Browsing by Author "Kajumbula, Henry"

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Disproportionate Distribution of HBV Genotypes A and D and the Recombinant Genotype D/E in the High and Low HBV Endemic Regions of Uganda: A Wake-Up Call for Regional Specific HBV Management
(Hindawi, 2022-01-11) Mukasa Kafeero, Hussein; Ndagire, Dorothy; Ocama, Ponsiano; Kato, Charles Drago; Wampande, Eddie; Kajumbula, Henry; Kateete, David; Walusansa, Abdul; Kudamba, Ali; Kigozi, Edgar; Katabazi, Fred Ashaba; Namaganda, Maria Magdalene; Ssenku, Jamilu E.; Sendagire, Hakim
Background. Hepatitis B virus (HBV) is the leading cause of liver-related diseases. In Uganda, there is a regional disparity in the HBV burden. Our study was aimed at establishing the circulating genotypes in a low and a high endemic region to give plausible explanations for the differences in regional burden and guide the future management of the disease. Methods. A total of 200 HBsAg-seropositive subjects were recruited into the study by convenience sampling. The HBsAg Rapid Test Strip (Healgen Scientific Limited Liability Company, Houston, TX77047- USA) was used to screen for HBsAg while the Roche machine (Roche, Basel Switzerland/Abbot Technologies (USA)) was used to determine the viral load. The Chemistry Analyzer B120 (Mindray, China) was used for chemistry analysis. For HBV genotyping, total DNA was extracted from whole blood using the QIAamp® DNA extraction kit. Nested PCR amplification was performed using Platinum Taq DNA Polymerase (Invitrogen Corporation, USA) to amplify the 400 bp HBV polymerase gene. Purification of nested PCR products was performed using Purelink PCR product purification kit (Life Technologies, USA). Automated DNA sequencing was performed using BigDye Terminator v3.1 Cycle Sequencing Kit on 3130 Genetic Analyzer (Applied Biosystems, USA). The NCBI HBV genotyping tool (https://www.ncbi.nlm.nih.gov/projects/genotyping/formpage.cgi) was used for determination of genotype for each HBV sequence. Pearson’s chi-square, multinomial logistic regression, and Mann–Whitney U tests were used for the analysis. All the analyses were done using SPSS version 26.0 and MedCalc software version 19.1.3 at 95% CI. A p < 0:05 was considered statistically significant. Results. Majority of our study subjects were female (64.5%), youth (51.0%), and married (62.0%). Overall, genotype A was the most prevalent (46%). Genotype D and the recombinant genotype D/E were proportionately more distributed in the high endemic (38.2%) and low endemic (36.5%) regions, respectively. Genotype D was significantly more prevalent in the high endemic region and among the elderly (p < 0:05). Genotype D was significantly associated with elevated viral load and direct bilirubin (p < 0:05). The recombinant genotype D/E was significantly associated with elevated viral load (p < 0:05). Similarly, genotype A was significantly associated with elevated AST and GGT, lowered viral load, and normal direct bilirubin levels (p < 0:05). Conclusion. There is disproportionate distribution of genotypes A and D and the recombinant genotype D/E in the low and high endemic regions of Uganda. This probably could explain the differences in endemicity of HBV in our country signifying the need for regional specific HBV management and control strategies.
Hepatitis B virus (HBV) serological patterns among the HBsAg negative hospital attendees screened for immunization
(Scientific Reports, 2022-05-06) Kafeero, Hussein Mukasa; Ndagire, Dorothy; Ocama, Ponsiano; Kato, Charles Drago; Wampande, Eddie; Walusansa, Abdul; Kajumbula, Henry; Kateete, David; Sendagire, Hakim
The Hepatitis B virus (HBV) is a highly infectious virus and is endemic in Uganda. It is one of the major etiological agents for liver diseases including liver cancer. In this work, we evaluated the prevalence of the HBV serological markers and the associated socio-demographic factors among hepatitis B surface antigen (HBsAg) seronegative persons screened during routine immunization against the virus in eastern Uganda. Data on the socio-demographic characteristics were collected using a structured questionnaire, while that on the serological markers were obtained from serum samples and evaluated by using the 5-panel HBV One Step Hepatitis B Virus Combo Test Device ( FastepR, HBV-P43M). The following markers were evaluated by the panel: HBsAg, HBsAb, HBcAb, and HBeAb. Data were analyzed using SPSS (version 26), and multinomial logistic regression was used to elicit the adjusted odds ratio. All the analysis were performed at a 95% confidence limit, and a P value ≤ 0.05 was considered significant. The 424 participants included in this study were mainly female (62.3%), married (55.4%) and aged 30 years and above (54.2%). The seropositivity of the HBsAb, HBeAb, HBcAb marker prevalence rates was 48(11.3%), 73(17.2%) and 45(10.6%) respectively. The majority of the participants (327, 77.1%) did not present with any marker. Married paricipants were significantly associated with reduced HBsAb seropositvity rate, whereas young people aged 18–29 years were associated the with increased odds of HBsAb seropositivity (p < 0.05). Male participants were significantly associated with the HBeAb and HBcAb seropositivity (p < 0.05). Similarly, contact with an HBV infected person was significantly associated with HBeAb and HBcAb seropositivity (p < 0.05). Further still, blood transfusion was significantly associated with the increased risk of HBcAb seropositivity (P < 0.05). This study has revealed a prevalence of HBV serological markers among the HBsAg seronegative persons in this community and an increased risk of transmission of the virus in the community. Our findings have key consequences pertaining the interventions that are pertinent in the control and prevention of the spread of the virus among apparently health persons. Hepatitis B virus (HBV) is the causative agent for liver inflammatory diseases, which, if not diagnosed in a timely manner and subsequently managed, are likely to progress to chronic liver diseases, liver fibrosis, liver cirrhosis, and liver cancer1. The virus has been