6: Distribution of Hepatitis C Virus based on Demographic Factor.

Figure 5: Distribution of Hepatitis C Virus according to Age.

TABLE 7: Distribution of Hepatitis C Virus based on Clinical Risk Factors.

Figure 6: Distribution of Hepatitis C Virus based on Clinical Risk Factors

TABLE 8: Distribution based on lifestyle-risk factors of Subjects Screened.

TABLE 9: Distribution of Hepatitis C Virus According To Family History

TABLE 10: Determination of Serum Alanine Aminotransferase on Hepatitis C Virus patients.

The present study found a slightly higher prevalence rate of 13.3% among Type 2 Diabetes Mellitus (T2DM) subjects when compared to the global prevalence rate of around (3%) in the general population. The results obtained in this study compares with the work of Nwokediuko et al.,, (2008) in Enugu where HCV occurrence rate among diabetic patients was found to be 14.0% (16). Although, Ejele et al., (2005) and Balogun et al.,, (2006), obtained a prevalence of 3.0% in Niger Delta region and 0.0% in Ibadan which is in contrast with the other results obtained by (17,18). Similar study conducted among diabetics by Ndako et al.,, (2009) showed 11.0% prevalence in Jos which is also lower than the result obtained in this study, while a prevalence of 5.0% was recorded in a study carried out among diabetes patients at UITH, Ndako et al., (2011), while 5.7% prevalence was reported from India Demitrost et al., 2015, which is lower compared to the findings obtained in this study.. However, Gray et al was the first to show a higher prevalence of HCV infection in T2DM patients with a prevalence of 8% among Asian patients. Differences in the incidence rate of HCV results attained from various regions globally depict geographical diversity. The variation in these occurrence rates can be ascribed to exposure to various risk factors which are capable of enhancing the spread and transmission of this virus amongst individuals(19).

The Prevalence rate of HCV infection among males recorded 8(4.4%) while the female subjects had 14(8.9%) seropositivity. This finding agrees with the result obtained from a similar work by Ndako et al.,, (2009) and Gacche et al.,, (2012) where the incidence of anti-HCV in diabetic among the female subjects were higher compared to the male subjects.Increased rate of occurrence in females could be attributed to various risk factor HCV infection, which was quite evident from the life style and history of the individuals recruited for this study(20).

A higher prevalence rate of 9(5.0%) was observed amongst subjects aged 41–50, this result is in accordance with the findings of Mehta et al.,, (2003) in which subjects above 40 years of age were found to be more likely to have diabetes with HCV infection compared to persons below 40 years of age (21), which is also closer to the results obtained by Klevens et al.,, (2009) which showed a higher incidence rate among subjects aged 35–44 and this concurs with the result gotten in this study(22). The high seropositivity observed in older age group could be attributed to possible differences in social practices, parenteral exposures, decline in physical mobility and a reduced rate of medical examination compared to younger individuals thus increasing chances of transmission of infection.(23).

The result obtained in this study showed that having multiple sexual partners is a major means of spreading HCV; however, it was observed that the prevalence of HCV was higher among married subjects (15.4%), similar study carried out by Qureshi et al.,, (2010) recorded a higher prevalence among married subjects. This is findings could be as a result of increased exposure to several risk factors to this infectious agent(24).

Regardless of the fact that HCV is a blood-borne virus, the sero-prevalence among individuals that had undergone blood transfusion or donation is of no statistical significant difference and this agrees with the work of Simo et al., (1996)(25).Among subjects that had history of blood donation in this study, 3 (1.7%) were found to be positive to HCV. However, it is observed that blood and blood products are potential sources of transmission for HCV infection(20). In the present study, sharing personal items that may be contaminated with infected blood and tattooing were defined as HCV predictors. The risk of HCV continues to be a great occupational threat. Consequently, blood transfusion was also identified as a predictor of HCV Infection(26).

High rate of positivity was observed in subjects screened for alcohol consumption, sharing of unsterilized objects and subjects that had tribal marks or tattoo ranging from 3.9%, 2.2% and 2.8% respectively with no statistical significant difference. However, participants with family history of diabetes recorded a sero-prevalence of 6.7% to HCV infection, This report is similar to the work of Muller et al.,, (1994) where the increased incidence of HCV was closely related with family history of diabetes mellitus, A significant difference was observed in participants with a family history of diabetes mellitus and those without, (27,28); this might be attributed to multiple sexual partners, transfusion of unscreened blood in hospitals, family history of related infections, risky behaviours such as alcohol intake and other potential unidentified routes of transmission which can only be discovered through advance studies(29).

