Human Immunodeficiency Virus and Hepatitis C Virus Co-infection in Cameroon: Investigation of the Genetic Diversity and Virulent Circulating Strains

Background: RNA virus infections represent a significant cause of illness and death in vertebrates. Specifically in humans, RNA viruses are responsible for a wide range of acute, chronic, emerging and re-emerging infections. HIV and HCV rank as some of the most severe RNA viruse infections facing Africa. Methods: To determine genotypes and subtypes of HIV and HCV among co-infected patients in Cameroon, viral RNA was isolated from HIV/HCV co-infected individuals, in Douala, Cameroon. A total of 36 HIV/HCV co-infected isolates (22 from volunteer blood donors and 14 from people living with HIV/AIDS not yet on antiretroviral treatment) were analyzed using molecular biology techniques that involved RT-PCR, gene/TOPO cloning, DNA sequencing, and bioinformatics tools for sequence management and analysis. Epidemiological data were examined as well.Results: Results show that HIV strains isolated belong to the circulating recombinant forms CRF02_AG, whereas HCV isolates from Cameroon belong to genotypes 1, 2, and 4. The corresponding HCV subtypes investigated were 1a, 1b, 1c, 2a, 2c, 2k, and 4a. Subtypes 1a and 1b, most frequently found in developed countries, also circulate in Cameroon. Epidemiologic data show that HIV/HCV co-infected patients are older than HIVmono-infected patients.Conclusions: These results indicate that HIV/HCV co-infection represent a significant threat in Cameroon. There is evidence of genetic diversity of HIV and HCV; virulent hepatitis C virus subtypes 1a and 1b circulate in Cameroon. An epidemiological and molecular database on HIV and HCV is necessary for the development of further intervention in Cameroon as an imperative for monitoring disease progression.Key words: HIV; HCV; Co-infection ; Genotypes ; Virulent

Individual and healthcare supply-related barriers to treatment initiation in HIV-positive patients enrolled in the Cameroonian antiretroviral treatment access programme

International audienceIncreasing demand for antiretroviral treatment (ART) together with a reduction in international funding during the last decade may jeopardize access to ART. Using data from a cross-sectional survey conducted in 2014 in 19 HIV services in the Centre and Littoral regions in Cameroon, we investigated the role of healthcare supply-related factors in time to ART initiation in HIV-positive patients eligible for ART at HIV diagnosis. HIV service profiles were built using cluster analysis. Factors associated with time to ART initiation were identified using a multilevel Cox model. The study population included 847 HIV-positive patients (women 72%, median age: 39 years). Median (interquartile range) time to ART initiation was 1.6 (0.5-4.3) months. Four HIV service profiles were identified: (1) small services with a limited staff practising partial task-shifting (n = 4); (2) experienced and well-equipped services practising task-shifting and involving HIV community-based organizations (n = 5); (3) small services with limited resources and activities (n = 6); (4) small services providing a large range of activities using task-shifting and involving HIV community-based organizations (n = 4). The multivariable model showed that HIV-positive patients over 39 years old [hazard ratio: 1.26 (95% confidence interval) (1.09-1.45), P = 0.002], those with disease symptoms [1.21 (1.04-1.41), P = 0.015] and those with hepatitis B co-infection [2.31 (1.15-4.66), P = 0.019] were all more likely to initiate ART early. However, patients in the first profile were less likely to initiate ART early [0.80 (0.65-0.99), P = 0.049] than those in the second profile, as were patients in the third profile [association only significant at the 10% level; 0.86 (0.72-1.02), P = 0.090]. Our findings provide a better understanding of the role played by healthcare supply-related factors in ART initiation. In HIV services with limited capacity, task-shifting and support from community-based organizations may improve treatment access. Additional funding is required to relieve healthcare supply-related barriers and achieve the goal of universal ART access