High rates of active hepatitis B and C co-infections in HIV-1 infected Cameroonian adults initiating antiretroviral therapy.

OBJECTIVES: To investigate the presence of hepatitis B virus (HBV) DNA and hepatitis C virus (HCV) RNA in HIV-infected patients initiating antiretroviral therapy in Cameroon. METHODS: Baseline blood samples from 169 patients were tested retrospectively for hepatitis B surface antigens (HBsAg), anti-hepatitis B core (anti-HBc), anti-HCV and - if HBsAg or anti-HCV result was positive or indeterminate - for HBV DNA or HCV RNA, respectively, using the Cobas Ampliprep/Cobas TaqMan quantitative assay (Roche Diagnostics GmbH, Mannheim, Germany). RESULTS: HBV DNA was detected in 14 of the 18 patients with positive or indeterminate HBsAg results [8.3% of the total study population, 95% confidence interval (CI) 4.6-13.5]. The median HBV viral load was 2.47 x 10(7) IU/mL [interquartile range (IQR) 3680-1.59 x 10(8); range 270 to >2.2 x 10(8)]. Twenty-one patients (12.4%, 95% CI 7.9-18.4) were found with HCV RNA (all with positive HCV serology). The median HCV viral load was 928 000 IU/mL (IQR 178 400-2.06 x 10(6); range 640-5.5 x 10(6)). No patient was co-infected with HBV and HCV. In multivariate analysis, HCV co-infection was associated with greater age [>or=45 years vs. <45 years, odds ratio (OR) 11.89, 95% CI 3.49-40.55, P<0.001] and abnormal serum alanine aminotransferase level [>or=1.25 x upper limit of normal (ULN) vs. <1.25 x ULN, OR 7.81, 95% CI 1.54-39.66, P=0.01]; HBV co-infection was associated with abnormal serum aspartate aminotransferase level (OR 4.33, 95% CI 1.32-14.17, P=0.02). CONCLUSIONS: These high rates of active HBV and HCV co-infections in HIV-positive Cameroonian patients requiring antiretroviral therapy underline the need to promote: (i) screening for HBV and HCV before treatment initiation; (ii) accessibility to tenofovir (especially in HBV-endemic African countries); and (iii) accessibility to treatment for HBV and HCV infections.

[Upper digestive system hemorrhages in Cameroon (apropos of 172 cases examined via endoscopy)]. / Les hémorragies digestives hautes au Cameroun (à propos de 172 cas explorés par endoscopie).

172 cases of upper gastrointestinal bleeding were explored endoscopically from 01 March 1987 to 15 May 1989 in 3 centers in Cameroon. The patients comprised 124 men and 48 women with an average age of 39.64 years. Haematemesis with resultant melena constituted the most frequent presentation (42.36%) while haematemesis and melena was the unique presentation in 37.22% and 17.91% of cases respectively. The aetiologic factors encountered were: duodenal ulcers (33.64%), acute gastric bleeding (22.08%) gastric ulcer (13.44%), ruptured gastroesophageal varices (13.92%). Predisposing factors included the ingestion of gastric irritant medication, spices and alcohol. The authors review the literature and in its light, discuss the epidemiology and aetiology of gastrointestinal bleeding in Cameroon.