Prevalence of anti-hepatitis C antibodies and its co-infection with HIV in the Abang Minko'o area of the South region of Cameroon

NDIP Valirie AGBOR (phillipovalerie@yahoo.co.uk)
Department of Haematology, Immunology, Microbiology and infectious diseases, Parasitology, Faculyt of Medicine and Biomedical Sciences, The University of Yaounde 1
July, 2015
 

Abstract

INTRODUCTION
Co-infection of hepatitis C virus (HCV) with human immunodeficiency virus (HIV) is now a major public health concern worldwide, owing both to its high prevalence and to interactions between the two diseases in terms of their diagnosis, natural course, and treatment. The morbidity and mortality of HIV patients due to hepatitis C have increased. This is due to the fact that both infections share similar routes of transmission, and HIV infected patients are living longer due to increase access to highly active antiretroviral therapy (HAART). The dual HCV/HIV infection increases the risk of transmission of both viruses. Hepatitis-related liver disease is the leading cause of non-AIDS related death among persons living with HIV/AIDS (PLWHA). The complications of hepatitis C infection progress faster in patients co-infected with HIV than in HCV mono-infected patients. On the other hand, HCV accelerate the progress of HIV infection to AIDS. Furthermore, these co-infected patients pose a problem with treatment as a slower sustained virological response (SVR) is seen in these patients. Data on the prevalence of HCV/HIV co-infection in the general Cameroonian population is sparse. The Abang Minko’o area of South Cameroon is a border town with a high commercial turnover, hence we carried out this study to evaluate the magnitude of HCV/HIV co-infection in this area with aim of contributing to curbing down these infections by identifying some of the peculiar risk factors associated with their prevalence in that area.

METHODS
This study was an analytic cross sectional study carried out from November 2014 to April 2015. Approval to carry out this study was sought from the Scientific and Ethical committee of the Faculty of Medicine and Biomedical Sciences (FMBS) of the University Yaoundé I, Cameroon. Permissions were also obtained from all necessary Administrative Authorities for work to proceed. Inclusion criteria for the study participants were age ≥ 12 years, those who gave their informed consent and were resident in Abang Minko’o for at least three months. Those who refused to participate or were less than 12 years old were excluded from the study. When informed consent was obtained, data for each participant was collected unto a pre-structured questionnaire in a private setting and a code was attributed to each participant. Data was obtained on socio-demographic characteristics, past medical and surgical history, and on sexual behaviour. Five millilitres of venous blood was collected into EDTA-containing tubes, and each tube carried a participant code. These blood samples were screened for HIV using DETERMINE® HIV1/2a (Alere; Bedfordview, South Africa) and then IMMUNOCOMB® II HIV 1&2 BiSpot (Organics, Yavne, Israel) if the former was positive. All samples were retested using MUREX HIV Ag/Ab Comboa (DiaSorin; Saluggia, Italy). These samples were also screened for the presence of anti-HCV antibody using IMMUNOCOMB® II HCV (Organics, Yavne, Israel). All positive and indeterminate samples were further tested for confirmation using the Architect anti-HCV qualitative assay (Abbott, Wiesbaden, Germany). Data were analysed with Epi Info version 3.5.3. The Chi square (X2) test or the Fisher’s exact test when the expected cell number was less than five was used. The Odds Ratio (OR) was utilized in assessing strength of association that could exist between measured variables. P values <0.05 were considered statistically significant.

RESULTS
A total of 174 participants were included in this study. There were more males 93(53.4%) than females 81(46.6%) and the mean age was 30.34 ± 13.26 years (range 12 – 77 years). The overall anti-HCV prevalence was 6.3% (11/174, 95% CI = 2.9 – 10.3). Males were more affected by the HCV infection (3.4%) than females (2.9%). Individuals aged 66 years and above had the highest prevalence of HCV infection (25.0%) followed by 46-55 years old age group (20.0%). There was no statistically significant difference in HCV seroprevalence in the different age groups nor was there a difference in the sex (p > 0.05). There was a statistically significant association between HCV sero-positivity of the participants and a past history of injectable drug treatments (p = 0.01) and history of minor surgery (p = 0.03). The prevalence of HIV in this study was 6.9%. The prevalence of HIV in females (7.4%) was higher than for males (6.5%). HCV/HIV co-infection was found in 3 cases (1.7%) and there was a statistically significant difference in HCV positivity between HIV-positive (25%) and HIV-negative (4.9%) participants (OR = 6.38; 95% CI = 1.44 – 28.22; p = 0.006).

CONCLUSIONS

This study showed that the prevalence of HCV and HIV co-infection in the study population was 1.7%. A high prevalence of HCV (6.3%) and HIV (6.9%) infections were also noted. The major risk factors associated with HCV infection were: A history of injectable drug treatment and minor surgery.

RECOMMENDATIONS
These findings suggest that the systematic screening of PLWHA for HCV should be reinforced. Measures should also be implemented to ensure proper sterilization of surgical equipments and the use of disposable materials in hospitals and clinics as much as possible. Moreso, similar studies with a larger sample size should be carried out in other regions for relevant details on the subject.

Key words: HCV, HIV, co-infection, Abang Minko’o


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