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Ahovègbé L, Shah R, Kpossou AR, Davis C, Niebel M, Filipe A, Goldstein E, Alassan KS, Keke R, Sehonou J, Kodjoh N, Gbedo SE, Ray S, Wilkie C, Vattipally S, Tong L, Kamba PF, Gbenoudon SJ, Gunson R, Ogwang P, Thomson EC. Hepatitis C virus diversity and treatment outcomes in Benin: a prospective cohort study. THE LANCET. MICROBE 2024:S2666-5247(24)00041-7. [PMID: 38889738 DOI: 10.1016/s2666-5247(24)00041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/22/2023] [Accepted: 02/01/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND 10 million people are chronically infected with the hepatitis C virus (HCV) in sub-Saharan Africa. The assessment of viral genotypes and treatment response in this region is necessary to achieve the WHO target of worldwide elimination of viral hepatitis by 2030. We aimed to investigate the prevalence of HCV genotypes and outcomes of treatment with direct-acting antiviral agents in Benin, a country with a national HCV seroprevalence of 4%. METHODS This prospective cohort study was conducted at two referral hospitals in Benin. Individuals were eligible for inclusion if they were seropositive for HCV and willing to consent to participation in the study; exclusion criteria were an inability to give consent or incarceration. Viraemia was confirmed by PCR. The primary outcomes were to identify HCV genotypes and measure sustained virological response rates 12 weeks after completion of treatment (SVR12) with a 12-week course of sofosbuvir-velpatasvir or sofosbuvir-ledipasvir, with or without ribavirin. We conducted phylogenetic and resistance analyses after the next-generation sequencing of samples with a cycle threshold (Ct) value of 30 or fewer cycles. The in-vitro efficacy of NS5A inhibitors was tested using a subgenomic replicon assay. FINDINGS Between June 2, 2019, and Dec 30, 2020, 148 individuals were screened for eligibility, of whom 100 were recruited prospectively to the study. Plasma samples from 79 (79%) of the 100 participants were positive for HCV by PCR. At the time of the study, 52 (66%) of 79 patients had completed treatment, with an SVR12 rate of 94% (49 of 52). 57 (72%) of 79 samples had a Ct value of 30 or fewer cycles and were suitable for whole-genome sequencing, from which we characterised 29 (51%) samples as genotype 1 and 28 (49%) as genotype 2. Three new genotype 1 subtypes (1q, 1r, and 1s) and one new genotype 2 subtype (2xa) were identified. The most commonly detected subtype was 2d (12 [21%] of 57 samples), followed by 1s (eight [14%]), 1r (five [9%]), 1b (four [7%]), 1q (three [5%]), 2xa (three [5%]), and 2b (two [3%]). 20 samples (11 genotype 2 and nine genotype 1) were unassigned new singleton lineages. 53 (93%) of 57 sequenced samples had at least two resistance-associated substitutions within the NS5A gene. Subtype 2d was associated with a lower-than-expected SVR12 rate (eight [80%] of ten patients). For one patient, with subtype 2b, treatment was not successful. INTERPRETATION This study revealed a high SVR rate in Benin among individuals treated for HCV with sofosbuvir-velpatasvir, including those with highly diverse viral genotypes. Further studies of treatment effectiveness in genotypes 2d and 2b are indicated. FUNDING Medical Research Council, Wellcome, Global Challenges Research Fund, Academy of Medical Sciences, and PHARMBIOTRAC.
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Affiliation(s)
- Lucrèce Ahovègbé
- Mbarara University of Science and Technology, Mbarara, Uganda; MRC-University of Glasgow Centre for Virus Research, Glasgow, UK.
| | - Rajiv Shah
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Aboudou Raïmi Kpossou
- Clinique Universitaire d'Hépato-gastroentérologie, Centre National Hospitalier et Universitaire Hubert Koutoukou Maga, Cotonou, Benin
| | - Chris Davis
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Marc Niebel
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Ana Filipe
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Emily Goldstein
- West of Scotland Specialist Virology Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - René Keke
- Programme National de Lutte contre le SIDA, Cotonou, Benin
| | - Jean Sehonou
- Clinique Universitaire d'Hépato-gastroentérologie, Centre National Hospitalier et Universitaire Hubert Koutoukou Maga, Cotonou, Benin
| | - Nicolas Kodjoh
- Programme National de Lutte contre les Hépatites, Cotonou, Benin
| | | | - Surajit Ray
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - Craig Wilkie
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | | | - Lily Tong
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Pakoyo F Kamba
- Department of Pharmacy, School of Health Sciences, Makerere University, Kampala, Uganda
| | - S Judith Gbenoudon
- Laboratory of Immunology, Infectious and Allergic Diseases, Institute of Applied Biomedical Sciences, Faculty of Sciences and Technology, University of Abomey-Calavi, Cotonou, Benin
| | - Rory Gunson
- West of Scotland Specialist Virology Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Patrick Ogwang
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK; London School of Hygiene & Tropical Medicine, London, UK.
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Kabamba-Tshikongo A, Manya-Mboni H, Mwamba-Mulumba C, Takaisi-Kikuni NB, Vandenbroucke AT, Pâques AT, Dessilly G, Kabamba-Mukadi B, Longanga-Otshudi A. Hepatitis C virus among blood donors in Lubumbashi, DRC: Seroprevalence and molecular characterisation. Transfus Clin Biol 2023; 30:272-278. [PMID: 36898574 DOI: 10.1016/j.tracli.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES To date, no study has been done yet on the distribution of Hepatitis C virus genotypes in Lubumbashi, Democratic Republic of Congo. The objective of this work was to determine the seroprevalence and study the distribution of hepatitis C virus (HCV) genotypes among blood donors in Lubumbashi, DRC. METHODS This was a cross-sectional descriptive study among blood donors. The detection of anti-HCV antibodies was carried out by rapid diagnostic test (RDT) then confirmed by Chemiluminescent immuno-assay (CLIA). Viral load was determined by Nucleic Acid Amplification test (NAT) on Panther system and genotyping by Next Generation Sequencing (NGS) on Sentosa platform. RESULTS The obtained seroprevalence was 4.8%. Genotypes 3a (5.0%), 4 (90.0%) and 7 (5.0%) and a few drug resistance mutations were identified in the study population. Significant disturbances of some studied biochemical parameters (HDL-cholesterol, direct bilirubin, transaminases, ALP, GGT and albumin) have been observed in positive HCV blood donors. Irregular family and volunteer donors have been found as the socio-demographic characteristics associated with hepatitis C. CONCLUSION With a seroprevalence of 4.8% obtained among blood donors, Lubumbashi is in an area with medium endemicity for HCV, highlighting the need to implement strategies aiming to improve transfusion safety among blood recipients in Lubumbashi. This study reports for the first time the presence of HCV strains of genotypes 3a, 4 and 7. These results might allow better therapeutic management of HCV infections and contribute to the development of the mapping of HCV genotypes in Lubumbashi and DRC as well.
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Affiliation(s)
- A Kabamba-Tshikongo
- Laboratoire de Biologie Clinique, Faculté des Sciences Pharmaceutiques, Université de Lubumbashi, Lubumbashi, Democratic Republic of the Congo; Centre d'Excellence et d'Expertise des hépatites virales et autres pathologies, Lubumbashi, Democratic Republic of the Congo; Institut de Recherche Expérimentale et Clinique, Pôle de Microbiologie, Université Catholique de Louvain, Brussels, Belgium.
| | - H Manya-Mboni
- Laboratoire de Biologie Clinique, Faculté des Sciences Pharmaceutiques, Université de Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - C Mwamba-Mulumba
- Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - N B Takaisi-Kikuni
- Laboratoire de Microbiologie Expérimentale et Pharmaceutique, Faculté des Sciences Pharmaceutiques, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - A T Vandenbroucke
- Institut de Recherche Expérimentale et Clinique, Pôle de Microbiologie, Université Catholique de Louvain, Brussels, Belgium
| | - A T Pâques
- Institut de Recherche Expérimentale et Clinique, Pôle de Microbiologie, Université Catholique de Louvain, Brussels, Belgium
| | - G Dessilly
- Institut de Recherche Expérimentale et Clinique, Pôle de Microbiologie, Université Catholique de Louvain, Brussels, Belgium
| | - B Kabamba-Mukadi
- Institut de Recherche Expérimentale et Clinique, Pôle de Microbiologie, Université Catholique de Louvain, Brussels, Belgium
| | - A Longanga-Otshudi
- Laboratoire de Biologie Clinique, Faculté des Sciences Pharmaceutiques, Université de Lubumbashi, Lubumbashi, Democratic Republic of the Congo; Centre d'Excellence et d'Expertise des hépatites virales et autres pathologies, Lubumbashi, Democratic Republic of the Congo
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3
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Tumbo AM, Schindler T, Dangy JP, Orlova-Fink N, Bieri JR, Mpina M, Milando FA, Juma O, Hamad A, Nyakarungu E, Chemba M, Mtoro A, Ramadhan K, Olotu A, Makweba D, Mgaya S, Stuart K, Perreau M, Stapleton JT, Jongo S, Hoffman SL, Tanner M, Abdulla S, Daubenberger C. Role of human Pegivirus infections in whole Plasmodium falciparum sporozoite vaccination and controlled human malaria infection in African volunteers. Virol J 2021; 18:28. [PMID: 33499880 PMCID: PMC7837505 DOI: 10.1186/s12985-021-01500-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/20/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Diverse vaccination outcomes and protection levels among different populations pose a serious challenge to the development of an effective malaria vaccine. Co-infections are among many factors associated with immune dysfunction and sub-optimal vaccination outcomes. Chronic, asymptomatic viral infections can contribute to the modulation of vaccine efficacy through various mechanisms. Human Pegivirus-1 (HPgV-1) persists in immune cells thereby potentially modulating immune responses. We investigated whether Pegivirus infection influences vaccine-induced responses and protection in African volunteers undergoing whole P. falciparum sporozoites-based malaria vaccination and controlled human malaria infections (CHMI). METHODS HPgV-1 prevalence was quantified by RT-qPCR in plasma samples of 96 individuals before, post vaccination with PfSPZ Vaccine and after CHMI in cohorts from Tanzania and Equatorial Guinea. The impact of HPgV-1 infection was evaluated on (1) systemic cytokine and chemokine levels measured by Luminex, (2) PfCSP-specific antibody titers quantified by ELISA, (3) asexual blood-stage parasitemia pre-patent periods and parasite multiplication rates, (4) HPgV-1 RNA levels upon asexual blood-stage parasitemia induced by CHMI. RESULTS The prevalence of HPgV-1 was 29.2% (28/96) and sequence analysis of the 5' UTR and E2 regions revealed the predominance of genotypes 1, 2 and 5. HPgV-1 infection was associated with elevated systemic levels of IL-2 and IL-17A. Comparable vaccine-induced anti-PfCSP antibody titers, asexual blood-stage multiplication rates and pre-patent periods were observed in HPgV-1 positive and negative individuals. However, a tendency for higher protection levels was detected in the HPgV-1 positive group (62.5%) compared to the negative one (51.6%) following CHMI. HPgV-1 viremia levels were not significantly altered after CHMI. CONCLUSIONS HPgV-1 infection did not alter PfSPZ Vaccine elicited levels of PfCSP-specific antibody responses and parasite multiplication rates. Ongoing HPgV-1 infection appears to improve to some degree protection against CHMI in PfSPZ-vaccinated individuals. This is likely through modulation of immune system activation and systemic cytokines as higher levels of IL-2 and IL17A were observed in HPgV-1 infected individuals. CHMI is safe and well tolerated in HPgV-1 infected individuals. Identification of cell types and mechanisms of both silent and productive infection in individuals will help to unravel the biology of this widely present but largely under-researched virus.
