Globally, in 2017 35 million people were living with HIV (PLHIV) and 257 million had chronic HBV infection (HBsAg positive). The extent of HIV-HBsAg co-infection is unknown. We undertook a systematic review to estimate the global burden of HBsAg co-infection in PLHIV. We searched MEDLINE, Embase and other databases for published studies (2002-2018) measuring prevalence of HBsAg among PLHIV. The review was registered with PROSPERO (#CRD42019123388). Populations were categorized by HIV-exposure category. The global burden of co-infection was estimated by applying regional co-infection prevalence estimates to UNAIDS estimates of PLHIV. We conducted a meta-analysis to estimate the odds of HBsAg among PLHIV compared to HIV-negative individuals. We identified 506 estimates (475 studies) of HIV-HBsAg co-infection prevalence from 80/195 (41.0%) countries. Globally, the prevalence of HIV-HBsAg co-infection is 7.6% (IQR 5.6%-12.1%) in PLHIV, or 2.7 million HIV-HBsAg co-infections (IQR 2.0-4.2). The greatest burden (69% of cases; 1.9 million) is in sub-Saharan Africa. Globally, there was little difference in prevalence of HIV-HBsAg co-infection by population group (approximately 6%-7%), but it was slightly higher among people who inject drugs (11.8% IQR 6.0%-16.9%). Odds of HBsAg infection were 1.4 times higher among PLHIV compared to HIV-negative individuals. There is therefore, a high global burden of HIV-HBsAg co-infection, especially in sub-Saharan Africa. Key prevention strategies include infant HBV vaccination, including a timely birth-dose. Findings also highlight the importance of targeting PLHIV, especially high-risk groups for testing, catch-up HBV vaccination and other preventative interventions. The global scale-up of antiretroviral therapy (ART) for PLHIV using a tenofovir-based ART regimen provides an opportunity to simultaneously treat those with HBV co-infection, and in pregnant women to also reduce mother-to-child transmission of HBV alongside HIV.

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Prevalence and burden of HBV co‐infection among people living with HIV: A global systematic review and meta‐analysis

Objective Better knowledge of hepatitis C virus (HCV) seroprevalence at the national level can help to implement pertinent strategies to address the HCV-related burden. The aim of this paper was to estimate the seroprevalence of HCV infection in Cameroon. Design Systematic review and meta-analysis. Participants People residing in Cameroon. Data sources Electronic databases including PubMed/MEDLINE, AJOL, WHO-Afro Library, Africa Index Medicus, National Institute of Statistics and National AIDS Control Committee, Cameroon from 1 January 2000 to 15 December 2016 were searched. English and French languages papers were considered. Two independent investigators selected studies. The methodological quality of the studies was assessed using the Newcastle–Ottawa scale. Results 31 studies including 36 407 individuals were finally considered. There was no national representative study. The overall pooled prevalence was 6.5% (95% CI 4.5% to 8.8%; I²=98.3%). A sensitivity analysis of individuals at low risk of HCV infection showed a pooled prevalence of 3.6% (95% CI 2.3% to 5.2%, I²=97.7%, 18 studies) among 22 860 individuals (general population, blood donors and pregnant women), which was higher than for a high-risk population (healthcare workers and people with other identified comorbidities), 12.2% (95% CI 4.9% to 22.2%; I²=98.3%, 13 studies); p=0.018. The prevalence was higher in the East region, in rural settings, and when using an enzyme immunoassay technique for detecting HCV antibodies. Sex, sites, study period, sample size, timing of data collection and methodological quality of studies were not sources of heterogeneity. Limitation One-third of studies (29.0%) had a low risk bias in their methodology and most were facility-based (87.1%). Conclusion The seroprevalence of HCV infection in Cameroon indicates the need for comprehensive and effective strategies to interrupt HCV transmission in the Cameroonian population. Specific attention is needed for the East region of the country, rural settings and high-risk populations. A national representative study is needed to provide better estimates.

https://bmjopen.bmj.com/content/bmjopen/7/6/e015298.full.pdf

Seroprevalence of hepatitis B virus infection in Cameroon: a systematic review and meta-analysis

