Molecular Diagnosis of Htlv-1 and Hcv Infection in Polytransfused Sickle Cell Disease in Kinshasa: Case of Cmmass

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Inkale, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7494059/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Jan, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted 14 You are reading this latest preprint version Abstract Context : Sickle cell patients present with permanent hemolytic anemia very often requiring transfusions. These transfusions put sickle cell patients at risk of HTLV-I and HCV infection. Objective : To determine the prevalence of HTLV-1 and HCV infection among polytransfused sickle cell patients in Kinshasa. Methods : This is a cross-sectional study with a descriptive aim in polytransfused sickle cell patients followed at the SS Mixed Medicine Center for Anemia (CMMASS). The parameters of interest were age, gender, number of transfusions. Molecular diagnosis of HTLV-I and HCV was carried out by conventional amplification. Results : The median age of polytransfused sickle cell patients is 29 years. The female gender is in the majority 51.1% and the median number of transfusions is 24. 11.1% of polytransfused sickle cell patients are infected with HCV with a female predominance (80%). 60% of cases infected with HCV received 2 to 19 transfusions. 5.5% of polytransfused sickle cell recipients are infected with HTLV-I with a female predominance (80%). 80% of cases infected with HTLV-I received more than 20 transfusions. 2.22% (2/90) of polytransfused sickle cell patients are coinfected with HCV and HTLV-1. The 2 cases are female and are all aged 26. They received more than 20 transfusions at 80%. Conclusion : Polytransfused sickle cell patients are a population at risk for HCV (11.1%) and HTLV-1 (5.5%) infections. Hence the need to introduce molecular tests and leukoreduction into transfusion safety. Polytransfused sickle cell patients RT-PCR HTLV-1 HCV Kinshasa INTRODUCTION Sickle cell disease is an autosomal recessive hereditary genetic disease. It is characterized by a transversion from base A to base T of the short arm of chromosome 11, at position 11p15.5 [ 1 , 2 ]. This mutation results in the replacement at the sixth codon of the first exon of the HBB gene of the beta globin chain of a GAG by a GTG, with the consequence, at the protein level, of the replacement of the 6th amino acid, glutamate. by valine [ 1 , 2 ]. This leads to the formation of hemoglobin S, hence the sickling of red blood cells. Patients with sickle cell disease often present with permanent hemolytic anemia and are at risk of developing chronic or acute organ damage (brain, lung, retina, kidney, etc.), sometimes severe [ 3 – 5 ]. The management of sickle cell disease often requires the use of blood transfusion to correct anemia or prevent certain complications. These transfusions put the sickle cell recipient at risk of viral transmission, including HTLV-1 and HCV infection. HTLV-1 is the causative agent of adult T-cell leukemia (ATL) and has been associated with tropical spastic paraparesis (TSP/HAM) [ 6 ] and HCV underlies liver cirrhosis and hepatocellular carcinoma. These two viruses are RNA viruses, their capsid is icosahedral and are enveloped viruses. HTLV-1 infection affects 10 to 20 million people worldwide [ 6 , 7 ] and HCV infection affects more than 178 million worldwide [ 8 ]. Sub-Saharan Africa is the largest reservoir of HTLV-1 virus, but its epidemiology remains poorly understood and transfusion remains the main route of transmission [ 7 ]. In the DRC, studies were carried out among sex workers, pregnant women [ 8 ] and in an ethnic group, in the former province of Equateur, where tropical spastic paraparesis was associated with HTLV-1 infection. [ 10 ]. But no study on HTLV-1 has been carried out in polytransfused sickle cell patients. West Africa and Central Africa appear to be areas of high endemicity with a seroprevalence greater than 9% for HCV infection [ 11 ]. In the DRC, approximately 2 million people are affected by HCV [ 12 ]. Publications on HCV infection based on rapid testing and enzymatic techniques exist with the residual risk [ 13 ] that this entails, but investigations based on molecular biology (PCR, Sequencing) do not seem to exist. In the DRC, HTLV-1 is not tested for during transfusion and HCV is tested for with a serological test. This