ABSTRACT It has been reported from several Caucasian studies that there is an epidemiological association between hepatitis c virus infection and diabetes mellitus. The objective of this study was to determine whether any such relationship exists in a black African population. To determine the prevalence of Hepatitis C virus infection in Nigerians with diabetes mellitus in North-Eastern Nigeria. Hospital -based cross-sectional study. Medical out-patient clinic and the Blood bank of the Federal Medical Centre, Yola. Nigeria. From June, 2008 to December 2009, Two hundred and eighty consecutively recruited diabetes mellitus patients comprising 108 males and 172 females were screened for HCV infection. These were compared with five hundred and ninetyfive voluntary blood donors who were screened during the same period. Serological testing for HCV infection was carried out with anti-HCV using Enzyme Linked Immuno-sorbent Assay (ELISA) method. The bio-data of the patients, history and duration of diabetes mellitus, history of jaundice, blood transfusion were recorded on a proforma. Out of the 280 diabetes mellitus patients tested, twenty-six were positive for anti-HCV antibodies giving an infection rate of 9.3% compared with fourteen subjects out of 595 voluntary blood donors 2.4% (p=0.0000105). History of blood transfusion, and jaundice was positively correlated with presence of HCV infection in diabetic patients. Hepatitis C virus is more common in Nigerian patients with diabetes mellitus than in non-diabetic control subjects. It may be necessary to screen patients with diabetes mellitus for hepatitis c virus infection particularly those with history of blood transfusion and jaundice

Abdulrahman M B

Aderibigbe S

Badung L H

Danburam A

Midala J

Olokoba A B

Salawu F K

Tidi S K

CiteSeerX

AMERICAN JOURNAL OF SCIENTIFIC AND INDUSTRIAL RESEARCH 
© 2010, Science Huβ, http://www.scihub.org/AJSIR 
ISSN: 2153-649X doi:10.5251/ajsir.2010.1.2.135.138 
 
 
Hepatitis C virus infection in Nigerians with diabetes mellitus 
1Olokoba A.B., 2Badung L.H., 3Abdulrahman M.B., 2Salawu F.K., 2Danburam A., 
 4Aderibigbe S., 2Midala J.,  2Tidi S.K. 
1Department of Medicine, 3Department of Chemical  
Pathology, 4Department of Epidemiology & Community Health, University of Ilorin Teaching 
Hospital, Ilorin, Nigeria. 
2Federal Medical Centre, Yola, Nigeria. 
 