Few studies have evaluated the prevalence of HBV in the general Cameroonian population or among antenatal attendants. The aim of this study was to determine the prevalence, correlates and patterns of Hepatitis B surface antigen among pregnant women attending antenatal care in Yaounde-Cameroon. This was a cross-sectional multicenter study carried out in a referral hospital and two secondary hospitals in Yaounde, the capital of Cameroon. The study lasted 15 months (March 2011 to June 2012), and recruited 959 pregnant women. Patient recruitment was consecutive. The HBsAg was tested using the Monalisa HBsAg Ultra ELISA kit. Other hepatitis B markers were equally tested. We used the statistical package for social sciences (SPSS) version 14.0 software to conduct a quantitative analysis of the derived data. Simple descriptive statistics such as means, standard deviations, and proportions were used to describe the data. We tested for association in categorical variables using the chi-squared (χ2) test. The odds ratio (OR) and the corresponding 95% confidence intervals (95% CI) were used to summarise the strength of association between specific binary exposure and outcome variables. The level of statistical significance for the study was set at p < 0.05. The prevalence of hepatitis B infection (HBsAg) among antenatal clinic attenders in our setting was 7.7%. Amongst these women, just 5.4% were previously aware of their HBsAg status. The rate of HBV infectivity was high, with 28% of HBsAg positive women having evidence of HBeAg in their plasma, and up to 45.8% of these women lacking antibodies against hepatitis B e antigen (anti-HBe). About 41% of the pregnant women had had previous contact with HBV as evidenced by the positive status for anti-HBc. Just 2.7% of the pregnant women had previously been vaccinated against HBV. The mean age for HBsAg positivity in our setting was 26.9 ±4.7 years, and the most affected age group was the 25 – 29 years age group. There was no statistically significant association between age or other socio-demographic risk factors and HBsAg status. Numerous risk factors for HBV acquisition exists in our settings, but amongst these, only a history of a contact with hepatitis B infection was found to be significantly associated with HBsAg positivity (OR 1.63, 95% C.I 1.15-2.30). Finally, the coinfection rate of HBV/HIV was 0.74%. The prevalence of hepatitis B among pregnant women in Cameroon is high, and the pattern tends towards high infectivity and therefore increased risk of perinatal HBV transmission. These highlight the need to step up preventive efforts against hepatitis B infection and perinatal HBV transmission in our community.

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Prevalence, correlates and pattern of Hepatitis B among antenatal clinic attenders in Yaounde-Cameroon: is perinatal transmission of HBV neglected in Cameroon?

Helicobacter pylori is a Gram negative bacterium that colonizes the stomach of approximately two-thirds of the human population and it is involved in the pathogenesis of gastroduodenal diseases. This study sought to determine potential risk factors associated with seroprevalence of H. pylori among dyspepsia patients in Cameroon for a better management of the disease. The study was carried out from August to December 2014 at Laquintinie Hospital and District Hospital of Bonassama in Douala metropolis. 205 patients (127 women and 78 men; mean age, 53.79 ± 11.11 years; range, 35–75 years) were enrolled. Each subject gave a written consent. The study was approved by the local Ethical Committee of Medical Sciences. A structured questionnaire was used to collect information on sociodemographic parameters and predisposing risk factors for Helicobacter pylori infection. For each patient, body mass index (BMI) and direct inquiry about dyspeptic symptoms were done. Blood samples were tested for H. pylori antibodies, and ABO/Rhesus blood group antigen typing was performed. The overall prevalence was 64.39%. All patients with upper abdominal pains and frequent burping were H. pylori seropositive. We found that infection takes place early in childhood and adolescence, and reaches its peak at adulthood at 35 to 44 years. Sixty-two percent of women over 68 of men were infected. 80.39% of patients with family history of gastric cancer were seropositive, while 19.60% were seronegative (p = 0.001). Prevalence of 79.09 and 47.4% was recorded respectively for subjects with low, middle and high income levels (p = 0.001). H. pylori infection rate was 60.48% in blood group O patients compared with 70.37% in other blood groups (p = 0.203). 73% of infected subjects over 59% of uninfected ones currently take NSAIDs (p = 0.0509). Overcrowded households have a higher rate of 65.32% seropositivity in contrast with a lower rate of 33.33% from norm household (p = 0.197). 69.29% of obese and overweight patients versus 58.24% of subjects with normal weight were seropositive (P = 0.215). The results of this study demonstrate that low income, family history of gastric cancer, clinical symptoms of nausea/vomiting and flatulence/bloating were risk factors of H. pylori infection in this population.

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Potential risk factors and prevalence of Helicobacter pylori infection among adult patients with dyspepsia symptoms in Cameroon.

