Drug-induced esophageal injuries with an atypical presentation mimicking acute coronary syndrome.

BACKGROUND: Pill-induced esophageal injury may cause severe complications if not diagnosed in a timely fashion. The condition is under-recognized and under-reported, and some patients present with atypical clinical or endoscopic features mimicking other common conditions. If the diagnosis is missed the patient will continue to take the offending drug, potentially worsening the illness. We present a case in which acute coronary syndrome was the initial working diagnosis leading to a delay in diagnosis of doxycycline-induced esophageal injury. The patient developed multiple esophageal ulcers and hemorrhage. CASE PRESENTATION: A 50-year-old male driver with a history of hypertension and dyslipidemia was brought to the emergency department with complaints of severe retrosternal chest pain, vomiting, diaphoresis and syncope. On initial evaluation, acute coronary syndrome was considered due to the clinical presentation and history of cardiovascular risk factors. Electrocardiogram and serum troponins were normal. On the second day of his admission, the patient developed odynophagia and bloody vomitus. Esophagogastroduodenoscopy revealed extensive esophageal ulcerations with hemorrhage. The patient was taking Doxycycline capsules for an acute febrile illness. Doxycycline is the oral medication most commonly reported to cause esophageal injury. Doxycycline was discontinued, and the patient was treated with intravenous omeprazole and oral antacid suspension. The patient improved, was discharged after 6 days of hospitalization, and reported resolution of all symptoms at an outpatient follow-up visit 3 weeks later. CONCLUSION: Medication-induced esophageal injury can present with atypical symptoms mimicking acute coronary syndrome. This condition should be included in the initial differential diagnosis of patients presenting with acute chest pain, especially those taking oral medications known to cause esophageal injury.

Chronic viral hepatitis: policy, regulation, and strategies for its control and elimination in Ethiopia.

BACKGROUND: Hepatitis B and C are silent killers not yet recognized as major public health challenges in many developing countries with huge disease burden. In Ethiopia, Hepatitis B is endemic with an average prevalence of 10.8 %, and the prevalence of Hepatitis C is 2 %. The prevalence of both infections, however, is likely to be underreported due to the lack of diagnostic facilities and appropriate surveillance systems. Ethiopia is also among the many Sub-Sahara African countries lacking a coordinated and systematic national response to chronic viral hepatitis. The objective of this study is to examine the current level of response to viral Hepatitis B & C in Ethiopia with the aim to bring identified gaps to the attention of relevant stakeholders and policy makers. METHODS: This cross-sectional qualitative study was based on semi-structured in-depth interviews with 21 key informants from health facilities, health offices, pharmaceutical companies, regulatory bodies, professional association and blood bank units. Participants were selected purposively based on their role in the national hepatitis response. The investigators also reviewed available policy and strategy documents, standards of practice and surveys, and paid visits to pharmaceutical premises to check the availability of antiviral drugs. Thematic analysis was employed to make sense of the data. During the data analysis process, all the authors critically read the materials, and data was triangulated by source, interpreter view and thematic perspective to ensure accurate representation and comprehensiveness, and validation of the interviewees' responses. Once each investigator reviewed the data independently, the team reached a common understanding of the scope and contexts of the information attained. Data were subsequently reduced to key concepts, and case stories were taken with successive revisions. The key concepts were later coded into most basic meaningful categories. The World Health Organization (WHO) global hepatitis response framework was used to organize the analysis. RESULTS: Ethiopia is in the process of preparing strategic plan and guidelines for viral hepatitis. However, the country still lacks the required partnerships, and resource mobilization as a national health response is limited. Community awareness on the disease transmission and its sequel is poor. Viral hepatitis screening services are not widely available except for the occasional mandatory medical checkups for work or travel purposes. Healthcare providers often take no further action after diagnosing patients with viral hepatitis due to lack of treatment guidelines and strategic frameworks for screening, diagnosis, and treatment. Besides, drugs that are effective in the treatment of viral hepatitis are not available, mainly due to regulatory challenges. CONCLUSIONS: Viral hepatitis and its disease burden are getting little attention in Ethiopia and many low-income countries. The levels of technical guidance and financial support from the international community are low. To date, the response to the infections in Ethiopia is patchy. Thus, the country needs to formulate policy and strategies in the areas of disease surveillance, risk group identification and screening, use of the birth dose of hepatitis B vaccine, and care and treatment. Improving availability of data on viral hepatitis, access to low-cost generic drugs and developing and dissemination of treatment guidelines are also critical. Leveraging the successful Health Extension Program for a hepatitis response, and exploring ways to learn from and integrate into the HIV/AIDS program should also be considered.