ABSTRACT 
It has been reported from several Caucasian studies that there is an epidemiological association 
between hepatitis c virus infection and diabetes mellitus. The objective of this study was to 
determine whether any such relationship exists in a black African population.  To determine the 
prevalence of Hepatitis C virus infection in Nigerians with diabetes mellitus in North-Eastern 
Nigeria. Hospital –based cross-sectional study.  Medical out- patient clinic and the Blood bank of 
the Federal Medical Centre, Yola. Nigeria. From June, 2008 to December 2009, Two hundred 
and eighty consecutively recruited diabetes mellitus patients comprising 108 males and 172 
females were screened for HCV infection. These were compared with five hundred and ninety-
five voluntary blood donors who were screened during the same period. Serological testing for 
HCV infection was carried out with anti-HCV using Enzyme Linked Immuno-sorbent Assay 
(ELISA) method. The bio-data of the patients, history and duration of diabetes mellitus, history of 
jaundice, blood transfusion were recorded on a proforma. Out of the 280 diabetes mellitus 
patients tested, twenty-six were positive for anti-HCV antibodies giving an infection rate of 9.3% 
compared with fourteen subjects out of 595 voluntary blood donors 2.4% (p=0.0000105). History 
of blood transfusion, and jaundice was positively correlated with presence of HCV infection in 
diabetic patients. Hepatitis C virus is more common in Nigerian patients with diabetes mellitus 
than in non-diabetic control subjects. It may be necessary to screen patients with diabetes 
mellitus for hepatitis c virus infection particularly those with history of blood transfusion and 
jaundice. 
Keywords: Hepatitis C virus, diabetes mellitus, anti-HCV, Nigeria 
INTRODUCTION  
Diabetes mellitus (DM) is a metabolic syndrome of 
multiple aetiologies characterised by chronic 
hyperglycaemia with disturbances of carbohydrates, 
fat and protein metabolism resulting from defects in 
insulin secretion, insulin action or both (Olokoba et al, 
2007). DM may result from the destruction of the beta 
cells of the pancreas with consequent insulin 
deficiency or resistance to insulin action at the 
receptor site (Olokoba et al, 2007).  DM can be 
broadly classified into type 1DM, type 2 DM, 
gestational DM, and other specific types of DM 
(Olokoba et al, 2007). 
Type 2 DM accounts for over 90% of all cases of DM 
(Alberti et al, 1990). Over 100 million people are 
diabetic worldwide and probably as many are not 
diagnosed (Alberti et al, 1990). A national survey in 
Nigeria showed a prevalence rate of 2.7% among 
Nigerians (Akinkugbe, 1997). 
At present, there are an estimated 170 million 
Hepatitis C virus (HCV) carriers worldwide, most of 
who are thought to be in the developing countries 
(Maddava et al, 2002). HCV plays an important role 
in the causation of chronic liver disease (CLD) (Lesi 
et al, 2002), and has become the leading cause of 
liver cirrhosis and primary liver cell carcinoma 
(PLCC) in North America, Southern Europe and 
Japan (Colquhon, 1996; Cheng, 1995).  
Infection with HCV affects not only the liver but also 
other extra-hepatic tissues as well (Ali et al, 2007). A 
number of extra-hepatic manifestations have been 
recognised including DM (Sene et al, 2004; Mason, 
2001). Although it remains to be determined whether 
HCV leads to DM or vice versa, but it is argued that 
patients with DM have an increased risk of exposure 
Am. J. Sci. Ind. Res., 2010, 1(2): 135-138 
 
 
136
to HCV owing to the nature of the disease and its 
inherent complications or frequent parenteral 
exposure (Ali et al, 2007). 
It has been reported from several Caucasian studies 
that there is an epidemiological association between 
HCV infection and DM. The objective of this study 
was to determine whether any such relationship 
exists in a black African population. We therefore 
determined the prevalence of HCV infection in 
Nigerians with DM in North-Eastern Nigeria. 
MATERIALS AND METHODS  
The serum samples of all consecutively recruited 
patients with confirmed DM were  screened for HCV 
using rapid test ELISA kits (ACON Laboratories, Inc 
San Diego CA 92121 USA) to detect antibodies to 
hepatitis C virus (anti-HCV). Similarly, the serum 
samples of all consecutively recruited voluntary blood 
donors (VBD) were screened for HCV infection. All 
positive serum samples were re-tested to eliminate 
false positives.   
 
Their bio data was obtained. Written informed 
consent was obtained from each patient. 
The study was approved by the Ethics and Research 
committee of the Federal Medical Centre, Yola, 
Nigeria. 
 
Analysis: The data obtained were analysed using 
the statistical package for social sciences (SPSS, 
version 11.0) statistical software. 
 
RESULTS 
 
At the conclusion of the study, out of the 280 DM 
patients tested, twenty-six were positive for anti-HCV 
antibodies giving an infection rate of 9.3% compared 
with fourteen subjects out of 595 VBD. 
 
History of blood transfusion and jaundice is positively 
correlated with presence of HCV infection in diabetic 
patients. 
 