Background. Infections with human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C virus (HCV) are currently major public health problems. Methods. A retrospective study was conducted from January to June 2008 at the Blood Bank of the Central Hospital, Yaounde (Cameroon). The objective was to study the prevalence of HIV, HBV, and HCV and their coinfections among blood donors. Results. A total of 4650 donors were identified, and the sex ratio (male/female) was 14/1. The median age of donors was 28 years (range: 16 to 69 years). Among blood donors, HBV, HIV, and HCV infection prevalences were 12.14%  
, 4.44%  , and 1.44%  ,
 respectively. Coinfection with HIV and HBV was observed among 0.77% donors, followed by hepatitis B and C co-infection (0.21%) and HIV and HCV coinfection (0.06%). Co-infection with HIV-HBV-HCV was encountered in 2 donors. The HIV, HBV, and HCV infections lead to a destruction of one out of six sets of blood collected. Conclusion. There is a need to review policies for blood collection from donors, by modifying the algorithm of blood donors testing. Pretesting potential donors using rapid tests could help to avoid collection and destruction of (infected) blood.

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High Rates of Hepatitis B and C and HIV Infections among Blood Donors in Cameroon: A Proposed Blood Screening Algorithm for Blood Donors in Resource-Limited Settings

Parenteral transmission of hepatitis B virus (HBV) during blood transfusion is not insignificant. Although blood transfusion safety has greatly improved over the last 15 years, the transfusion risk of HBV remains high in developing countries. In the context where blood transfusion safety is limited in some hospitals in Cameroon, the development of good and quality practice for blood donation, based on the use of the most sensitive techniques for the detection of infectious risk of blood donation should be a priority of health authorities. The aim of this paper is to document the epidemiology of HBV infection in the population of blood donors and to assess the risk of infection during blood transfusions at the Central Hospital Yaounde (CHY), Ca- meroon. Methods: During a seven months period, 1000 volunteer donors were recruited prospectively at the blood bank of the CHY. Those included in the study were people aged from 18 years to 55 years without any particular medical history. Data collection was done through an investigation form. Samples were first analysed at the CHY and then Centre Pasteur of Cameroon. Results: Of the 1000 samples tested 108 (10.8%) were positive for HBs Ag. The male and the female sex represented 83.1% and 16.9% respectively. According to the age groups, 56.2% were 18 to 27 years, 30.5% were 28 years to 37 years, 10.4% were 38 years to 47 years and 29% were 48 years to 55 years. The 892 negative sera were analyzed for total anti-HBc antibodies of which 75.78% were positive and 24.56% negative. The 676 samples positive for anti-HBc antibody were retested for HBs Ag using enzyme immunoassay with a confidence level of 95%, between 52 and 82 positive tests were still positive, a proportion that vary between 7.64% and 12.14% (9.89% ± 2.25%). Conclusion: The prevalence rate of 10.8% found in our series is consistent with data in Cameroon. The infectious risk of transmission of HBV among blood donors remains a major problem (9.89% ± 2.25%) related to the test used.

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HBs antigene prevalence in blood donors and the risk of transfusion of hepatitis b at the central hospital of yaounde, cameroon

Resume But de l’etude La prevention de la transmission des infections transmises par transfusion sanguine depend de la bonne selection des donneurs et de la realisation des tests serologiques adequats pour la detection des agents pathogenes, notamment les virus des hepatites B et C et le virus de l’immunodeficience humaine (VIH). Le but de cette etude etait double : determiner les seroprevalences des infections dues aux VHB, VHC, VIH et de la syphilis parmi les donneurs de sang de l’hopital central de Yaounde (HCY) et determiner les caracteristiques sociodemographiques, afin de trouver des strategies pour ameliorer la securite transfusionnelle au Cameroun. Patients et methodes Il s’agit d’une etude retrospective ayant porte sur 9024 donneurs de sang consecutifs de l’HCY dans la region du centre, Cameroun, inclus de janvier a decembre 2013. Les donnees ont ete recueillies sur les questionnaires de pre-don et des resultats des tests biologiques de qualification effectues sur les dons de sang au laboratoire de l’HCY avec des tests Elisa. Resultats L’âge moyen des donneurs etait de 28 ans. Le sex-ratio M/F etait de 14,8. Selon le mode de don, 97,2 % etaient des donneurs de compensation et 76,8 % etaient des nouveaux donneurs. Au total, 19,3 % des donneurs etaient positifs pour au moins un agent infectieux, parmi eux 1,5 % etaient positifs pour au moins 2 marqueurs viraux. Les seroprevalences globales de l’AgHBs, des anti-VHC, des anti-VIH et de la syphilis etaient respectivement de : 12,6 %, 3,2 %, 3,3 % et 0,2 %. Pour l’AgHBs, la prevalence etait significativement plus elevee chez les hommes ( p  = 0,001) et les nouveaux donneurs ( p  = 0,003). La prevalence des anti-VHC etait significativement plus elevee parmi les nouveaux donneurs ( p  = 0,05). La prevalence des anti-VIH etait significativement plus elevee chez les nouveaux donneurs (3,7 % vs 2,2 % ; p  = 0,02). Conclusion Le profil du donneur camerounais est de type compensation et nouveaux donneurs. Les seroprevalences du VIH, du VHB, du VHC et de la syphilis parmi les donneurs de sang sont elevees et refletent l’importance de ces agents dans notre milieu.

