|Year : 2022 | Volume
| Issue : 3 | Page : 228-235
Common hepatitis B virus genotypes among blood donors in Lagos, Nigeria
Ebele I Uche1, Nwakaego E Chukwukaodinaka2, Akinsegun A Akinbami1, Oluwatosin I Adeyemi2, Aderonke O Hassan2, Rafah A Bamiro2, Ismaila Nda Ibrahim3, Aisha M Suleiman3, Benjamin Augustine3, Doris Chinyelu Anaduaka2
1 Department of Haematology and Blood Transfusion, Lagos State University College of Medicine, Lagos, Nigeria
2 Department of Haematology and Blood Transfusion, Lagos State University Teaching Hospital, Lagos, Nigeria
3 Department of Haematology and Blood Transfusion, Ahmadu Bello University, Zaria, Kaduna, Nigeria
|Date of Submission||20-Jan-2022|
|Date of Decision||01-Mar-2022|
|Date of Acceptance||26-Mar-2022|
|Date of Web Publication||22-Jul-2022|
Ebele I Uche
Department of Haematology and Blood Transfusion, Lagos State University College of Medicine, Ikeja, Lagos
Source of Support: None, Conflict of Interest: None
Background: Hepatitis B virus (HBV) infection is one of the public health diseases causing global health problems. It is a leading cause of cirrhosis and hepatocellular carcinoma. Blood transfusion is a major route of its transmission and screening of blood is suboptimal in our environment. Occult HBV infection describes the presence of HBV DNA in blood or liver tissue in patients who are hepatitis B surface antigen (HBsAg) seronegative. This study documented the common genotypes of HBV a blood-borne infection in the population of blood donors in Lagos. Methods: This was a cross-sectional study carried out at the blood donor clinics of ten Lagos State Government-owned hospitals in Lagos State. A total of 1400 participants were recruited consecutively from November 2020 to June 2021. All participants' samples were screened using Diaspot Rapid Test Kit (RTK) and Dialabenzyme enzyme-linked immunosorbent assay (ELISA) kit. Furthermore, some of the plasma samples were used for HBV DNA extraction and genotyping using the real time-polymerase chain reaction. Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS) software version 26 and P value was considered significant at ≤0.05. Results: The sero-prevalence of HBsAg using RTK and ELISA was 19.9% and 22.4%, respectively. The prevalence of occult HBV infection was 5.2%. A total of 278 and 313 HBsAg RTK and ELISA positive samples were obtained, respectively. HBV genotype result had A (46.6%) as the most prevalent followed closely by B (44.7%), E (23.8%), D (20.9%) and C (11.2%). Conclusion: HBV infection has a high prevalence among blood donors. ELISA is a more sensitive screening tool and its use should be advocated nationally. HBV genotype A is the most prevalent genotype from our study.
Keywords: Enzyme-linked immunosorbent assay, genotype, hepatitis B virus, rapid kit, screening
|How to cite this article:|
Uche EI, Chukwukaodinaka NE, Akinbami AA, Adeyemi OI, Hassan AO, Bamiro RA, Ibrahim IN, Suleiman AM, Augustine B, Anaduaka DC. Common hepatitis B virus genotypes among blood donors in Lagos, Nigeria. Niger Postgrad Med J 2022;29:228-35
|How to cite this URL:|
Uche EI, Chukwukaodinaka NE, Akinbami AA, Adeyemi OI, Hassan AO, Bamiro RA, Ibrahim IN, Suleiman AM, Augustine B, Anaduaka DC. Common hepatitis B virus genotypes among blood donors in Lagos, Nigeria. Niger Postgrad Med J [serial online] 2022 [cited 2022 Aug 13];29:228-35. Available from: https://www.npmj.org/text.asp?2022/29/3/228/351720
| Introduction|| |
The burden of hepatitis B virus (HBV) infection is high in Nigeria, with a prevalence rate of 11%. Infection is more common in males. HBV is vertically transmitted particularly in under-fives and can also be acquired as a blood transfusion transmissible infection (TTI).
HBV infection is endemic in sub-Saharan Africa and East Asia with a prevalence rate of between 5% and 10%., The highest prevalence of over 8% is reported in Asia and the lowest of <2% in North Africa. Prevalence rates among blood donors range from 3% to 22% in West Africa. The Nigerian prevalence is on the average 11%; this is however dependent on the region and method of assay. In the South West of Nigeria, values of 9.8%, 8.5%, and 9.8% among healthy blood donors were reported in Lagos, Ibadan, and Abeokuta, respectively.