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Affiliation(s)
- Anneth-Mwasi Tumbo
- Department of Intervention and Clinical Trials, Ifakara Health Institute, Bagamoyo, Tanzania
- Department of Medical Parasitology and Infection Biology, Clinical Immunology Unit, Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Tobias Schindler
- Department of Medical Parasitology and Infection Biology, Clinical Immunology Unit, Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jean-Pierre Dangy
- Department of Medical Parasitology and Infection Biology, Clinical Immunology Unit, Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nina Orlova-Fink
- Department of Medical Parasitology and Infection Biology, Clinical Immunology Unit, Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jose Raso Bieri
- Equatorial Guinea Malaria Vaccine Initiative, Malabo, Bioko Norte, Equatorial Guinea
| | - Maximillian Mpina
- Department of Intervention and Clinical Trials, Ifakara Health Institute, Bagamoyo, Tanzania
- Department of Medical Parasitology and Infection Biology, Clinical Immunology Unit, Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Equatorial Guinea Malaria Vaccine Initiative, Malabo, Bioko Norte, Equatorial Guinea
| | - Florence A Milando
- Department of Intervention and Clinical Trials, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Omar Juma
- Department of Intervention and Clinical Trials, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Ali Hamad
- Department of Intervention and Clinical Trials, Ifakara Health Institute, Bagamoyo, Tanzania
- Equatorial Guinea Malaria Vaccine Initiative, Malabo, Bioko Norte, Equatorial Guinea
| | - Elizabeth Nyakarungu
- Department of Intervention and Clinical Trials, Ifakara Health Institute, Bagamoyo, Tanzania
- Equatorial Guinea Malaria Vaccine Initiative, Malabo, Bioko Norte, Equatorial Guinea
| | - Mwajuma Chemba
- Department of Intervention and Clinical Trials, Ifakara Health Institute, Bagamoyo, Tanzania
- Equatorial Guinea Malaria Vaccine Initiative, Malabo, Bioko Norte, Equatorial Guinea
| | - Ali Mtoro
- Department of Intervention and Clinical Trials, Ifakara Health Institute, Bagamoyo, Tanzania
- Equatorial Guinea Malaria Vaccine Initiative, Malabo, Bioko Norte, Equatorial Guinea
| | - Kamaka Ramadhan
- Department of Intervention and Clinical Trials, Ifakara Health Institute, Bagamoyo, Tanzania
- Equatorial Guinea Malaria Vaccine Initiative, Malabo, Bioko Norte, Equatorial Guinea
| | - Ally Olotu
- Department of Intervention and Clinical Trials, Ifakara Health Institute, Bagamoyo, Tanzania
- Equatorial Guinea Malaria Vaccine Initiative, Malabo, Bioko Norte, Equatorial Guinea
| | - Damas Makweba
- Dar-Es-Salaam Institute of Technology, Dar-Es-Salaam, Tanzania
- Tanzania Education and Research Networks, Dar-Es-Salaam, Tanzania
- Tanzania Commission for Science and Technology, Dar-Es-Salaam, Tanzania
| | - Stephen Mgaya
- Tanzania Education and Research Networks, Dar-Es-Salaam, Tanzania
- Tanzania Commission for Science and Technology, Dar-Es-Salaam, Tanzania
| | - Kenneth Stuart
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, 307 Westlake Avenue, N. Suite 500, Seattle, WA, 98109, USA
| | | | - Jack T Stapleton
- Iowa City Veterans Administration and the University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Said Jongo
- Department of Intervention and Clinical Trials, Ifakara Health Institute, Bagamoyo, Tanzania
- Equatorial Guinea Malaria Vaccine Initiative, Malabo, Bioko Norte, Equatorial Guinea
| | | | - Marcel Tanner
- Department of Medical Parasitology and Infection Biology, Clinical Immunology Unit, Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Salim Abdulla
- Department of Intervention and Clinical Trials, Ifakara Health Institute, Bagamoyo, Tanzania
- Equatorial Guinea Malaria Vaccine Initiative, Malabo, Bioko Norte, Equatorial Guinea
| | - Claudia Daubenberger
- Department of Medical Parasitology and Infection Biology, Clinical Immunology Unit, Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
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4
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Mudji J, Madinga B, Horsmans Y. Seroprevalence of Viral Hepatitis B and C and Knowledge of the Hepatitis B Virus among Pregnant Women Attending Prenatal Care in the Democratic Republic of Congo. Am J Trop Med Hyg 2021; 104:1096-1100. [PMID: 33399040 DOI: 10.4269/ajtmh.20-0804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/25/2020] [Indexed: 12/17/2022] Open
Abstract
Viral hepatitis B (HBV) and C (HCV) can significantly influence maternal and child health. Although HIV infection, malaria, and syphilis in pregnant women are likely to be systematically screened for and managed according to national guidelines in the Democratic Republic of Congo, there is no plan for HBV and HCV. Furthermore, there is no documentation regarding pregnant women's knowledge about HBV and HCV. This situation has motivated the researchers to undertake the current study, which was designed to estimate the seroprevalence of HBV and HCV. We have also assessed knowledge of the HBV infection among pregnant women who consulted for antenatal care for the first time at Vanga Evangelical Hospital in Vanga. A cross-sectional study was conducted with 457 pregnant women who attended antenatal care. Sociodemographic, obstetric, and previous medico-surgical data, as well as information related to women's HBV knowledge, were collected using a questionnaire. Rapid tests were used to detect HBV surface antigen and HCV antibodies. Most pregnant women were aged 20-24 years. Only 6.8% of respondents had knowledge of HBV, and the main source of this knowledge was health facilities (4.6%). Only 0.7% reported having been tested, whereas 98.5% said that they had not been offered a test. Overall, 18 (3.9%) participants were HBV positive and 22 (4.8%) were positive for HCV. There is limited knowledge about HBV and HCV among pregnant women in rural Vanga. All pregnant women should be screened during antenatal care, and a well-implemented program of management is needed.
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Affiliation(s)
- Junior Mudji
- Département de médecine de famille et soin de santé Primaire, Université Protestante au Congo, Kinshasa, Democratic Republic of Congo.,Hôpital Evangélique de Vanga, Kikwit, Democratic Republic of Congo
| | - Blaise Madinga
- Département de médecine de famille et soin de santé Primaire, Université Protestante au Congo, Kinshasa, Democratic Republic of Congo.,Hôpital Evangélique de Vanga, Kikwit, Democratic Republic of Congo
| | - Yves Horsmans
- Hepato-GastroenterologyDepartment, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels Belgium
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Zambrano LD, Jentes E, Phares C, Weinberg M, Kachur SP, Basnet MS, Klosovsky A, Mwesigwa M, Naoum M, Nsobya SL, Samson O, Goers M, McDonald R, Morawski B, Njuguna H, Peak C, Laws R, Bakhsh Y, Iverson SA, Bezold C, Allkhenfr H, Horth R, Yang J, Miller S, Kacka M, Davids A, Mortimer M, Stauffer W, Marano N. Clinical Sequelae Associated with Unresolved Tropical Splenomegaly in a Cohort of Recently Resettled Congolese Refugees in the United States-Multiple States, 2015-2018. Am J Trop Med Hyg 2020; 103:485-493. [PMID: 32372751 PMCID: PMC7356405 DOI: 10.4269/ajtmh.19-0534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 03/09/2020] [Indexed: 12/20/2022] Open
Abstract
Tropical splenomegaly is often associated with malaria and schistosomiasis. In 2014 and 2015, 145 Congolese refugees in western Uganda diagnosed with splenomegaly during predeparture medical examinations underwent enhanced screening for various etiologies. After anecdotal reports of unresolved splenomegaly and complications after U.S. arrival, patients were reassessed to describe long-term clinical progression after arrival in the United States. Post-arrival medical information was obtained through medical chart abstraction in collaboration with state health partners in nine participating states. We evaluated observed splenomegaly duration and associated clinical sequelae between 130 case patients from eastern Congo and 102 controls through adjusted hierarchical Poisson models, accounting for familial clustering. Of the 130 case patients, 95 (73.1%) had detectable splenomegaly after arrival. Of the 85 patients with records beyond 6 months, 45 (52.9%) had persistent splenomegaly, with a median persistence of 14.7 months (range 6.0-27.9 months). Of the 112 patients with available results, 65 (58.0%) patients had evidence of malaria infection, and the mean splenomegaly duration did not differ by Plasmodium species. Refugees with splenomegaly on arrival were 43% more likely to have anemia (adjusted relative risk [aRR]: 1.43, 95% CI: 1.04-1.97). Those with persistent splenomegaly were 60% more likely (adjusted relative risk [aRR]: 1.60, 95% CI: 1.15-2.23) to have a hematologic abnormality, particularly thrombocytopenia (aRR: 5.53, 95% CI: 1.73-17.62), and elevated alkaline phosphatase (aRR: 1.57, 95% CI: 1.03-2.40). Many patients experienced persistent splenomegaly, contradicting literature describing resolution after treatment and removal from an endemic setting. Other possible etiologies should be investigated and effective treatment, beyond treatment for malaria and schistosomiasis, explored.