Age 
The age of the DM patients studied ranged from 26-
85years with a mean of 51.5+/-12.0years. There was 
a steady increase in the age of the DM patients until 
a plateau at 5th decade (i.e. 40-49years). Thereafter 
there was a decline. Majority of the DM patients were 
in the 40-59 year age bracket (57.5%). The age 
range of the VBD was from 18-61 years with a mean 
of 31.3+/-7.9 years. Majority of the VBD were in the 
20-39 year age bracket (83.3%). See table 1.  
Gender: Out of the 280 DM patients screened, 108 
patients (38.6%) were males while 172 patients 
(61.4%) were females, giving a male to female ratio 
of 1:1.59. while out of the 595 VBD screened, 571 
were males (96.0%) while 24 were females (4.0%) 
giving a male to female ratio 23.8:1. There is no 
gender predilection in the occurrence of HCV 
infection in DM patients. See table 2. 
 
table 1.  Age distribution of diabetes mellitus patients 
and voluntary blood donors 
  
Age 
groups 
(Years) 
DM patients voluntary blood 
donors 
 frequency (n) (%) frequency (n) (%)     
       <20 0 (0) 15(2.5)             
-                   
         
     20-29 7(2.5) 265(44.5)       
        
     30-39 35(12.5) 231(38.8)       
       
     40-49 87(31.1) 66(11.1)         
   
     50-59 74(26.4) 15(2.5)          
  
     60-69 46(16.4) 3(0.5) 
        
     70-79 27(9.6) 0(0) 
   
     80-89 4(1.4) 0(0) 
   
     Total 280(100.0) 595(100.0)     
 
Table 2. Gender distribution of diabetes mellitus 
patients and voluntary blood donors 
  
Gender DM patients voluntary blood donors 
 frequency (n) 
(%) 
frequency (n) (%)     
   Male 108(38.6) 571(96.0)                 
         
   
Female 
172(61.4) 24(4.0)                    
        
  Total 280(100.0) 595(100.0)                
  
Duration of diabetes mellitus: The duration of DM 
ranged from 0.1 to 27 years with a mean of 5.67+/- 
5.08 years 
 
Blood sugar control: The range of fasting blood 
sugar control was 3.6 to 31.6 mmol/L with a mean of 
8.97+/-4.27 years. The range of glycosylated 
Am. J. Sci. Ind. Res., 2010, 1(2): 135-138 
 
 
137
haemoglobin was 5.0 and 14.6 with a mean of 
7.76+/-1.49 %. 
Frequency of HCV infection: Out of the 280 DM 
patients screened, 26 of them (9.3%) were 
seropositive for anti-HCV antibodies while 14(2.4%) 
of the 595 VBD were seropositive. There was a 
statistically significant increase in the sero-positivity 
for anti-HCV in DM patients compared with non-
diabetic VBD (p<0.05) See table 3. 
 
Risk factors to HCV infection 
Out of the 26 DM patients who were sero-positive for 
anti-HCV antibodies, 18 of them (69.2%) had a 
history of jaundice compared with 8(30.8%) who did 
not. This difference is statistically significant (p=0.00). 
Similarly, out of the 26 DM patients who were sero-
positive for anti-HCV antibodies, 18 of them(69.2%) 
had a history of blood transfusion compared with 
8(30.8%) who did not. This is also statistically 
significant (P=0.00). Therefore, a history of blood 
transfusion and jaundice is positively correlated with 
presence of HCV infection in DM patients. See table 
4.  
Table 3.  Frequency of HCV infection 
 
Variable DM patients voluntary blood donors   
 
(%) 
frequency (n)  
 
frequency (n) (%) x2 p-value      
Anti-HCV positive 26 (9.3) 14(2.4) 19.42 0.0000105 
     
Anti-HCV negative 254(90.7) 581(97.6)   
     
Total 280(100.0) 595(100.0)         
  
Table 4.  Anti-HCV status versus variables in diabetic patients 
History of Jaundice History of BT Gender  Variable 
Yes No Yes No Yes No 
Anti-HCV positive 18(69.2) 8(30.8) 18(69.2) 8(30.8) 18(69.2) 8(30.8)      
Anti-HCV negative 62(24.4) 192(75.6) 50(19.7) 204(80.3) 154(60.6) 100(39.4) 
 X2 =21.17   p-value=0.00,  X2 =28.85 p-value=0.00,  X2 =0.42 p-value=0.52                       
Key 
BT= Blood transfusion 
 