serological test can not reveal a positive diagnosis before séroconversion. To avoid this risk, it seems important to use the molecular test which does not know the barrier of the serological window and the introduction of screening tests for HTLV-I in transfusion safety. The objective of this work is to use Molecular Biology techniques to investigate HTLV-1 and HCV infections in polytransfused sickle cell patients in the city of Kinshasa. METHODS This is a descriptive cross-sectional study involving polytransfused sickle cell patients at the SS Mixed Medicine Center for Anemia (CMMASS). It concerned polytransfused sickle cell patients from the CMMASS having received at least 2 transfusions, the last of which was less than 6 months ago, aged over 5 years and having agreed to participate in the study. This study took place from January 14, 2022 to March 14, 2022 The sampling applied is consecutive to the study period and not probabilistic. Parameters of interest included age, gender, number of transfusions as well as conventional Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) diagnostic results for HCV and HTLV-I. Patients who had given their consent to participate in the study (or consent from the guardian) received a sample of 5 ml of whole blood in an EDTA tube at the CMMASS and then brought in the cold to the Molecular Biology laboratory. from the Faculty of Medicine (LBFMM) of the University of Kinshasa. RNA extraction was carried out at LBMFM from plasma using the QiaGEN QIAmp®Viral RNA Mini ® extraction kit, following the manufacturer's recommendations. Two classic RT-PCRs were launched, one for the diagnosis of HCV and the other for HTLV-I following the diagram below: Obtaining the cDNA from the retrotranscriptase (Luna script RT super mix) with the RNA extract from each sample (see Table 1 ) in the micro-PCR tubes placed in the thermal cycler under the following conditions: 25 °c for 2 minutes; 55°c for 10 minutes; 95°c for 1 minute to obtain the cDNA (Table 1 ). Table 1 RT (Retrotranscriptase) composition. Prepared tubes Quantity Luna script RT super mix 2 µL RNA sample 8 µL Total 10 µL Start the PCR: primers, reaction composition and amplification cycle as described in Tables 2 , 3 and 4 for HCV and Tables 2 , 3 and 4 for HTLV-I. Table 2 HCV and HTLV-I primers REGIONS PRIMER SEQUENCES 5’-UTRs of HCV Forward primer 5’-TGCACGGTCTACGAGAC-3’ 322e339 5’-UTRs of HCV Reverse primer 5’-GCCTTGTGGTACTGCCTGAT-3’ 277e297 ENV of HLTV-1 Forward primer 5-GAACGCTCTAATGGCATTCTTAAAACC-3 ENV of HLTV-1 Reverse primer 5-GTGGTTGATTGTCCATAGGGCTAT-3 Table 3 Composition of the PCR mix (HCV AND HTLV-I) Prepared tubes Fl/sample reaction flight Q5 master mix 12,5 µL Primer Solution 1,1 µL PCR Water 8,9 µL Total 22,5 µL Table 4 the stages of the thermal cycle for HCV and for HTLV-I. HCV HTLV-I Steps Température Times Cycle Température Times Cycle Initial Dénaturation 95°C 15min 95°C 15min Dénaturation 95°C 30sec 95°C 30sec Hybridization 55°C 30sec 40 50°C 30sec 40 Elongation 72°C 30sec 72°C 30sec Elongation 72°C 7min 72°C 5min 4°C 4°C Each PCR product was mixed with bromophenol blue and placed in each well of 1% agarose gel. Statistical analysis Information on the subjects participating in the study as well as the results were recorded on the survey sheets. The data collected was entered on Windows Excel version 2016. The analysis of the results was carried out on SPSS version 2020 for Windows. The statistical tests used in this work are: the student test for quantitative variables and the chi-square test (x²) for qualitative variables. The results are expressed as mean standard deviation. The tables are reformatted in Excel. Ethical consideration The present study obtained the approval of the Ethics Committee of the School of Public Health of the Faculty of Medicine, University of Kinshasa (ESP/CE/1108/2021) and the agreement of those responsible for CMMASS before its start. Polytransfused sickle cell patients were informed of the study and gave their signed consent on an informed consent form before collecting the data. Guardian consent was sought for those under 18 years old. RESULTS 90 samples out of 90 polytransfused sickle cell patients who consulted at CMMASS/Yolo during the work period and who freely agreed to participate in the study, were amplified. Or an amplification rate of 100%. 