Clinical and social determinants of liver fibrosis among Hepatitis C virus infected patients in Rwanda

Abstract

ABSTRACT

Background: Liver fibrosis prevalence is poorly understood in the Rwandan context, it is of much importance to know the staging of liver fibrosis in Hepatitis C Virus infected patients. Biopsy is the gold standard to assess liver fibrosis but very expensive and can‟t be accessed everywhere, this makes Non-invasive methods, Aspartate to Platelet Ratio Index score included to be very useful in assessing that, thus hindering the severity of fibrosis that leads to cirrhosis and finally to liver cancer. Methods: This is a descriptive analytical cross-sectional study of secondary data from Simplifying Hepatitis C Antiviral therapy in Rwanda for Elsewhere in the Developing world (SHARED) study that was done in 2016 at Rwanda Military Hospital (RMH). Our aim is to determine the prevalence of Liver fibrosis among HCV infected participants and we used results of serum biomarkers that were tested in the laboratory to determine liver fibrosis.

Results: The prevalence of liver fibrosis in our study population as calculated using the APRI score is 15.8%. Socio-demographic statistics indicate that the mean age of our study population was 61.8±14.1 and most of our participants were female with a proportion of 62%. The majority of the study participants had primary education (45.5%) followed by secondary education at 25.9% and 16.5% had no education at all. Eighty-two percent of the study participants were of low socio-economic status (SES) 16.1% were of middle income and only 1.7% was regarded as of high SES. 63.4% of the study population were jobless whereas 16% had paid jobs (Table1). In our study population 14.2% were alcohol consumers whereas 85.8% were not, 57.2% had 0-1 sex partners, 26.6% had 2-4 sex partners, 5-10 and ≥11 sex partners had 8.1%. More than a half of the participants (50.8%) are of normal weight (BMI between 18.5 and 24.9) and 42.8% are under weight (BMI less than 18.5). It is noteworthy that only 1.7% was obese and 4.8% were overweight. The HIV prevalence in our study population is 9.1% and most laboratory tests showed that most individuals had normal test results except for GGT (9–48U/L). (Table2)

Discussion and conclusion: HCV infection is one of the main causes of liver fibrosis, the prevalence of liver fibrosis in Rwanda is poorly understood, this study is among those that can contribute to our understanding of liver fibrosis among HCV infected individuals. APRI score would be of much preference to be used in the Rwandan context to assess the development of liver fibrosis.