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



Screening 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.



Overall, 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.



HIV 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.
Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. antoine.jaquet@isped.u-bordeaux2.fr.|INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. antoine.jaquet@isped.u-bordeaux2.fr.
Antoine
A
Jaquet
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.
Gilles
G
Wandeler
Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Sénégal.
Judicaël
J
Tine
Service de virologie, BIOLIM, Université de Lomé, Lomé, Togo.
Claver A
CA
Dagnra
Service de hépato-gastroentérologie, CHU de Yopougon, Abidjan, Côte d'Ivoire.
Alain
A
Attia
Service de maladies infectieuses et tropicales, CHU Sylvanus Olympio, Lomé, Togo.
Akouda
A
Patassi
Pavillon Spécial, Hôpital Aristide Le Dantec, Dakar, Sénégal.
Abdoulaye
A
Ndiaye
Centre d'investigation de la fibrose hepatique, Hopital Haut-Leveque, CHU de Bordeaux & INSERM U1053, Université de Bordeaux, Bordeaux, France.
Victor
V
de Ledinghen
Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.|INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.|Département de Santé Publique, Faculté des Sciences de la santé, Université de Lomé, Lomé, Togo.
Didier K
DK
Ekouevi
Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Sénégal.
Moussa
M
Seydi
Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.|INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.
François
F
Dabis
D000328:Adult; D000354:Africa, Western / Q000453:epidemiology; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D060085:Coinfection / Q000453:epidemiology; D015897:Comorbidity; D004279:DNA, Viral / Q000097:blood; D054459:Elasticity Imaging Techniques; D015658:HIV Infections / Q000453:epidemiology*; D006509:Hepatitis B / Q000097:blood / Q000453:epidemiology*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics; D006526:Hepatitis C / Q000097:blood / Q000453:epidemiology* / Q000276:immunology; D018937:Hepatitis C Antibodies / Q000276:immunology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D016488:Medicine, African Traditional / Q000706:statistics & numerical data; D016017:Odds Ratio; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D012307:Risk Factors; D012675:Senegal / Q000453:epidemiology; D012720:Severity of Illness Index; D013997:Time Factors; D014037:Togo / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
Africa; HIV; Hepatitis B; Hepatitis C; Liver fibrosis