3.1. Age, Gender and Number of transfusions (Table 5 ) Table 5 Distribution of polytransfused sickle cell patients according to age in year, Gender and Number of transfusion . Age in year N = 90 % 06–15 34 37,8 16–25 42 46,7 26–35 12 13,3 36–45 1 1,1 46–55 1 1,1 Gender N = 90 % Male 44 48,9 Female 46 51,1 Number of transfusion N = 90 % 02–10 49 54,40 11–19 28 31,11 20–28 6 6,66 29–37 5 5,55 38–46 2 2,22 Age Most polytransfused sickle cell patients are in the age group of 16 to 25 years at 46.7% followed by the age group of 6 to 15 years at 37.8% then the age group of 26 to 35 years. at 13.3%, finally the age group of 36 to 45 years and the age group of 46 to 55 years each have 1.1%. The median age was 29 years with a range of 6 to 50 years. Gender The female gender is in the majority at 51.1% compared to 48.9% of the male gender, giving a sex ratio of 1.04. Number of transfusions The majority of polytransfused sickle cell patients have a history of 2 to 10 transfusions at 54.4% followed by those with a history of 11 to 19 transfusions at 31.11% then those with a history of 20 to 28 transfusions at 6.6% finally. those with a history of 29 to 37 transfusions at 5.5% and a history of 38 to 46 transfusions at 2.2%. The median number of transfusions was 24. 3.2. Molecular diagnosis of HCV Frequency 11.1% of polytransfused sickle cell patients have HCV infection (Table ). Table 6 Frequency of HCV infections in polytransfused sickle cell patients. Result N % Positive 10 11,1 Négative 80 88,9 Total 90 100 Age 50% of polytransfused sickle cell patients are infected in the age group of 16 to 25 years, followed by 30% in the age group of 26 to 35 years and finally 20% in the age group of 6 to 15 years. Gender There is a female predominance with female/male sex ratio of 4/1 Number of transfusions The number of 2 to 10 transfusions and 11 to 19 transfusions each represent 30% of polytransfused sickle cell patients and the number of 29 to 37 transfusions represents 20%. The number 20 to 28 transfusions and the number 38 to 46 each represent 10%. These data above are shown in Table 7 Table 7 Distribution of HCV infections according to age, sex and number of transfusions Age in year N = 10 % 06–15 2 20 16–25 5 50 26–35 3 30 36–45 0 0 46–55 0 0 Gender N = 10 % Male 2 20 Female 8 80 Number of transfusion N = 10 % 02–10 3 30 11–19 3 30 20–28 1 10 29–37 2 20 38–46 1 10 A.3.Diagnosis of HTLV-1 infection Frequency 5.5% of polytransfused sickle cell patients are infected with HTLV-1 (Table 8 ). Table 8 Frequency of HTLV-1 infections in polytransfused sickle cell patients. Result Fréquency % Positive 5 5,55 Négative 85 94,45 Total 90 100 Age. The age group of 26 to 35 represents 40% of infected polytransfused sickle cell patients followed by the following three groups 6 to 15 years, 16 to 25 years and 46 to 55 years. Each has 20%. b. Gender There is a female predominance with a sex ratio of 4/1 f. Number of transfusions The number of 20 to 28 transfusions represents 40% of polytransfused sickle cell patients and the numbers of 2 to 10, 29 to 37 and 38 to 46 transfusions each represent 20%. The number of transfusions greater than 20 represents 80% of polytransfused diagnoses. These data above are shown in Table 9 Table 9 Distribution of HTLV-1 infections according to age, sex and number of transfusions Age in year N = 5 % 06–15 1 20 16–25 1 20 26–35 2 40 36–45 0 0 46–55 1 20 Gender N = 5 % Male 1 20 Female 4 80 Number of transfusion N = 5 % 02–10 1 20 11–19 0 0 20–28 2 40 29–37 1 20 38–46 1 20 A.4. HCV and HTLV-1 coinfection This study noted a prevalence of 2.22% (2/90) of polytransfused sickle cell patients coinfected with HCV and HTLV-1. The 2 cases are female and are all aged 26. They received more than 20 transfusions (table 10,11). Tableau 11 : Distribution of HCV and HTLV-1 co-infection according to age, sex and number of transfusions DISCUSSION The objective of this work is to use Molecular Biology techniques to investigate HTLV-1 and HCV infections in polytransfused sickle cell patients in the city of Kinshasa. Ninety polytransfused sickle cell patients were included in the study. Age, Gender and Number of transfusions Age The age of polytransfused sickle cell patients varies between 6 to 50 years. The age group of 16 to 25 is more dominant with 46.7%. The median age was 29 years. These data corroborate with those carried out by Mwanaut I in Kinshasa over a period of 11 years, in 180 polytransfused sickle cell patients