Abstract
Hepatitis C virus (HCV) contributes to liver-related morbidity and mortality throughout Africa despite effective antivirals. HCV is endemic in the Democratic Republic of the Congo (DRC) but data on HCV/HIV co-infection in pregnancy is limited. We estimated the prevalence of and risk factors for HCV/HIV co-infection among pregnant women in the Kinshasa province of the DRC. This cross-sectional study was conducted as a sub-study of an ongoing randomized trial to assess continuous quality improvement interventions (CQI) for prevention of mother-to-child transmission (PMTCT) of HIV (CQI-PMTCT study, NCT03048669). HIV-infected women in the CQI-PMTCT cohort were tested for HCV, and risk factors were evaluated using logistic regression. The prevalence of HCV/HIV co-infection among Congolese women was 0.83% (95% CI 0.43-1.23). Women who tested positive for HCV were younger, more likely to live in urban areas, and more likely to test positive during pregnancy versus postpartum. HCV-positive women had significantly higher odds of infection with hepatitis B virus (HBV) (aOR 13.87 [3.29,58.6]). An inverse relationship was noted between HCV infection and the overall capacity of the health facility as measured by the service readiness index (SRI) (aOR:0.92 [0.86,0.98] per unit increase). Women who presented to rural, for-profit and PEPFAR-funded health facilities were more likely to test positive for HCV. In summary, this study identified that the prevalence of HCV/HIV co-infection was < 1% among Congolese women. We also identified HBV infection as a major risk factor for HCV/HIV co-infection. Individuals with triple infection should be linked to care and the facility-related differences in HCV prevalence should be addressed in future studies.
Highlights
Hepatitis C virus (HCV) accounts for a large proportion of morbidity and mortality from liver disease globally, in sub-Saharan Africa (SSA)
Of 1,942 HIV-positive Congolese women tested for HCV, 16 (0.83%; 95% confidence intervals (CIs) 0.43-1.23) were HCV/HIV coinfected (Fig. 1)
About two-thirds (67.8%) of women included in the parent study were either divorced, separated, widowed, or never married
Summary
Hepatitis C virus (HCV) accounts for a large proportion of morbidity and mortality from liver disease globally, in sub-Saharan Africa (SSA). Liver-related complications have been demonstrated to be a frequent cause of mortality in co-infected individuals as well[4]. Infection with both HCV and HIV has been seen throughout SSA. HCV/HIV co-infection has a clear impact on individuals living in SSA, data on the prevalence of and risk factors for HCV/HIV co-infection in pregnancy are limited. We previously conducted a cross-sectional study investigating hepatitis B virus (HBV) and HIV co-infection in pregnant and postpartum women, demonstrating a high prevalence of co-infection and raising concern for increased risk of vertical transmission of both HIV and H BV8. We investigated facility-level factors that were associated with HCV status, such as location and type of facility the women attended, as well as the service readiness index, a measure of the quality of care a facility provides
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