COMMON GENOTYPES AND TREATMENT OUTCOMES OF HCV INFECTION AMONG ETHIOPIAN PATIENTS: A PROSPECTIVE STUDY.

BACKGROUND: The treatment response of HCV infection is dependent on genotype and stage of the disease. However, genotype pattern and treatment outcomes of HCV infection among Ethiopian patients has not been studied so far. OBJECTIVES: To evaluate the common HCV genotypes and treatment outcomes among Ethiopian adult patients. METHOD: Adult patients aged 18 and above with HCV infection referred from various regions of the country were included in the study after written informed consent. As there was no free or insurance coverage for treatment of HCV infection in the country, those who could afford to pay for treatment with PEG Interferon and Ribavirin were recruited during January 1, 2008 through December 31,2013 at United Vision, Adera. Old Airport, and Mexico referral higher clinics in Addis Ababa. Patients with decompensated cirrhosis and pregnant ladies were excluded from the study. The patients were counseled on treatment options, cost, treatment outcomes, adverse drug effects, and possible complications. Data were collected on demographic features, clinical characteristics, viral genotypes, and treatment outcomes during follow up visits until six months after completion of recommended standard treatment. Data were analyzed using SPSS software. RESULTS: A total of 200 adults with chronic HCV infection were treated with PEG-Interferon and Ribavirin (for 24 or 48 weeks according to the genotypes) during the study period. Of the 200 patients enrolled in the study, 120 (60%) were male, 90% were from Addis Ababa, and the median age was 48 years. Sixty per cent of the patients were infected with genotype 4,17% with genotype 1, 13.5% with genotype 2 and 9.5% with genotype 3. Eighty percent of the patients had end of treatment response; of these, 74.4% had undetectable HCV RNA at 6th month after end of treatment. The end of treatment response was noted to be close to 90% for patients with HCV genotypes 2 and.3 infections. CONCLUSION: This study indicates that genotype 4 is the prevalent HCV genotype followed by 1, 2, and 3 among Ethiopian patients. Treatment with interferon and ribavirin was well tolerated and provided a very good response.

A 60 year old Ethiopian farmer diagnosed with tick paralysis at Adera Medical Center.

A 60 year old farmer from west Shewa in Ethiopia presented on February 13 2014, with right arm flaccid monoplegia after bitten by a tick stuck to his right arm pit. The case was initially misdiagnosed as cellulitis. To our knowledge, tick paralysis has not been reported from Ethiopia. We report the case presentation with literature review.

Epidemic dropsy: case report and the morphologic features in a patient who died at Tikur Anbessa Specialized Hospital.

Epidemic dropsy results from the consumption of edible oils adulterated with argemone mexicana oil. In a 2008 epidemic in Addis Ababa five patients died and in one of these a partial autopsy has been performed. The clinical impression of acute respiratory distress syndrome has been confirmed by the demonstration of massive diffuse alveolar damage. These features are consistent with findings reported in similar epidemics.

Outbreak of epidemic dropsy in Ethiopia: the clinical and therapeutic observation.

INTRODUCTION: Epidemic dropsy results from ingestion of argemone oil contaminated food staffs. The oil from Argemone Mexican seeds contains toxic alkaloids called sanguinarine and dehydrosangunarine. These cause wide spread capillary dilatation, proliferation and leakages. This leads to oedema, hypovolemia and hypotension. OBJECTIVE: To describe the socio-demographic and clinical manifestations of the patients affected with epidemic dropsy in Tikur Anbessa specialized Hospital (TASH). METHODS: A case series study was conducted in an outbreak with unusual cases which was later diagnosed to be epidemic dropsy. Clinical evaluation of suspects was done and optimal therapy given for the complications detected and information was filled in structured format by medical residents and medial chart records review was made for occurrence of new complications in the end of 9 months. RESULTS: A total of 164 patients were seen at TASH from 26 households, in 8 sub-cities of Addis Ababa. A wide range of age group was affected with 70% from 16 to 40 years of age. There was no case among less than 5 years of age. Females were affected more than threefold as compared to males. All the patients manifested with bilateral leg swelling and pitting oedema. It was tender in 50 (30.4%) of them while 43 (26.2%) had erythema. Tachycardia was the next common manifestation occurring in 135 (82.3%), followed by cough in 123 (75%), anaemia in 59 (36%), headache in 58 (35.4%), shortness of breathing in 52 (31.2%), hair loss in 44 (26.8%) and respiratory distress in 35 (21.3%). Abdominal pain, hepatomegally, nausea and vomiting were also seen. There was abnormality in the chest X-ray of 31 (27.2%). Hair loss, tingling and burning extremities, difficulty of standing, hyperpigmentation, pruritic rash and eye symptoms were observed lately during follow up. Five of the patients died while in hospital care due to acute respiratory distress syndrome (ARDS). CONCLUSIONS: The commonest clinical manifestation in our patients is bilateral leg swelling which is similar to other outbreaks of epidemic dropsy elsewhere. The mortality rate is also comparable with other series but all cases died by ARDS in our series which is unusual in other reports. As this is the first reported epidemics in Ethiopia the findings will create awareness of clinical features of epidemic dropsy among clinicians, and therefore, helps for diagnoses of similar problems in the future.

