High Prevalence of Hepatitis B Virus Infection Compared to Human Immunodeficiency Virus among Blood Donors in Bangui

Introduction: Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) infection is a public health problem worldwide, particularly in sub-Saharan Africa. Objective: to compare the epidemiological, clinical and biological characteristics of chronic HBV and HIV infection in blood donors at the National Center for Blood Transfusion (NCBT) in Bangui. Patients and Methods: This was an 8-month analytical cross-sectional study from August 10, 2011 to April 9, 2012. During this study, we consecutively enrolled consenting blood donors of both sexes in which the search for HBsAg and HIV infection was carried out. Results: During the study period, 850 blood donors were collected. HBsAg was found in 142 donors (16.7%), of whom 55 blood donors (6.5%) were coinfected with HIV. On the other hand, HIV serology was positive in 77 blood donors (9.1%) including 55 co-infected (6.5%) (10.6%). The risk factor found during HIV infection and HBV was unprotected sex with a p of 0.0038 and 0.0017 respectively. Conclusion: The prevalence of HBV infection is higher than that of HIV among blood donors in Bangui. The setting up of a national viral hepatitis control program, which will develop screening, treatment and vaccination actions could make the curve bend.


Hepatitis B Virus (HBV) infection and Human Immunodeficiency
deaths in 2018 worldwide [2]. In the Central African Republic, the prevalence of HBV infection varies from 10.6 to 19.8 depending on the study population [3] [4] [5] [6], while the prevalence of HIV infection is 4% [7]. These are two viruses that share the same modes of transmission. Blood remains the potential source of transmission of HBV and HIV. This is why it is important and essential to look for these two viruses apart from other infections in blood donors, in order to guarantee transfusion safety. Our objective was to compare the epidemiological characteristics of blood donors infected with HBV with those infected with HIV at the National Center for Blood Transfusion (NCBT) in Bangui.

Patients and Methods
We conducted an 8-month cross-sectional analytical study from August 10, 2011 to April 9, 2012

Results
During the study period, we collected 850 blood donors (791 men and 59 women) among which 142 (16.7%) were carriers of HBsAg and 77 (9.1%) were infected with HIV. Among donors infected with HIV and HBV, we had 55 (6.5%) blood donors co-infected with HBV/HIV (51 men and 4 women). The statistical analysis concerned only the mono-infected patients HBV and HIV in order to allow a better interpretation of the risk factors. Table 1 shows the distribution by sex.
The average age of HIV and HBV patients was 25.7 and 26.2 years, respectively. Figure 1 shows the distribution by age group. Table 2 shows the different types of blood donors according to HBsAg status.
Family donors and occasional donors were linked to the carriage of HBsAg.
The distribution of blood donors according to HIV status is presented in Table 3. Only family donors were more exposed to HIV infection.
Risk factors for HIV infection and HBV are shown in Figure 2. The only risk factor found was protected or unprotected sex.

Discussion
However, our study has limitations, notably the lack of funding for the biological (HBV viral load, blood fibrosis tests) and morphological (fibroscan or liver biopsy puncture for histological analysis) evaluation of the stage of chronic hepatitis B in seen to consider treatment. This management difficulty could only be overcome if the country had a national program to combat viral hepatitis. However, our study has the merit of showing decision-makers the extent of HBV infection in the population and the risk that patients run in the years to come, in particular the occurrence of complications such as cirrhosis and/or hepatocellular carcinoma. The prevalence of HBV and HIV infection in our study is higher than that observed in Yaoundé in Cameroon [8], in Kinshasa in the Democratic Republic of Congo [9], in Niamey in Niger [10], in Dar Es Salaam in Tanzania [11] and Burkina Faso [12]. However, it is lower than that reported by the authors in Osogo in Nigeria [13] and in Bamako in Mali [14]. Table 4 presents the prevalence of HBV and HIV infections in the different countries.
However, in Morocco, the prevalence of HBV infection is 3.97‰ and that of HIV infection 0.15‰ [15]. In Tripoli, Libya, the authors reported a prevalence of HBV infection at 2.6% for HBV and 0.4% for HIV [16]. These results confirm that the prevalence of HBV and even HIV infection is higher in sub-Saharan Africa. Also, the frequency of HBV infection is higher than that of HIV infection.  [17]. It is linked to the fact that it is men who are often asked to donate blood, especially when it comes to compensatory donation, where the family sees only men first. The average age of donors infected with HBV is slightly higher than that of donors infected with HIV. The average age of blood donors infected with HBV in our study of 26.2 years and that of blood donors infected with HIV of 25.7 years is slightly lower than that reported by the authors in Cameroon, where the mean age was 28 years for HBV-infected blood donors and 26.3 years for HIV-infected blood donors [8]. HBV and HIV infection is more common in young adults in Africa. This is the sexually active population, probably not often using preventive measures. In our study, compensating family donors and occasional donors were the most infected with HBV and HIV.  [18]. The risk factor for HBV and HIV infection found in our donors was unprotected sex. Sexual transmission is one of the common modes of transmission of these two viruses. People should always be made aware of the use of condoms during casual sex.

Conclusion
The prevalence of HBV infection is higher than that of HIV among blood donors in Bangui. Hence the need to set up a national program to fight viral hepatitis, which will develop awareness-raising, screening, treatment and above all vaccination of subjects not infected with HBV.