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Open Journal of Gastroenterology, 2022, 12, *-*
https://www.scirp.org/journal/ojgas
ISSN Online: 2163-9469
ISSN Print: 2163-9450
DOI:
10.4236/***.2022.***** **** **, 2022 1 Open Journal of Gastroenterology
Clinical, Biological, Immunological and
Therapeutic Profile of Patients Co-Infected with
HIV-HBV and/or HCV in Kinshasa, in the
Democratic Republic of the Congo: Multicenter
Cross-Sectional Study
Jean-Paul Kimpiatu Mayimona1, Aliocha Nkodila Natuhoyila2*, Antoine Tshimpi Wola Yaba1,
Charles Mbendi Nlombi1, François Lepira Bompeka3, Thérèse Ndarabu1, Jean Jacques Matimbo1,
Youyou Paka1, Sebastien Mbendi Nsukini1, Fiston Mbutiwi4, Jean Robert Makulo Rissassi3,
Hippolyte Situakibanza Nani-Tuma5, Benjamin Longo Mbenza6
1Garstroenterology Department, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
2Faculty of Family Medicine and Primary Health Care, Protestant University in Congo, city, Democratic Republic of the Congo
3Department of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
4Department of Nephrology, University of Kikwit, Kikwit, Democratic Republic of the Congo
5Department of Infectious Diseases, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
6Department of Cardiology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
Email: *nkodilaaliocha@gmail.com
Abstract
Background and Objective:
HIV infection is often associated with HBV and
HCV infection, together leading to high morbidity and mortality in develop-
ing countries. The objective of this study is to describe the clinical, biological,
immunological and therapeutic profile of patients co-infected with HIV-
HBV
and/or HCV.
Methods:
A cross-sectional and descriptive st
udy including 180
people living with HIV (PLWHIV) in the city of Kinshasa province was con-
ducted. Sociodemographic, clinical, biological and serological characteristics
were analyzed.
Results:
The frequency of HIV-HBV/HCV co-
infection was
23.9%. The distribution of age and sex of patients did not differ significantly
according to co-
infection status. The notion of pedicure and manicure was
significantly more observed in patients free from viral hepatitis (51.1%
versus
32.6%, p = 0.034). The median duration
of knowledge of the HIV status
which was longer in the co-infected (4 years
versus
2 years, p = 0.022). A
lower median level of GPT was observed in co-
infected compared to other
patients (14 IU/L
vers
us 20 IU/L, P = 0.041). Serum albumin (3.1 g/L versus
How to cite this paper:
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2 and Author 3 (20
22) Paper Title.
Open
Journal of Gastroenterology
,
12
, *-*.
https://doi.org/10.4236/***.202
2.*****
Received:
**** **, ***
Accepted:
**** **, ***
Published:
**** **, ***
Copyright ©
2022 by author(s) and
Scientific
Research Publishing Inc.
This work is licensed under the Creative
Commons Attribution International
License (CC BY
4.0).
http://creativecommons.org/licenses/by/4.0
/
Open Access
J.-P. K. Mayimona et al.
DOI:
10.4236/***.2022.***** 2 Open Journal of Gastroenterology
3.3 g/L, p = 0.034) and prothrombin (58.3%
versus
65.6%, P = 0.045) were
lower in HIV co-infected -VHB and/or VHC. The median INR was higher in
co-infected than in other patients (1.6
versus
1.4; P
= 0.009). Patients without
therapy Antiretroviral (TARV) medication were more numerous in co-infected
(20.9% versus 8.0%, p = 0.025).
Conclusions:
The profile of PLWHIV was
dominated by the presence of pedicures and manicures with high transami-
nases and without anti-viral treatment.