Outbreak investigation of epidemic dropsy in Addis Ababa, Ethiopia:.

BACKGROUND: A 17 year old female patient who presented to a tertiary Hospital in Addis Ababa with bilateral painful leg swelling of two months and shortness of breath, associated with cough and haemoptysis of one week duration was reported to the Ministry of Health and the Addis Ababa Health Bureau. The condition was later detected in 18 individuals from 4 households indicating occurrence of an outbreak of unknown cause in Addis Ababa which lasted during May-July 2008. OBJECTIVE: An outbreak investigation was initiated to identify the cause and prevent further spread, morbidity and mortality. METHODS: Using semi-structured questionnaire, quantitative assessment involving individual cases and affected households was conducted to detect aetiology and risk factors. Unaffected households as well as unaffected members of affected households were also included for comparison purpose. Record review of patients visiting hospitals was also done. Data were collected through house to house visits, and using interview of cases admitted to hospital. Samples of cooking oil were collected for laboratory testing. Data analysis was done using SPSS. RESULTS: A total of 182 patients, 50 (27.5%) males and 132 (72.5%) females, were identified till the outbreak was controlled fully. Age varied from 6-90 years. Death was confirmed in 12 cases, 8 of whom were female. The majority of the patients came from the adjoining Lideta (39.0%) and Kolfe Keranyo (31.9%) subcities. History of illness ranged from less than a week to 12 weeks before presentation. Out of the 106 household members of the 24 affected households identified during the first phase of the investigation, 83 were affected. Most family members who infrequently take meals at home, and children aged 3 years and below were spared. The 21 visited affected households from Kolfe keranyo, Lideta and Bole subcities bought cooking oil produced by a firm in Lideta subcity and all had bought their last supplies in March and April 2008. Samples of cooking food oil taken from this firm and from the affected households were found to have alkaloids of Argemone Mexicana. The number of new cases dropped to zero within 6 weeks after the source was closed. CONCLUSION: The occurrence of bilateral leg swelling in more than one family member of affected households, that bought cooking oil from the same source, sparing the toddlers, and those who infrequently take meals at home, further strengthened by laboratory confirmation of presence of argemone alkaloids in the cooking oil samples taken from the affected households and the common sources led to the diagnosis of the outbreak to be epidemic dropsy.

Laboratory investigation of epidemic dropsy in Addis Ababa, Ethiopia.

BACKGROUND: Food adulteration including adulteration of edible oils may cause serious health problems. One of the most common edible adulterants is argemone oil. An outbreak of epidemic dropsy occurred in Addis Ababa during May-June, 2008. One hundred and eighty two cases were recorded with twelve confirmed deaths. Dietary history of the cases revealed that vegetable oils were the usual cooking medium. OBJECTIVE: The aim of the study was hence to investigate the causes of this outbreak. METHODS: Contaminant identification was done using standard chemical tests, complemented with TLC. Toxicity study was done using Swiss albino mice feed with contaminated and non contaminated standard diet for 30 days. RESULTS: Laboratory investigation of the edible oils has indicated that 47 of the 280 edible oils analyzed were adulterated with argemone oil. About 81% of the edible oil samples collected from Lideta sub-city were adulterated with argemone oil. Toxicological investigation of the adulterated oils also indicated typical features of argemone alkaloid poisoning in mice. CONCLUSION: Results of both laboratory analysis and toxicological studies confirmed consumption of edible oils adulterated with argemone oil as the cause of epidemic dropsy in Addis Ababa.