DISCUSSION 
A review of the literature shows that controversy 
exists in the relationship between HCV infection and 
DM (Nwokediuko and Oli, 2008; Adegoke et al, 2008; 
Balogun et al, 2006).  Our study shows a significant 
increase in HCV infection in patients with DM 
compared with non-diabetic controls as 9.3% of our 
diabetic patients were found to have HCV infection 
compared with 2.4% of non-diabetic VBD. A review of 
the local literature shows that there are few Nigerian 
studies with which to compare. Nwokediuko and Oli 
(2008) in Enugu, South-eastern, Nigeria found that 
HCV infection is more common in DM patients 
compared with their non-diabetic controls (14.1% 
versus 3.7%). However, Adegoke et al (2008) in Ile-
ife, South-west, Nigeria found a low prevalence of 
HCV infection (0.01%) among DM patients. Similarly, 
Balogun et al (2006) found a low prevalence of HCV 
infection in their DM patients in Ibadan, South-west, 
Nigeria. 
Ali et al (2007) in their study amongst Pakistanis 
found that HCV infection occurred more in DM 
patients. Similarly, Bahtiyar et al (2004) found a 
higher prevalence of HCV seropositivity in DM 
patients than in the general population in the United 
States of America. Furthermore, Knobler and 
Schattner (2001) found a positive association 
between HCV infection and DM among their Israeli 
patients. Manson et al (1999) and Ryu et al (2001) 
working separately, found a positive association 
between HCV infection and DM among American and 
Korean patients respectively. Conversely, Mangia et 
al (1998) found a negative association between HCV 
infection and DM among their Italian patients. Various 
reasons have been adduced for the increased 
occurrence of HCV infection in DM patients. These 
are frequent parenteral injections and exposure due 
to frequent insulin administration, extra-hepatic 
manifestations of HCV infection which includes DM, 
and the fact that patients with liver diseases are 
known to have a higher prevalence of glucose 
intolerance. A higher prevalence of DM in HCV 
related liver cirrhosis in comparison with cirrhosis 
secondary to other causes has also been postulated 
(Chen et al, 2003).  There is scant evidence for 
Am. J. Sci. Ind. Res., 2010, 1(2): 135-138 
 
 
138
infection of pancreas by HCV and destruction of beta 
cells either directly by HCV or by an immune 
response, although HCV ribonucleic acid has been 
found in pancreatic tissue (Everhart, 1999). 
In this study, only anti-HCV antibodies were used to 
screen for HCV infection. HCV RNA was not assayed 
for. If HCV RNA was assayed for, the actual HCV 
infection rate would probably be higher than the 
present reported figure of 9.3%. We also observed 
that a history of blood transfusion and a past history 
of jaundice are positive predictors of HCV infection in 
patients with DM. From this study, we did not find any 
relationship between gender and the presence of 
HCV seropsitivity in DM patients. This is similar to the 
findings of Ali et al (2007) who did not find any 
relationship between gender and the risk of HCV 
infection. In contrast to this, Cacoub et al (1999) 
found female gender as a frequent factor in the 
extrahepatic manifestation of HCV infection 
In conclusion, HCV infection is more common in 
Nigerians with DM. A past history of blood transfusion 
and a past history of jaundice are independent 
predictors of HCV infection in DM patients. There is 
no relationship between gender and the occurrence 
of seropositivity to HCV infection in DM patients.  
 