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Affiliation(s)
- Laura Divens Zambrano
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | - Emily Jentes
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | - Christina Phares
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | - Michelle Weinberg
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | - S. Patrick Kachur
- Columbia University Mailman School of Public Health, New York, New York
| | | | | | - Moses Mwesigwa
- International Organization for Migration, Geneva, Switzerland
| | - Marwan Naoum
- International Organization for Migration, Geneva, Switzerland
| | - Samuel Lubwama Nsobya
- School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - Olivia Samson
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Matthew Goers
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Division of Global Health Protection, Center for Global Health, CDC, Atlanta, Georgia
| | - Robert McDonald
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- New York State Department of Health, Albany, New York
| | | | - Henry Njuguna
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Washington State Department of Health, Tumwater, Washington
| | - Corey Peak
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | - Rebecca Laws
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- California Department of Public Health, Sacramento, California
| | - Yasser Bakhsh
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- California Department of Public Health, Sacramento, California
| | - Sally Ann Iverson
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Arizona Department of Health Services, Phoenix, Arizona
| | - Carla Bezold
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Arizona Department of Health Services, Phoenix, Arizona
| | | | - Roberta Horth
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Utah Department of Health, Salt Lake City, Utah
| | - Jun Yang
- Pennsylvania Department of Human Services, Harrisburg, Pennsylvania
| | - Susan Miller
- Pennsylvania Department of Human Services, Harrisburg, Pennsylvania
| | - Michael Kacka
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina
| | - Abby Davids
- Family Medicine Residency of Idaho, Boise, Idaho
| | | | - William Stauffer
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
- University of Minnesota, Minneapolis, Minnesota
| | - Nina Marano
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
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6
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Parr JB, Lodge EK, Holzmayer V, Pepin J, Frost EH, Fried MW, McGivern DR, Lemon SM, Keeler C, Emch M, Mwandagalirwa K, Tshefu A, Fwamba F, Muwonga J, Meshnick SR, Cloherty G. An Efficient, Large-Scale Survey of Hepatitis C Viremia in the Democratic Republic of the Congo Using Dried Blood Spots. Clin Infect Dis 2019; 66:254-260. [PMID: 29048459 DOI: 10.1093/cid/cix771] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/24/2017] [Indexed: 02/07/2023] Open
Abstract
Background Efficient viral load testing is needed for hepatitis C (HCV) surveillance and diagnosis. HCV viral load testing using dried blood spots (DBSs), made with a single drop of finger-prick whole blood on filter paper, is a promising alternative to traditional serum- or plasma-based approaches. Methods We adapted the Abbott Molecular m2000 instrument for high-throughput HCV viremia testing using DBSs with simple specimen processing and applied these methods to estimate the national burden of infection in the Democratic Republic of the Congo (DRC). We tested DBSs collected during the 2013-2014 DRC Demographic and Health Survey, including 1309 adults ≥40 years of age. HCV-positive samples underwent targeted sequencing, genotyping, and phylogenetic analyses. Results This high-throughput screening approach reliably identified HCV RNA extracted from DBSs prepared using whole blood, with a 95% limit of detection of 1196 (95% confidence interval [CI], 866-2280) IU/mL for individual 6-mm punches and 494 (95% CI, 372-1228) IU/mL for larger 12-mm punches. Fifteen infections were identified among samples from the DRC Demographic and Health Survey; the weighted country-wide prevalence of HCV viremia was 0.9% (95% CI, 0.3%-1.6%) among adults ≥40 years of age and 0.7% (95% CI, .6%-.8%) among human immunodeficiency virus-infected subjects. All successfully genotyped cases were due to genotype 4 infection. Conclusions DBS-based HCV testing represents a useful tool for the diagnosis and surveillance of HCV viremia and can easily be incorporated into specimen referral systems. Among adults ≥40 years of age in the DRC, 100000-200000 may have active infection and be eligible for treatment.
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Affiliation(s)
- Jonathan B Parr
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill
| | - Evans K Lodge
- School of Medicine, University of North Carolina, Chapel Hill
| | | | | | | | - Michael W Fried
- Division of Gastroenterology, Department of Medicine, University of North Carolina, Chapel Hill
| | - David R McGivern
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill
| | - Stanley M Lemon
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill
| | - Corinna Keeler
- Department of Geography, University of North Carolina, Chapel Hill
| | - Michael Emch
- Department of Geography, University of North Carolina, Chapel Hill.,Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Kashamuka Mwandagalirwa
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill.,Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Franck Fwamba
- National AIDS Control Program, Kinshasa, Democratic Republic of Congo
| | - Jérémie Muwonga
- National AIDS Control Program, Kinshasa, Democratic Republic of Congo
| | - Steven R Meshnick
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill
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Slavov SN, Maraninchi Silveira R, Hespanhol MR, Sauvage V, Rodrigues ES, Fontanari Krause L, Bittencourt HT, Caro V, Laperche S, Covas DT, Kashima S. Human pegivirus-1 (HPgV-1) RNA prevalence and genotypes in volunteer blood donors from the Brazilian Amazon. Transfus Clin Biol 2019; 26:234-239. [PMID: 31277987 DOI: 10.1016/j.tracli.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/09/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The objectives of this study were to evaluate the prevalence of Human Pegivirus-1 (HPgV-1) viremia and genotype diversity among healthy blood donors from the Eastern Brazilian Amazon (city of Macapá, State of Amapá). There is little information for prevalence and circulation of HPgV-1 in this remote Brazilian region. MATERIALS AND METHODS We conducted a study evaluating the HPgV-1 RNA prevalence and circulating genotypes in 431 volunteer blood donors originating from the Eastern Brazilian Amazon. The obtained HPgV-1 positive samples were submitted to sequencing and genotyping analysis in order to examine the genotype diversity of this virus in the Brazilian Amazon. RESULTS Our results demonstrated a prevalence of HPgV-1 RNA in 9.5% of the tested blood donors. The phylogenetic analyses of the detected positive samples showed the presence of HPgV-1 genotypes 1, 2 and 3. The most frequently detected genotype was 2 (78.0% of the cases) represented by sub-genotypes 2A (39.0%) and 2B (39.0%). At lower rates, genotypes 1 (14.6%) and 3 (7.4%) were also detected. CONCLUSION Our results revealed the presence of genotypes with European, Asiatic and African endemicity in Amazonian blood donors, probably due to the complex miscegenation processes that took place in this Brazilian region. More investigations, including information for the prevalence of HPgV-1 RNA in blood donors from other Latin American countries are needed to estimate the viremic rates and genotype distribution of this virus in a highly diverse continent like South America.
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Affiliation(s)
- S N Slavov
- Regional Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, 14051-140 Ribeirão Preto, São Paulo, Brazil; Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, 14051-140 Ribeirão Preto, São Paulo, Brazil.
