Browsing by Author "Ocama, P."
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Item Hepatitis B incidence and prevention with antiretroviral therapy among HIV positive individuals in Rakai, Uganda(AIDS (London, England), 2017) Seremba, E.; Ssempijja, V.; Kalibbala, S.; Gray, R. H.; Wawer, M. J.; Nalugoda, F.; Casper, C.; Phipps, W.; Ocama, P.; Serwadda, D.; Thomas, D. L.; Reynolds, S. J.Antiretroviral therapy (ART) may interfere with replication of hepatitis B (HBV) raising the hypothesis that HBV infection might be prevented by ART. We investigated the incidence and risk factors associated with HBV among HIV-infected adults in Rakai, Uganda. Methods—We screened stored sera from 944 HIV-infected adults enrolled in the Rakai Community Cohort Study between September 2003 and March 2015 for evidence of HBV exposure. Serum from participants who tested anti-HBc negative (497) at baseline were tested over 3-7 consecutive survey rounds for incident HBV. Poisson incidence methods were used to estimate incidence of HBV with 95% confidence intervals while Cox proportional regression methods were used to estimate hazard ratios.Item Hepatitis B virus and HIV infection among patients with primary hepatocellular carcinoma in Kampala, Uganda(African health sciences, 2011) Ocama, P.; Opio, K. C.; Kagimu, M.; Seremba, E.; Wabinga, H.; Colebunders, R.Hepatitis B virus (HBV) is the commonest cause of primary hepatocellular (PHC) carcinoma worldwide. Coinfection with the HIV leads to more rapid progression of liver disease. Objectives: We described prevalence of HBV and HIV among patients with PHC admitted to Mulago Hospital, Kampala, Uganda. Methods: We assessed all patients admitted to the gastrointestinal service of Mulago hospital with a diagnosis of PHC for HBV and HIV infection. Results: From March to June 2008, we recruited 15 patients. Nine (60%) were male; the overall median age was 32 years (IQR 15 -67), with median ages for male and female 33 and 36 years respectively. Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and AFP were all elevated with median values of 57.5 IU/L, 222 IU/L, 392 IU/L and 362 ng/ml respectively (IQR 14-145, 49-393, 165-1294 and 7-480). Eight (53%) patients were from North and Northeastern Uganda. The HBsAg was reactive in 13(87%) patients and HIV in 3(20%), all of whom were also co-infected with HBV. Conclusion: There is high prevalence of HBV and HBV/HIV co-infection among patients with PHC in Uganda with high mortality. Reduction in incidence and mortality due to PHC in Uganda will require urgent large scale HBV vaccination.Item Poor Performance of Hepatitis C Antibody Tests in Hospital Patients in Uganda(Journal of medical virology, 2010) Seremba, E.; Ocama, P.; Opio, C.K.; Kagimu, M.; Thomas, D.L.; Yuan, H.J.; Attar, N.; Lee, W.M.Most hepatitis C testing in Uganda is performed using commercial rapid strip assays (RSA) to detect antibodies to hepatitis C virus (anti-HCV), rather than enzyme immunoassays (EIA). The prevalence of hepatitis C antibodies in a Ugandan hospital population was determined using both methods to test their accuracy using nucleic acid testing (NAT) as a reference. Sera from 380 consecutive hospitalized Ugandan patients were tested for anti-HCV using anRSAin Uganda, with subsequent automated third-generation EIA testing in the United States, followed by NAT. Recombinant immunoblot assays (RIBA) were used as a supplementary test to detect anti- HCV epitopes. Overall, anti-HCV was detected in 48/380 (13%) by one or both antibody tests. Anti-HCV was detected in 19 (5.0%) patients by RSA and in 33 (8.7%) patients by EIA; only four patients were anti-HCV positive by both methods. Fourteen of the 48 anti-HCV positive patients had detectable serum HCV RNA, 7 each by bDNA assay or by PCR. RSA detected only 7 of 14 HCV RNA positive sera. Of 29 RNA negative but anti-HCV positive patients tested by RIBA, only two were anti-HCV positive; 27 were anti-HCV negative or indeterminate. Anti-HCV testing by