IOSR Journal Of Pharmacy www.iosrphr.org (e)-ISSN: 2250-3013, (p)-ISSN: 2319-4219 Volume 7, Issue 1 Version. 1 (Jan 2017), PP. 78-85 Burden of Hepatitis B, Hepatitis C and HIV Infections Among Adult Citizens in Kandahar City, Afghanistan 1 Khwaja Mir Islam Saeed (MD, MSc) 1 Head of Grant and Service Contract Management Unit (GCMU), Ministry of Public Health, Kabul- Afghanistan, Tel: 0093700290955 ABSTRACT: -Background:Blood borne diseases including viral hepatitis are important public health challenges worldwide. There is a notable dearth of data about Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and HIV prevalence in Afghanistan. The objective of this study was to estimate the seroprevalence of HBV, HCV, HIV infections among adult populations in Kandahar city, Afghanistan. Methods and Materials:A total of 1165 adult citizens in Kandahar city were included in the study using a cross-sectional design in October-November 2015. Data on demographic, socioeconomic and lifestyle factors were collected using WHO STEP wise approach. Rapid tests were conducted to identify the prevalence of HBV, HCV, and HIV infections. Statistical analysis performed Using SPSS v.20. Results: Of total records, females constituted almost half 597 (51.2%) with overall mean age of 38.3±11.2 years. The prevalence of HBV was 2% (22 out of 1153) for HBsAg on rapid test and 12 subject (1%) were seropositive for anti-HCV on rapid tests. None of subjects had co-infections. None of specimen were positive for HIV infection showed zero prevalence. Proportion of married groups was 79.3%, illiteracy rate was 73.2% and 88.5% of women were at home doing housework (housewives). About one tenth (9.7%) were smokers and 16.3% were snuffers. There was no statistical association of studied factors with HBV and HCV. Conclusion: The study found low prevalence of HBV and HCV in adult citizens in Kandahar city. Public awareness and health education regarding risk factors for viral hepatitis and encouragement for vaccination is recommended. More focus is needed to be given to high risk groups due their vulnerability to diseases. Keywords: Hepatitis, HBV, HCV, HIV infection, risk factors, Afghanistan II. INTRODUCTION The Hepatitis B virus (HBV) is blood born virus and a serious public health problem worldwide. It has a major cause of morbidity and mortality, touching almost every class of person and age group with vertical transmission, the commonest route of transmission in many endemic areas [1]. World Health Organization (WHO) estimates that more than 2 billion people have been infected with HBV and 350 million people across the world continue to carry chronic infection, of which almost 1 million die annually from HBV related liver disease [2]. The prevalence of HBV is ranging from below 2% in low endemic countries to greater than 8% in high endemic countries [3]. HBV infection is transmitted by parenteral route, by percutaneous or per-mucosal exposure to blood or other body fluids. In low endemic regions, most cases of hepatitis B are related to sexual exposure, while in high endemic areas perinatal or early childhood transmission is the most common form [4]. During the last two decades, serological, virological, biochemical, and histological diagnostic tools are used frequently to monitor and characterize the clinical state of HBV infection. One of the first serologic markers ap- pearing after HBV infection is Hepatitis B surface antigen (HBsAg). Its persistence for more than 6 months reveals chronic HBV infection [5]. Europe, Asia, Africa, the Middle East, and the Pacific basin population are places where HBV is the leading cause of cirrhosis and hepatocellular carcinoma (HCC) [6-7]. The prevalence of HBV and its modes of transmission vary geographically, and it can be classified into three endemic patterns [8-10]. Around 45% of the world’s population live in regions of high endemicity, defined as areas where 8% or more of the population are positive for HBsAg such as Southeast Asia and Sub-Saharan Africa. The moderately endemic areas, such as in Mediterranean countries and Japan, are defined as those areas where 2–7% of the population are HBsAg positive, and around 43% of the world’s population live in regions of moderate endemicity. Western Europe and North America are considered as areas with low endemicity (<2% of the population is HBsAg positive) and it constitutes 12% of the world’s population [8, 11].Certain types of behaviors increase the risk for contracting HBV such as: use of contaminated needle during acupuncture, intravenous drug abuse, ear piercing and tattooing, sexually active heterosexuals or homosexuals, infants/children in highly endemic areas, infants born to infected mothers, health care workers, hemodialysis patients, blood receivers prior (blood transfusion), hemophiliacs, prisoners with long term sentences as well as visitors to highly endemic regions [11]. Furthermore, having concurrent infections including HBV, HCV and HIV infections make the situation worse and requires complex management. 