The United Nations, during the 69th World Health Assembly proposed elimination of viral hepatitis by the year 2030. To this end, Nigeria must develop strategies to achieve that by ensuring safe blood transfusion.,
Occult hepatitis B infection
This describes the presence of HBVDNA in blood or liver tissue in patients who are hepatitis B surface antigen (HBsAg) sero-negative when screened with RTK and enzyme-linked immunosorbent assay (ELISA)., Occult hepatitis B infection (OBI) can linger undetected in individuals for years before any symptom of overt HBV infection emerges. Most occult HBV infections are asymptomatic and would only be detected by viral screening for HBVDNA. The long asymptomatic nature of chronic occult HBV infection in patients poses the risk of developing severe, long-term liver damage such as liver cirrhosis and hepatocellular carcinoma, which may lead to premature deaths.
The prevalence of OBI is higher among subjects at high risk for HBV infection and with liver disease.
Worldwide, the prevalence of occult HBV infection is quite variable, depending on the level of the disease endemicity, the assay technique used, and the different populations studied. In Nigeria, HBV infection studies have shown a 17% prevalence rate of occult HBV infection in Ogbomoso, 5.4% in Ile-Ife among blood donors and 14.6% among end-stage renal disease patients on haemodialysis in Lagos.
The gold standard for diagnosing occult HBV infection is the use of HBV nucleic acid amplification testing (NAT) which is a polymerase chain reaction (PCR) technique with detection limits of 10 copies of HBV DNA per reaction.
Hepatitis B genotypes
The pathogenesis and consequences of infection such as the development of liver cirrhosis and hepatocellular carcinoma are dependent on the infecting genotype.
The infecting genotype also determines the clinical outcomes, HBeAg seroconversion rates, mutational patterns in the precore and core promoter regions, disease severity, response to therapy, disease chronicity, transplantation outcomes and occult infection.,,
There are 10 genotypes (A to J) reported in literature which is dependent on an inter-group divergence of 8% or more in the complete nucleotide sequence.,, Genetic heterogeneity of HBV is as a result of high mutation rate which is about 100 times higher than that of other DNA viruses.
The genotypic distribution in the African region includes A, B, C, D, and E., Osuji et al. reported a predominance of “E” genotype in Nigeria while genotypes A, B, D, and E were documented to be prevalent in other parts of Africa.
The transmissibility characteristics also depend on the type of genotype and this varies from region to region. Some genotypes are more transmitted vertically, prone to chronicity, and more prevalent in the younger age group, especially B and C genotypes, and of high prevalence in the Asian region., While genotypes A and D are highly prevalent in the western world and some part of Africa, they are prone to acute infections and acquired at a later age.,, Vertical transmission is high in Africa; however, majority are cleared before the age of 20 years.
There are three serotypes of genotype A namely, A1, A2, and A3. A1serotype is more prevalent in Eastern Africa, A2 prevalent in North Africa while A3 is prevalent mainly in the west and central Africa. While genotype D has seven serotypes: Serotype D1 and D7 are prevalent in Northern Africa.
Genotype E is prevalent in Western and Central Africa.,, HBV/E is the most occurring genotype in Benin, Togo, Nigeria as well as the Central African Republic and the Democratic Republic of the Congo.,
This study aimed to determine the common genotypes of HBV among blood donors in Lagos.
| Methods|| |
The study was done over a period of 6 months from November 2020 to June 2021.
Ethical clearance was obtained from the Health Research and Ethics committee of the Lagos State University Teaching Hospital, Ikeja Lagos, Nigeria with a reference number-LREC/06/10/1343 (Approval date 26th March 2020) and the Lagos State Health Service Commission that oversees all the General Hospital used with the reference number-HSC/2222/53 (approval date 15th November 2020). Consent was obtained from individual donors before enrolment.
The study was conducted in the Blood donor clinic of Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos State Blood Transfusion Screening Centres (LSBTSC) and blood banks of nine General Hospitals in Lagos State [Table 1].
LASUTH, blood banks of the General Hospitals and LSBTSC serve patients from within Lagos and beyond being strategically located in various parts of the state.
These centres were selected because of their high blood donor turnout while some house the LSBTSC.