Keywords
HIV-HCV-HBV Co-Infection, Clinical Profile, Biology, TARVs, Kinshasa
1. Introduction
The hepatotropic and lymphotropic virus, HCV and HBV induce a specific cy-
totoxic T immune response which, combined with the production of interferon
γ
, allows in some patients to eliminate the virus with a frequency of around 11%
to 32% in HIV-HCV/HBV co-infected patients [1]. However, the chances of
spontaneous recovery from acute hepatitis C or B in people living with HIV
(PLWHIV) are lower than without HIV infection, ranging from 11% to 32%
[2]-[8]. The transition to the chronic phase of viral C and B infection is the re-
sult of the modulating effect exerted by the virus itself on the balance established
after infection between costimulatory and pro/anti-apoptotic molecules, between
Treg cells and T-helpers but also the establishment of escape mechanisms that
allow the virus to remain in the body indefinitely, mainly in hepatocytes [9].
However, there is evidence of HCV or HBV replication in other cell types in-
cluding lymphocytes. Chronic viral replication of HCV and HBV occurs against
a background of permanent immune activation, higher in HIV-HCV/HBV
co-infected patients [10], whose long-term effects are only just beginning to be
identified and quantified. Several studies have thus demonstrated a higher vascular
risk in HCV/HBV mono-infected patients (stroke, obliterating arterial disease of
the lower limbs, coronary artery disease), as well as renal failure (by nephroangios-
clerosis and extra-membranous glomerulonephritis), diabetes mellitus and can-
cers, especially extrahepatic, the first of them identified being non-Hodgkin’s ma-
lignant lymphoma [11] [12] [13] [14]. In the Democratic Republic of the Congo,
we do not have sufficient data to support the role of HCV/HBV co-infection in
patients infected with HIV. The objective of this study is to describe the clinical,
biological, immunological and therapeutic profile of patients co-infected with
HIV-HBV and/or HCV.
2. Methods
It was a cross-sectional and descriptive study. It took place in the city of Kinsha-
sa, the political capital of the Democratic Republic of the Congo. In this city,
J.-P. K. Mayimona et al.
DOI:
10.4236/***.2022.***** 3 Open Journal of Gastroenterology
HIV care is organized in all general hospitals, in certain general and university
hospitals, in certain private medical centers and in the medical training of cer-
tain NGOs. Depending on the availability and completeness of the information
sought in our study, we considered two NGOs located in urban-rural areas,
namely: the Pediatric Foundation of Kimbondo and the NGO “Community Ac-
tions AIDS/Better Future for Orphans of Congo (ACS/AMO-Congo) “which are
among the oldest centers in Kinshasa for HIV care. It was during the period
from November 10, 2013 to January 10, 2014. The study had consecutively in-
cluded elderly people of at least 18 years known to have HIV who consulted
during the study period at the two selected sites and who freely consented to
participate in the study. Inclusion criteria were to be PLWHIV at least 18 years
of age consenting to participate in the study and followed in one of the two
treatment centers selected for the study, to have a medical file including the pa-
rameters sought. To carry out the present study, were used as materials data col-
lection sheet, informed consent sheet, strips for rapid qualitative tests HBsAg
and AcVHC of the brand “ACCURATE of Indian manufacture”, quantitative
tests for the determination of the markers of the hepatitis B (ELISA) brand
“DIALAB Austrian manufacture”, test for determination of HCV antibodies
(ELISA) brand “DIALAB Austrian manufacture”, tests for evaluation of hepatic
synthetic function.
The actual data collection involved 3 stages: 1) administering a questionnaire
to patients to collect socio-demographic information, medical history and risk
behaviors for viral hepatitis; 2) the blood test for the determination of markers of
the hepatic functions studied and of HBV and HCV; 3) analysis of the medical
file of each patient selected in search of clinical, immunological and therapeutic
information relating to HIV infection. Socio-demographic parameters included
age, sex, occupation, marital status, level of education and religion. Regarding
the medical history and risky behavior, we looked for the concept of previous
blood transfusion, vaccination against HBV, the number of sexual partners, the
type of sexual intercourse, the concept of scarification, circumcision, excision,
piercing, drug addiction, knowledge of one’s HBV and HCV serological status
and the notion of surgical intervention in the past. The analysis of the medical
file of each patient allowed us to gather information on the year of the diagnosis
of HIV, the clinical stage of the HIV infection, the current ARV treatment regi-
men and, if applicable, the highest rate. recent CD4; only CD4 counts not older
than 3 months before the survey were taken into account. On the blood test, the
HBV biological markers sought were HBs Ag, anti-HBs Ab, anti-HBc Ab, HBe
Ag and anti-HBe Ab. For HCV, total anti-HCV Abs were assayed. Transami-
nases (SGOT and SGPT) were the desired markers of hepatic cytolysis. To ex-
plore cholestasis, we assayed for
γ
GT, total and direct bilirubin as well as alka-
line phosphatases. To assess hepatic synthetic function, prothrombin, serum al-
bumin, and INR were assayed. In terms of the collection process, any patient se-
lected for the study received, after consultation by the center’s medical team, the
J.-P. K. Mayimona et al.