implicated as one the most common oncogenic virus in humans2. It is a highly transmissible virus and is 50 to 100 times more infectious than Human Immune deficiency Virus (HIV). In addition, it has extreme resilience, allowing it to survive for several days on dry surfaces. This complicates its epidemiology and explains the increased chances of intra-familial horizontal transmissions3. Despite the presence of a safe and highly efficacious vaccine, HBV infection is still one of the major global health problems4. The Uganda Population-Based Impact Assessment (UPHIA) 2016–2017 survey reported a drastic decrease in the prevalence of HBV in Uganda5. According to this survey, the national prevalence of HBV dropped from 10% in the general population in 20156 to 4.3% in 2016 and 4.1% in 2017, with east-central posting a prevalence of 2.1%. However, HBV is a chronic infection and these data are suggestive of either massive death of the chronically infected persons or a higher level of sero-conversion to HBsAb between the sampling intervals. Nevertheless, the rapid sero-conversion indicated by a high prevalence of the HBsAb with normal levels of the correlates of liver damage over a short period of time seems to be unrealistic. Similarly, the drastic decrease in the risk of infection because of improved immunity or public health awareness appears idealistic. The relative importance of the socio-demographic factors to HBV infection varies from population to population7, and their contribution to community spread of HBV have been previously reported with concordance in some studies and contradictions in other studies8– 12. Understanding these sociodemographic factors related to infection and their relationship with markers of HBV exposure will provide plausible answers to the recent drastic decline in HBV in Uganda. To understand the sero-prevalence of hepatitis B virus, screening of a large number of people is needed. Serological markers for detection of HBV are diverse13 and include hepatitis B surface antibody (HBsAb), hepatitis B pre-core antibody (HBeAb), hepatitis B pre-core antigen (HBeAg), hepatitis B core antibody (HBcAb) and hepatitis B surface antigen (HBsAg). However, in resource limited settings, screening for hepatitis B virus infection is limited to only the HBsAg using the rapid diagnostic test. Unfortunately, the use of a single marker of exposure is associated with vast irregularities in the diagnosis of HBV. This inconclusive diagnosis is likely to mislead clinicians in their decisions when managing the HBV-infected persons as well as the decision to discard donated blood for transfusion by local and regional blood banks. HBV exposure markers have high sensitivity but low specificity, justifying the need to investigate them not in isolation for comprehensive case management and explicit assessment of blood for transfusion. The Anti-HBc is characteristic of a hidden HBV carrier state and/ or resolved disease14. Anti-HBs antibodies are associated with acquired immunity either due to previous exposure and natural response to the virus or due to vaccination15, whereas the Anti-HBe antibody is a marker of the minimally infective phase and disease remission or recovery from the infection16. Thus, as eluded from above, the relative significance of different sociodemographic risk factors for infection, the comparative expression of markers of liver damage and the relative prevalence of different markers of exposure to HBV at the community level can provide constructive clues on the trend of HBV prevalence and infectivity in a population. Consequently, we sought to understand the current state of the risk factors for HBV infection and the prevalence of the markers of immunity against HBV among HBsAg seronegative individuals to justify the drastic reduction in the burden of HBV in Uganda.
TREAT-B Algorithm for Treatment Eligibility Among Chronically Infected Hepatitis B Virus Persons in a Low and a High Endemic Region: A Potential Strategy Towards Virus Elimination by 2030
(Frontiers in Virology, 2022-04-11) Kafeero, Hussein Mukasa; Ndagire, Dorothy; Ocama, Ponsiano; Drago, Charles; Wampande, Eddie; Kajumbula, Henry; Kateete, David Patrick; Walusansa, Abdul; Kudamba, Ali; Ssenku, Jamilu E.; Sendagire, Hakim
Background: Little is known about treatment eligibility in Africa for the hepatitis B virus (TREAT-B) algorithm. We investigated the treatment eligibility among the HBV chronically infected patients in a low and a high endemic region using the TREAT-B algorithm. Methods: We recruited 227 treatment-naïve HBV-infected hospital attendees from the low and high HBV endemic regions. We assessed the treatment eligibility by testing for HBeAg serostatus and ALT levels. Socio-demographic data were collected with a structured questionnaire. The accessory correlates of treatment eligibility (AST, ALP, ALB, GGT, and TBIL) and the socio-demographic factors were analyzed by both univariate and multinomial logistic regression using the SPSS and Medcalc. The analysis was done at 95% CI and a p < 0.05 was considered statistically significant. Results: Overall, 56.8% of the participants qualified for treatment at TREAT-B cutoffs of ≥2, with those from the low endemic region (90, 69.8%) having significantly higher treatment eligibility indication than those from the high endemic region (p < 0.05). Alcohol use and household contact with an HBV-infected person were independent socio-demographic factors significantly associated with treatment eligibility for both low and high endemic regions (p < 0.05). However, birth place was only indicated for treatment eligibility among the high endemic participants (p < 0.05). AST, GGT, and total bilirubin were the liver-related parameters significantly associated with treatment eligibility (p < 0.05), with GGT and AST being significantly elevated among the eligible low endemic dwellers compared to high endemic dwellers (p < 0.05). Conclusion: Using TREAT-B algorithm can be a plausible alternative to the orthodox methods to specify treatment eligibility with the potential to scale up interventions targeting HBV management and elimination.