This included prospective blood donors at the various donor centres of the hospitals selected, who consented to participate in the study by signing the consent form (after adequate information concerning the study) and filling the questionnaire.
This was a cross-sectional, hospital-based study, conducted at the blood donor clinics of LASUTH, Ikeja, and nine General Hospitals where consenting donors were recruited consecutively.
Sample size determination
The appropriate sample size formula chosen is that designed for a non-comparative single proportion study.
The calculation of the sample size:
N = (z2pq)/d2
N = Desired sample size in a population
Z = Standard deviation set at 1.96, corresponding to the 95% confidence interval
P = Prevalence of the target population estimated to have a particular characteristic. In this case, is HBV.
Q = 1-p complimentary probability to P
D = degree of precision or absolute error set at 5% (0.05)
In this study, P was taken as 24% representing the prevalence rate of genotype A.
Mathematically, sample size is N = (1.96)2 × prevalence × (1-prevalence)/(0.05)2
N = (1.96)2 × 0.24 (1 − 0.24)/(0.05)2
= 0.7007/0.0025 = 280
Minimum sample size is 280
10% attrition = 28.
Sample size = 308.
A total of one thousand, four hundred consenting donors were screened to be able to get 313 HBsAg positive subjects for this study.
Inclusion criteria included; Donors above 18 years and below 65 years; All donors who were both HBsAg positive and negative, using pre-donation rapid diagnostic kit test kit (RTK); and All other inclusion criteria for blood donation in Lagos State applies.
Exclusion criteria included; Donors who have had Hepatitis B vaccination within 14 days preceding intending donation. All exclusion criteria for blood donation in Lagos State were applied in this study except for those that were HBsAg positive using RTK.
A consecutive, non-purposive sampling technique was used for all consenting healthy blood donors.
Laboratory procedures and sample collection
All participants' samples were screened with RTK and ELISA while some of the ELISA positive and negative had HBV DNA extraction and genotyping.
Storage and stability
The rapid test kits used for the study were packed and stored at room temperatures (22°C–28°C) while the ELISA kits were kept at between 2°C and 8°C before use. The DNA extraction kits, master mix and standards for genotyping were shipped in by airfreight in a cold box (15°C–20°C) and stored at 2°C–8°C before use.
Specimen collection and processing
From an intravenous access, under aseptic conditions using a vacutainer needle, 5 ml of blood sample was collected in plain bottles which were allowed to clot naturally at room temperature and spun at 3000 rpm for 5 min to obtain serum free from any visible particulate. The sera obtained were used to test for HBsAg using RTK and ELISA.
Another 5 mls of blood sample was collected in EDTA. The blood samples were transported to LASUTH Ikeja, where the plasma was separated. The plasma from EDTA samples was stored at −20°C until samples were ready for HBV DNA extraction and genotyping.
HBsAg screening was done for all samples in LASUTH and the nine general hospital donor Clinics. The sera were subjected to rapid test kits using DiaSpot HBsAg test strips from DiaSpot Diagnostics, USA and performed according to the manufacturer's specification.,,
Thereafter, ELISA-based test was conducted on all participants' sera irrespective of their HBV Rapid test kit result. ELISA was done using DiaLab HBsAg sensitive ELISA from DiaLab Austria. ELISA was done at the LASUTH's TTI screening room and other Lagos State Screening Centres located at General hospital Marina, General hospital Ikorodu, General hospital Agege, General hospital Gbagada and General hospital Igando.
DNA extraction for genotypic analysis
HBV DNA extraction was carried out on the EDTA samples. The EDTA samples were spun at 3000 rpm for 5 min to settle the red cell. The plasma was pipetted into cryotubes and stored at −20°C. The stored plasma was later sent to the MRC Laboratory, LASUCOM, Ikeja, Lagos where HBV DNA extraction and molecular analysis were done. HBV DNA extraction was carried out on the 290 HBsAg positive samples because 23 of the 313 samples were haemolysed. The plasma of the study subjects that tested HBsAg negative by ELISA was pooled in batches of 10 for HBV DNA extraction and genotyping. For any batch that was successfully genotyped, the 10 plasma samples were re-extracted singly and re-genotyped.
Genotypic analysis of all HBV positive samples and some pooled HBV negative samples was done using DNA extracted from plasma samples using real-time Tel- real time-PCR (RT-PCR)-HBV Genotypes A-E from Telsa-Dx Consultancy, Toowong DC, Brisbane, QLD, 4066, Australia.
