Epidemiology of hepatitis C virus infection in Nepal.

Prevalence of hepatitis C virus (HCV) infection in Nepal was studied by assaying sera from different population groups for anti-HCV by the second generation enzyme immunoassay method and for HCV RNA by polymerase chain reaction. The anti-HCV was positive in 0.6% of 2,860 healthy adults. HCV infection was responsible for 1.3% of acute viral hepatitis. Only drug addicts (DA) are known to have a very high incidence of the infection. The number of intravenous drug abusers (IDA) in Nepal have increased considerably since 1991 when buprenorphine (tidigesic) was introduced in the local market. About 72% of the drug addicts were found to be IDA and 94% of the IDA were anti-HCV positive. It is concluded that though the prevalence of HCV infection in the community is low, and at present it accounts for only a small number of acute and chronic liver diseases, the presence of a large number of DA in the country with high incidence of HCV infection may result in the emergence of HCV as an important cause of chronic liver disease in Nepal in future.

Hepatitis B and C infection among drug abusers in Nepal.

Prevalence of hepatitis B and C virus infection amongst intravenous drug users (IDU) in Nepal is not known. To estimate such prevalence 72 IDU individuals were tested for HBV and HCV markers. About 80% of the drug abusers are both anti-HBc (59/72) and anti-HCV (58/72) sero-positive. However persistent infection with hepatitis B, as indicated by positive HBsAg, was detected in only 5.5% (n = 4). Active hepatitis C infection, as indicated by HCV RNA positivity, was documented in 74% (42/58) of those who were anti-HCV positive. Importance of awareness of this observation among the healthcare workers in the prevention of hepatitis C in the community is stressed.

Endemicity and clinical picture of liver disease due to obstruction of the hepatic portion of the inferior vena cava in Nepal.

Obstructive lesion of the hepatic portion of the inferior vena cava is common in Nepal. The clinical data on 150 patients who were seen at the Liver Unit, Bir Hospital, Kathmandu, in three years from 1990 to 1992 were analysed. Although the majority of patients were over 20 years of age, 25 patients were below 10 years of age; there were more males than females in this study. This disease accounted for 17% of 866 patients with chronic liver disease and for nearly one quarter of 267 biopsies performed on this patient group during the same period. Obstructive lesions of the inferior vena cava seem to be more common among poor people with malnutrition. Clinically, our patient group could be divided into acute (n = 27), subacute (n = 43) and chronic (n = 80) cases. The important clinical features are hepatomegaly and/or ascites and, in chronic cases, prominent dilated superficial veins over the body trunk with cephalad flow. Ultrasound is the most helpful diagnostic procedure, especially in subacute and chronic cases, as it frequently demonstrates caval obstruction, thrombosis, dilated hepatic veins and intrahepatic collaterals. Diagnosis is confirmed by cavography, which shows a caval obstruction of varying lengths at the cavo-atrial junction or a marked narrowing of the hepatic portion of the vena cava. In subacute and chronic cases cavography also demonstrates collateral veins, such as the ascending lumbar, hemiazygos and azygos that drain into the superior vena cava. Chronic cases had periods of exacerbation often associated with bacterial infection. The aetiology of inferior vena cava obstruction at its hepatic portion is not known, but there seems to be a frequent association of bacterial infection with the disease.