An epidemiological study into the investigation of liver disease of unknown origin in a rural community of northern Ethiopia, 2005.

BACKGROUND: An outbreak of an unidentified cause of liver disease that claimed the lives of more than 45 people occurred in a rural community, in Northwestern Tigray. Despite the wider need for an urgent response there was no obvious explanation for the disease occurrence. OBJECTIVE: The aim of the study was to collect basic descriptive information and compare exposure status among case and control house-holds to better understand the illness and its pattern of occurrence so as to identify the sources, mode of transmission and possible cause of the illness. METHODS: The initial study principally involved combination of descriptive and analytic study designs. Combinations of quantitative and qualitative data were collected using semi-structured questionnaires. STUDY SUBJECTS: Samples of the affected and non-affected individuals of study village, key informants from various levels in the administrative system, and focus group discussions organized from both the affected and non-affected households of the study village were the subjects included for the study. RESULTS: The outbreak involved about 118 people, (78 males and 40 females) who were residents of the same village, in most, members of same family. More than half of the cases were under the age of 15 years. The outstanding clinical features were abdominal pain, rapidly filling ascites and hepatomegaly. The median duration of illness was six months (range; 1, 36 months). Of the 118 cases, 45 were deaths reported from the same community, during the period of illness with an estimated case fatality rate of 38%. Of the 45 deaths, 64.4% were children below 15 years of age. Qualitative information from both case and control communities showed difference in their water source. Eighty four percent of the dwellers in the affected village of Tsaeda Amba fetch water for their drink from an open shallow unprotected pond, Mai Habi-Tselam, Analysis of the data on exposure to the risk factor (case--control house-holds) revealed that users of the Habi-Tselam water source were almost 3 times more likely to develop the liver disease than those who used other water sources in the same village, OR = 3.14, 95% CI: 3.14 (3.12, 3.23). Age, nutritional status and long duration of exposure to an implicated source tended to influence the prognosis. CONCLUSION: The initial epidemiological investigations therefore gave an important insight as to the need to conduct further possible in-depth etiologic investigations, including clinical and toxicological studies, Study recommended an intermediary control measures including: banning the use of the implicated water source and provision of save and alternative potable water to the affected community.

An outbreak of veno-occlusive liver disease in northern Ethiopia, clinical findings.

BACKGROUND: Following the emergence of an unidentified fatal disease in Tahtay Koraro, rural farmers' village in Tigray, northern Ethiopia since 2001, a team of experts from Addis Ababa University Medical Faculty was assigned in November 2005, to investigate the problem in the field. The team consisted of an Infectious disease specialist, a Gastroenterologist, an Epidemiologist, a Pathologist, and a Microbiologist. The team was also joined by a group of Tigray Regional Health Bureauprofessionals. OBJECTIVES: To investigate the nature of unidentified liver disease, identify possible cause(s) and recommend specific interventions/treatment in order to save lives and stop further spread of the disease. METHODS: Data were collected from Clinical history, clinical evaluation of the affected cases in the area, relevant laboratory investigations, and histopathologic studies. RESULTS: The team evaluated sixty one of patients in the field (37 males and 24 females) with mean age of 27 years. The disease affected both gender and all age groups. Duration of the illness ranged from 1 month to 3 years with a median of 6 months. The illness was reported to have started with abdominal cramp in 75%, febrile syndrome in 77%, and abdominal distention in 63% of the cases. This was usually followed by jaundice, bleeding tendencies, and edematous states mainly in the form of rapidly filling ascites. Majority of the patients had similarly sick family members and/or lost family member(s) due to the same illness. Moreover, laboratory, sonography, histopathological, and toxicological studies revealed VOLD due to Pyrrolizidine alkaloid (PA) toxicity as described in the other sections of the supplement. CONCLUSION: From a detailed clinical and epidemiological investigation as well as histopathological and toxicological analyses, the disease was found to be fatal toxic hepatitis (veno-occlusive liver disease (VOLD). To our knowledge, this is the first report of VOLD from Ethiopia.

Veno-occlusive liver disease: a case report.

