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HIV infection, viral hepatitis and liver fibrosis among prison inmates in West Africa

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      Abstract

      BackgroundPrisoners represent a vulnerable population for blood-borne and sexually transmitted infections which can potentially lead to liver fibrosis and ultimately cirrhosis. However, little is known about the prevalence of liver fibrosis and associated risk factors among inmates in sub-Saharan Africa.MethodsScreening of liver fibrosis was undertaken in a randomly selected sample of male inmates incarcerated in Lome, Togo and in Dakar, Senegal using transient elastography. A liver stiffness measurement ≥9.5 KPa was retained to define the presence of a severe liver fibrosis. All included inmates were also screened for HIV, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infection. Substances abuse including alcohol, tobacco and cannabis use were assessed during face-to-face interviews. Odds Ratio (OR) estimates were computed with their 95 % Confidence Interval (CI) to identify factors associated with severe liver fibrosis.ResultsOverall, 680 inmates were included with a median age of 30 years [interquartile range: 24–35]. The prevalence of severe fibrosis was 3.1 % (4.9 % in Lome and 1.2 % in Dakar). Infections with HIV, HBV and HCV were identified in 2.6 %, 12.5 % and 0.5 % of inmates, respectively. Factors associated with a severe liver fibrosis were HIV infection (OR = 7.6; CI 1.8–32.1), HBV infection (OR = 4.8; CI 1.8–12.8), HCV infection (OR = 52.6; CI 4.1–673.8), use of traditional medicines (OR = 3.7; CI 1.4–10.1) and being incarcerated in Lome (OR = 3.3; CI 1.1–9.8) compared to Dakar.ConclusionsHIV infection and viral hepatitis infections were identified as important and independent determinants of severe liver fibrosis. While access to active antiviral therapies against HIV and viral hepatitis expands in Africa, adapted strategies for the monitoring of liver disease need to be explored, especially in vulnerable populations such as inmates.

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        Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence.

        In efforts to inform public health decision makers, the Global Burden of Diseases, Injuries, and Risk Factors 2010 (GBD2010) Study aims to estimate the burden of disease using available parameters. This study was conducted to collect and analyze available prevalence data to be used for estimating the hepatitis C virus (HCV) burden of disease. In this systematic review, antibody to HCV (anti-HCV) seroprevalence data from 232 articles were pooled to estimate age-specific seroprevalence curves in 1990 and 2005, and to produce age-standardized prevalence estimates for each of 21 GBD regions using a model-based meta-analysis. This review finds that globally the prevalence and number of people with anti-HCV has increased from 2.3% (95% uncertainty interval [UI]: 2.1%-2.5%) to 2.8% (95% UI: 2.6%-3.1%) and >122 million to >185 million between 1990 and 2005. Central and East Asia and North Africa/Middle East are estimated to have high prevalence (>3.5%); South and Southeast Asia, sub-Saharan Africa, Andean, Central, and Southern Latin America, Caribbean, Oceania, Australasia, and Central, Eastern, and Western Europe have moderate prevalence (1.5%-3.5%); whereas Asia Pacific, Tropical Latin America, and North America have low prevalence (<1.5%). The high prevalence of global HCV infection necessitates renewed efforts in primary prevention, including vaccine development, as well as new approaches to secondary and tertiary prevention to reduce the burden of chronic liver disease and to improve survival for those who already have evidence of liver disease. Copyright © 2012 American Association for the Study of Liver Diseases.
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          Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity.

          Chronic hepatitis B virus infection is one of the most serious infections and a major risk factor for deaths from cirrhosis and liver cancer. We estimate age-, sex- and region-specific prevalence of chronic HBV infection and calculate the absolute number of persons being chronically infected. A systematic review of the literature for studies reporting HBV infection was conducted and worldwide HBsAg seroprevalence data was collected over a 27-year period (1980-2007). Based on observed data, age-specific prevalence and endemicity were estimated on a global level and for all world regions for 1990 and 2005 using an empirical Bayesian hierarchical model. From 1990 to 2005, the prevalence of chronic HBV infection decreased in most regions. This was particularly evident in Central sub-Saharan Africa, Tropical and Central Latin America, South East Asia and Central Europe. Despite this decrease in prevalence, the absolute number of HBsAg positive persons increased from 223 million in 1990 to 240 million in 2005. Age-specific prevalence varied by geographical region with highest endemicity levels in sub-Saharan Africa and prevalence below 2% in regions such as Tropical and Central Latin America, North America and Western Europe. Asian regions showed distinct prevalence patterns with lower intermediate prevalence in South Asia, but up to 8.6% HBsAg prevalence in East Asia. Strong declines were seen in South East Asian children. Declines in HBV infection prevalence may be related to expanded immunization. The increasing overall number of individuals being chronically infected with HBV, and the widespread global differences in HBV prevalence call for targeted approaches to tackle HBV-related mortality and morbidity. HBV infection prevalence data are needed at country and sub-national level to estimate disease burden and guide health and vaccine policy. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Author and article information

            Affiliations
            [ ]Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000 Bordeaux, France
            [ ]INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000 Bordeaux, France
            [ ]Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Sénégal
            [ ]Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
            [ ]Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
            [ ]Service de virologie, BIOLIM, Université de Lomé, Lomé, Togo
            [ ]Service de hépato-gastroentérologie, CHU de Yopougon, Abidjan, Côte d’Ivoire
            [ ]Service de maladies infectieuses et tropicales, CHU Sylvanus Olympio, Lomé, Togo
            [ ]Pavillon Spécial, Hôpital Aristide Le Dantec, Dakar, Sénégal
            [ ]Centre d’investigation de la fibrose hepatique, Hopital Haut-Leveque, CHU de Bordeaux & INSERM U1053, Université de Bordeaux, Bordeaux, France
            [ ]Département de Santé Publique, Faculté des Sciences de la santé, Université de Lomé, Lomé, Togo
            Contributors
            33 (0)5 57 57 95 37 , 33 (0)5. 57.57.45.28 , antoine.jaquet@isped.u-bordeaux2.fr
            Journal
            BMC Infect Dis
            BMC Infect. Dis
            BMC Infectious Diseases
            BioMed Central (London )
            1471-2334
            6 June 2016
            6 June 2016
            2016
            : 16
            27267370
            4895802
            1601
            10.1186/s12879-016-1601-4
            © The Author(s). 2016

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            Funding
            Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;
            Award ID: 5U01AI069919
            Award Recipient :
            Categories
            Research Article
            Custom metadata
            © The Author(s) 2016

            Infectious disease & Microbiology

            africa, hepatitis c, hepatitis b, hiv, liver fibrosis

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