| | - R Maraninchi Silveira
- Regional Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, 14051-140 Ribeirão Preto, São Paulo, Brazil
| | - M R Hespanhol
- Regional Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, 14051-140 Ribeirão Preto, São Paulo, Brazil
| | - V Sauvage
- Institut national de la transfusion Sanguine (INTS), département d'études des Agents transmissibles par le sang (DATS), Centre national de référence risques infectieux transfusionnels, 75015 Paris, France
| | - E S Rodrigues
- Regional Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, 14051-140 Ribeirão Preto, São Paulo, Brazil
| | - L Fontanari Krause
- Laboratory of Biosciences, Franciscan University, 97010-030 Santa Maria, Rio Grande do Sul, Brazil
| | - H T Bittencourt
- Institute of Hematology and Hemotherapy of Amapá, 68900-074 Macapá, Amapá, Brazil
| | - V Caro
- Pole for Genotyping of Pathogens (PGP), Laboratory for Urgent Response to Biological Threats, Environment and Infectious Risks Research and Expertise Unit, Institut Pasteur, 75724 Paris, France
| | - S Laperche
- Institut national de la transfusion Sanguine (INTS), département d'études des Agents transmissibles par le sang (DATS), Centre national de référence risques infectieux transfusionnels, 75015 Paris, France
| | - D T Covas
- Regional Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, 14051-140 Ribeirão Preto, São Paulo, Brazil
| | - S Kashima
- Regional Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, 14051-140 Ribeirão Preto, São Paulo, Brazil
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8
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Davis C, Mgomella GS, da Silva Filipe A, Frost EH, Giroux G, Hughes J, Hogan C, Kaleebu P, Asiki G, McLauchlan J, Niebel M, Ocama P, Pomila C, Pybus OG, Pépin J, Simmonds P, Singer JB, Sreenu VB, Wekesa C, Young EH, Murphy DG, Sandhu M, Thomson EC. Highly Diverse Hepatitis C Strains Detected in Sub-Saharan Africa Have Unknown Susceptibility to Direct-Acting Antiviral Treatments. Hepatology 2019; 69:1426-1441. [PMID: 30387174 PMCID: PMC6492010 DOI: 10.1002/hep.30342] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/30/2018] [Indexed: 12/11/2022]
Abstract
The global plan to eradicate hepatitis C virus (HCV) led by the World Health Organization outlines the use of highly effective direct-acting antiviral drugs (DAAs) to achieve elimination by 2030. Identifying individuals with active disease and investigation of the breadth of diversity of the virus in sub-Saharan Africa (SSA) is essential as genotypes in this region (where very few clinical trials have been carried out) are distinct from those found in other parts of the world. We undertook a population-based, nested case-control study in Uganda and obtained additional samples from the Democratic Republic of Congo (DRC) to estimate the prevalence of HCV, assess strategies for disease detection using serological and molecular techniques, and characterize genetic diversity of the virus. Using next-generation and Sanger sequencing, we aimed to identify strains circulating in East and Central Africa. A total of 7,751 Ugandan patients were initially screened for HCV, and 20 PCR-positive samples were obtained for sequencing. Serological assays were found to vary significantly in specificity for HCV. HCV strains detected in Uganda included genotype (g) 4k, g4p, g4q, and g4s and a newly identified unassigned g7 HCV strain. Two additional unassigned g7 strains were identified in patients originating from DRC (one partial and one full open reading frame sequence). These g4 and g7 strains contain nonstructural (ns) protein 3 and 5A polymorphisms associated with resistance to DAAs in other genotypes. Clinical studies are therefore indicated to investigate treatment response in infected patients. Conclusion: Although HCV prevalence and genotypes have been well characterized in patients in well-resourced countries, clinical trials are urgently required in SSA, where highly diverse g4 and g7 strains circulate.
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Affiliation(s)
- Chris Davis
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | - George S. Mgomella
- Department of Medicine ‐ University of CambridgeCambridgeCambridgeshireUnited Kingdom
- Wellcome Sanger InstituteHinxtonCambridgeshireUnited Kingdom
| | - Ana da Silva Filipe
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | | | | | - Joseph Hughes
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | | | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research UnitEntebbeUganda
- Uganda Virus Research InstituteEntebbeUganda
| | | | - John McLauchlan
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | - Marc Niebel
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | - Ponsiano Ocama
- Department of MedicineMakerere University College of Health SciencesKampalaUganda
| | - Cristina Pomila
- Department of Medicine ‐ University of CambridgeCambridgeCambridgeshireUnited Kingdom
| | - Oliver G. Pybus
- Department of ZoologyUniversity of OxfordOxfordUnited Kingdom
| | | | - Peter Simmonds
- Peter Medawar Building for Pathogen ResearchUniversity of OxfordUnited Kingdom
| | - Joshua B. Singer
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | - Vattipally B. Sreenu
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | | | - Elizabeth H. Young
- Department of Medicine ‐ University of CambridgeCambridgeCambridgeshireUnited Kingdom
- Wellcome Sanger InstituteHinxtonCambridgeshireUnited Kingdom
| | - Donald G. Murphy
- National Institute of Public Health of Quebec, Laboratory of Public Health of QuebecSainte‐Anne‐de‐BellevueQuebecCanada
| | - Manj Sandhu
- Department of Medicine ‐ University of CambridgeCambridgeCambridgeshireUnited Kingdom
- Wellcome Sanger InstituteHinxtonCambridgeshireUnited Kingdom
| | - Emma C. Thomson
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
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9
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Sood A, Suryaprasad A, Trickey A, Kanchi S, Midha V, Foster MA, Bennett E, Kamili S, Alvarez-Bognar F, Shadaker S, Surlikar V, Garg R, Mittal P, Sharma S, May MT, Vickerman P, Averhoff F. The burden of hepatitis C virus infection in Punjab, India: A population-based serosurvey. PLoS One 2018; 13:e0200461. [PMID: 30048454 PMCID: PMC6061991 DOI: 10.1371/journal.pone.0200461] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/27/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction Hepatitis C virus (HCV) infection prevalence is believed to be elevated in Punjab, India; however, state-wide prevalence data are not available. An understanding of HCV prevalence, risk factors and genotype distribution can be used to plan control measures in Punjab. Methods A cross-sectional, state-wide, population-based serosurvey using a multi-stage stratified cluster sampling design was conducted October 2013 to April 2014. Children aged ≥5 years and adults were eligible to participate. Demographic and risk behavior data were collected, and serologic specimens were obtained and tested for anti-HCV antibody, HCV Ribonucleic acid (RNA) on anti-HCV positive samples, and HCV genotype. Prevalence estimates and adjusted odds ratios for risk factors were calculated from weighted data and stratified by urban/rural residence. Results 5,543 individuals participated in the study with an overall weighted anti-HCV prevalence of 3.6% (95% Confidence Interval [CI]: 3.0%–4.2%) and chronic infection (HCV Ribonucleic acid test positive) of 2.6% (95% CI: 2.0%–3.1%). Anti-HCV was associated with being male (adjusted odds ratio 1.52; 95% CI: 1.08–2.14), living in a rural area (adjusted odds ratio 2.53; 95% CI: 1.62–3.95) and was most strongly associated with those aged 40–49 (adjusted odds ratio 40–49 vs. 19–29-year-olds 3.41; 95% CI: 1.90–6.11). Anti-HCV prevalence increased with each blood transfusion received (adjusted odds ratio 1.36; 95% CI: 1.10–1.68) and decreased with increasing education, (adjusted odds ratio 0.37 for graduate-level vs. primary school/no education; 95% CI: 0.16–0.82). Genotype 3 (58%) was most common among infected individuals. Discussion The study findings, including the overall prevalence of chronic HCV infection, associated risk factors and demographic characteristics, and genotype distribution can guide prevention and control efforts, including treatment provision. In addition to high-risk populations, efforts targeting rural areas and adults aged ≥40 would be the most effective for identifying infected individuals.
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Affiliation(s)
- Ajit Sood
- Dayanand Medical College, Ludhiana, Punjab, India
| | - A. Suryaprasad
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - A. Trickey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | | | - V. Midha
- Dayanand Medical College, Ludhiana, Punjab, India
| | - M. A. Foster
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - E. Bennett
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - S. Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - S. Shadaker
- CDC Foundation, Atlanta, GA, United States of America
| | | | - R. Garg
- Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - P. Mittal
- Mittal Liver and Gastroenterology Centre, Patiala, Punjab, India
| | - S. Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - M. T. May
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - P. Vickerman
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - F. Averhoff
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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10
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Low prevalence of HCV infection with predominance of genotype 4 among HIV patients living in Libreville, Gabon. PLoS One 2018; 13:e0190529. [PMID: 29385148 PMCID: PMC5791959 DOI: 10.1371/journal.pone.0190529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 12/15/2017] [Indexed: 11/24/2022] Open
Abstract
Background Gabon is an endemic area for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) and the risk of co-infection is high. Method Between November 2015 and April 2016, we conducted retrospective study on HCV infection among people living with HIV/AIDS (PLHA). A total of 491 PLHA were included in this study and tested for the presence of HCV infection. HIV viral loads were obtained using the Generic HIV viral Load® assay and the CD4+ T cells count was performed using BD FACSCount™ CD4 reagents. HCV screening was performed using the MP Diagnostics HCV ELISA 4.0 kit. HCV genotypes were determined by sequence analysis of NS5B and Core regions. The Mann-Whitney test was used to compare the groups. Chi-2 test and Fisher's Exact Test were used to compare prevalence. Results HCV seroprevalence was 2.9% (14/491), (95% confidence interval (CI):1.4–4.3%). The percentage of HCV viremic patients, defined by the detection of HCV RNA in plasma, was 57% (8/14), representing 1.6% of the total population. HCV seroprevalence and replicative infection were not statistically differ with gender. The percentage of co-infection increased with age. No correlation with CD4+ T cells count and HIV viral load level was registered in this study. Identified HCV strains were predominantly of genotype 4 (87.5%) including 4k, 4e, 4g, 4p, 4f and 4c subtypes. Only one strain belonged to genotype 2 (subtype 2q). Analysis of the NS5B region did not reveal the presence of resistance-associated substitutions for sofosbuvir. Conclusion A systematic screening of hepatitis C is therefore strongly recommended as well as genotyping of HCV strains in order to adapt treatments for the specific case of people living with HIV/AIDS in Central Africa.
