Seroprevalence and Molecular Biodiverisity of Hepatitis C Infection in Congolese Diabetics

Summary: There is no evidence for comorbidity diabetes and hepatitis C virus infection in the Congo. The aim of this work was to determine the seroprevalence and molecular biodiversity of HCV in order to contribute to improving the management of Congolese diabetics. Patients and methods: It was a cross-sectional study that took place from 1 February to 30 September 2018 at the Brazzaville University Hospital, the Diabcare Health Center and the Adolphe Cissé Hospital in Pointe-Noire. It concerned diabetic patients followed in Brazzaville and Pointe-Noire agreeing to the study, after obtaining the opinion of the ethics committee of the research in health science. All samples collected were screened for the presence of anti HCV Ab using a rapid ALERE HCV test and the Monolisa HCV Ag-Ab ultra test for confirmation in Congo. Detection of the viral RNA was done by PCR retrotranscription and genotyping was performed according to the reverse hybridization technique in France. Data analysis was done with EpiInfo 6.0 software (2016); the proportions were compared using the Chi-square test or the Fisher test at the significance level of 5%. Results: Of 447 patients with diabetes mellitus, 49 had HCV positive serology and the sex ratio was 0.63. RNA was detectable genotypes was defined in = of of 4 patients, and in one of genotype 1 patients. The subtypes identified were subtype 4e subtype 4e subtype 4a/4c/4d and subtype 4h Conclusion: The prevalence of HCV is high in our study. These are important data for the improvement of the management of diabetics.


Introduction
Diabetes and hepatitis C infection are major public health problems worldwide [1] [2]. It is estimated that there are approximately 387 million cases of diabetes in the world. This number can reach 592 million by 2035 and 185 million the number of patients with viral hepatitis C, 80% of whom are chronic carriers [1] [3] [4]. It is a major cause of morbidity and mortality because it can be complicated by cirrhosis and hepatocellular carcinoma [3] [4]. It is interesting to note that some studies have shown that the prevalence of HCV infection in diabetics is much higher than that of the normal population; others studies have shown that HCV-infected patients tend to develop diabetes, reason attributed to insulin resistance [5]. It is known that diabetic patients are at increased risk of acquiring HCV due to extensive hospitalization and daily use of syringes [6]. In the Congo, the prevalence of HCV varies between 4% and 8% [7] [8] [9]. These results come from several studies carried out on certain populations such as blood donors and polytransfused patients [7] [8]. But no study has been done in diabetics in Congo. The absence of data in the Congo enables us to carry out the present study to determine the seroprevalence of the hepatitis C virus and the molecular profile of HCV in Congolese diabetics in order to contribute to the improvement of the in charge of diabetic patients.

Patients and Methodes
This was a descriptive and cross-sectional study that took place from 20

Discussion
The seroprevalence of anti-HCV Ab in our study population is high (11%). The results of our study are identical to those found in the world by other authors [4] [10] [11]. This high prevalence among diabetics is explained by the absence of a policy for the prevention and control of viral hepatitis C in Congo. Indeed, despite progress in prevention, control and care, the Congo does not always have a program to fight against viral hepatitis. Laloo et al. reported lower prevalence among diabetics [5]. Elira-Dockekias et al. reported 13.6% (n = 35) in sickle cell patients [8]. However, Atipo-Ibara et al. found 4.6% in blood donors [7]. The difference can be explained by the loyalty efforts of regular and occasional blood donors. This supports the hypothesis that regular blood donors are at low risk of transmission through blood transfusion, to the extent that they receive information about the importance of transfusion safety and are followed up by regular screening at each blood donation [7]. HCV RNA was detected in 35 out Open Journal of Gastroenterology of 49 HCV-positive patients, with a molecular prevalence of 71.4%. Diarra et al.
in Mali reported a molecular prevalence of 92% [4]. This high prevalence of patients with chronic HCV infection may be due to delayed diagnosis and/or lack of early management of the disease.Indeed, before our investigation, no diabetic patient knew his viral status. We identified genotype 4 in 10.7% of patients and genotype 1 in 0.2% of patients. The preponderance of Genotype 4 in our series is due to its endemic nature in Central Africa. Indeed, the epicenter of genotype 4 is located in Central Africa [12] [13] [14]. Several studies carried out in Congo corroborate our results although they are different populations [8] [13]. Genotype 1 is not common in Congo, its presence in our series could be explained by the immigration of Western populations, West Africans and Magrebine in Congo. Kabbaj et al. in Morocco reported a predominance of genotype 1 (60.4%) and genotype 2 (39.6%). However, genotypes 3 and 4 were not found in their study [15]. The difference between our studies is explained by the phileogeography of HCV in the world [16]. In our study, subtype 4e was predominant 61.4%, followed by subtype 4h (2.9%). However, our data are identical to those reported by Mongo-Onkouo et al. [13]. In addition to patients with genotype 4 and 1, the subtype could not be clearly identified in 4 cases. The difficulty of subtype determination by the INNO LIPA method has been noted by several authors [5] [12].
Our study has some limitations including the non-systematic realization of the load in all patients because a negative HCV serology does not exclude the carriage of HCV RNA. Thus, PCR remains the best diagnostic tool for HCV infection because the detection of HCV RNA is the only control viral replication.
Similarly, the size of our sample is small, it does not allow us to extrapolate our results on the national diabetic population.

Conclusion
At the end of our study, the prevalence of HCV is high among diabetics. This rise in prevalence highlights the importance of HCV testing in Congolese diabetic patients. The establishment of a program to fight against viral hepatitis will reduce the morbidity of this infection as well as these complications in the Congolese population.