RSA and/or EIA was neither sensitive nor specific for detection of ongoing HCV infection in hospitalized Ugandan patients. Our findings underscore the importance of confirmatory nucleic acid testing, which, despite its increased cost, appears essential to manage African patients with HCV.Item Trends in the incidence of primary liver cancer in Central Uganda, 1960–1980 and 1991–2005(British journal of cancer, 2009) Ocama, P.; Nambooze, S.; Opio, C. K.; Shiels, M. S.; Wabinga, H. R.; Kirk, G.D.Trends in primary liver cancer (PLC) incidence rates will generally reflect temporal changes in exposure to aetiological agents. Worldwide, and in sub-Saharan Africa in particular, the great majority of PLCs are hepatocellular carcinomas (HCCs). In North America and Europe at present, HCCs are one of the few cancers observed with increasing incidence (Taylor-Robinson et al, 1997; El-Serag, 2004; West et al, 2006), largely attributed to earlier exposure to hepatitis C virus (HCV) (Davila et al, 2004). Prevalence of obesity and diabetes has also been increasing in these populations during concurrent time periods and has been suggested as another possible aetiological factor in rising HCC rates (Calle et al, 2003; El-Serag et al, 2004). However, trends in HCC rates from other regions are less clear. In particular, limited data exist from regions where HCCs is primarily attributable to chronic hepatitis B viral infection. In Asia, HCC rates may be declining (Goh, 1997; McGlynn et al, 2001). Reductions in HCC incidence among young children in Taiwan has been linked to nation-wide hepatitis B vaccination (Chang et al, 1997). In sub-Saharan Africa, hepatitis B viral infection is endemic and the attributable fraction of HCCs due to hepatitis B virus (HBV) is high (B60%) (Kirk et al, 2004; Parkin, 2006). Further, most African countries do not routinely provide or only recently initiated hepatitis B vaccination as part of their national immunisation programmes. Urbanisation, obesity, and HIV infection might also affect HCC rates in Africa. To characterise temporal trends in HCC rates within an urban African population, we evaluated cancer registry data collected in Central Uganda from 1960 through 2005.Item Validity of the Rapid Strip Assay Test for Detecting HBsAg in Patients Admitted to Hospital in Uganda(Journal of medical virology, 2010) Seremba, E.; Ocama, P.; Opio, C.K.; Kagimu, M.; Yuan, H.J.; Attar, N.; Thomas, D.L.; Lee, W.M.Commercially available rapid strip assays (RSAs) for hepatitis B surface antigen (HBsAg) are used for most routine clinical testing in sub-Saharan Africa. This study evaluated the validity of RSA and a more sophisticated enzyme immunoassay (EIA) with confirmation by nucleic acid testing (NAT) in hospitalized patients in Uganda. Sera from 380 consecutive patients collected and tested for HBsAg and anti-HIV in Kampala, Uganda by RSA were sent frozen to Dallas for EIA including HBsAg, total anti-hepatitis B core, hepatitis B e antigen, and anti-HIV. NAT was performed on all HBsAg-positives and on a random sample of 102 patients that were HBsAgnegative by both assays. Overall, 31 (8%) were HBsAg positive by RSA while 50 (13%) were HBsAg-positive by EIA; 26 were concordant between the two assays. Of 55 HBsAg-positive patients, nearly all showed detectable serum hepatitis B virus (HBV) DNA by bDNA (46) or PCR (4) assay. The 26 patients who were HBsAg positive by both EIA and RSA had significantly higher median serum HBV DNA levels than the 24 patients who were HBsAg positive by EIA alone. An additional 12/102 (12%) HBsAg negative patients had very low serum HBV DNA levels by NAT. Several differences in expected results of serologic testing were observed in this large series of African patients. RSA HBsAg testing is less sensitive than EIA; even EIA failed to detect allHBVDNApositive sera.Amorecomplex testing protocol than RSA alone will be needed in Africa to improve patient care. J. Med. Virol. 82:1334–1340, 2010. 2010 Wiley-Liss, Inc.