DOI:
10.4236/***.2022.***** 4 Open Journal of Gastroenterology
survey questionnaire. After completing the questionnaire, the patient was di-
rected to the laboratory with a token bearing an identification code. Once ar-
rived at the laboratory, a 5 cc venous blood sample was taken in two tubes, a dry
tube for hematological and biochemical analyzes and another tube with citrate
for serological analyzes. The samples were centrifuged using a German brand
A-RD-42-26 device at 1500 revolutions/min/5min, decanted and then stored in
the refrigerator at a temperature between 2˚C to 8˚C at the site laboratories. stu-
dies. Qualitative tests for HBsAg and for total HCV antibodies were performed
on site; the rest of the samples were sent to the Lomo Médical laboratory where
hematological, biochemical and serological analyzes were carried out.
A spectrophotometer of the brand “Spectrum” and a “Bain Marie of the
HUMAN brand” and ELISA reader “HIMARETADR-FINGLE of the HUMAN
brand” were used to carry out the hematological and biochemical analyzes ac-
cording to the manufacturer’s standards. Kinetic methods for GOT, GPT, PAL,
γGT; enzymatic for serum albumin, total and direct bilirubin, prothrombin and
INR; and immunoenzymatic type ELISA for quantitative tests for viral hepatitis
B and C were used. The results were transcribed on an ad hoc form with the
corresponding codes.
Definition of concepts
Anti-HBs Ab were found to be positive when in the Elisa test, the anti-HBs Ab
titre was >12 IU/L [15];
HIV-HBV co-infection was selected on the basis of the positivity of HBsAg in
HIV + patients [15];
HIV-HCV coinfection was selected on the basis of the positivity of anti-HCV
Ab in HIV + patients [15].
Statistical analyzes
The processing and analysis of the data collected was carried out using SPSS
version 21 software. During the analysis, the age of the patients was categorized
into tertiles (<40 years, 40 - 49 years and ≥50 years). CD4 counts were dichoto-
mized at the threshold of their median value (3 years and 303 cells/mm3, respec-
tively). The descriptive statistics applied include the mean ± standard deviation
for continuous quantitative variables with symmetric distribution, the median
with extreme values for those with asymmetric distribution, and relative (%)
and/or absolute (n) frequencies for qualitative variables. For comparison of
means and medians, Student’s t test and Wilcoxon/Mann-Whitney nonparame-
tric test were applied. For the analysis of the contingency tables, we used Pear-
son’s chi-square test or Fisher’s exact test or linear trend chi-square, as appro-
priate. For the tests used, the statistical significance level retained was P value <
0.05.
Ethical considerations
The protocol was submitted to the ethics committee of the School of Public
Health of the University of Kinshasa and was agreed at number ESP/CE/012/14.
Thus, when recruiting patients, anonymity and confidentiality were guaranteed.
J.-P. K. Mayimona et al.
DOI:
10.4236/***.2022.***** 5 Open Journal of Gastroenterology
3. Results
Clinical profile of HIV-HBV and/or HCV co-infected of the 180 PLWHIV in-
cluded in the study, 43 had an HIV-HBV-HCV coinfection, a frequency of
23.9% coinfection.
Table 1 presents the clinical profile of all patients and the HIV-HBV and/or
HCV co-infection status.
The age and sex distribution of the patients did not differ significantly according
to co-infection status. The notion of pedicure and manicure was significantly more
Table 1. Clinical characteristics of patients according to HIV-HBV and/or HCV co-infection
status.