78 Burden Of Hepatitis B, Hepatitis C And HIV Infections Among Hepatitis C Virus (HCV) infection is being recognized as a global health problem. Around 170 million people are chronically infected and 3 – 4 million are newly affected every year [12]. Most of the patients are asymptomatic till the disease is at its terminal stage posing a great danger to spread this infection silently [13]. There is currently no vaccine available for HCV infection prevention due to the high degree of strain variation [14]. Of the five hepatitis viruses (A, B, C, D and E), chronic hepatitis B virus (HBV) infection and hepatitis C virus (HCV) infection have the greatest impact on morbidity and mortality and together resulted in an estimated 1.4 million deaths in 2010 [15-16]. In Pakistan a weighted average of hepatitis B antigen prevalence in pediatric populations was 2.4% and for hepatitis C antibody was 2.1%. A weighted average of hepatitis B antigen prevalence among healthy adults was 2.4% (range 1.4—11.0%) and for hepatitis C antibody was 3.0% [17]. In the Middle East region, the prevalence of HBV carriers among adults varies from less than 2%, as in Bahrain, to more than 15%, as in the Republic of Yemen [18]. In a study which was conducted in Lahore Pakistan among tested samples 4.9% of the subjects were confirmed to harbor active HCV infections in adult population without gender difference [19]. In a hospital based study in Pakistan it was reported that hepatitis B and C was present in 5.15% of which 3.12% were suffering from hepatitis C and 2.02% were suffering from hepatitis B while co- infection was present in 0.12% patients [20]. The burden of Hepatitis and HIV infection is poorly available in Afghanistan due to few surveys conducted, however the country lies in intermediate level of prevalence for HBV and high risk for HIV infection.UNAIDS data indicate that the epidemic of HIV infection is presently remains under <0.1% among the general population in Afghanistan, yet has the potential to grow quickly from a small base of injecting drug users to their sexual partners and thus to heterosexual men and women unless effective, vigorous, and sustained action is taken early [21]. A prevalence study in Jalalabad city among adult population reported that 3.8% were seropositive for HBsAg on rapid test and 3.4% were confirmed positive after ELIZA. Totally 0.9% were seropositive for anti-HCV on rapid tests. Independent predictors for HBsAg infection were being male (p-value <0.01) traditional practice of tattooing (p-value <0.05) and history of jaundice (p value <0.001) [22]. The overall prevalence of HBV and HCV among injecting drug users were 6.5% and 36.6% respectively in 2005-2006 [23]. In 2005 it is estimated that 7% of the general population have chronic HBV infection [24]. A meta-analysis estimates the prevalence of 1.9% for HBV and 1.1% for HCV in general population [25]. The proportion of HBV in IDUs ranged from 5.8-6.5%, with an overall prevalence of 6.15% while the prevalence of HCV in same population was 36.4 % [26]. In addition the prevalence of HCV and HBV in Female Sex Workers (FSWs) in three big cities in the country was 1.92%, and 6.54% respectively [27]. A genotype study reported that genotype D is the predominant genotype circulating in Afghani’s population after which the genotypes C, A and B predominates [28]. The Human Immunodeficiency Virus (HIV) epidemic is widespread throughout many countries in Asia. Many of the same risk factors, which facilitate the virus transmission in these countries, are also present in Afghanistan. The burden of HIV epidemic is low and mostly prevalent in high risk groups in the country. A survey of HIV 2012 showed that prevalence of HIV among people with injecting drug user was 4.4% while it was 0.4% among male sex workers, 0.3% among female sex workers and 0.7% among prisoners [29]. The cumulative number of HIV infections until 2012 were reported to be 1529 by sex ration of 6:1 male to female [30]. However, Joint United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimates around 4,300 (1,600-14,000) number of people are living with HIV (PLHIV) in the country [21]. I. METHODS AND MATERIALS The main study was a provincial cross sectional survey by design and the target population were all residents 25-70 years old living in urban areas of Kandahar city. Ethical approval was obtained from Ministry of Public Health Institutional Review Board (IRB). Temporary residents (resident < 6 months) and those living in institutionalized settings or insecure areas were excluded.