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11
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Ghoma Linguissi LS, Nkenfou CN. Epidemiology of viral hepatitis in the Republic of Congo: review. BMC Res Notes 2017; 10:665. [PMID: 29197421 PMCID: PMC5712139 DOI: 10.1186/s13104-017-2951-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/21/2017] [Indexed: 02/06/2023] Open
Abstract
Objective Considered an endemic zone, Republic of Congo has a high seroprevalence rate of hepatitis B and C virus. To know the extent of hepatitis infection as a public health problem, we reviewed published literature and other sources for reports of these viral infections in the country. Results High seroprevalence of HBV and HCV carriage in blood donors were observed in studies confirming Congo’s place in the hyperendemic area of HBV and HCV infection. These prevalence were compared by Chi square test. We compared the prevalence of three studies conducted in 1996, 2015 and 2016. The statistical results were very significant. HBV genotype E was most prevalent. Very few studies were done on pregnant women. Difficulties in the care and management of patients were also noted because of the high cost of often unavailable treatments. Difficulties arise, however, when an attempt was made to implement the National Hepatitis Control Program. Despite studies conducted on hepatitis prevalence, health interventions are still needed to care and manage these patients and the need to implement the national hepatitis control is more pressing in the Congo.
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Affiliation(s)
| | - Celine Nguefeu Nkenfou
- Chantal Biya International Reference Centre for Research on Prevention and Management on HIV and AIDS, Yaounde, Cameroon.,Higher Teachers Training College, University of Yaounde I, Yaounde, Cameroon
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12
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Singh S, Blackard JT. Human pegivirus (HPgV) infection in sub-Saharan Africa-A call for a renewed research agenda. Rev Med Virol 2017; 27. [PMID: 29148108 DOI: 10.1002/rmv.1951] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 08/26/2017] [Accepted: 08/28/2017] [Indexed: 12/14/2022]
Abstract
The human pegivirus (HPgV)-formerly GB virus C-has a beneficial impact on HIV disease progression that has been described in multiple studies. Given the high prevalence of HIV in sub-Saharan Africa and the continuing need to suppress HIV replication, this review provides a comprehensive overview of the existing data on HPgV infection in sub-Saharan Africa, with a particular focus on studies of prevalence and the circulating HPgV genotypes. This review also highlights the need for additional studies of HPgV conducted on the African continent and proposes a research agenda for evaluation of HPgV.
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Affiliation(s)
- Shivank Singh
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jason T Blackard
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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13
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Ishizaki A, Bouscaillou J, Luhmann N, Liu S, Chua R, Walsh N, Hess S, Ivanova E, Roberts T, Easterbrook P. Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries. BMC Infect Dis 2017; 17:696. [PMID: 29143609 PMCID: PMC5688462 DOI: 10.1186/s12879-017-2767-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background There have been few reports on programmatic experience of viral hepatitis testing and treatment in resource-limited settings. To inform the development of the 2017 World Health Organization (WHO) viral hepatitis testing guidance and in particular the feasibility of proposed recommendations, we undertook a survey across a range of organisations engaged with hepatitis testing in low- and middle-income countries (LMICs). Our objective was to describe current hepatitis B and C testing practices across a range of settings in different countries, as well as key barriers or challenges encountered and proposed solutions to promote testing scale-up. Methods Hepatitis testing programmes in predominantly LMICs were identified from the WHO Global Hepatitis Programme contacts database and through WHO regional offices, and invited to participate. The survey comprised a six-part structured questionnaire: general programme information, description of hepatitis testing, treatment and care services, budget and funding, data on programme outcomes, and perceptions on key barriers encountered and strategies to address these. Results We interviewed 22 viral hepatitis testing programmes from 19 different countries. Nine were from the African region; 6 from the Western Pacific; 4 from South-East Asia; and 3 from Eastern Europe. All but four of the programmes were based in LMICs, and 10 (45.5%) were supported by non-governmental or international organizations. All but two programmes undertook targeted testing of specific affected populations such as people living with HIV, people who inject drugs, sex workers, health care workers, and pregnant women. Only two programmes focussed on routine testing in the general population. The majority of programmes were testing in hospital-based or other health facilities, particularly HIV clinics, and community-based testing was limited. Nucleic acid testing (NAT) for confirmation of HCV and HBV viraemia was available in only 30% and 18% of programmes, respectively. Around a third of programmes required some patient co-payment for diagnosis. The most commonly identified challenges in scale-up of hepatitis testing were: limited community awareness about viral hepatitis; lack of facilities or services for hepatitis testing; no access to low cost treatment, particularly for HCV; absence of national guidance and policies; no dedicated budget for hepatitis; and lack of trained health care and laboratory workers. Conclusions At this early stage in the global scale-up of testing for viral hepatitis, there is a wide variation in testing practices and approaches across different programmes. There remains limited access to NAT to confirm viraemia, and patient self-payment for testing and treatment is common. There was consensus from implementing organizations that scale-up of testing will require increased community awareness, health care worker training, development of national strategies and guidelines, and improved access to low cost NAT virological testing. Electronic supplementary material The online version of this article (10.1186/s12879-017-2767-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Azumi Ishizaki
- Global Hepatitis Programme, World Health Organization, 20 Avenue Appia, 1211, 27, Geneva, Switzerland
| | | | - Niklas Luhmann
- Médecins du Monde, 62 rue Marcadet, 75018, Paris, France
| | - Stephanie Liu
- World Health Organization, Regional Office of the Western Pacific, United Nations Avenue, 1000, Manila, Philippines
| | - Raissa Chua
- World Health Organization, Regional Office of the Western Pacific, United Nations Avenue, 1000, Manila, Philippines
| | - Nick Walsh
- World Health Organization, Regional Office of the Western Pacific, United Nations Avenue, 1000, Manila, Philippines
| | - Sarah Hess
- Global Hepatitis Programme, World Health Organization, 20 Avenue Appia, 1211, 27, Geneva, Switzerland
| | - Elena Ivanova
- Foundation for Innovative New Diagnostics, Campus Biotech, Building B2, Level 0, 9 Chemin des Mines, 1202, Geneva, Switzerland
| | - Teri Roberts
- Foundation for Innovative New Diagnostics, Campus Biotech, Building B2, Level 0, 9 Chemin des Mines, 1202, Geneva, Switzerland
| | - Philippa Easterbrook
- Global Hepatitis Programme, World Health Organization, 20 Avenue Appia, 1211, 27, Geneva, Switzerland.
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14
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Mazigo HD, Kepha S, Kaatano GM, Kinung'hi SM. Co-infection of Schistosoma mansoni/hepatitis C virus and their associated factors among adult individuals living in fishing villages, north-western Tanzania. BMC Infect Dis 2017; 17:668. [PMID: 29017483 PMCID: PMC5635496 DOI: 10.1186/s12879-017-2780-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/29/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Schistosoma mansoni and Hepatitis C virus (HCV) are co-existence in sub-Saharan Africa and co-infection is common among humans population. The immunological responses characterized with Th2-immune responses for S. mansoni and Th1-immune responses for HCV are responsible for development hepatic morbidities in infected individuals. However, the co-occurrences of S. mansoni and HCV infection, their related ultrasound detectable morbidities and associated risk factors at community levels have not been examined in fishing communities, north-western Tanzania. In this context, the present study covers that gap. METHODS A cross-sectional study was conducted among 1924 asymptomatic individuals aged 15-55 years in four fishing villages (Igombe, Igalagala, Sangabuye and Kayenze) of Northwestern Tanzania. A single stool sample was collected from each study participants and examined for S. mansoni eggs using Kato Katz technique. Hepatitis C surface antigen (HCVsAg) was determined from a finger prick blood sample using a rapid test. RESULTS Overall, 51.8% (997/1924; 95%CI: 49.6-54.1) of the study participants were infected with S. mansoni and had a mean intensity of 223.7epg (95%; 202.4-247.1). Of the study participants, 90 (4.7%) were infected with hepatitis C virus (HCV). Overall, 2. 4% (47/1924) of the study participants were co-infected with S. mansoni and hepatitis C virus. Among the co-infected individuals, 42.6%, 70.2% and 19.1% had splenomegaly, hepatomegaly and periportal fibrosis (PPF). Factors associated with S. mansoni/HCV co-infection were being aged 26-35 years (aRR = 2.67, 95%CI: 1.03-6.93, P < 0.04), 46-55 years (aRR = 2.89, 95%CI: 1.10-7.57, P < 0.03) and having marked hepatomegaly (aRR = 2.32, 95%CI: 1.09-4.9, P < 0.03). CONCLUSION In this setting, S. mansoni and Hepatitis C are co-endemic and a proportion of individuals were co-infected. Hepatosplenic morbidities characterized with hepatomegaly, splenomegaly, hepatosplenomegaly and PPF were observed in co-infected individuals. These results highlight the need for integrated interventions measures against parasitic and viral diseases.
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Affiliation(s)
- Humphrey D Mazigo
- Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
| | | | - Godfrey M Kaatano
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Safari M Kinung'hi
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
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15
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N'Guessan KF, Anderson M, Phinius B, Moyo S, Malick A, Mbangiwa T, Choga WT, Makhema J, Marlink R, Essex M, Musonda R, Gaseitsiwe S, Blackard JT. The Impact of Human Pegivirus on CD4 Cell Count in HIV-Positive Persons in Botswana. Open Forum Infect Dis 2017; 4:ofx222. [PMID: 29255726 PMCID: PMC5726461 DOI: 10.1093/ofid/ofx222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/05/2017] [Indexed: 02/02/2023] Open
Abstract
Background Human pegiviruses (HPgV)-formerly known as hepatitis G virus or GB virus C (GBV-C)-are common single-stranded RNA viruses that may have a beneficial impact on slowing HIV disease progression. The data on HPgV in resource-limited regions such as Sub-Saharan Africa are scarce. Thus, we conducted the first study of HPgV in Botswana as part of a natural history study of HIV subtype C disease progression. Methods Plasma samples from 133 HIV-positive adults were evaluated for HPgV RNA, and the 5'UTR was sequenced to determine the HPgV genotype. Results HPgV RNA was detected in 41 (30.8%) individuals. While the presence of HPgV RNA had no impact on baseline HIV viral load, a significant difference in baseline CD4 cell count was observed. HPgV genotypes were determined for 27 individuals and included 5 individuals (18.5%) with genotype 1 and 22 (81.5%) with genotype 5. Baseline CD4 cell counts were significantly higher for persons infected with HPgV genotype 5 compared with genotype 1. Conclusions These data suggest that HPgV infection is common among HIV-positive individuals in Botswana and has a significant impact on CD4 cell count. This difference in CD4 cell count based on HPgV genotype suggests that HPgV genotype should be evaluated as a possible predictor of HIV disease progression and highlights the need for additional studies of this virus in resource-limited settings.