REFERENCES 
Adegoke, O.A., Kolawole, B.A., Ikem, R.T., Adeniran, A., 
Aboderin, A.O., Salawu, A (2008). Seroprevalence of 
hepatitis C virus infection in Nigerians with Type 2 
Diabetes mellitus. Nigerian Journal of Clinical Practice. 
11(3):199-201. 
Akinkugbe, O.O (1997). Final report of National expert 
committee on Non-communicable diseases.( Federal 
Ministry of Health and Social services, series 4): 64-90. 
Alberti, K.J.M.M., Mellander, A., Sevrano- Rios, M (1990). 
Guest editor’s introduction: An update on NIDDM IDF 
Bulletin. 3S:2. 
Ali, S.S., Ali, I.S., Aamir, A.H., Jadoon, Z., Inayatullah, S 
(2007). Frequency of Hepatitis C infection in diabetic 
patients. J Ayub Med Coll Abbottabad. 19(1):46-49. 
Bahtiyar, G., Shin, J.J., Aytaman ,A., Sowers, J.R., 
McFarlane, S.I (2004). Association of diabetes and 
hepatitis c infection: epidemiologic evidence and 
pathophysiologic insights. Curr Diab Rep. 4(3):194-
198. 
Balogun, W., Adeleye, J., Akinlade, K., Otegbayo, J (2006). 
Low prevalence of hepatitis-C viral seropositivity 
among patients with type-2 diabetes mellitus in a 
tertiary hospital. J Natl Med Assoc. 98(11):1805-1808. 
Cacoub, P., Poynard, T., Ghillani, P., Charlotte, F., Olivi, 
M., Piette, J.C et al (1999). Extra hepatic 
manifestations of chronic hepatitis C. MULTIVIRC 
Group. Multidepartment virus C. Arthritis Rheum. 
42(10):2204-2212.  
Chen, L.K., Hwang, S.T., Tsai, S.T., Luo, J.C., Lee, S.D., 
Chang, F.Y (2003). Glucose intolerance in Chinese 
patients with chronic hepatitis C. World J 
Gastroenterol. 9(3): 505-508. 
Cheng, D.S (1995). Hepatitis C virus in chronic liver 
disease and Hepatocellular carcinoma in Taiwan. 
Princess Takamatsu symp. 25:27-32. 
Colquhon, S.D (1996). Hepatitis C: A clinical update. Arch 
Surg 131:18-23. 
Everhart, J (1999). A confluence of epidemics: does 
hepatitis C cause type 2 diabetes? Hepatology. 
30(4):1059-1063. 
Knobler, H., Schattner, A (2001). Associaton of Hepatitis C 
and Diabetes mellitus. Ann Intern Med. 132(2): 141. 
Lesi, O.A., Kehinde, M.O., Anomneze, E.E., Wali, S.S 
(2002). Hepatitis C infection and the risk of chronic 
liver disease in Lagos. Nig Q J Hosp Med.12:1-4. 
Maddava, V., Burgess, C., Drucker, E (2002). 
Epidemiology of chronic hepatitis co-infection in sub-
Saharan Africa. Lancet, Infectious disease. 2:293-302. 
Mangia, A., Schiavone, G., Lezzi, G., Marmo, R., Bruno, F., 
Villani, M.R et al (1998). HCV and diabetes mellitus: 
evidence for a negative association. Am J 
Gastroenterol. 93(12):2362-2367. 
Mason, A (2001). Viral induction of type 2 diabetes and 
autonomic liver disease. J Nutri. 131(10):2805S-
2808S. 
Mason, A.L., Lau, J.Y., Hoang, N., Qian, K., Alexander, 
G.J., Xu, L et al (1999). Association of diabetes 
mellitus and chronic hepatitis c virus infection. 
Hepatology. 29(2):328-333. 
Nwokediuko, S.C., Oli, J.M (2008). Hepatitis C virus 
infection in Nigerians with Diabetes mellitus. Nigerian 
Journal of Clinical Practice. 11(2):94-99. 
Olokoba, A.B., Bojuwoye, B.J., Katibi, I.A., Ajayi, A.O., 
Olokoba, L.B., Braimoh, K.T et al (2007). Cholelithiasis 
and type 2 diabetes mellitus in Nigerians. South 
African Gastroenterology Review. 5(3):14-17. 
Ryu, J.K., Lee, S.B., Hong, S.J., Lee, S (2001). Association 
of chronic hepatitis c virus infection and diabetes 
mellitus in Korean patients. Korean J Intern Med. 
16(1):18-23. 
Sene, D., Limal, N., Cacoub, P (2004). Hepatitis C virus-
associated extra-heapatic manifestations, a review. 
Metab Brain Dis. 19(3-4): 357-81. 
 


Hepatitis C virus infection in Nigerians with diabetes mellitus

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Hepatitis C virus infection in Nigerians with diabetes mellitus

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