Before genotyping, the purity and concentration of the extracted DNA were checked with Nano Drop2000/2000c spectrophotometer (ND-2000) with a detection range from 2 to 15,000 ng/μL (dsDNA) from Thermo Fisher Scientifics Inc. DE USA, and samples with very low concentration were excluded to avoid poor amplification during genotyping.
Consideration was given to genotypes prevalent in Africa, namely genotypes A, B, C, D and E with RT-PCR as the kits contain primer for these genotypes. A few samples were run together with the positive control (standard) and negative control to validate and optimise the master mix and the standards before use.
Procedure for genotypic analysis
The TEL-RT-PCR-HBV is a reagent system based on SYBR Green PCR technology for the qualitative or quantitative single-plex detection of HBV Genotypes A-E. The detection of the virus occurs in a single reaction tube after viral DNA has been extracted. The use of this system only required the addition of DNA extract.
The kit consists of Master-Mix for HBV genotype A-E, HBV A-E Standards and HBV A-E Negative control.
The test was based on 25 μl final reaction (23 μl of master-mix +2 μl of extracted DNA).
The amplification was done with the following protocol
Holding stage of 3 min to bring up the temperature to 95°C followed by 40 cycles of repeated denaturation at 95°C for 15 s Annealing at 65°C for 15 s was done then extension at 72°C for 10 s.
It took a total of 1 h 14 min for an amplification run of 40 cycles to be completed. Each amplification run contains one positive and one negative control for each genotype amplified. Amplification plots were read from the computer.
Interpretation of result
The negative and positive control amplification plots with their concentrations/cycle computed tomography were noted. These were compared with the amplification plots of each extracted sample for genotype A-E. Any amplification distinct from negative amplification was considered positive while amplification aligning with or beyond negative amplification was considered as negative as shown in the appendix (examples of positive and negative amplification plots).
Participants' informed consent
The participants were informed about the study, as well as their rights and benefits. Written informed consent was obtained using a voluntarily signed consent form or initials obtained from illiterate participants through the research assistants. No participant was coerced in any way to participate in this study, which was at no cost to them.
Participants were assigned unique identification numbers. Paper records were stored securely. Electronic data were password protected.
Questionnaire administration and history taking
With the use of an interviewer-administered questionnaire, each participant was interviewed to obtain relevant demographic and clinical data. The questionnaire contained questions on Bio data, medical history, immunization history, past transfusion history, social/sexual history, and educational history.
An interpreter was used in a situation where the participant did not understand or speak English language.
Data were analyzed using SPSS version 26.0 (Statistical Package for Social Sciences. Inc, Chicago, Illinois, USA III. 2019). Data obtained from the study were discrete binary data. The data were presented as tables and proportions calculated. For the method of assays comparisons, True positive, false positive, true negative, false negative were determined to calculate the sensitivity and specificity of the screening test, also the positive predictive and negative predictive values were calculated.
The degree of association between variables was evaluated with Chi-square test. P value was considered significant at ≤0.05.
| Results|| |
A total of 1400 subjects were recruited into the study and included 89.1% males and 10.9% females within the age range of 18–60 years with a mean age of 34.4 ± 7.7 years. Educational status varied from tertiary to no formal education though more than 90% of the subjects had secondary education and above. About 66.6% were self-employed, 9.6% were students and civil servants constituted about 20% of the study population. Health workers constituted 1% of the subjects. A total of 85.9% of the subjects were replacement donors, 10.6% were voluntary blood donors 3.1% commercial donors and 0.4% were directed blood donors.
RTK hepatitis B virus screening
The RTK screening result is presented in [Table 2].
|Table 2: Rapid test kit hepatitis B virus screening outcome of blood donors|
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Enzyme-linked immunosorbent assay screening of all participants
This is presented in [Table 3].
|Table 3: Enzyme-linked immunosorbent assay hepatitis B virus screening outcome of blood donors|
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Hepatitis B virus DNA extraction and genotyping
Of the 313 HBsAg ELISApositive samples, 189 HBsAg positive samples had DNA extraction and genotyped. Of these, only 153 (81.0%) were successfully genotyped.