A case of veno-occlusive liver disease (VOLD) in a 12-years old Ethiopian boy is described The salient clinical features and gross and microscopic examination of biopsy material are reviewed. Veno-occlusive disease which occurs in the West Indies, East and West Africa, and India is an acute, subacute or chronic condition that affects the central and sublobular hepatic veins. In the West Indies (1) it is related to the consumption of bush tea made from plants that contain toxic pyrrolizidine alkaloids, such as Crotalaria and Senecio (2). Hepatotoxic compounds in Crotalaria, Senecio, Heliotropium and other composite plants can also enter the diet through the contamination of cereals with weed seeds. For example 28 of 67 patients died with veno-occlusive disease in central India after consuming a local cereal, gondli contaminated with the seeds of Crotalaria (3). Heliotropium Popovii has been implicated in outbreaks in villages in northwestern Afghanistan, with high mortality (4). The primary pathological change of hepatic veno-occlusive disease is sub-endothelial edema followed by intimal growth of connective tissue, with narrowing and occlusion of the central and sub-lobular hepatic veins. Atrophy or necrosis of liver cells, with consequent fibrosis leads to gross changes similar to those seen in cardiac cirrhosis, portal hypertension results. The present report, the first of it kind in Ethiopia describes a case of veno-occlusive liver disease in a 12-year old Ethiopian boy.

A Case of Severe 2,4-Dichlorophenoxyacetic Acid Poisoning Causing Diagnostic and Treatment Challenges.

2,4-Dichlorophenoxyacetic acid is a poisonous herbicide. Though poisoning reports from this compound are rare, there is a tendency toward increased use of it in the agrarian society of Ethiopia. We herein report a case of a young female farmer from rural Ethiopia who was admitted to a local hospital after presenting with loss of consciousness and excess oral secretions 2 hours after a suicidal ingestion of an unknown toxic agent. She was originally treated for organophosphate poisoning, and then transferred to Saint Peter's Hospital in Addis Ababa for more intensive care. There, ingestion of 2,4-D was confirmed, and she received supportive care, mechanical ventilation, and forced alkaline diuresis. Despite these interventions, she died several days later. Due to the similarity of some clinical signs with organophosphate poisoning in acute settings, there are possible missed cases of 2,4-D acid herbicide poisoning. No specific treatment is known, so a high index of suspicion for early detection, decontamination, and initiation of supportive care is crucial to improve survival after exposure. In addition, local policies on proper and controlled use of these herbicides are needed to improve awareness among users and prevent accidental and intentional exposures.

Increasing Burden of Acute Hepatitis A among Ethiopian Children, Adolescents, and Young adults: A Change in Epidemiological Pattern and Need for Hepatitis A Vaccine.

Background: Hepatitis A is a vaccine-preventable, feco-oral infection due to poor sanitary conditions. It is predominantly acquired during early childhood and results in lasting acquired protective immunity. However, it results in severe disease which can end up in acute fulminant hepatitis and hepatic failure when acquired during adolescence and adulthood. The prevalence of acute hepatitis A is increasing among children, adolescents, and young adults from higher-income households. They acquire this infection at a later age when they are exposed for the first time to contaminated food and drinks after being brought up in a relatively clean environment. This calls for the introduction of the Hepatitis A vaccine in Ethiopia; possibly as part of the Expanded Program on Immunization (EPI). Methods: Socio-demographic and clinical data were collected from patients who were diagnosed to have hepatitis A infection at Adera Medical Center in 2020. Results: This study showed that clinical acute hepatitis A is becoming common among children, adolescents, and young adults from relatively high-income families. Among patients with acute hepatitis, 89% were from middle and high-income families. Conclusions: There is a need for the incorporation of hepatitis A vaccine in the Ethiopian EPI program.

Acquired Hepatocerebral Degeneration After a Splenorenal Shunt in the Sub-Saharan Africa Context: A Case Report and Brief Review of Literature.

Acquired hepatocerebral degeneration (AHD) is a neurologic syndrome caused by liver dysfunction and long-standing portosystemic shunting. The pathogenesis of the condition is predominantly considered to be related to the deposition of manganese in parts of the brain due to shunting. We report a case of a 25-year-old male who underwent splenectomy and splenorenal shunt for recurrent upper GI bleeding (UGIB) due to esophageal varices caused by non-cirrhotic portal hypertension (NCPH). He presented with bradykinesia, hypophonia, gait instability, and rigidity of the lower extremities 18 months after the procedure was done.

A Case Report of Belly Dancer Dyskinesia in a 54 Years Old Female: Gastroenterology Meets Neurology.