This study found that elevated liver enzymes; especially ALT has a direct relationship with seropositivity to HCV in the diabetic population studied, showing the relevance of this as a screening test in diabetics. In a study by Mason, 2000 more than 20% of diabetes patients with consistently elevated serum aminotransferases had evidence of HCV infection. It was also discovered that most of the anti-HCV positive diabetic patients presented with an abnormal liver function tests, a combination of hepatocellular and cholestasis pattern being the predominant biochemical alteration(25). Elevation of ALT in hepatitis C positive diabetes patients in this study is usually mild, with most having ALT level between one to two times upper limit of normal.

The outcome of this study has some important implications. The increased risk of HCV infection in patients with T2DM warrants routine screening of diabetes subjects for HCV. Similarly, the study adds to the limited data on the subject available in this region and will help in increasing awareness regarding association of HCV and diabetes, which will further help to reduce morbidity and possible mortality associated with this comorbidity in the long run. The need for prompt enlightenment of the general public on the threats of the coinfection of HCV and diabetes is strongly advocated. In addition, it is important that health care worker approach the settings of early diagnosis and management of this condition among infected persons to avert further complications among type 2 diabetes.

Abbreviations:

HCV-Hepatitis C Virus; T2DM-Type 2 Diabetes Mellitus; ALT-Alanine Transaminases; ELISA-Enzyme-Linked Immunosorbent Assay.

Acknowledgements:

The author deeply acknowledges the Management of the Landmark University Medical Center for the opportunity to use the Medical Laboratory department to assay our samples. Staffs of the FTC Ido Medical Laboratory Department are also deeply acknowledged.

Authors Contributions:

JAN - Made substantial contributions to the drafting, conception, field analysis and sample collection of this Research.

AOO- Made substantial contributions on design module of this research.

JAO - Made substantial contributions on the Monitoring of the subjects recruited for this study.

JAA- Made substantial contributions on the laboratory analysis of the samples obtained.

OO - Made substantial contributions on the interpretation of the statistical analysis used.

BAA- Made substantial contributions on the field work and the analysis of the samples obtained.

All authors have read and approved the manuscript.

Authors Information:

Not Applicable

Funding:

This research work was solely funded by the authors. This has assisted in the enlightenment of the population. This self-funding effort by the authors covered design of the study and collection, analysis, and interpretation of data.

Ethics approval and consent to participate:

Ethical clearance and approval was obtained from the appropriate ethical committee of the Federal Teaching Hospital Idi-Nigeria.

Consent for publication:

Only consented volunteers, obtained through volunteer forms filled by respective subjects were enrolled for the study. I wish to declare that consent for participation obtained from study participants was verbal, the reason being that such patients on routine check for their diabetic status are on referral by a physician. They counseled on the relevance of the screening before sample collection is embarked upon. This was explained to the ethics committee and was so approved.

Availability of supporting data and material:

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests:

The authors declare that they have no competing interests.

