Introduction: The human immunodeficiency virus (HIV) and human T-lymphotropic virus (HTLV) have gained global concern in the last decades. Infection with HIV is a major public health problem worldwide responsible for diverse clinical manifestations with increased morbidity and mortality in infected individuals. The emergence of several pathogens like HTLV in HIV carriers has complicated the management of the coinfection as there is neither a cure nor effective treatment for HTLV infection. The impact of co-infection of these two viruses on the immune system and disease progression remains unclarified. These retroviruses share similar routes of transmission and as a result co-infection is not rare in areas where they both co-exist. Cameroon which is an endemic zone for HTLV, has one of the highest HIV prevalence rates in Central Africa. However, information on HIV and HTLV co-infection in Cameroon is sparse. As a result, we carried out this study in a border area of the South Region of Cameroon.

Objectives: This study was carried out with the main aim to determine the prevalence of HIV and HTLV co-infection in the Abang Minko’o area of the South Region of Cameroon.

Methods: From October 2014 to May 2015, we carried out a cross-sectional analytic and descriptive study, in which pre-structured questionnaires were completed by the principal investigator and blood samples were collected from adults in the Abang Minko’o area of the South Region of Cameroon. Abang Minko’o is a border area located at about 220 km from the capital city, Yaounde and 1.5 km away from the border between Cameroon and Gabon. It is a commercial area with an international market, ‘Marché Mondial’ which attracts people from different regions in Cameroon, Gabon, Equatorial Guinea, Sao Tome and Principe, and Congo, and who all interact freely there. Hence, sexual promiscuity is high in this area. The blood specimens collected were screened for HIV using two rapid tests, Determine® HIV 1/2 test and ImmunoComb® II HIV 1 and 2 BiSpot test on the field site in Abang Minko’o, and the samples were transported to Yaounde, where in the Haematology Laboratory of the Yaounde University Teaching Hospital, further screened using an Enzyme-Linked ImmunoSorbent assay, Murex HIV Ag/Ab Combo. The samples were also screened for HTLV using the rapid test ImmunoComb® II HTLV 1 and 2 assay, which does not distinguish between the two types. Data was entered using Microsoft Excel 2013 and analyzed using SPSS version 20.0. Where appropriate, the Chi Square test was used to establish risk ratio (RR), confidence intervals (CI) and p-values. All p-values less than 0.05 were considered statistically significant.

Results: Out of 157 participants’ blood specimens analyzed, 10 were seropositive for HIV infection giving a prevalence rate of 6.4%. The prevalence was highest in the age group of 50-59 years (25% that is 3 participants out of 12) followed by in young adults of 30-39 years (9.5% that is 4 participants out of 42). Females were more infected (7.1%) than males (5.7%). The natives from Abang Minko’o called the Ntoumous, had the highest HIV prevalence rate (8.4%). Infection with HTLV 1 and 2 was found in 35 out of the 157 participants included in our study, giving a prevalence rate of 22.3%. The prevalence of HTLV generally increased with age and was highest amongst the age group 50-59 years (41.7%). Males were more infected (26.4%) than females (17.1%) with a sex ratio of 1.92.Co-infection with HIV and HTLV 1 and 2 was found in 4 out of the 157 participants, giving a prevalence rate of co-infection of 2.5%. The prevalence of HTLV 1 and 2 in HIV-1 positive participants was 40% which was 16 times more when compared to the co-infection rate in the general population. All the co-infected participants were natives from Abang Minko’o, the Ntoumous with males more infected than females (sex ratio 3:1). The trends of HIV and HTLV 1 and 2 infections in seropositive participants for each virus were almost similar.

  Amongst the risk factors associated with sexual behaviour and HIV transmission identified, sex-money exchange (prostitution) and a history of sexually transmitted infections (STIs) were significantly associated with HIV infection. Those practising sex-money exchange were more infected (10.5%; p = 0.039) and almost 2 times more at risk of HIV infection (RR 1.729; p = 0.039), and those who did so regularly were 4 times more exposed (RR 4.450; p = 0.075) even though this difference was not statistically significant. Participants with a history of STIs were more infected (12%; p = 0.048) and were 2 times more exposed to HIV infection (RR 2.005; p = 0.048). However, some other risk factors identified though not statistically significant, exposed more to HIV infection like alcohol consumption (RR 1.097; p = 0.786), cigarette consumption (RR 1.838; p = 0.381), visitation of night clubs or bars (RR 1.114; p = 0.754) with 2 times more exposure in regular visitors (RR 2.066; p = 0.506), sexual activity (RR 1.035; p = 0.553), age at first sex ˂16 years (RR 1.216; p = 0.260), having more than one sexual partner in the last 12 months (RR 1.421; p = 0.206), cheating on partner (RR 1.452; p = 0.124), homosexuality (RR 3.675; p = 0.205) and having a history of induced abortion or unwanted pregnancy (RR 1.405; p = 0.313). The use of condoms was found to be protective against HIV infection (RR 0.808; p = 0.455) and consistent use was even more protective (RR 0.000; p = 0.554) than inconsistent use (RR 0.854; p = 0.554).

Conclusion: We can conclude that the prevalence of HIV and HTLV 1 and 2 are high in Abang Minko’o. Co-infection of HIV and HTLV 1 and 2 is not rare. The prevalence of HTLV 1 and 2 in HIV-1 infection is high. Sexual behaviours are less tempered by social norms and values in this border area. The Abang Minko’o population constitutes a potentially vulnerable group for HIV and HTLV transmission. We can conclude that the prevalence of HIV and HTLV 1 and 2 are high in Abang Minko’o. Co-infection of HIV and HTLV 1 and 2 is not rare. The prevalence of HTLV 1 and 2 in HIV-1 infection is high. Sexual behaviours are less tempered by social norms and values in this border area. The Abang Minko’o population constitutes a potentially vulnerable group for HIV and HTLV transmission.

Recommendations: The Ministry of Public Health should emphasize on the need for regular and consistent use of condoms especially in mobile populations as a tool to prevent HIV transmission and co-infections, and also evaluate the cost-effectiveness of systematic screening for HTLV 1 and 2 on all blood donors before transfusion of collected samples in order to prevent transmission of the virus by blood transfusion through complementary studies on HTLV nationwide.

Keywords: Retroviruses; HIV; HTLV; Co-Infection; Prevalence; Risk Factors; Sexual Behavior; Border Area

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Citation

Citation: Fonweban Yvonne Ngoikuh., et al. “HIV and HTLV Co-Infection in Abang Minko’o Area of the South Region of Cameroon". Acta Scientific Medical Sciences 4.2 (2020): 12-31.

Copyright

Copyright: © 2020 Fonweban Yvonne Ngoikuh., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.