Dyskinesia limited only to the axial musculature is very rare, and if it is localized to the anterior abdominal wall, it is called belly dancer's dyskinesia. Despite reports of variable clinical characteristics, a common feature is a myriad of involuntary, repetitive, sometimes painful, and often rhythmic movements of the anterior abdominal wall, with the majority being bilateral, resembling that of a belly dancer. As the symptom is mainly localized to the abdomen, patients could visit a gastroenterology service thinking it might be associated with underlying visceral pathology. Since the first report in 1990, only a few cases of belly dancer dyskinesia have been reported over the years. We herein report the case of a 54 years old female who presented to our OPD with a recurrent painless writhing movement of the abdomen, diagnosed as belly dancer dyskinesia and successfully treated with chlordiazepoxide.

Association of dyspepsia symptoms and Helicobacter pylori infections in private higher clinic, Addis Ababa, Ethiopia.

BACKGROUND: The discovery of Helicobacter pylori [H. pylori] by Marshall and Warren revealed that, this organism has been implicated as the main etiological agent in the development of acute and chronic active gastritis, peptic ulcer disease, gastric cancer and mucosa-associated lymphoid tissue [MALT] lymphoma in humans. Recent estimates suggest that 50% of the world's population is infected with this gastric bacterium. Dyspepsia is a complex set of symptoms, rather than an indication of a specific disease entity and many causes of dyspepsia exist including Helicobacter pylori infections. OBJECTIVE: This study was initiated to determine the association of dyspepsia symptoms and H. pylori infections. DESIGN: A Case control study was conducted to determine the association of dyspepsia symptoms and H. pylori infections using non-invasive tests [Helicobacter pylori stool antigen and Helicobacter pylori rapid antibody] at Noble Higher Clinic, Addis Ababa. Ethiopia, between April 2009 and June 2009. METHODS: A total of 238 informed and consented adult outpatients [n=119 dyspeptic patients and n=119 asymptomatic controls] were investigated for H. pylori infections by Helicobacter pylori stool antigen and Helicobacter pylori rapid antibody tests. RESULTS: The prevalence of H. pylori infection was found in 53% [63/119] dyspeptic patients and 39%[46/119] asymptomatic controls. odds ratio[OR: 1.785:95%, CI, 1.066 to 2.989]. In the asymptomatic controls, the prevalence of H. pylori infection was peak at the age group of 38-45 yrs [61%], followed by 54-61 yrs [60%]. In the dyspeptic patients, the peak prevalence of H. pylori infection was at the age group of 54-61 yrs [75%], followed by 30-37 yrs [72%]. CONCLUSION: There is a statistically significant difference between dyspeptic and non-dyspeptic participant by HpSA test. This demonstrates that H. pylori infection is associated with dyspepsia in this study, even if the causes of dyspepsia were not assessed by the study. Although, this 53 percent prevalence of H. pylori infection in dyspeptic patients seems lower than the previous hospital based studies, further study need to be conducted in the primary health care setup.

Budd-Chiari syndrome.

UNLABELLED: A 16-year-old Ethiopian male patient presented with 18 months history of anasarca, anemia & hepatomegaly associated with hypoprothrombinemia, and diagnosed to have Budd-Chiari syndrome (BCS). The patient responded markedly to medical therapy with diuretics, anticoagulation and salt restriction. The clinical features and treatment of BCS is briefly reviewed and discussed. INTRODUCTION: BCS is a rare disorder resulting from obstruction to the outflow of blood from the liver. It results from occlusion or partial occlusion of one, two, or all three of the major hepatic veins and/or occlusion or partial occlusion of the inferior vena cava (IVC). The clinical diagnosis is difficult and Radiology plays a critical role for diagnosis and classification. Type I is occlusion of the IVC with/without hepatic veins, type II is occlusion of major hepatic veins with/without IVC, and type III is occlusion of small centrilobar veins.

Treatment of Hepatitis C Genotypes 1 to 5 in Sub-Saharan Africa Using Direct-Acting Antivirals.

There is limited knowledge of the use of direct acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) in sub-Saharan Africa. We prospectively evaluated individuals infected with HCV genotypes 1 to 5 in Addis Ababa, Ethiopia. Liver fibrosis was assessed by AST-platelet ratio index score and cirrhosis by imaging and laboratory values. All 164 individuals completed treatment. The majority of patients had genotype 4 (76%), and 19% of participants showed evidence of cirrhosis. Sustained virologic response (SVR) across all genotypes was 98.8%. In those with cirrhosis, SVR was 93.5% and in non-cirrhotics 100%. Our study demonstrates broad genotype successful treatment of HCV with DAAs in sub-Saharan Africa, demonstrating the feasibility of HCV elimination in resource-limited settings.