Rosen HR. Chronic hepatitis C infection. N Engl J Med. 2011;364(25):2429–38.
Gane EJ. The natural history of recurrent hepatitis C and what influences this. Liver Transplant. 2008;14(2):36–44.
Foster GR, Goldin R. Management of chronic viral hepatitis. Taylor Fr Gr. 2005;2nd Editio.
Shinn JH, Liang KC. Chronic hepatitis C and Diabetes Mellitus. Chinese J Med Assoc. 2006;69(4):143–5.
Alter MJ. Epidemiology of Hepatitis C virus. J Hepatol. 1997;26:625–55.
Vescovo T, Refolo G, Vitagliano G, Fimia GM, Piacentini M. Molecular mechanisms of hepatitis C virus–induced hepatocellular carcinoma. Clin Microbiol Infect. 2016;22(10):853–61.
Elfiky AA, Elshemey WM, Gawad W, Desoky O. Molecular modeling comparison of the performance of NS5b polymerase inhibitor (PSI–7977) on prevalent HCV genotypes. Protein J. 2013;32(1):75–80.
Mehta SH. Hepatitis C Virus infection and incident Type 2 diabetes. J Hepatol. 2003;38(1).
Imam K. Clinical features, diagnostic criteria and pathogenesis of diabetes mellitus. Adv Exp Med Biol. 2012;771:340–55.
Peck T, Price C, English P, Gill G. Oral health in rural South African type 2 diabetic patients. Trop Doct. 2006;36(2):111–2.
Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014;383(9911):69–82.
H K, R S, A Z, G F, A. S. Increased risk of type 2 diabetes in noncirrhotic patients with chronic hepatitis C virus infection. Mayo Clin. 2000;75:355–9.
Zein CO, Levy C, Basu A, NN Z. Chronic hepatitis C and type II diabetes mellitus: a prospective cross-sectional study. Am J Gastroenterol. 2005;100:48–55.
Younossi ZM, Stepanova M, Nader F, Younossi Z, Elsheikh E. Associations of chronic hepatitis C with metabolic and cardiac outcomes. Aliment Pharmacol Ther. 2013;37(6):647–52.
Naing C, Mak JW, Ahmed SI, M. Maung M. Relationship between hepatitis C virus infection and type 2 diabetes mellitus: meta-analysis. World J Gastroenterol. 2012;18(14):1642–51.
Nwokediuko SC, Oli JM. Hepatitis C Virus Infection in Nigerians with diabetes mellitus. Niger J Clin Pract. 2008;11(2):94–9.
Ejele O, Erhabor O, Nwauche CA. The risk of transfusion-transmissible viral infections in the Niger-Delta area of Nigeria. Sahel Med J. 2005;8(1).
Balogun WO, Adeleye JO, Akinlade KS, Kuti M, Otegbayo JA. Low prevalence of hepatitis-C viral seropositivity among patients with type–2 diabetes mellitus in a tertiary hospital. J Natl Med Assoc. 2006;98(11):1805.
Hannah P, Gary B. Commentary: A review of risk of hepatitis B and C transmission through biting or spitting. J Viral Hepat. 2018;25(12).
Razavi-Shearer D, Gamkrelidze I, Nguyen MH, Chen D-S, Van Damme P, Abbas Z, et al. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study. Lancet Gastroenterol Hepatol. 2018 Jun;3(6):383–403.
Mehta SH, Pankow FLBSASJS, Netski D, Coresh J, Szklo M, Thomas DL. Hepatitis C Virus infection and incident Type 2 diabetes. J Hepatol. 2003;38(1).
Klevens RM, Miller J, Vonderwahl C, Speers S, Alelis K, Sweet K, et al. Population-based surveillance for hepatitis C virus, United States. Emerg Infect Dis. 2009;15(9):1499.
Lee SR, Kardos KW, Schiff E. Evaluation of a new, rapid test for detecting HCV infection, suitable for use with blood or oral fluid. J Virol Methods. 2011;172(1–2):27–31.
Qureshi H, Bile KM, Jooma R, Alam SE, Afrid. HUR. Prevalence of hepatitis B and C viral infections in Pakistan: findings of a national survey appealing for effective prevention and control measures. East Mediterr Heal J. 2010;16(8):15–23.
Simo R, Hernadez C, Genesa J, Jardi R, Mesa J. High prevalence of Hepatitis virus infection in diabetic patients. Am Diabetes Assoc. 1996;19(9):998–1000.
Cardinal GF, Di Martino V, Lambrey G, Nalet B, Anciaux M. Prevalence of hepatitis C infection and risk factors in hospitalized diabetic patients: results of a cross-sectional study. Eur J Gastroenterol Hepatol. 2008;20(9):829–36.
Francesca W, Lutje. V, Declan D, Valerie S. Sexual transmission of Hepatitis C Virus infection in a heterosexual population: A systematic review [version 1; referees: 2 approved]. HRB Open Res. 2018;
Osi O, Sanaa MK. Hepatitis C in Developing countries. Acad Press. 2018;71–81.
Ghany MG, Strader DB, Thomas DL, Seeff LB. Diagnosis, management and treatment of hepatitis C. J Hepatol. 2009;

Due to technical limitations, Tables 1 - 10 are only available for download from the Supplementary Files section.

Download PDF

Journal Publication

published 09 Sep, 2020

Read the published version in BMC Infectious Diseases →

Editorial decision: Major revision
23 Oct, 2019
Review #2 received at journal
24 Sep, 2019
Review #1 received at journal
16 Sep, 2019
Reviewer #2 agreed at journal
03 Sep, 2019
Reviewer #1 agreed at journal
21 Aug, 2019
Editor assigned by journal
20 Aug, 2019
Reviewers invited by journal
20 Aug, 2019
Submission checks completed at journal
19 Aug, 2019
Editor invited by journal
19 Aug, 2019
First submitted to journal
09 Aug, 2019

You are reading this older preprint version

Read the latest preprint version →

Studies on the Prevalence of Hepatitis C Virus Infection in Diabetic Patients.

Status:

Journal Publication

Version 1

Abstract

Figures

Background

Method

Study area and population:

Ethical permit and consent:

Inclusion and Exclusion criteria:

Questionnaire and sample size:

Sample collection and processing:

Data analysis:

Sample processing:

Results

Discussion

Conclusion

Declarations

Abbreviations:

Acknowledgements:

Authors Contributions:

Authors Information:

Funding:

Ethics approval and consent to participate:

Consent for publication:

Availability of supporting data and material:

Competing interests:

References

Tables

Supplementary Files

Status:

Journal Publication

Version 1