Servais Albert Fiacre Bagnaka Eloumou

Characteristics of anti-hepatitis C virus antibody-positive patients in a hospital setting in Douala, Cameroon.

INTRODUCTION Hepatitis C virus (HCV) infection is a major public health problem, especially in resource-limited settings where many patients are diagnosed at the stage of complications. In Cameroon, where HCV is endemic, little is known about the clinical, biological, and virological profile of HCV-infected patients. METHODS A clinical case note review of all patients positive for antibodies against HCV diagnosed at the gastroenterology outpatient clinic of the Douala General Hospital, Cameroon, from January 2008 to December 2014, was performed. RESULTS A total of 524 patients were included in the study, 53% of whom were female. The mean age was 56±13 years. A history of blood transfusion and a history of scarification were the most common potential risk factors for HCV exposure, as found in 16% and 13% of the study population, respectively. Current alcohol use was found in 24% of patients. Co-infection with hepatitis B virus and HIV was 3.6% and 3.4%, respectively. Among the patients, 39% had no complaint at diagnosis; only 16% were diagnosed through a routine medical checkup. Clinically, the most common finding was hepatomegaly (26.1% of patients). Transaminases above the upper limit of normal were found in 55.2% of patients, particularly those aged >57 years (p=0.001). Genotypes 1 (43.95%), 2 (25.11%), and 4 (28.25%) were the most common. Liver cirrhosis was present in 11% of patients and hepatocellular carcinoma in 4%, the latter being more common in males (p<0.001) and in those aged >57 years (p=0.03). CONCLUSIONS In the gastroenterology clinic of Douala General Hospital, while almost 40% of patients who were anti-HCV antibody-positive were asymptomatic and diagnosed fortuitously, some already presented complications, including cirrhosis and hepatocellular carcinoma. There is an urgent need to put in place programs to increase awareness and diagnosis of HCV infection and to develop extensive and targeted anti-HCV treatment guidelines to improve the management of these patients in Cameroon.

Sero-prevalence and Correlates of Hepatitis B and C Co-infection Among HIV-infected Individuals in Two Regional Hospitals in Cameroon

Background: Liver disease related to Hepatitis B (HBV) and C (HCV) infection has become a major cause of morbidity and mortality in HIV/AIDS patients. Data on the prevalence of HBV and HCV in Cameroon remains inconclusive. Objective: We aimed to determine the sero-prevalence and correlates of Hepatitis markers in HIV/AIDS patients in two Regional Hospitals. Methods: A cross-sectional study carried out from December 2014 to March 2015. HIV/AIDS patients aged 21 were included and above, receiving care at HIV treatment centres. Data was collected using a structured questionnaire. Blood samples were collected to screen for Hepatitis with HBsAg and anti HCV antibody rapid immunochromatographic test kits. Correlates of hepatitis were investigated by logistic regression. STATA was used for data analysis. Results: We included 833 HIV/AIDS patients,78.8% (657) were female. Mean age was 44(SD 11) years. Prevalence of Hepatitis in general (total of two viral markers tested) was 8.9% (74/833), with 6.1% for HBsAg and 2.8% for Anti-HCV antibodies. From multivariate analysis, the likelihood of having hepatitis was independently increased by a history of surgical interventions [OR: 1.82(1.06-3.14)], and of sexually transmitted infections [OR: 2.20(1.04-4.67)]. Conclusion: Almost one in ten participants with HIV/AIDS attending the BRH and LRH tested positive for either HBsAg or anti HCV antibodies. Screening for HBV and HCV should therefore be integrated to the existing guidelines in Cameroon as it can influence management. More studies are needed to evaluate the extent of liver disease and magnitude of HIV suppression in hepatitis and HIV coinfection in this setting.

Hepatitis C Continuum of Care in a Treatment Center in Sub-Saharan Africa

Background Hepatitis C virus (HCV) infection is a major public health challenge in Cameroon with over three million people infected. Government efforts to improve care and treatment are unsatisfactory and need to be assessed. We aimed at studying the several steps along the HCV continuum of care in one of two hepatitis treatment centers in Cameroon. Methods We undertook a retrospective chart review of anti-HCV positive individuals, who attended the Douala general hospital between 2008 and 2015. We defined the HCV treatment cascade as follows: step 1-HCV RNA testing, step 2-complete pre-therapeutic evaluation (genotyping and liver fibrosis markers), step 3-initiation of treatment, step 4-treatment completion, and step 5-sustained virological response (SRV). Each successive step in the HCV care continuum was dependent on passing through the previous step. Results The mean age of the 669 anti-HCV antibody positive individuals was 57 (sd: ±13) years. Females were 52.8% of the study population. 410 (61.3%) were tested for HCV RNA. Three hundred and sixty-six (54.7%) were confirmed to have viral replication (HCV RNA positive). One hundred and eighty (26.9%) did a complete pre-therapeutic evaluation (both HCV genotyping and liver fibrosis assessment included). Eighty-one (12.1%) initiated treatment with pegylated interferon/ribavirin. Seventy-two (10.8%) completed treatment and 44 (6.6%) had SVR. Sociodemographic characteristics including age, gender, marital status, having medical insurance, and profession were associated with attaining later steps in the care cascade. Conclusion This study shows that HCV continuum of care and treatment is less optimal at the Douala general hospital and is highly impacted by socio-economic factors. Continued efforts are needed to improve HCV care.