from the CMMASS whose median age was 28 years [ 14 ] and those of the Ngo SF study in Dakar, carried out on a period of 13 years, in 129 polytransfused sickle cell patients in the clinical hematology department of the National Blood Transfusion Center in Dakar; the median age was 27 years [ 15 ]. It is important to note that hemoglobin S almost completely replaces hemoglobin F around 12 to 48 months. This thus promotes the occurrence of sickle cell crises indicating a blood transfusion, which are often more serious and more frequent during early childhood and adulthood. The number of blood transfusions also increases with age due to the absence of fetal hemoglobin and because of the vulnerability of these patients [ 16 ]. Gender The female gender is in the majority at 51.1% with a sex ratio of 1.04. This predominance is also found in the study by Mwanaut I in Kinshasa [ 14 ], Ya Pongombo S.M in Lubumbashi [ 17 ] and Nacoulma in Ouagadougou in Mali [ 18 ]. On the other hand, other authors in the DRC including Abdala K.A [ 19 ] and Mashako MR [ 20 ] and in Africa Diagne and Mabiala report a slight predominance of the male sex [ 21 , 22 ]. Finally, others see no predominance between the two sexes; this is the case of Thuilliez [ 23 ] and Dreux [ 24 ]. These differences would be related to the demographic data of each country because the transmission of sickle cell disease is not linked to sex [ 25 , 26 ]. Number of transfusions The median number of transfusions was 24. It is probably high because medications that increase fetal hemoglobin and vaccination are not systematic. The following authors (Tshilolo, Mukinayi BM [27] and Ya Pongombo [ 17 ] SM show that in Africa as in the DRC the first transfusion takes place around 2 years of age. The number of blood transfusions increases with age due to the absence of fetal hemoglobin and because of the vulnerability of these patients [ 16 ]. 4.3. Molecular diagnosis of HCV infection This study noted a prevalence of 11.1% of polytransfused sickle cell recipients infected with HCV with a female predominance (80%) in the age groups of 16 to 35 years. This prevalence is higher than the prevalence of the general population of donors in the DRC (1.21%), polytransfused sickle cell patients from Kisangani in the DRC (7.9%), those from the South-West of Nigeria (2.2%)., from Lagos (5%), to Jalingo (5%), in Taraba State, to Benin City (5%) but it is lower than that of Bahia (13.4%) in Brazil [ 28 – 34 ] . This can be explained by the fact that this study uses the molecular test. The other studies use serological tests which have the problem of residual risk, false positives and indeterminate results. The relatively small sample size may have contributed to the higher rate reported in the present study. Compared to the general population of donors, it could be normal that this result is higher because the more the patient is transfused, the more he runs the risk of becoming contaminated with HCV, especially since transfusion safety in sub-Saharan Africa in general and in the Democratic Republic of Congo in particular is faced with the problem of shortage of biological analysis inputs [ 35 ] and the use of tests incapable of detecting virus antibodies before the seroconversion period [ 35 – 37 ]. Compared to the results from Kisangani [ 28 ], all infected polytransfused sickle cell patients were those who received blood before the introduction of HCV screening tests in 2004. This is not necessarily the case in this study because the infected patients had for some under 20 years old and the DRC often experiences problems with shortages of inputs linked to transfusion safety. This study is cross-sectional and cannot attribute this high prevalence to transfusion alone because there are studies (cohort and control cases) which have concluded a higher prevalence of HCV infection among those never transfused than those with a history of transfusion [ 29 – 30 ]. This would suggest that blood transfusion cannot be considered the main mode of transmission of HCV [ 30 , 33 ]. This study noted a female predominance unlike other studies [ 29 – 32 ]. This is due to chance because the viral transmission of HCV is not linked to sex. The results of this study show that adults are more affected than children as in other studies [ 28 – 29 ]. This study shows that from the history of 2 transfusions that one can be infected with