Variable
Over all
(n = 180)
HIV
(n = 137)
HIV+/HBV+/
HCV (n = 43)
P value
Age (year)
44.2 ± 11.0
44.6 ± 10.6
42.8 ± 12.2
0.369
<40%
33.3
29.9
44.2
0.132
40% - 49%
34.4
38.0
23.3
≥50%
32.2
32.1
32.6
Gender, %
0.416
Female
76.7
78.1
72.1
Male
23.3
21.9
27.9
Transfusion, %
32.8
33.6
30.2
0.684
Pedicure and manicure, %
46.7
51.1
32.6
0.034
Jaundice in the past, %
5.6
5.1
7.0
0.704
Concept of anti-HBV vaccination, %
1.1
1.5
0.0
-
Scarification, piercing, excision, %
40.0
39.4
41.9
0.775
Substance addiction, %
6.7
5.1
11.6
0.161
Number of sexual partners, %
0.125
1
61.1
64.2
51.2
>1
38.9
35.8
48.8
Condom use, %
20.0
21.2
16.3
0.484
Surgery in the past, %
45.0
43.8
48.8
0.562
Knowledge of status
1.1
0.7
2.3
0.424
Duration of HIV infection (years)
3 (1 - 20)
4 (1 - 15)
2 (1 - 20)
0.022
Clinical stage of HIV, %
0.194
I
10.0
8.0
16.3
II
30.6
28.5
37.2
III
46.1
49.6
34.9
IV
13.3
13.9
11.6
J.-P. K. Mayimona et al.
DOI:
10.4236/***.2022.***** 6 Open Journal of Gastroenterology
observed in patients free from viral hepatitis (51.1% versus 32.6% in co-infected,
P = 0.034). The same is true of the median duration of knowledge of the HIV
status, which was significantly longer in this latter group (4 years versus 2 years
in the co-infected, P = 0.022). The other characteristics noted, in this case, a his-
tory of transfusion (32.8%), jaundice (5.6%), anti-HBV vaccination (1.1%), sca-
rification, piercing and excision (40%), drug addiction (6.7%) or surgery (45%),
condom use (20%), number of sexual partners, or clinical stage of HIV infection
did not differ significantly according to co-infection status.
Biological profile of HIV-HBV and/or HCV co-infected
The data are indicated in Table 2.
Biologically (Table 1), the median levels of SGOT (23 IU/L), gamma-GT (28
IU/L), alkaline phosphatase (160 IU/L), total bilirubin (0.4 g/L) and direct bili-
rubin (0.1 g/L) did not differ significantly depending on coinfection status. In
contrast, a significantly lower median level of SGPT was observed in HIV-HBV
and/or HCV coinfected compared to other patients (14 IU/L
versus
20 IU/L; P =
0.041). The same is true of the mean serum albumin levels (3.1 g/L
versus
3.3
g/L; P = 0.034) and prothrombin (58.3%
versus
65.6%; P = 0.045) which were
significantly lower in the group of HIV-HBV and/or HCV co-infected. The me-
dian INR was significantly higher in co-infected than in other patients (1.6
ver-
sus
1.4; P = 0.009).
Therapeutic profile of HIV-HBV and/or HCV co-infected
The results are presented in Table 3.
The ARV therapeutic profile of the patients differed significantly depending
on the co-infection status. In particular, more patients without ARV medication
were observed in the group of HIV-HBV and/or HCV co-infected (20.9% versus
8.0%; p = 0.025) (Table 3).
Immunological profile of HIV-HBV and/or HCV co-infected
Table 2. Laboratory characteristics of patients according to HIV-HBV and/or HCV
co-infection status.