Treatment of Viral Hepatitis C by the Sofosbuvir and Ledipasvir With or Without Ribavirin Combination in Cameroon: Efficiency, Tolerance and Significant Predictors of SVR12

Background: There has been a revolution in the treatment of hepatitis C virus (HCV) infection since the introduction of new direct-acting antivirals agents (DAAs) in 2014. About 95% of the patients have a sustained virological response (SVR) after 12 weeks with DAAs. The aim of this study was to evaluate the SVR after 12 weeks of treatment with the combination of sofosbuvir (SOF)/ledipasvir (LDV) +/ribavirin (RBV) among a cohort of Cameroonian HCV carriers. Methods: This was a cross-sectional study in HCV treatment centers in Cameroon health facilities in Yaounde and Douala. It focused on patients with chronic HCV of genotypes 1 and 4 treated with the SOF/ LDV +/RBV combination for 12 weeks. The virological response after 4 and 12 weeks of treatment was determined. SVR indicating recovery was determined 12 weeks after the end of treatment (SVR12). Results: A total of 111 patients with chronic HCV were included. There was female predominance with a proportion of 58.6%. The average age of the patients was 58.8 ± 8.2 years. Genotype 1 was the most frequent with 68.5% of the cases. The SVR was 93.7% (95% CI (87.4% 97.4%)) regardless of protocol and genotype. HCV infection without cirrhosis was associated with good SVR (aOR = 0.1, 95 CI (0.1 0.9), P = 0.02). The most common clinical adverse reaction was asthenia with 12.5% (n = 10). Conclusions: The SVR12 in Cameroonian patient infected with HCV genotypes 1 and 4 treated with the combination SOF/LDV +/RBV was 93.7%. Cirrhosis is a factor of poor response.

Anorectal pathology amongst HIV infected patients attending the Douala General Hospital: a cross-sectional study.

While gastrointestinal disease is common among HIV infected individuals, the prevalence and distribution of ano-rectal pathology has not been well studied in our setting. The objective of this study therefore was to determine the prevalence and determinants of ano-rectal pathology in HIV infected patients attending the Douala General Hospital HIV treatment centre. A hospital-based cross-sectional study was undertaken. We collected socio-demographic, clinical and laboratory data using a structured questionnaire and patients’ files. Each study participant had a full physical and ano-rectal examination. We further studied factors associated with having at least one ano-rectal lesion by logistic regression reporting odds ratios (ORs) and their 95% confidence intervals (CI). We included 390 HIV infected patients. The mean age was 41 (SD: 8) years and 48% were men. Median duration since HIV diagnosis was 3 (interquartile range: 2–5) years and median CD4 cell count was 411 (interquartile range: 234–601) cells/mm3. Prevalence of ano-rectal pathology was 22.8% (95% CI: 18.7–27.3). Hemorrhoids and proctitis were most common lesions found; each in 10% of patients. From multivariate logistic regression, factors associated with ano-rectal pathology were CD4 < 350 cells/ml (OR: 2.1, 95% CI: 1.1–4.2), not on highly active antiretroviral therapy (OR: 2.2, 95% CI: 1.1–4.6), inpatient (OR: 2.3, 95% CI: 1.2–4.3), ano-rectal intercourse (OR: 5.0, 95% CI: 1.7–15.1), and more than one sexual partner (OR: 2.4, 95% CI: 1.3–4.2). Ano-rectal pathology is common amongst HIV infected patients. Care givers should actively investigate and treat them as this will improve the quality of life of people living with HIV/AIDS.

Pentastomiase humaine: à propos d’un cas découvert à l’hôpital central de Yaoundé, Cameroun

La pentatosmiase est une parasitose inhabituelle chez l’homme causee par des larves des differentes especes de pentastome. C’est un parasite de la famille des pentastomides ayant des caracteristiques a la fois des arthropodes et des annelides. Nous rapportons ici un cas de pentatostome au Cameroun cause par Armillifer armillatus. Il s’agissait d’un homme de 33 ans, instituteur, celibataire, originaire de la region du Centre Cameroun qui correspond a la zone geographique du grand sud du Cameroun mais qui vivait depuis plus de 10 ans dans un petit village de l’Adamaoua (zone geographique du grand nord). Ce patient a presente une pentastomiase dont le diagnostic a ete fortuit a l’issue d’une intervention chirugicale. La pentastomiase humaine, maladie inhabituelle est paradoxalement rare au Cameroun alors que plusieurs cas sont decrits en Afrique Centrale et de l’Ouest. La realisation des autopsies de maniere systematique pourrait permettre les progres de la science non seulement en ce qui concerne cette affection, mais aussi pour la medecine en general.