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Affiliation(s)
| | - Motswedi Anderson
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Biological Sciences, Gaborone, Botswana
| | - Bonolo Phinius
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Alyyah Malick
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard College, Cambridge, Massachusetts
| | - Tshepiso Mbangiwa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,School of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | | | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Richard Marlink
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Max Essex
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Rosemary Musonda
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Gürtler LG, Eberle J. Aspects on the history of transmission and favor of distribution of viruses by iatrogenic action: perhaps an example of a paradigm of the worldwide spread of HIV. Med Microbiol Immunol 2017; 206:287-293. [PMID: 28434128 PMCID: PMC5511299 DOI: 10.1007/s00430-017-0505-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/13/2017] [Indexed: 02/07/2023]
Abstract
Transmission of infectious agents might be associated with iatrogenic actions of charitable help in health care. An example is the vaccination against yellow fever in USA that transmitted hepatitis B virus. Another example is injections of praziquantel for treatment and cure of schistosomiasis in Central and Northern Africa, with a focus in Egypt that has spread hepatitis C virus. There is no indication that human T-lymphotropic virus type 1 was spread by injection treatment for African trypanosomiasis, syphilis and treponematosis, but these treatments might have contributed to the early spread of human immunodeficiency virus type 1 (HIV-1) in Central Africa. Slave trade contributed as well to the spread of viruses from Africa to the Americas; it was stopped in 1850. Until that date HIV-1 was not transported to the Americas. By analysis of nucleic acid sequence data it can be concluded that the continental spread of HCV and HIV-1 might have started around 1920 with an exponential phase from 1940 to 1970. Further iatrogenic actions that promoted the spread of HCV and HIV-1 might be vaccinations to prevent deadly diseases. The successful vaccination was followed by diminution of the infectious agent in the population such as small pox, yellow fever and measles. Measurements to reduce the spread of plague and cholera were further benefits increasing survival of diseased subjects in a population. Thus, the reduction of exposure to deadly infectious agents might have given a chance to HIV-1 infected subjects to survive and for HIV-1 to be distributed around the world starting from Central Africa in the 1950s.
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Affiliation(s)
- Lutz G. Gürtler
- Max von Pettenkofer Institute, National Reference Centre for Retroviruses, Ludwig-Maximilians-University of München, Pettenkofer Str 9A, 80336 Munich, Germany
| | - Josef Eberle
- Max von Pettenkofer Institute, National Reference Centre for Retroviruses, Ludwig-Maximilians-University of München, Pettenkofer Str 9A, 80336 Munich, Germany
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17
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Bonsall D, Gregory WF, Ip CLC, Donfield S, Iles J, Ansari MA, Piazza P, Trebes A, Brown A, Frater J, Pybus OG, Goulder P, Klenerman P, Bowden R, Gomperts ED, Barnes E, Kapoor A, Sharp CP, Simmonds P. Evaluation of Viremia Frequencies of a Novel Human Pegivirus by Using Bioinformatic Screening and PCR. Emerg Infect Dis 2016; 22:671-8. [PMID: 26982117 PMCID: PMC4806942 DOI: 10.3201/eid2204.151812] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Bioinformatic screening and PCR-based approaches detected active infection with human hepegivirus-1 in exposed populations. Next-generation sequencing has critical applications in virus discovery, diagnostics, and environmental surveillance. We used metagenomic sequence libraries for retrospective screening of plasma samples for the recently discovered human hepegivirus 1 (HHpgV-1). From a cohort of 150 hepatitis C virus (HCV)–positive case-patients, we identified 2 persons with HHpgV-1 viremia and a high frequency of human pegivirus (HPgV) viremia (14%). Detection of HHpgV-1 and HPgV was concordant with parallel PCR-based screening using conserved primers matching groups 1 (HPgV) and 2 (HHPgV-1) nonstructural 3 region sequences. PCR identified 1 HHPgV-1–positive person with viremia from a group of 195 persons with hemophilia who had been exposed to nonvirally inactivated factor VII/IX; 18 (9%) were HPgV-positive. Relative to HCV and HPgV, active infections with HHpgV-1 were infrequently detected in blood, even in groups that had substantial parenteral exposure. Our findings are consistent with lower transmissibility or higher rates of virus clearance for HHpgV-1 than for other bloodborne human flaviviruses.
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Salmona M, Caporossi A, Simmonds P, Thélu MA, Fusillier K, Mercier-Delarue S, De Castro N, LeGoff J, Chaix ML, François O, Simon F, Morand P, Larrat S, Maylin S. First next-generation sequencing full-genome characterization of a hepatitis C virus genotype 7 divergent subtype. Clin Microbiol Infect 2016; 22:947.e1-947.e8. [PMID: 27515394 DOI: 10.1016/j.cmi.2016.07.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 02/06/2023]
Abstract
We report the near-full-length genome sequence of a hepatitis C virus (HCV) isolate from a man originating from Democratic Republic of Congo, the genotype of which could not be determined by the routinely used sequencing technique. The near-complete genome sequence of this variant BAK1 was obtained by the association of two next-generation sequencing technologies. Evolutionary analysis indicates that this isolate, BAK1, could be the first reported strain belonging to a new HCV-7b subtype. This new subtype has been incorrectly identified as genotype 2 by the Versant HCV Genotype 2.0 assay (LiPA). The requirement of three independent isolates has been filled, and a new subtype can be assigned. More examples of HCV-7 are required to better understand its origin, its pathogenicity and its relationship with genotype 2.
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Affiliation(s)
- M Salmona
- Université Paris Diderot, Pres Sorbone Paris Cité, Microbiology Laboratory, Hôpital Universitaire Saint-Louis, France
| | - A Caporossi
- Clinical Investigation Center, Public Health, UJF-CNRS, Centre Hospitalier Universitaire de Grenoble-Alpes, France; TIMC-IMAG Laboratory, Université de Grenoble Alpes, UMR 5525, Saint-Martin-d'Hères, France
| | - P Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - M-A Thélu
- Hepato-Gastroenterology Department, Centre Hospitalier Universitaire de Grenoble-Alpes, France
| | - K Fusillier
- Virology Laboratory, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire de Grenoble-Alpes, France
| | - S Mercier-Delarue
- Université Paris Diderot, Pres Sorbone Paris Cité, Microbiology Laboratory, Hôpital Universitaire Saint-Louis, France
| | - N De Castro
- Infectious Diseases Department, Hôpital Saint-Louis, Paris, France
| | - J LeGoff
- Université Paris Diderot, Pres Sorbone Paris Cité, Microbiology Laboratory, Hôpital Universitaire Saint-Louis, France
| | - M-L Chaix
- Université Paris Diderot, Pres Sorbone Paris Cité, Microbiology Laboratory, Hôpital Universitaire Saint-Louis, France
| | - O François
- TIMC-IMAG Laboratory, Université de Grenoble Alpes, UMR 5525, Saint-Martin-d'Hères, France
| | - F Simon
- Université Paris Diderot, Pres Sorbone Paris Cité, Microbiology Laboratory, Hôpital Universitaire Saint-Louis, France
| | - P Morand
- Virology Laboratory, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire de Grenoble-Alpes, France; IBS, UMR 5075 CEA-CNRS-UGA, Grenoble, France
| | - S Larrat
- Virology Laboratory, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire de Grenoble-Alpes, France; IBS, UMR 5075 CEA-CNRS-UGA, Grenoble, France
| | - S Maylin
- Université Paris Diderot, Pres Sorbone Paris Cité, Microbiology Laboratory, Hôpital Universitaire Saint-Louis, France.
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19
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Muzembo BA, Akita T, Matsuoka T, Tanaka J. Systematic review and meta-analysis of hepatitis C virus infection in the Democratic Republic of Congo. Public Health 2016; 139:13-21. [PMID: 27450441 DOI: 10.1016/j.puhe.2016.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/25/2016] [Accepted: 06/16/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Hepatitis C virus (HCV) infection is endemic in the Democratic Republic of the Congo (DRC), where the prevalence of HCV antibodies (anti-HCV) is reported to range from 0.2% to 13.7%. However, the reported prevalence rates have been inconsistent. Therefore, a meta-analysis of observational studies was conducted to provide updates on the prevalence of HCV infection in the DRC. STUDY DESIGN Systematic review and meta-analysis. METHODS Medline, EMBASE and Google Scholar were searched for publications reporting on HCV infection in the DRC up to autumn 2015. In addition, a manual search was undertaken to detect relevant papers. Studies performed in groups at low risk of HCV (blood donors and pregnant women) were used for the meta-analysis. The random effects model was used to estimate the pooled prevalence of anti-HCV. RESULTS Sixteen studies with 13,799 participants (aged 6 months-71 years) met the inclusion criteria. The studies were performed in blood donors, pregnant women, military personnel, individuals with human immunodeficiency virus, children, commercial sex workers, Congolese patients living in Canada, patients with sickle cell disease and hospitalized patients. The reviewed studies revealed the presence of anti-HCV in almost all studied age groups and did not differ between sexes. The pooled prevalence of anti-HCV was 2.9% [95% confidence interval 1.5-4.3%]. Subgroup analyses revealed that the prevalence rates of anti-HCV in blood donors and pregnant women were 2.7% (95% confidence interval: 1.1-4.4%) and 3.3% (1.4-5.1%), respectively. CONCLUSIONS HCV infection remains an issue of public concern in the DRC, demonstrating a need for adequate hepatitis control programmes. Efforts must be made to virtually eliminate transfusion-transmitted HCV throughout the country.