HCV. The number of transfusions increases with age and adults are more affected than children. The search for HCV is all the more important when we know that the presence of HCV and iron overload is directly linked to the number of blood transfusions in sickle cell patients, contributing to the increase in iron absorption, chronic hemolysis and direct liver damage due to tissue hypoxia during sickle cell disease-related vascular occlusion [ 34 , 24 ] Molecular diagnosis of HTLV-I infection This study noted a prevalence of 5.5% of polytransfused sickle cell recipients infected with HTLV-I with a female predominance (80%) in the age groups of 26 to 35 years (40%). The number of blood transfusion is 20 or more. This prevalence is similar to the results of the study by Diarra et al. In Mali in multi-transfused patients (2.8% and 7.5%) [ 35 ] and by Jose P et al in Bahia (4.7%) in Brazil [ 34 ]. This can be explained firstly by the fact that this study uses the molecular test which does not have the problem of residual risk, false positives and indeterminate results [ 38 ]. The Malian study used Elisa during screening and did not confirm positive sera by Western blot or PCR while a study carried out in Ivory Coast showed 37% (6/16) false positives using Elisa for screening and PCR as a comparator [ 39 ]. Another study among blood donors in Mozambique showed that out of 21 sera positive by Elisa (Murex) only nine were positive by WB and PCR [ 40 ]. It is possible that the seroprevalence is lower than that reported in the Malian study. Sub-Saharan Africa is an area of ​​high endemicity and seroprevalence may be underestimated by studies on blood donors [ 41 ]. The strength of this study is to prove that polytransfused sickle cell recipients are infected by HTLV-I and this encourages us to adopt a strategy of leukoreduction of blood products which contributes to better blood safety and to adopt PCR as a means of diagnosis. on. HTLV-I research in sickle cell patients is also important because HTLV-I infection is associated with or aggravates osteoporosis, respiratory disorders [ 42 , 43 ] and contributes to increasing certain parameters such as hemoglobin, hematocrit and red blood cells. Blood cells may contribute to worsening bone disorders through an increase in blood viscosity secondary to infection [ 35 ]. The female predominance is found in several studies including those carried out in South Africa, and the older age but the small size of our study and the lifespan of sickle cell patients pushes us to have reserve. Female predominance is often mentioned in sexual contamination. This study is cross-sectional and cannot attribute this high prevalence to transfusion alone. A.4. HCV and HTLV-1 coinfection has. Prevalence. This study noted a prevalence of 2.22% (2/90) of polytransfused sickle cell patients coinfected with HCV and HTLV-1. The 2 cases are female and are all aged 26. They received more than 20 transfusions. This prevalence is lower than that encountered in Bahia in Brazil where in a retrospective study of 1415 sickle cell patients, they diagnosed 45 cases of HCV and HTLV-1 infections, i.e., 3.1% [ 35 ]. These cases of coinfection were found in sickle cell patients who have a history of leg ulcers. A.5. Study limitations This study, using RT-PCR, demonstrates the presence of an emerging HTLV-1 virus and a non-emergent HCV virus in patients with multiple sickle cell disease (SCD) in the DRC. It did not establish a link between transfusion and HTLV-1 and HCV infections in patients with multiple sickle cell disease. A cohort or case-control study is important. CONCLUSION Polytransfused sickle cell patients are a population at risk for HCV infections (11.1%), HTLV-1 (5.5%) and co-infection with both (2.22%). Hence the need to introduce molecular tests and leukoreduction into transfusion safety and the management of sickle cell disease. Declarations Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Conflict of interest : None Thanks All authors thank the staff and patients of the SS Mixed Medicine and Anemia Center (CMMASS) for contributing to the completion of this study. Contributions AIKK. EKN initiated the study and wrote study protocol. AIKK.CMK carried out the data and sample collection, performed lab analysis and data interpretation. AIKK.EKN carried out the statistical analysis. AIKK.EKN and BKO drafted the manuscript and were major