Séroprévalence des virus des hépatites B et C, du VIH-1/2 et de la syphilis chez les donneurs de sang de l’hôpital central de Yaoundé, région du centre, Cameroun

BACKGROUND: A high prevalence of Helicobacter pylori (H pylori) infection is observed in the pediatric age in developing countries. Thus, in these countries with a high prevalence of H pylori infection, peptic ulcer disease (PUD) is still common in the pediatric age. This study aimed to describe the prevalence, clinical manifestations and complications of PUD in the pediatric age in Cameroon. MATERIAL AND METHODS: This was a 9-year retrospective study. Data of children and adolescents admitted to the “Centre Medical la Cathedrale” of Yaounde, for upper GI tract endoscopy between January 2006 and December 2014 were reviewed. A group of 115 patients with PUD (84 boys [73.0%], 31 girls [27.0%]; 24 children [20.9%], 91 adolescents [79.1%]; mean age 14.7 ± 3.0 years) were compared with a control group of 99 patients without ulcer (49 boys [49.5%], 50 girls [50.5%]; 35 children [35.4%], 64 Adolescents [64.6%]; mean age 14.1 ± 3.4 years). H pylori was diagnosed when the rapid urease test and histology were both positive. RESULTS: PUD was found in 33.1% (115/347) of patients. The overall prevalence of H pylori was 68.3%. Peptic ulcers were mostly duodenal ulcers (75.7%) and Helicobacter pylori-positive ulcers (77.4%). The prevalence of Helicobacter pylori in gastric ulcer and in duodenal ulcer was 61.9% and 79.3%, respectively. H pylori was more frequent in patients with PUD than in control patients (77.4% vs. 52.4%; p=0.0001). H pylori was more frequently detected in girls than in boys (90.3% vs. 72.6%; p= 0.07), in adolescents than in children (78.0% vs. 75.0%, p= 0.75). Most of patients were admitted due to abdominal pain (80.9%). There was no significant association between abdominal pain and Helicobacter pylori infection (p= 0.99). Peptic ulcer hemorrhage accounted for 20% of PUD and was mostly duodenal ulcer in children. Stenosis complicated 13% of PUD and this was more frequent in male adolescents. CONCLUSION: PUD is common in the pediatric age in Cameroon. H pylori-related PUD is the most frequent variety and is more common among boys and in the duodenum. Measures to improve the hygienic and the social conditions are necessary to protect children against H pylori infection. RESUME OBJECTIF : Evaluer la prevalence de l’infection a H pylori, determiner les manifestations cliniques et les complications dans la maladie ulcereuse peptique chez l’enfant et l’adolescent camerounais. MATERIELS ET METHODES: Il s’agit d’une etude retrospective sur 9 ans chez des patients issus de la cohorte du Centre Medical la Cathedrale de Yaounde, qui effectue des endoscopies digestives. Un groupe de 115 patients avec un ulcere peptique (84 garcons [73,0%], 31 filles [27,0%] ; 24 enfants [20,9%], 91 adolescents [79,1%] ; moyenne d’âge 14,7±3,0 ans) a ete compare a un groupe controle de 99 sujets sans ulcere (49 garcons [49,5%], 50 filles [50,5%] ; 35 enfants [35,4%], 64 adolescents [64,6%] ; moyenne d’âge 14,1±3,4 ans). Tous ont beneficie d’une endoscopie digestive haute a la meme periode pour des symptomes digestifs. L’infection a H pylori etait diagnostiquee quand le test rapide a l’urease et l’histologie etaient tous les deux positifs. RESULTATS: L’ulcere peptique a ete retrouve chez 33,1% (115/347) des patients ayant beneficies d’une endoscopie. La prevalence globale de H. pylori etait de 68,3%. La majorite des ulceres etaient duodenaux (75,7%) et H pylori positif (77,4%). La prevalence de H pylori dans l’ulcere gastrique et dans l’ulcere duodenale etait de 61,9% et 79,3%, respectivement. H pylori etait plus frequent chez les patients avec un ulcere que chez les sujets controles (77, 4% vs. 52,4% ; p=0,0001). H pylori etait detecte plus frequemment chez les filles que chez les garcons (90, 3% vs. 72,6% ; p=0,07), chez les adolescents que chez les enfants (78,0% vs. 75,0% ; p=0,75). La majorite des patients etaient admis pour les douleurs abdominales (80,9%) et les hematemeses (23,5%). Il n’y avait pas d’association significative entre la douleur abdominale et l’infection a H pylori (p=0,99). L’ulcere peptique hemorragique representait 20% des ulceres et etait plus frequent dans le duodenum et chez l’enfant. La stenose compliquait 13% des ulceres et plus frequemment chez les adolescents de sexe masculin. CONCLUSION: La maladie ulcereuse est tres frequente parmi les enfants et adolescents camerounais, il s’agit souvent des ulceres compliques duodenaux et H pylori positif.