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Affiliation(s)
- B A Muzembo
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - T Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - T Matsuoka
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - J Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
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20
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Riou J, Aït Ahmed M, Blake A, Vozlinsky S, Brichler S, Eholié S, Boëlle PY, Fontanet A. Hepatitis C virus seroprevalence in adults in Africa: a systematic review and meta-analysis. J Viral Hepat 2016; 23:244-55. [PMID: 26477881 DOI: 10.1111/jvh.12481] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/27/2015] [Indexed: 12/13/2022]
Abstract
With the introduction of more efficient treatments for hepatitis C virus (HCV), improved epidemiological information is required at the country level to allow evidence-based policymaking for elaboration of national strategies and HCV resources planning. We present a systematic review with meta-analysis of HCV seroprevalence data in adults in African countries. We conducted a systematic review of all HCV seroprevalence estimates reported in African countries from 2000 to 2014 in MEDLINE, AJOL and grey literature. We assessed studies performed in the general population and among blood donors, pregnant women and HIV-positive patients. A meta-regression analysis was used to provide adjusted estimates of HCV seroprevalence in the general adult population in each country, accounting for the heterogeneity in sample age structure and population types in the included studies. We identified 775 national-level estimations, among which 184 were included. Estimates of HCV seroprevalence were produced for 38 countries, in addition to the results from nationwide representative surveys available in Egypt and Libya. Next to Egypt, which clearly stands out, the highest levels of seroprevalence were found in Middle Africa (e.g. Cameroon, Gabon and Angola) and some West African countries (e.g. Burkina Faso, Benin), and the largest absolute numbers of infected adults were found in Nigeria, Ethiopia and Democratic Republic of Congo. This study exposes the diversity of HCV epidemiology among African countries. Egypt and several countries of West and Middle Africa present a HCV burden that will require strong governmental commitment to promote efficient preventive and curative interventions.
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Affiliation(s)
- J Riou
- Institut Pasteur, Unité d'Epidémiologie des Maladies Emergentes, Paris, France
| | - M Aït Ahmed
- Institut Pasteur, Unité d'Epidémiologie des Maladies Emergentes, Paris, France
| | - A Blake
- Institut Pasteur, Unité d'Epidémiologie des Maladies Emergentes, Paris, France
| | - S Vozlinsky
- Institut Pasteur, Unité d'Epidémiologie des Maladies Emergentes, Paris, France
| | - S Brichler
- Service de Bactériologie, Virologie, Hygiène, laboratoire associé au Centre National de Référence des Hépatites B, C et Delta, Assitance Publique-Hôpitaux de Paris, Université, Sorbonne Paris Cité, Hôpital Avicenne, Bobigny, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - S Eholié
- Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - P-Y Boëlle
- Sorbonne Universités, Université Pierre et Marie Curie, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - A Fontanet
- Institut Pasteur, Unité d'Epidémiologie des Maladies Emergentes, Paris, France.,Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France
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21
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Mueller A, Stoetter L, Kalluvya S, Stich A, Majinge C, Weissbrich B, Kasang C. Prevalence of hepatitis B virus infection among health care workers in a tertiary hospital in Tanzania. BMC Infect Dis 2015; 15:386. [PMID: 26399765 PMCID: PMC4581415 DOI: 10.1186/s12879-015-1129-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 09/18/2015] [Indexed: 02/06/2023] Open
Abstract
Background Sub-Saharan Africa has a high prevalence of hepatitis B virus (HBV) infections. Health care workers (HCWs) are at high risk of contracting HBV infection through their occupation. Vaccination of HCWs against HBV is standard practice in many countries, but is often not implemented in resource-poor settings. We aimed with this cross-sectional study to determine HBV prevalence, HCW vaccination status, and the risk factors for HCWs contracting HBV infection in Tanzania. Methods We enrolled 600 HCWs from a tertiary Tanzanian hospital. Their demographics, medical histories, HBV vaccination details and risk factors for contracting blood-borne infections were collected using a standardized questionnaire. Serum samples were tested for HBV and hepatitis C virus (HCV) markers by ELISA techniques, PCR and an anti-HBs rapid test. HCWs were divided in two subgroups: those at risk of contracting HBV (rHCW 79.2 %) via exposure to potentially infectious materials, and those considered not at risk of contracting HBV (nrHCW, 20.8 %). Results The overall prevalence of chronic HBV infection (HBsAg+, anti-HBc+, anti-HBs-) was 7.0 % (42/598). Chronic HBV infection was found in 7.4 % of rHCW versus 5.6 % of nrHCW (p-value = 0.484). HCWs susceptible to HBV (HBsAg-, anti-HBc-, anti-HBs-) comprised 31.3 %. HBV immunity achieved either by healed HBV infection (HBsAg-, anti-HBc+, anti-HBs+) or by vaccination (HBsAg-, anti-HBc-, anti-HBs+) comprised 36.5 % and 20.2 %, respectively. 4.8 % of participants had indeterminate results (HBsAg-, anti-HBc+, anti-HBc-IgM-, anti-HBs-). Only 77.1 % of HCWs who received a full vaccination course had an anti-HBs titer >10 ml/U. An anti-HBs point-of-care test was 80.7 % sensitive and 96.9 % specific. There was a significantly higher risk for contracting HBV (anti-HBc+) among those HCW at occupational risk (rHCW) of older age (odds ratios (OR) in rHCW 3.297, p < 0.0001 vs. nrHCW 1.385, p = 0.606) and among those HCW being employed more than 11 years (OR 2.51, p < 0.0001***). HCV prevalence was low (HCV antibodies 1.2 % and HCV-RNA 0.3 %). Conclusions Chronic HBV infection is common among Tanzanian HCWs. One third of HCWs were susceptible to HBV infection, highlighting the need for vaccination. Due to high prevalence of naturally acquired immunity against HBV pre-testing might be a useful tool to identify susceptible individuals.
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Affiliation(s)
- A Mueller
- Department of Tropical Medicine, Medical Mission Hospital, Salvatorstrasse 7, 97074, Wuerzburg, Germany.
| | - L Stoetter
- Department of Tropical Medicine, Medical Mission Hospital, Salvatorstrasse 7, 97074, Wuerzburg, Germany.
| | - S Kalluvya
- Bugando Medical Centre, P.O. Box 1370, Mwanza, United Republic of Tanzania. .,CUHAS, P.O. Box 1370, Mwanza, United Republic of Tanzania.
| | - A Stich
- Department of Tropical Medicine, Medical Mission Hospital, Salvatorstrasse 7, 97074, Wuerzburg, Germany.
| | - C Majinge
- Bugando Medical Centre, P.O. Box 1370, Mwanza, United Republic of Tanzania.
| | - B Weissbrich
- Institute of Virology and Immunobiology, University of Wuerzburg, Versbacher Strasse 7, 97078, Wuerzburg, Germany.
| | - C Kasang
- Medical Mission Institute, Salvatorstrasse 7, 97067, Wuerzburg, Germany.
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22
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Graham CS, Swan T. A path to eradication of hepatitis C in low- and middle-income countries. Antiviral Res 2015; 119:89-96. [PMID: 25615583 DOI: 10.1016/j.antiviral.2015.01.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 12/11/2022]
Abstract
We are entering a new era in the treatment of hepatitis C virus (HCV) infection and almost all patient groups in high-income countries have the potential to be cured with all-oral, highly potent combinations of direct-acting antiviral drugs. Soon the main barrier to curing hepatitis C, even in wealthy countries, will be the high price of these all-oral regimens. The gulf between the advances in HCV drug development and access to treatment for individual patients will be even greater in low- and middle-income countries (LMIC) where 80% of the global burden of HCV infection and mortality exists. Ensuring that people in LMIC have access to regimens against HCV will require a similar level of advocacy and public-private partnerships as has transformed the control of other global diseases such as HIV. Numerous challenges will need to be overcome. These include improving low-cost diagnostic tests, especially in sub-Saharan Africa where the false-positive rate is unacceptably high, reducing iatrogenic spread of HCV, addressing transmission among people who inject drugs (PWID), and ensuring affordable access to antiviral treatment for all people living with HCV infection in LMIC. This article forms part of a symposium in Antiviral Research on "Hepatitis C: next steps toward global eradication."
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Affiliation(s)
- Camilla S Graham
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Tracy Swan
- Treatment Action Group, New York, NY, United States
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23
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Layden JE, Phillips RO, Owusu-Ofori S, Sarfo FS, Kliethermes S, Mora N, Owusu D, Nelson K, Opare-Sem O, Dugas L, Luke A, Shoham D, Forbi JC, Khudyakov YE, Cooper RS. High Frequency of Active HCV Infection Among Seropositive Cases in West Africa and Evidence for Multiple Transmission Pathways. Clin Infect Dis 2014; 60:1033-41. [DOI: 10.1093/cid/ciu965] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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24
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Faria NR, Rambaut A, Suchard MA, Baele G, Bedford T, Ward MJ, Tatem AJ, Sousa JD, Arinaminpathy N, Pépin J, Posada D, Peeters M, Pybus OG, Lemey P. HIV epidemiology. The early spread and epidemic ignition of HIV-1 in human populations. Science 2014; 346:56-61. [PMID: 25278604 PMCID: PMC4254776 DOI: 10.1126/science.1256739] [Citation(s) in RCA: 362] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Thirty years after the discovery of HIV-1, the early transmission, dissemination, and establishment of the virus in human populations remain unclear. Using statistical approaches applied to HIV-1 sequence data from central Africa, we show that from the 1920s Kinshasa (in what is now the Democratic Republic of Congo) was the focus of early transmission and the source of pre-1960 pandemic viruses elsewhere. Location and dating estimates were validated using the earliest HIV-1 archival sample, also from Kinshasa. The epidemic histories of HIV-1 group M and nonpandemic group O were similar until ~1960, after which group M underwent an epidemiological transition and outpaced regional population growth. Our results reconstruct the early dynamics of HIV-1 and emphasize the role of social changes and transport networks in the establishment of this virus in human populations.
