Infection with Hepatitis B and C Virus in the Democratic Republic of Congo: A Public Health Problem ()
1. Introduction
Hepatitis B and C viruses (HBV and HCV) are different viruses that have the same modes of transmission, the same targets and present the same symptoms. HBV is a DNA virus belonging to the family of hepadnaviridae of the genus orthohepadnavirus [1] . In contrast, HCV is an RNA virus of the flaviridae family of the genus hepacivirus [1] .
Viral hepatitis represents a major public health burden with more than 375 million people with chronic hepatitis B infection and 130 to 150 million with hepatitis C for 2016, of which 4 to 5 million infected with the Human Immunodeficiency Virus (HIV) and about one million deaths per year [1] . Sub-Saharan Africa bears the greatest burden of the epidemic.
For HBV, transmission is mainly parenteral, sexual and maternofetal [2] [3] . It is linked to parenteral injections (blood transfusions, intravenous drug use, hemodialysis), sex with people infected with the virus, transplacental transit or delivery (vertical transmission) [1] [2] [3] [4] . Immunocompetent adults have more than 90% spontaneous HBV clearance capacity. Likewise for HCV, transmission is mainly parenteral [1] [2] [3] [5] .
People infected with HBV and HCV do not usually feel sick and recover completely. Those who are symptomatic have symptoms similar to the common flu (fever, headaches, etc.) as well as stomachaches, diarrhea and jaundice that normally begin 1 - 3 months after the virus enters the body. Ten percent (10%) of adults with acute hepatitis B and 80% of those with hepatitis C develop chronic infection that may result in cirrhosis and/or liver cancer later in the patient [1] .
For several years, different works have made it possible to better understand and specify the different profiles as well as the carriage of hepatitis infection in the Democratic Republic of Congo (DRC) among transfused persons, blood donors and People Living with HIV (PLHIV). The objective of this review is to present the characteristics of hepatitis B and C infections (HBV and HCV), to present the synthesis and to estimate the extent of this infection in the DRC for the last 20 years.
2. Methods
2.1. Literature Search
2.2. Criteria for Inclusion and Non-Inclusion
3. Results and Discussions
The objective of this literature review was to present the carriage and extent of hepatitis B and C infection (HBV and HCV) in the Democratic Republic of Congo (DRC) compared to the different data published over the last 20 years. Seven (7) works have been documented for the DRC particularly meeting the different selection criteria. According to the various works published and presented in conference since 1997, the populations targeted for the surveillance surveys on the hepatitis B and C infections are the poly-transfused, the blood donors and the People Living with HIV (PLHIV). All data are presented in Table 1.
In 1999, Mbendi NC et al. reported a prevalence of HBV infection of 9.2% using 7277 sera from volunteers who agreed to donate blood for the first time (first time blood donor) in the eastern part of the city of Kinshasa [6] . The average age was 32.01 ± 9.23 years with extremes ranging from 10 to 79 years. The most represented age group in this cohort was 30 to 39 years, followed by 25 to 29 years. The male patients dominated in the total population of 77.9% [6] . This work was carried out in collaboration with the following hospitals: University Clinics of Kinshasa (UCK), Kingasani Hospital Center (CHK), Kinshasa
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Table 1. Prevalence of Hepatitis infections per studies in DRC.
Kimbanguist Hospital (HKK) and N’djili Hospital (HND) [6] .
In 2000, Baleka F et al. worked on 373 blood donor sera from blood transfusion centers at Kinshasa General Hospital (KGH), Kimbanseke Kimbanguist Hospital, Kintambo Hospital, Bondeko Clinic and Ngaliema Clinic, all in the city of Kinshasa [7] . HBV carriage was 5.9% while HCV carriage was 4.8% in this donor population. The most represented age group is that of 21 to 39 years followed by that of 40 to 49 years for both viral infections [7] . Donors were predominantly male dominated with 311 donors (83.4%). The median age of the population was 36 years old. The majority of donors (92.5%) were family donors [7] .
In 2001, Laurent C et al. presented a carriage of 5.0% for HCV in an all-female population of 1806 HIV-negative patients [8] . The population consisted of professional sex workers followed in appropriate treatment centers and pregnant women followed in prenatal consultation structures accredited by the health system of Kinshasa [8] .
In Kisangani, capital of Orientale Province, Batina A et al. published a portage of HBs antigen in the period from 2003 to 2004 of 5.4% in a population of 3390 blood donors at the Provincial Blood Transfusion Center (PBTC) of Kisangani [9] . The average age of donors was 35 ± 1.24 years, and females (54.4%) dominated the donor population [9] . The majority (69.2%) of blood donors were family donors followed by volunteer donors (29.2%) [9] .
In Bukavu, capital of South Kivu province, Kabinda JM et al. reported hepatitis B and C prevalences of 8% and 10% respectively in a population of 209 immunocompromised patients (HIV positive) and 8% and 4% in a population of 211 immunocompetent controls (HIV-negative) in 2008 [10] . The mean ages of the 2 populations were 36.7 ± 11.7 years and 37.3 ± 11.3 years, respectively, for immunocompromised and immunocompetent patients. The most represented age group was 21 to 39 years in both populations [10] . Females were more represented in both populations; 67.2% in the immunocompetent group and 67.4% in the immunocompromised group [10] . The immunocompetent group consisted of 143 (67.8%) volunteer blood donors and 68 (32.2%) patients hospitalized in the Internal Medicine Department of the Bukavu Provincial Hospital [10] .
In 2014, Kabinda JM et al. published a seroprevalence of hepatitis B and C respectively of 4.2% and 3.8% on a population of 1079 voluntary unpaid blood donors in Bukavu [11] . The most represented age group was under 30 years in the range of 18 to 60 years and a median age of 26 years. The male sex (72.4%) was dominant in the surveyed population [11] . Just over half, 54.5%, consisted of new blood donors [11] . According to the study, for the city of Bukavu, the profile of the donor at risk is a married male blood donor from rural areas under the age of 30 years [11] .
For the years 2012 and 2013, Kamangu NE et al. published a carriage of HCV respectively 5.8% and 5.2% of 5271 and 5040 blood bags tested at National Blood Transfusion Center (NBTC) in Kinshasa, a total of 10,311 blood bags for 2 years [12] . The most represented age group in the population was 18 - 30 years old with 82.6% followed by that of 31 - 40 years old with 13.5% and that of 41 - 50 years old with 3.2% [12] . The male dominated the population with 85.8%. Carriage of HCV was twice that of HIV infection under the same conditions [12] .
Studies presenting the prevalence of hepatitis B and C in the DRC are for the most part conducted in Blood Transfusion Centers (BTC) across the country. There is no study conducted in the general population.
Through all these different studies, it is clear that the prevalence of hepatitis is always higher than that of HIV in blood donor populations; from 6.4% and 9.2% in 1999 [6] to 3.8% and 5.9% in 2000 [7] respectively for HIV and HBV, or 3.8% and 4.8% in 2000 [7] to 2.1% and 5.2% in 2013 [12] respectively for HIV and HCV specifically in Kinshasa. The prevalence of HBV is always higher than that of HCV in the same populations [7] [10] [11] .
4. Conclusion
Although often asymptomatic, viral hepatitis B and C are a public health problem for the Democratic Republic of Congo. The carriage of these viral infections is far superior to that of HIV infection in Blood Transfusion Centers across the country.
Conflict of Interest
The authors declare that there is no conflict of interest.