Variable
Over all
(n = 180)
HIV
(n = 137)
HIV+/HBV+/
HCV (n = 43)
P
SGOT (UI/L)
23 (1 - 748)
25 (1 - 138)
18 (2 - 748)
0.055
SGPT (UI/L)
19 (4 - 150)
20 (4 - 150)
14 (4 - 144)
0.041
Gamma-GT (UI/L)
28 (4 - 232)
30 (4 - 232)
24 (4 - 129)
0.623
Alkaline phosphatases (IU/L)
160 (18 - 689)
157 (34 - 689)
182 (18 - 565)
0.116
Total bilirubin (g/L)
0.4 (0.1 - 3.9)
0.4 (0.1 - 1.2)
0.5 (0.1 - 3.9)
0.313
Direct Bilirubin (g/L)
0.1 (0.0 - 1.0)
0.1 (0.0 - 0.8)
0.1 (0.0 - 1.0)
0.822
Serum albumin (g/L)
3.2 ± 0.6
3.3 ± 0.6
3.1 ± 0.6
0.034
Prothrombin (%)
63.8 ± 21.0
65.6 ± 21.0
58.3 ± 20.3
0.045
INR
1.4 (1.0 - 5.9)
1.4 (1.0 - 5.9)
1.6 (1.0 - 5.9)
0.009
Data are expressed as mean ± standard deviation or median (range).
J.-P. K. Mayimona et al.
DOI:
10.4236/***.2022.***** 7 Open Journal of Gastroenterology
Table 3. Therapeutic characteristics of patients according to HIV-HBV and/or HCV
co-infection status.
Variable
Over all
(n = 180)
HIV
(n = 137)
HIV+/HBV+/HCV
(n = 43)
P
ARV treatment, %
0.025
No treatment
11.1
8.0
20.9
AZT + 3TC + NVP
73.9
73.7
74.4
TDF + 3TC + EFV
11.1
13.9
2.3
ABC + DDI + [ALUVIA ou LPV/r]
3.9
4.4
2.3
The median CD4 lymphocyte count did not differ significantly depending on
the HIV-HBV/C co-infection status (347 cells/mm3 in the co-infected patients
versus 303 cells/mm3 in the non-co-infected; p = 0.606).
4. Discussion
The purpose of this study was to describe the clinical, biological and therapeutic pro-
file of HIV-HBV-HCV co-infection in Kinshasa. With regard to HIV-HBV/HCV
co-infection, the age groups < 40 years, 40 - 49 years and ≥50 years represented a
frequency of 44.2%, 23.3%, 32.6%, respectively. %. The difference in frequency
between age groups was not statistically significant (P =). These results are con-
tradictory to other epidemiological studies reported in the literature [16] [17]
[18]. The discrepancy of our results compared to the aforementioned studies is
justified by the fact that the data of the literature read so far and which mention
the age do not speak about the importance of the infection with HBV and HCV
compared to each age category. The difference in work methodology took us
away, but also the population sizes of the aforementioned studies were almost 2
to 20 times larger than ours [xxx].
In addition, the female sex is more predominant (72.1%) than the male sex
(27.9%). This result is consistent with the fact that in the general population fe-
male PLHIV are more common. The practice of manicures and pedicures has
emerged as the main risk factor for the occurrence of HIV-hepatitis B and/or C
co-infection alongside the duration of the HIV infection. The laboratory profile
of co-infected patients was dominated by the high level of GPT 14 (4 - 144), an
increase to 3x> normal. These results are close to those of Idoko in Nigerian
[19]. A low level of serum albumin, prothrombin and INR was observed with
respectively 3.1 ± 0.6 (P = 0.034), 58.3 ± 20.3 (P = 0.045), 1.6 (1.0 - 5.9) (P =
0.009).
Regarding the treatment of hepatitis C and B in PLWHIV, this study confirms
the strong dynamics of treatment since the availability of direct viral agents with
an efficacy and a tolerance comparable to those observed in people with
mono-infected with HIV, including in patients with HIV-HCV/HBV [20]. This
dynamic is also observed routinely in France [21]. However, there is a significant
percentage of PLWHIV co-infected with HCV and HBV still to be treated, as
J.-P. K. Mayimona et al.
DOI:
10.4236/***.2022.***** 8 Open Journal of Gastroenterology
shown by a survey conducted in June 2016 (
i.e.
almost 2 years after the possibil-
ity of treating all co-infected PLWHIV), at within the ICONE cohort comprising
10,087 PLHIV followed in the centers of the Bourgogne-Franche Comté, Grand
Est and Hauts de France regions [21].
