1. Introduction
Hepatitis B virus (HBV) and Helicobacter pylori (HP) infections each constitute a major public health problem worldwide [1] [2] .
According to the World Health Organization (WHO), the global prevalence of HBV in 2015 was estimated at 10.5% [2] [3] . Sub-Saharan Africa is located in an area of high endemicity of HBV infection. The prevalences are generally greater than or equal to 8% [4] . In 2015, Atipo Ibara et al. reported a frequency of 9.9% in a study on the seroprevalence of HBV among blood donors in Congo [5] . A recent study carried out by Itoua Ngaporo Ngala et al. in 2018 reported a frequency HP of 79.8% among adults in Brazzaville [6] .
A primary event in the natural history of viral hepatitis B is the development of cirrhosis and hepatocellular carcinoma (HCC) are largely responsible for the high morbidity and mortality of this condition [7] . The occurrence of these complications involves factors linked to the virus, the environment and the terrain. Apart from age and gender, comorbidities play an important role.
The association between HP infection and chronic viral hepatitis B has been the subject of several studies in recent decades. Abu Al-Soud et al. reported that the presence of hpDNA in HBV-contaminated samples is associated with a high risk of developing HCC [8] [9] .
A Chinese study carried out on patients with liver disease at different stages, showed a high rate of HP infection [10] .
Ponzetto et al. in the 2000s found a prevalence of 89% versus 59% [11] .
In Congo, no study has been conducted on HP-HBV co-infection. The objective of this work was to describe the epidemiological and paraclinical aspects of HP infection in HBV carriers.
2. Patients and Method
This was a descriptive cross-sectional study ranging from January 1 to August 30, 2019, a period of 8 months. It took place in the Hospital Centers of the two major cities of Congo (Brazzaville and Pointe-Noire). The target population of our study consists of patients carrying HBV under antiviral treatment or not. Patients aged at least 18 years and consenting with a biological and morphological assessment were included. We did not include in our study patients taking or having taken antibiotics and/or PPIs less than 4 weeks ago. We excluded all patients who did not deposit fresh stools and those in whom stool extraction could not be done manually. Data collection was carried out in the different locations of the study. Data collection took place in two phases. Data collection using a pre-established survey form followed by stool sampling and analysis. This sampling consisted of searching for the HP antigen in the patients’ fresh stools using a ‘CerTest Hp®’ rapid detection kit. The variables studied covered sociodemographic, clinical and paraclinical aspects. Data entry was done using Excel 8.0 software. Statistical analysis was carried out with SPSS 20.0 software. The quantitative variables were presented as mean and/or standard deviation and the qualitative ordinal and nominal variables as number and percentage. Comparative tests were carried out with the Pearson chi2 test or the Fischer test. The test was considered significant when p ≤ 0.05.
3. Results
3.1. Sociodemographic Aspects
During our study, we included 169 patients. The frequency of HPAG in the stools of HBV carriers in our study population was 63.9% (n = 109).
Male patients represented 69% (n = 75) and female patients represented 31% (n = 34). The average age of the patients is 43.92 ± 13.51 years with the extremes of 18 years and 80 years. HP infection predominated in the age group over 40, at a rate of 64.50%. Sociodemographic aspects are represented in Table 1.
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Table 1. Socio-demographic factors of HP+ patients.
3.2. Transmission Risk Factors
Households comprising between 4 - 10 people and the use of public latrines were the risk factors most represented in 69% (n = 75) and 88% (n = 96), respectively. The distribution of transmission risk factors is shown in Table 2.
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Table 2. Transmission risk factors among HP-HBV co-infected.
3.3 Clinical and Biological Signs
During our study, half of the patients had hepatomegaly (Table 3). Biologically, the viral load of the hepatitis virus was detectable in 60.6% of cases (n = 66). Table 4 shows the distribution of patients according to biological signs
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Table 3. Clinical signs of HP-HBV co-infected patients.
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Table 4. Biological signs of HP-HBV co-infected patients.
4. Discussion
The frequency of HP infection was 63.9% among chronic HBV carriers. Our results are superimposable to data from the literature. Indeed, work carried out in China by Hao Q et al. in 2017 as well as Li BS et al. in 2011 found a prevalence of 63.9% and 63.82% respectively [12] [13] . In Egypt, Amal AM et al. reported a prevalence of 60% in 2018 [14] . A study carried out in 2019 in Benin reported a frequency of 57.9% [15] . The similarity of the results observed in these studies could be explained by the fact that the sampling method used is identical and that the population of HBV carriers is predominantly male. On the other hand, some authors have reported frequencies below ours. This is Wang MY et al. in 2011 in China who found a prevalence of 38.67% [16] . This difference could be explained by the fact that the patients included in their study were asymptomatic carriers of HBV and probably have unevolved chronic hepatitis B with a relatively uncollapsed immune system.
The average age in this study was 43.92 ± 13.51 years with extremes of 18 and 80 years. There is no statistically significant difference between different age groups and HP infection in HBV carriers. But HP infection predominated in the age group over 40, at a rate of 64.50%. This average is similar to that reported by Wang MY et al. in China in 2011 of 43 years, as well as Séhonou J et al. in Cotonou (Benin) which was 42.3 ± 11.6 years [15] [16] .
In our study, the average number living under the same roof is 4.33 ± 2.32 people per household with no statistically significant link with HP infection. This result is higher than that of the study carried out by the EDSC-II which reports an average of 4.3. This result could be explained by the fact that large households are common in our countries [16] .
These results are contrary to those reported by Ji SW et al. in 2008 in China [9] . This discrepancy could be explained by the precarious conditions that we find in our countries, thus promoting promiscuity in households.
In our study, the use of public latrines was the most frequent in 88% of cases.
These results are similar to those of Itoua Ngaporo et al. in Brazzaville in 2018 as well as Aguenom et al. in Benin in 2005 who found a significant link between the type of latrine and HP infection with p = 0.016 [6] [17] . These similarities could be explained by the poor hygienic conditions of public latrines. Additionally, HP infection is known as dirty hands disease. After using public latrines, hand washing is not systematic.
The frequency of hepatomegaly in this population is 43.8%. This frequency is higher in patients carrying the hepatitis B virus. The existence of the large liver could be explained by the fact that half of the population was at the F4 fibrosis stage.
Our study noted a link between HBV viral load levels and HP infection. In Benin, Séhonou J et al. in 2018 as well as in China, Wang MY et al. in 2013 and Ji et al. in 2008 reported that there was no statistically significant link between HP infection and HBV DNA [9] [15] [16] .
On the other hand, Huang J et al. in 2017 and Xi et al. in 2015 reported that the rate of HP infection in patients with an HBV viral load greater than 103 copies/mL was significantly higher than in subjects with HBV viral load less than 103 copies/mL [7] [18] . Huang J et al. had suggested that HBV replication could increase the infection rate of Hp.
5. Conclusion
This study highlighted a high frequency of Helicobacter pylori infection in chronic HBV carriers. The use of public latrines has been identified as a factor associated with co-infection.