contributors in writing the manuscript. All authors read and approved the final version of manuscript. Corresponding Authors : Alain Ilunga Kabongo Katamba. and Erick Kamangu Ntambwe. Ethical Statements Ethical Approval and Consent to Participate The protocol for this study and the informed consent form were approved by the Ethics Committee of the School of Public Health, University of Kinshasa (Approval No.: ESP/CE/1108/2021). All subjects aged 18 and over signed informed consent for their inclusion, and for those under 18, their guardians signed. The data collected were fully anonymized. This study was conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication ; Not applicable. Competing interests ; The authors declare no competing interests. there was no Funding, References Programme National de Lutte Contre la Drépanocytose (PNLCD), Ministère de Sante publique et Hygiène, République Démocratique du Congo, avec l’appui de l’Organisation Mondiale de la Santé (OMS) (2016) Protocole National de Prise en Charge de la Drépanocytose en République Démocratique du Congo. 2eme Edition. Badibabi B. L., Kamangu E. N., J. 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Families affected by sickle cell disease: à local survey. The Pan African Medical Journal. 2018. 29 :24 https://www.doi.org/10.11604/pamj.2018.29.24.12276 Alain K. Ilunga, Pacifique Misingi, Paul Kabamba, Christine M. Katuanda, Botha Greeta, Berry I. Bongenia and Erick N. Kamangu: Evaluation of Flagship Transfusion Safety Indicator from 2010 to 2020 in the Democratic Republic of Congo. Insights Blood Disord. 2022 ; 1(1) : 1 6. Batina Agasa S, Dupont E, Kayembe T, Molima P, Malengela R, Kabemba S, Andrien M, Lambermont M, Cotton F, Vertongen F, Gulbis B. : Multiple transfusions for sickle cell disease in the Democratic Republic of Congo : the importance of the hepatitis C virus. Transfus Clin Biol 2010 ; 17(4) :254–9. A.G. (2021) Paper Title. World Journal of AIDS, 11, 101-119.https://doi.org/10.4236/wja.2021.113009 Lesi, O. and Kehinde, M. (2003) Hepatitis C Virus Infection in Patients with Sickle Cell Anaemia at the Lagos University Hospital. The Nigerian Postgraduate Medical Journal, 10, 79-83. Omote, V., Kashibu, E., Ojumah, I., Adda, D., Etaghene, J. and Ukwamedua, H. (2018) Serological Screening of Hepatitis B Virus and Hepatitis C Virus among Patients Attending a Tertiary Hospital in Jalingo, Taraba State, Nigeria. Saudi Journal for Health Sciences, 7, 167-171. https://doi.org/10.4103/sjhs.sjhs_39_18 Ejiofor, O.S., Emechebe, G.O., Igwe, W.C., Ifeadike, C.O. and Ubajaka, CF. (2010) Hepatitis C Virus Infection in Nigerians. Nigerian Medical Journal, 51, 173-176. Olusola, B.A., Gometi, E.A., Ogunsemowo, O., Olaleye, D.O. and Odaibo, G.N. (2017) High Rate of Hepatitis B Virus Infection among Hairdressers in Ibadan, Nigeria. Journal of Immunoassay & Immunochemistry, 38, 322-332. Jose P. Moura Neto, Isa Menezes Lyra, Mitermayer G. Reis, Marilda S. Goncalves : The association of infection and clinical severity in sickle cell anaemia patients ; Transactions of the Royal Society of Tropical Medicine and Hygiene 105 (2011) 121–126 https://doi.org/10.1080/15321819.2016.1260585 Diarra AB, Kouriba B, Guindo A, Maiga D.T, Diabaté I, Douyon S.I, Diawara B.A. Touré S. Fonkoro E.L. Murphy D.A. Diallo.: Prevalence of HTLV-I virus in blood donors and transfusion in Mali: Implications for blood safety. Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine 2014 ; 21 : 139–42. Luis Baião Peliganga , Vinicius Motta Mello , Paulo Sergio Fonseca de Sousa , Marco Aurelio Pereira Horta, Álvaro Domingos Soares, João Pedro da Silva Nunes, Miguel Nobrega and Lia Laura Lewis-Ximenez Transfusion Transmissible Infections in Blood Donors in the Province of Bié, Angola, during a 15-Year Follow-Up, Imply the Need for Pathogen Reduction Technologies Pathogens 2021, 10 (12), 1633; https://doi.org/10.3390/pathogens10121633 Custer B, Agapova M, Martinez RH. The cost-effectiveness of pathogen reduction technology as assessed using a multiple risk reduction model. Transfusion 2010 , 50 , 2461-2473. Calvignac-Spencer S, Adjogoua EV, Akoua-Koffi C, Hedemann C, Schu-bert G, Ellerbrok H, et al. Origin of human T-lymphotropic virus type 1 inrural Cote d’Ivoire. Emerg Infect Dis 2012 ;18 :830–3. Eduardo Samo Gudo , Celina M Abreu, Tufária Mussá, Angelo do Rosário Augusto, Koko Otsuki, Evelina Chambo, Nádia Amade, Amílcar