Only 325 (30%) of HBsAg ELISA negative samples were subjected to HBV DNA extraction, 17 (5.2%) had DNA extracted and genotyped. All 17 were successfully genotyped. Therefore, the proportion of HBV DNA positivity in HBsAg negative samples was 17 (5.2%) representing occult hepatitis [Table 4].
|Table 4: Hepatitis B virus DNA result among enzyme-linked immunosorbent assay hepatitis B surface antigen positive and enzyme-linked immunosorbent assay hepatitis B surface antigen negative samples|
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[Table 5] shows that genotype A is more prevalent in the group that were HBsAg negative but HBV DNA positive as it occurred 14 (82.4%) times either as mono or mixed infections among the 17 participants in this group. However, genotype A occurred 82 (43.4%) times either as mono or mixed infections out of the 189 participants who were HBsAg positive. The difference (82.4% vs. 43.4%) is statistically significant Chi-square was 9.52, P value of 0.002.
|Table 5: Hepatitis B genotypes results of all enzyme-linked immunosorbent assay hepatitis B surface antigen positive and enzyme-linked immunosorbent assay hepatitis B surface antigen positive negative|
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There were 153 successfully genotyped samples out of the 313 HBsAg positive samples. There were also 17 successfully genotyped HBsAg negative samples. In all there were 170 successfully genotyped samples. Of these, 101 were mono infection (89 from 153 and 12 from 17). The rest were mixed infections. [Table 6] shows the distribution of the mixed infections.
| Discussion|| |
Expectedly, the mean age for this study was 34.4 ± 7.7 (47.1%) because majority of the donors were family replacement donors who were donating for their spouses as 56.5% of them were married. The recruitment of participants for this study was unintentionally skewed in favour of males (89.1%) and this may be due to the sociocultural belief that males are fitter to donate blood and some of the females who volunteered to donate may be rejected due to the possibility of being on menstrual period during the period of intending blood donation. This is in keeping with other studies where male donors dominated the donor pool.,,
Family replacement donors made up the bulk of donors in this study, followed by voluntary donors. Replacement donation is the usual practice in Lagos State. This is similar to a study in Cameroon where replacement donation is the most common and encouraged by the country's blood transfusion policy. The implication of high replacement donors is that most of them are under stress to donate for their loved ones and as such may not pay attention to the questionnaire and may even deny some medical conditions and risky behaviours that may render then ineligible to donate blood as is observed in this study. It may also be difficult to get regular voluntary donors from this group.
Despite the fact that paid donors are discouraged in Lagos State, some paid donors were captured while filling the questionnaire. The least was directed donors, who would want their blood to be used specifically for their relatives. This prevalence is low due to the peculiarity of blood banking in Lagos where such requests were not followed up and not adhered to.
Only 290 of HBsAg positive sample were available for HBV DNA assay, 153 had sufficient DNA concentration for genotyping while 36 showed no genotype among the available primers for genotype A, B, C, D and E that were assayed in this study. It may be that the genotypes of these 36 samples belonged to the other genotypes not assayed such as genotype F, G, H, I, J.
One of the key points of this study is the finding of 17 out of 325 (30%) ELISA HBsAg negative samples with HBV DNA. Thus, occult HBV prevalence rate in this studywas 5.2%. Among the 17 amplified samples, 12 (3.75%) have single genotype infection while 5 (1.56%) had mixed infections with two or more genotypes. Genotype A was more prevalent in this group followed by genotype B. Genotype C was not seen in this group.
Occult hepatitis B infection is as a result of low HBsAg levels that may be seen in chronic carriers. Such patients are usually anti-HBc positive; therefore, NAT can be used to confirm positivity as blood/blood products of such persons are still infective. In this study, the prevalence of occult HBV infection (5.2%) obtained is similar to the study by Olotu et al. in Ile-Ife, Nigeria, where the prevalence was 5.4%. On the contrary, higher and lower prevalence rates have been documented by other researchers. While a study done in Lagos by Akinbami et al. showed a lower prevalence of 3% among blood donors, another study done in a hospital in Abakaliki, South Eastern Nigeria, among blood donors showed a prevalence of 8%. In the study by Akinbami et al., only one center was used (LASUTH) unlike our study that was multi-centered. In addition, our sample size was much higher than that used by Akinbami et al. in their study. This may explain the difference in prevalence rate gotten in both studies that were done both done in Lagos State. A joint study done in two teaching hospitals in the South-South region of Nigeria and another in the North-Central region of Nigeria showed a higher prevalence of 14%. The study in the two teaching hospitals had all infected with genotype E. In Burkina Faso the genotype found in the Occult HBV were mainly genotype E and A.
