By Charles MBENDI NLOMBI

Works Manager

Thesis presented with a view to obtaining the degree of Associate Professor of Higher Education in Medicine

Promoter: Professor Dr. Benjamin LONGO MBENZA

Co-Promoter: Professor Dr. Moustapha MOULAY ENNAJ

SUMMARY

Background: Hepatitis B and C virus infections and HIV remain a major public health problem in sub-Saharan Africa, where their management is inadequate. These conditions pose management challenges due to under-information among the population, inadequate diagnosis, and the combination therapy required by their co-infection.

Objective: The objective of this thesis was to take stock of HBV and HCV infection and HIV-HBV-HCV coinfection in the population of the Kinshasa region.

Methods: This was a multicenter study with two components: analytical cross-sectional and historical cohort, covering several socio-professional categories interviewed or followed in the Kinshasa region during the period from 2001 to 2018. Several parameters were collected including sociodemographic, clinical, biological data, exposure to factors associated with the transmission of hepatitis B and C; and HIV-specific data.

Proportional hazard analysis by logistic regression or Cox was used to document factors associated with the transmission of hepatitis B and C; and predictors of mortality at the threshold of p < 5%.

Results :

• Among PLHIV, the frequency of HBV was 17.3% vs 13.6% for HCV.
• Among sex workers, there were 33% of HBV vs 27.2% of HCV. The population of PLHIV and SW; HIV status (ORa=3.02), sex worker status (ORa=2.98) and piercing/tattooing (ORa=3.66) were associated with the transmission of hepatitis B and C.
• In pregnant women, the frequency of hepatitis B was 15.8%. Factors associated with this transmission were non-use of condoms (ORa=2.26), blood transfusion (ORa=3.49), multiple sexual partners (ORa=2.39) and the number of factors greater than 4 (ORa=2.44).
• Among health workers, the frequency of hepatitis B was 18.6%. The status of physician (ORa=2.80), laboratory technician (ORa=3.35) and multiple sexual partners (ORa=3.05) were the factors associated with this transmission.
• In cirrhotic patients, the etiology was viral in 22.4% of cases including 11.3% of HBV, 34% of HCV and 54.7% of HBV-HCV co-infection. During follow-up, 37.8% had died. Hepatic encephalopathy (HR: 3.62), hepatocarcinoma (HR: 3.48), Child Pugh class B and C (HR: 7.14) and (HR: 8.79), were the risk factors for death.

Conclusion : The seroprevalence of hepatitis B and C is high among people living with HIV, sex workers, pregnant women, health workers, and cirrhotics, whose survival is reduced in the DRC. Several associated factors have been identified, including risk behaviors and belonging to a certain socio-professional category. Additional longitudinal studies throughout the DRC should assess the prevalence and determine the risk factors for hepatitis B and C.

Keywords: Frequency, HBV infection, HCV, HIV, Risk factors, Socio-professional category, Kinshasa, DRC