Prevalence and determinants of Hepatitis C Virus Infection and Genotypes in Chronic Hemodialysis Patients in Kinshasa

Context and objective. The steady increase in the number of chronic hemodialysis patients in sub-Saharan Africa (SSA) calls for improved management of those patients. The present study aimed to determine the frequency of hepatitis C virus (HCV) infection, the prevalent genotypes, and the risk factors associated with HCV in hemodialysis patients in Kinshasa (DR Congo). Methods. A cross-sectional study was conducted from February to June 2018 in all hemodialysis centers in Kinshasa. Blood samples were collected from 127 chronic hemodialysis patients and tested for the presence of antibodies against HCV. The HCV genotype was identified by real-time polymerase chain reaction (RT- PCR). Results. Twenty-two (17.3 %) patients were positive for anti-HCV antibodies, ranging from 0 % to 52.9 % in different centers. Genotype 4 was detected in 18/22 (81.8 %), followed by genotype 2 in 2/22 (9.1%), and both genotypes 2 and 4 in one patient (4.5%). One patient had an undetermined genotype (4.5 %). Having received at least 4 transfusions [7,21 (1,09- 10,61); p=0.040)], not being under EPO treatment [5,81(1,47-12,96); p=0.012)], being on hemodialysis for at least 14 months [3,63(1,60-5,05); p=0.035)]and being dialyzed in an overloaded center [2,06(0,83-5,86); p=0.073)] were associated with a greater risk of HCV infection. Conclusion. This high HCV prevalence (17.3 %) represents a substantial health burden in HD patients from Kinshasa, DR Congo. It is largely driven by the number of blood transfusions, the duration time in hemodialysis. Observations from the present study underscore the need of reducing the number of blood transfusions in people on dialysis through the administration of erythropoietin, given the unaffordable cost of HCV therapy for most individuals in DR Congo.

Contexte et Objectifs. Le nombre des patients hémodialisés en Afrique subsaharienne en constante augmentation ; justifiant de ce fait une meilleure prise en charge de ces patients. La présente étude détermine la prévalence de l'infection par le virus de l'hépatite C en en determinant les génotypes ainsi que les facteurs y associés dans ce groupe de patients. Méthodes. 127 patients hémodialisés chroniques ont subis des tests sérologiques à la recherche des anticorps anti-VHC dans plusieurs centres de Kinshasa de février à juin 2018. Le génotype viral a été déterminé par la RT-PCR. Résultats. La fréquence des anticorps anti-VHC a varié de 0 à 52,9 % dans ce groupe. Les génotypes le plus fréquents ont été le 4 (18/22) et le 2 (2/22) ; étant sumultanément rétrouvé chez un patient, et indéterminé chez un autre sujet. Avoir reçu au moins 4 transfusions [7,21 (1,09-10,61; p=0.040)], ne pas être sous EPO [5,81(1,47-12,96); p=0.012)], être en hémodialyse depuis au moins 14 mois [3,63(1,60- 5,05); p=0.035)] et être dialysé dans un centre surchargé [2,06 (0,83-5,86); p=0.073)] étaient associés à un risque plus élevé d'infection par le VHC. Conclusion. Ses principaux déterminants sont : le nombre des transfusions sanguines et la durée d'HD ; d'où la nécessité de réduire les transfusions sanguines chez les sujets dialysés par l'administration d'EPO, étant donné le coût prohibitif du traitement contre le VHC dans notre contexte

Recommandations de la Société Congolaise de Néphrologie (SOCONEPH) pour la prise en charge des patients en dialyse dans le contexte de pandémie à COVID-19

Les patients en hémodialyse présente un risqué élevé d'infection à SARS-Cov-2. Les stratégies préventives doivent donc être mises en place pour réduire le risque de transmission de la maladie en hémodialyse parmi lesquelles, l'éducation du staff médical ainsi que des patients, le screening de la maladie à COVID-19 ainsi que la séparation des patients infectés ou symptomatiques des non infectés

Admission hyperglycemia and associated risk factors among patients with acute stroke in intensive care units in Kinshasa, the Democratic Republic of the Congo

Context and objective. Despite being established as a correlate of unfavorable outcome in acute stroke, little is known about the burden and associated risk factors of admission hyperglycemia in acute stroke in sub-Saharan Africa. The present study aimed to assess its frequency and associated risk factors in Congolese patients admitted in Intensive Care Units (ICUs) in the acute phase of stroke. Methods. A multicenter (6 ICUs) prospective cohort study including consecutive patients with acute stroke was undertaken from July 15th, 2017 to March 15th, 2018.The Glasgow Coma Scale helped to determine the severety of the disease at admission. Stress hyperglycemia was considered for a random blood glucose levels at admission ˃140 mg/dL in patients without type 2 diabetes mellitus (T2DM). Independent factors associated with admission hyperglycemia were assessed using logistic regression analysis. Results. Out of 194 patients (mean age 58.7±13.1 years; 64% males, 74.7% light to moderate stroke severity; 59% hemorrhagic stroke) enrolled, admission hyperglycemia was found in 106 (54.6%) of patients (mean age 60.1 ± 14.3 years; 67% men, 67% hypertension) with 77 (72.6%) and 29 (27.4 %) of them having stress and chronic hyperglycemia, respectively. Independent predictors of admission hyperglycemia were age [aOR 1.98; 95%CI 1.17-3.36), GCS < 8 (aOR 3.83; 95% CI 1.99-7.35) and diabetes (aOR 9.02; 95%CI 3.38-14.05). Conclusion. More than half of critically ill patients exhibit admission hyperglycemia with age, severity of stroke and known diabetes as its main associated risk factors