Tanuri, Orlando C Ferreira Jr, Ilesh V Jani;. Serologic and molecular typing of human T-lymphotropic virus among blood donors in Maputo City, Mozambique. Transfusion 2009 ;49 :1146–50. Gessain A. [Human retrovirus HTLV-1: descriptive and molecular epidemiology, origin, evolution, diagnosis and associated diseases]. Bull Soc Pathol Exot 2011 ;104 :167–80. Eriko Atsumi , Satomi Yara, Futoshi Higa, Tetsuo Hirata, Shusaku Haranaga, Masao Tateyama, Jiro Fujita Influence of human T lymphotropic virus type I infection on the etiology of community-acquired pneumonia. Intern Med 2009 ; 48 :959–65. Littleton ET, Man WD, Holton JL, Landon DN, Hanna MG, Polkey Ml, G P Taylor . Human T cell leukaemia virus type I associated neuromuscular disease causing respiratory failure. J Neurol Neurosurg Psychiatry 2002 ; 72 :650–2. Additional Declarations No competing interests reported. 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Inkale","email":"","orcid":"","institution":"university of kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Cagod.","middleName":"","lastName":"Inkale","suffix":""},{"id":512570003,"identity":"c15cb3e2-3361-4c0c-a810-1a78aceab299","order_by":3,"name":"Tarcise Kilara","email":"","orcid":"","institution":"university of kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Tarcise","middleName":"","lastName":"Kilara","suffix":""},{"id":512570005,"identity":"7c3bb285-a021-4b00-a971-62b73d99c58e","order_by":4,"name":"Isaac Woto","email":"","orcid":"","institution":"university of kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Isaac","middleName":"","lastName":"Woto","suffix":""},{"id":512570006,"identity":"fed362b8-9e7a-4dfd-a842-e6098a72df4b","order_by":5,"name":"Berry Bongenya Ikolango","email":"","orcid":"","institution":"university of kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Berry","middleName":"Bongenya","lastName":"Ikolango","suffix":""},{"id":512570007,"identity":"bb4fbe35-4f48-4be2-af4f-9a0d9da353db","order_by":6,"name":"Gisele Kabengele kasanka","email":"","orcid":"","institution":"University of Kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Gisele","middleName":"Kabengele","lastName":"kasanka","suffix":""},{"id":512570008,"identity":"6b4f462e-7748-4577-b5c1-144e02ad067a","order_by":7,"name":"Baudouin Buassa","email":"","orcid":"","institution":"University of Kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Baudouin","middleName":"","lastName":"Buassa","suffix":""},{"id":512570010,"identity":"ba947adf-2c8a-43c7-b483-95392592188c","order_by":8,"name":"Dieudonné NyembueTshipukane","email":"","orcid":"","institution":"University of Kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Dieudonné","middleName":"","lastName":"NyembueTshipukane","suffix":""},{"id":512570011,"identity":"ba3882bb-fe89-42fc-87b7-f19af58cdb5e","order_by":9,"name":"Benoit kabengele Obel","email":"","orcid":"","institution":"university of kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Benoit","middleName":"kabengele","lastName":"Obel","suffix":""},{"id":512570012,"identity":"adb56da8-2c89-4b29-9239-e6300e4a63b6","order_by":10,"name":"Erick Kamangu Ntambwe","email":"","orcid":"","institution":"university of kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Erick","middleName":"Kamangu","lastName":"Ntambwe","suffix":""}],"badges":[],"createdAt":"2025-08-30 08:53:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7494059/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7494059/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-026-12612-3","type":"published","date":"2026-01-22T15:58:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":101152042,"identity":"beb9b8d0-d5be-498e-8656-dcfc94b4458e","added_by":"auto","created_at":"2026-01-26 16:09:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1041297,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7494059/v1/1de94e69-61cb-4fde-a8f4-6d52d9f35818.pdf"},{"id":91426144,"identity":"aad578b9-8150-4e16-b128-db5fa1babb98","added_by":"auto","created_at":"2025-09-16 11:17:39","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":123333,"visible":true,"origin":"","legend":"","description":"","filename":"CONVENTIONALHCVPCRRESULT.docx","url":"https://assets-eu.researchsquare.com/files/rs-7494059/v1/bfc612a817a4a082d2b7b36b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eMolecular Diagnosis of Htlv-1 and Hcv Infection in Polytransfused Sickle Cell Disease in Kinshasa: Case of Cmmass\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eSickle cell disease is an autosomal recessive hereditary genetic disease.