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Affiliation(s)
- Nuno R Faria
- Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, UK. KU Leuven - University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Minderbroedersstraat 10, B-3000 Leuven, Belgium
| | - Andrew Rambaut
- Institute of Evolutionary Biology, University of Edinburgh, Ashworth Laboratories, Kings Buildings, West Mains Road, Edinburgh EH9 3JT, UK. Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA. Centre for Immunity, Infection and Evolution, University of Edinburgh, Kings Buildings, West Mains Road, Edinburgh EH9 3JT, UK
| | - Marc A Suchard
- Departments of Biomathematics and Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA 90095-1766, USA. Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, CA 90095-1766, USA
| | - Guy Baele
- KU Leuven - University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Minderbroedersstraat 10, B-3000 Leuven, Belgium
| | - Trevor Bedford
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Melissa J Ward
- Institute of Evolutionary Biology, University of Edinburgh, Ashworth Laboratories, Kings Buildings, West Mains Road, Edinburgh EH9 3JT, UK
| | - Andrew J Tatem
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA. Department of Geography and Environment, University of Southampton, Highfield, Southampton, UK
| | - João D Sousa
- KU Leuven - University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Minderbroedersstraat 10, B-3000 Leuven, Belgium. Centro de Malária e outras Doenças Tropicais and Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | | | - Jacques Pépin
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, CHUS, 3001, 12ème Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - David Posada
- Department of Biochemistry, Genetics and Immunology, University of Vigo, Vigo 36310, Spain
| | - Martine Peeters
- Laboratoire Retrovirus, UMI233, Institut de Recherche pour le Développement and University of Montpellier, 911 Avenue Agropolis, BP5045, 34032 Montpellier, France
| | - Oliver G Pybus
- Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, UK.
| | - Philippe Lemey
- KU Leuven - University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Minderbroedersstraat 10, B-3000 Leuven, Belgium.
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25
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Identification of Indian sub-continent as hotspot for HCV genotype 3a origin by Bayesian evolutionary reconstruction. INFECTION GENETICS AND EVOLUTION 2014; 28:87-94. [PMID: 25224661 DOI: 10.1016/j.meegid.2014.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 09/04/2014] [Accepted: 09/06/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recent emphasis in Hepatitis C virus (HCV) evolutionary biology has focused on analysis using Core, E1/E2 and/or NS5b regions, with limited appreciation of full length genome. While HCV genotypes have been described as endemic in the Indian subcontinent, there has been no confirmation at the molecular evolutionary level of these genotypes. We have attempted here to determine the status of Indian HCV genotype 3a sequences in relation to similar genotypes from other parts of the world. METHODS Cloning, sequencing and molecular characterization was performed on 9 Indian sequences and comparative analyses were performed with 46 sequences from other countries. Evolutionary-rate and molecular-clock hypothesis testing was addressed by Bayesian MCMC. RESULTS Genetic analysis of full length genome revealed two hypervariable regions (HVR) in E2 region - HVR496 and HVR576, with a variable 5-8 amino-acid insertion sequence and a putative N-glycosylation site. Phylogenetic analysis revealed a divergence resulting in 2 distinct clades: clade-1 represented by HCV 3a subtype and clade-2 represented by other 3 subtype genomes. Clade-2 shows earlier divergence than clade-1. Analysis revealed that genotype 3a genomes from India roots out first (∼99 years ago) in clade1. Bayesian skyline plot analysis revealed an increase in effective number of infections from 1940s to 1990s, followed by a gradual decrease after 2000. CONCLUSIONS Genotype 3a sequences appear to have originated in India and later dispersed to United Kingdom around mid 1940s, most likely around the time of Indian independence and World War II.
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26
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Iles JC, Raghwani J, Harrison GLA, Pepin J, Djoko CF, Tamoufe U, LeBreton M, Schneider BS, Fair JN, Tshala FM, Kayembe PK, Muyembe JJ, Edidi-Basepeo S, Wolfe ND, Simmonds P, Klenerman P, Pybus OG. Phylogeography and epidemic history of hepatitis C virus genotype 4 in Africa. Virology 2014; 464-465:233-243. [PMID: 25105489 PMCID: PMC4162651 DOI: 10.1016/j.virol.2014.07.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/04/2014] [Accepted: 07/05/2014] [Indexed: 12/18/2022]
Abstract
HCV genotype 4 is prevalent in many African countries, yet little is known about the genotype׳s epidemic history on the continent. We present a comprehensive study of the molecular epidemiology of genotype 4. To address the deficit of data from the Democratic Republic of the Congo (DRC) we PCR amplified 60 new HCV isolates from the DRC, resulting in 33 core- and 48 NS5B-region sequences. Our data, together with genotype 4 database sequences, were analysed using Bayesian phylogenetic approaches. We find three well-supported intra-genotypic lineages and estimate that the genotype 4 common ancestor existed around 1733 (1650-1805). We show that genotype 4 originated in central Africa and that multiple lineages have been exported to north Africa since ~1850, including subtype 4a which dominates the epidemic in Egypt. We speculate on the causes of the historical intra-continental spread of genotype 4, including population movements during World War 2.
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Affiliation(s)
- James C Iles
- Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK
| | - Jayna Raghwani
- Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK
| | - G L Abby Harrison
- Department of Infection & Immunity, Walter & Eliza Hall Institute, Victoria 3052, Australia
| | - Jacques Pepin
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | | | | | | | - Felix M Tshala
- Department of Military Health, Ministry of Defense, Kinshasa, Democratic Republic of the Congo
| | - Patrick K Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Jean Jacques Muyembe
- National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Samuel Edidi-Basepeo
- National AIDS Control Program, Reference Laboratory, Kinshasa, Democratic Republic of the Congo
| | - Nathan D Wolfe
- Metabiota, San Francisco, USA; Stanford University Program in Human Biology, Stanford, USA
| | - Peter Simmonds
- Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - Oliver G Pybus
- Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK.
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27
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Matthews PC, Geretti AM, Goulder PJR, Klenerman P. Epidemiology and impact of HIV coinfection with hepatitis B and hepatitis C viruses in Sub-Saharan Africa. J Clin Virol 2014; 61:20-33. [PMID: 24973812 DOI: 10.1016/j.jcv.2014.05.018] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 05/22/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023]
Abstract
Human immunodeficiency virus (HIV), Hepatitis B (HBV) and Hepatitis C (HCV) are blood-borne viruses with potentially shared routes of transmission. In high-income settings, the impact of antiretroviral therapy (ART) on survival has unmasked chronic liver disease from viral hepatitis B or hepatitis C as a leading cause of morbidity and mortality in individuals with HIV infection. It is now feared that progressive liver disease may threaten the success of ART programmes in developing countries, where HCV or HBV testing and monitoring are not yet systematic among HIV-infected patients and ART use is generally blind to these co-infections. We set out to review recent data from Sub-Saharan Africa, in order to build a detailed and up-to-date picture of the epidemiology and emerging impact of HBV and HCV coinfection in countries at the heart of the HIV pandemic. There is a preponderance of HIV/HBV coinfection compared to HIV/HCV in this region, and significant caveats exist regarding the accuracy of published HCV seroprevalence surveys. Morbidity and mortality of coinfection is significant, and may be further enhanced in African populations due to the influence of host, viral and environmental factors. Careful scrutiny of the coinfection problem is vital to inform an approach to directing resources, planning public health initiatives, providing clinical care, and guiding future research.
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Affiliation(s)
- Philippa C Matthews
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford OX1 3SY, UK; Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
| | - Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, 8 West Derby Street, Liverpool L69 7BE, UK
| | - Philip J R Goulder
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford OX1 3SY, UK; Department of Paediatrics, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Paul Klenerman
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford OX1 3SY, UK; Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK; NIHR Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
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28
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Abstract
HCV is a blood-borne virus transmitted by percutaneous exposure to infected blood or blood-derived body fluids. The main routes of transmission are blood transfusions, medical procedures and injection drug use. In industrialized countries, HCV transmission through blood transfusions has been virtually eliminated and iatrogenic transmission occurs only sporadically during local breaches of infection control procedures. As most new cases originate from injection drug use, harm-reduction programmes (including opiate substitution, needle exchange and health education) can greatly reduce HCV transmission. Currently, the main approach to reduce the HCV disease burden is by increasing awareness of both the public and health-care providers to hepatitis C, enhancing screening opportunities and treatment of the infected population. In resource-limited countries, the priority is reducing transmission through blood transfusions and invasive medical procedures. This approach requires training of health-care providers and also structural changes and financial investments in countries where antibody screening, disposable materials and effective sterilization procedures are not routinely available. In these countries, reducing the HCV burden has been hampered by limited access to treatment, largely owing to the cost of drugs. Access to treatment is moving up on the agenda of international and non-governmental organizations in conjunction with the future availability of highly efficacious oral drug regimens.
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