Genetic Diversity of Hepatitis B and Hepatitis C Viruses in Ethiopia

Hepatitis B and C viruses are a major cause of mortality and morbidity worldwide. In 2015 alone, viral hepatitis caused 1.34 million deaths, a number comparable to annual deaths caused by tuberculosis but higher than those caused by either HIV or malaria. However, in contrast to these three infectious diseases, viral hepatitis has received relatively little attention. Worldwide, only 9% of HBV-infected and 20% of HCV-infected persons have access to affordable hepatitis testing. Even more worrisome is the fact that only 8% of those diagnosed with HBV and 7.4% of those diagnosed with HCV had started treatment. This is even more problematic in low-income countries like Ethiopia where more than 80% of the population are living in rural areas with a very limited access to healthcare and where viral hepatitis has never been considered a major health priority. Most importantly, the clinical and treatment outcomes of HBV and HCV infections are largely influenced by the high genetic diversity (genotype, subgenotype, recombinants and quasispecies variants) of these viruses that also display distinct geographical distribution worldwide. In this thesis, therefore, we studied the seroepidemiology of HBV and HCV infection and determined the molecular epidemiology and genetic diversity of HBV and HCV in different geographic regions of Ethiopia. We identified that genotype A (A1) and genotype D (D2 and novel D10) of HBV and genotype 4 ( 4d and 4r ) of HCV are the most prevalent in Ethiopia. We further analyzed HBV and HCV quasispecies variants and their association with patients’ clinical characteristics using ultra-deep sequencing approach and found some important variants.

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