Helicobacter Pylori Infection and Peptic Ulcer Disease in Children and Adolescents from the Age Range of 6 to 18 Years Old in Yaounde (Cameroon)

Introductionl’etiologie des lesions gastroduodenales est multifactorielle. Peu d’etudes ont releve l’impact de chacun de ces facteurs en Afrique. L’objectif de ce travail etait de faire ressortir les facteurs associes a la survenue des lesions gastroduodenales au Cameroun.

Risk factors associated with gastroduodenal lesions in a Douala referral hospital (Cameroon)

L’association entre steatose hepatique et lipodystrophie secondaire a la multitherapie antiretrovirale (ARV) chez les patients VIH positifs a ete etudiee chez 117 patients atteints de sida a Yaounde, Cameroun (6,3 F/1 M; 40 ± 9,4 ans), traites par ARV comportant la stavudine (d4T) ou la zidovudine (AZT) depuis plus de six mois. Echographie abdominale et evaluation anthropometrique avec calcul de l’indice de masse corporelle (IMC). Analyse statistique multivariee avec odds ratio (OR) et test de χ2 pour identifier les facteurs associes a la lipodystrophie. Cinquante et un patients presentaient une lipodystrophie. Les prevalences respectives de l’hepatomegalie et de la splenomegalie etaient de 70,1 et 25,6 %. La prevalence de la steatose etait de 28,2 %; 37,3 % parmi les cas de lipodystrophie et 21,1 % en absence de lipodystrophie (p = 0,03). Selon la forme clinique de lipodystrophie: 40,6 % des cas de lipohypertrophie, 38,5 % des cas de lipodystrophie mixte et 16,7 % des cas de lipoatrophie. La lipohypertrophie etait associee a un risque eleve de steatose echographique, OR = 2,5; IC 95 %: [1,01–6,39] (p = 0,04). Le traitement par la d4T etait associe a un risque eleve de lipodystrophie. Aucune association entre IMC et steatose. La prevalence de la steatose hepatique est elevee parmi les patients sous ARVet est associee a la lipohypertrophie.

M. Biwole Sida

Papers

HBs antigene prevalence in blood donors and the risk of transfusion of hepatitis b at the central hospital of yaounde, cameroon

Séroprévalence des virus des hépatites B et C, du VIH-1/2 et de la syphilis chez les donneurs de sang de l’hôpital central de Yaoundé, région du centre, Cameroun

Helicobacter Pylori Infection and Peptic Ulcer Disease in Children and Adolescents from the Age Range of 6 to 18 Years Old in Yaounde (Cameroon)

Risk factors associated with gastroduodenal lesions in a Douala referral hospital (Cameroon)

Lipodystrophie et stéatose hépatique échographique chez les patients VIH positifs sous multithérapie antirétrovirale (ARV) à Yaoundé (Cameroun)