According to a study by Busch, some patients in chronic state may also have low levels of HBsAg which can only be detected by NAT. The need to make NAT a standard is being advocated especially in centres where plasma is used for fractionated derivatives even if pooling can be done to reduce cost. Occult hepatitis B infection is one of the rising causes of HBV infection among blood recipients due to non-diagnosis after ELISA screening and are diagnosed using NAT.
Interestingly, the 3 studies with lower prevalence rates were conducted in the South West region of Nigeria. Different samples sizes, different assay methods, as well as disease burden in relation to chronicity could have impacted on the various prevalence rates obtained.
When DNA genotyping was done, HBV DNA positive samples consisted of 153 (24.9%) ELISA positive samples and 17 (2.7%) ELISA negative samples. The outcome of HBV genotyping obtained from combined HBsAg ELISA positive and HBsAg ELISA negative samples indicated that HBV genotype A is the most prevalent followed closely by genotype B. In contrast, other studies have documented different results. Studies done in the Zaria, northern Nigeria, as well as in Port Harcourt, Nigeria reported mixed infection with genotypes E, B and A, however E was the most prevalent., In a study done in Benin-city Nigeria, infection with genotypes E was also the most prevalent. Studies in Ghana, Senegal, Niger, Cote d'Ivoire also reported mixed infection with genotypes E, A and D however, E was the most prevalent.
Lagos is a largely populated city with a lot of migrants and international travels are common, hence there may be risk of importing uncommon strains into the country which may be responsible for the deviation from the common pattern and non-amplification seen with some samples as they may be having strains not genotyped. High rate of diversity seen with HBV may be responsible for the variations in geographical pattern noticed in recent studies.
Epidemiologically, infection with genotype B has been shown to cause reduced viral activity as well as slower progression to degeneration of the liver when compared with genotype C. Patients with genotype B (as well as genotype A) have also been shown to respond better to treatment with interferon but have early resistance to Lamivudine when compared with genotypes C and D., Genotypes A and B are also associated with a high rate of sustained remission, HBsAg and DNA clearance compared with genotypes C and D while Genotypes C and D are associated with early progression to liver cirrhosis and hepatocellular carcinoma.,,, Genotype E has low genetic diversity as it is believed to be new and domiciled in West Africa including Nigeria.,,, Genotypes E and D are said to be difficult to treat, respond slowly to interferon., Genotypes B, E and D are prone to relapse following treatment., Genotype A is found in North America, Europe, South and East Africa., These two genotypes are the most prevalent in this study and it can be attributed to the influence of migration and intercultural marriages as factors of HBV genotypes distribution. This is gradually changing the global pattern of the distribution.
This was a multi-centre study hence sample processing was not done on a daily basis in centres far away from LASUTH. This could have accounted for the 23 haemolysed samples. In addition, the High cost of conducting HBV DNA extraction and genotyping limited its use especially for the HBsAg negative samples in this study. DNA extraction and genotyping were for a fraction of the ELISA negative samples (30%) to save cost. Also, this study relied on the information provided by the donors in the questionnaire and it is possible some of this information may not be accurate.
Contribution to knowledge
The prevalent genotype in Nigeria was known to be genotype E but this study has shown that genotype A is the most prevalent followed by genotype B. Further studies need to be done to either confirm or refute our findings. The HBsAg prevalence in this study was higher than the value obtained from previous studies. This calls for re-enforcement in the awareness campaign against HBV.
| Conclusion|| |
HBV genotype A was the most prevalent in our study, followed by B as against genotype E that has been well documented in the country. Further population studies will need to be done in order to either confirm or refute our findings.
- ELISA is a more sensitive screening method for HBV infection and its use should be made mandatory nationally
- Occult HBV infection prevalence is high in this study, genotyping should be considered soon especially for organ transplant and plasma derivatives
- Pooling of samples should be explored if NAT is to be considered as pooling could be cost-saving
- HBV genotype A is the most prevalent followed by B as against genotype E that has been well documented in the country. This knowledge should inform our management decisions on patients with HBV infection that present for treatment.
All authors gave consent for publication.
The authors acknowledge Mrs. Ndulue Uzoma who assisted with the ELISA and Dr Makanjuola Samira who did the HBV genotyping for all the participants.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]