Prevalence of hepatitis B and C viral co-infection and associated factors with HIV infection in children in South Kivu, Democratic Republic of the Congo

The main objective of this study was to determine the seroprevalence as well as risk factors of HBV and HCV co-infections in HIV- children. In particular, the study found that seroprevalence of HBV is higher in seropositive children than in seronegative.

HBV seroprevalence is higher than in all previous published data in HIV-negative children. Indeed, according to the latest estimates, DRC is among high intermediate endemic area (prevalence of HBsAg from 5 to 7%) for both children and adults [4, 12]. Our data also seem to show a significantly higher seroprevalence than those previously found in other subgroups of children, including 0% in poly-transfused children but 1.96% was found in HIV children in the Capital City of Kinshasa in the Western part of the DRC [21,22,23]. A community study carried out in the center of the country (Province of Maniema) noted a seroprevalence of 3.6% among children aged from 0 to 59 months [20].

It is well established that HBV transmission in Africa remains MTC and community-based during the first years of life [10, 19, 23, 24]. The possibility of sharing main routes of contamination as well as the importance of family context in transmission may be explained since our study noted that a history of jaundice was associated with a risk factor for HIV infection: OR 1.93 (95%CI: 1.05–3.52). p = 0.028.

The high prevalence of HBV in our children could be explained by the sharing of transmission ways with HIV but also by the fact that vaccination coverage is not yet optimal in all parts of the DRC [10, 20, 21, 23, 24]. This could explain the difference in seroprevalence with that of Province of Maniema [20]. Indeed, this last province is among the least covered by HBV vaccination. As for naive children, systematic vaccination remains the single most effective preventive factor in addition to systematic screening of the two viruses in pregnant women and administration of the first dose of the anti-HBV vaccine at birth.

Compared to HCV, although seroprevalence is slightly elevated in HIV + children but the difference is not statistically significant. In addition, it remains low compared to national estimates or to previous studies in other subgroups of children. Indeed, a prevalence of 13.5% was found among transfused children in Kinshasa and 2.8% in a community study in Maniema [20, 21]. Unfortunately, to our knowledge, there are no comparative studies on HIV + patients in the DRC. Nevertheless, other studies conducted in Africa have been able to find an association between HIV infections and HCV [25,26,27].

Apart from the small size of our sample, the risk factors for HCV contamination have already been pinpointed in previous studies, in particular case of blood transfusion and scarification [13]. The lack of difference in HCV seroprevalence between the 2 groups (HIV positive and naïve patients) observed in our study may be partly explained by the low frequency of risk factors in children compared to hepatitis B. Indeed, the risk of MTC transmission is 8–10 times less than during hepatitis B.

Nevertheless, it should be noted that the prevalence of co-infections with viral hepatitis across the country is not uniform and depends on several associated factors, such as cultural and religious factors as well as the quality of healthcare services. On the other hand, the cross-border movements of populations are likely to have transformed the epidemiology of these pathologies in the DRC, more particularly in the border provinces like South Kivu.

However, our study has some limitations that should be noted. Firstly, the limited size of our sample could not allow us to specify the importance of some considered factors. On the other hand, the fact that the HBV test was only performed during a single course could not help to confirm the possibility of chronic infection. In addition, the lack of use of PCR (Polymerase Chain Reaction) does not allow us to confirm the presence of an active infection.

In conclusion, our study showed that the prevalence of HBV in HIV-infected children is globally higher than in naive children. In contrast, the rate of HCV does not seem very different in the two groups likely due to low risk of MTC transmission with this virus. However, some factors seem to suggest a mutual influence of contamination routes in the family context. Systematic screening for these three viruses in pregnant women associated to a better therapeutic choice in co-infected children should remain the major recommendations. In addition, conventional preventive measures against hepatitis B, including blood transfusion safety, systematic vaccination as well as the increase of vaccination coverage, should continue to be promoted.