The limitations of our study are the fact that it was not multicenter therefore
not representative in our country, the cost of biological tests did not allow the
study to be extended to other sites. The methodology used in our study does not
identify the factors associated with HIV-HBV-HCV infection. We did not test
whether the infection was new or old in relation to anti HBc Ab, or assay the
viral DNA to separate cases of cure from that of infection.
Apart from these limitations, this work constitutes the first research carried
out in this field in Kinshasa. The participation rate which is particularly inter-
esting since the study was carried out in a developing country where the inhabi-
tants are not used to participating in epidemiological studies and research. The
biological analyzes were carried out in one of the reference laboratories in our
country.
5. Conclusions
The results of our study on the frequency and the clinical-biological profile of
HIV and hepatitis B and C virus co-infection in an HIV + population in Kin-
shasa have shown that:
• Hepatitis B and C are frequent in this population;
• The notion of pedicure and manicure as well as the duration of HIV infection
emerged as the clinical profile most associated with HIV/hepatitis B and/or C
virus co-infection;
• Acute and occult hepatitis B was the most common typological profile;
• A low SGPT transaminase level, a low serum albumin and prothrombin level
as well as a high INR level were the laboratory profile most associated with
HIV/viral hepatitis B co-infection and/or C.
Author’s Contributions
All authors contributed to data analysis, drafting or revising the article, have
agreed on the journal to which the article will be submitted, gave final approval
of the version to be published, and agree to be accountable for all aspects of the
work.
Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this pa-
per.
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APPENDIX 2: Data Collection Sheet on the Prevalence of
Co-Infections by Hepatitis B and C Viruses and
Evaluation of Hepatic Function in an HIV+
Population in Kinshasa
1. Identity
Name…………………………………………………………………………………
Post name:…………………………………….............................……………………
Age:………………...........................................................................................................
Sex:……………………………………………………………………………………
Race:….………………………………………………………………………………
Civil status:……………………......................................................................................
Profession:………………………………………………………………………….
Address:………………………………………………………………………………
Province of origin:…………………………………………………………………
Level of studies completed:…………………………………………………………
Religion:……………………………………………………………………………
2. Background
Blood transfusion…………………... Yes No
Blood group…………….................... Yes No
Pedicure and Manicure …………… Yes No
Jaundice …………………………… Yes No
Previous vaccination against
Hepatitis B………………………… Yes No
Scarifications……………………… Yes No
Circumcision……………………… Yes No
Piercing…………………………… Yes No
Circumcision……………………… Yes No
Drug addiction…………………… Yes No
Number of sexual partners One Several Yes No
Safe sex Yes No
HBV or HCV known before HIV diagnosis Yes No
Year of HIV diagnosis……………………………..……..……..……..……..……..
Current antiretroviral treatment……………………………………………………
Antiretroviral regimens……………………………………………………………
Surgical intervention in the past Yes No
Current stage of HIV infection……………………………………………………
3. Paraclinical
at. Medical Biology
Qualitative HBs antigen…………………… Positive Negative
Qualitative HCV antibody………………… Positive Negative
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HBs antigen (ELISA):………...……...……. Positive Negative
HBs Antibody (ELISA)……………...…...… Positive Negative
HBc Antibody (ELISA)…………...……...… Positive Negative
HBe antigen (ELISA)……………...……...… Positive Negative
HBe (ELISA) Antibody ……...………...…... Positive Negative
Total VH Antibodies (ELISA) …...………... Positive Negative
ALAT:……………. Normal High Specify the value:…...................................
AST:…………… Normal High Specify value:………...........................…
Gamma GT …….. Normal High Specify value……………………………
Serum albumin… Normal Low Specify value………………………..……
Prothrombin …… Normal Low Specify value…………………………..…
Alkaline phosphatase Normal Low Specify value………………………….…
Total bilirubin Normal High Specify value……………………………
Direct bilirubin Normal High Specify the value………………………
CD4 (specify value):…………………………………………………………………
Done in Kinshasa, on………../……../201…….….