\u003c/p\u003e\u003cp\u003eIt is characterized by a transversion from base A to base T of the short arm of chromosome 11, at position 11p15.5 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This mutation results in the replacement at the sixth codon of the first exon of the HBB gene of the beta globin chain of a GAG by a GTG, with the consequence, at the protein level, of the replacement of the 6th amino acid, glutamate. by valine [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This leads to the formation of hemoglobin S, hence the sickling of red blood cells.\u003c/p\u003e\u003cp\u003ePatients with sickle cell disease often present with permanent hemolytic anemia and are at risk of developing chronic or acute organ damage (brain, lung, retina, kidney, etc.), sometimes severe [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe management of sickle cell disease often requires the use of blood transfusion to correct anemia or prevent certain complications.\u003c/p\u003e\u003cp\u003eThese transfusions put the sickle cell recipient at risk of viral transmission, including HTLV-1 and HCV infection. HTLV-1 is the causative agent of adult T-cell leukemia (ATL) and has been associated with tropical spastic paraparesis (TSP/HAM) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and HCV underlies liver cirrhosis and hepatocellular carcinoma.\u003c/p\u003e\u003cp\u003eThese two viruses are RNA viruses, their capsid is icosahedral and are enveloped viruses. HTLV-1 infection affects 10 to 20\u0026nbsp;million people worldwide [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and HCV infection affects more than 178\u0026nbsp;million worldwide [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSub-Saharan Africa is the largest reservoir of HTLV-1 virus, but its epidemiology remains poorly understood and transfusion remains the main route of transmission [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the DRC, studies were carried out among sex workers, pregnant women [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and in an ethnic group, in the former province of Equateur, where tropical spastic paraparesis was associated with HTLV-1 infection. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. But no study on HTLV-1 has been carried out in polytransfused sickle cell patients.\u003c/p\u003e\u003cp\u003eWest Africa and Central Africa appear to be areas of high endemicity with a seroprevalence greater than 9% for HCV infection [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the DRC, approximately 2\u0026nbsp;million people are affected by HCV [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Publications on HCV infection based on rapid testing and enzymatic techniques exist with the residual risk [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] that this entails, but investigations based on molecular biology (PCR, Sequencing) do not seem to exist.\u003c/p\u003e\u003cp\u003eIn the DRC, HTLV-1 is not tested for during transfusion and HCV is tested for with a serological test. This serological test can not reveal a positive diagnosis before séroconversion. To avoid this risk, it seems important to use the molecular test which does not know the barrier of the serological window and the introduction of screening tests for HTLV-I in transfusion safety.\u003c/p\u003e\u003cp\u003eThe objective of this work is to use Molecular Biology techniques to investigate HTLV-1 and HCV infections in polytransfused sickle cell patients in the city of Kinshasa.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis is a descriptive cross-sectional study involving polytransfused sickle cell patients at the SS Mixed Medicine Center for Anemia (CMMASS). It concerned polytransfused sickle cell patients from the CMMASS having received at least 2 transfusions, the last of which was less than 6 months ago, aged over 5 years and having agreed to participate in the study.\u003c/p\u003e\u003cp\u003eThis study took place from January 14, 2022 to March 14, 2022\u003c/p\u003e\u003cp\u003eThe sampling applied is consecutive to the study period and not probabilistic.\u003c/p\u003e\u003cp\u003eParameters of interest included age, gender, number of transfusions as well as conventional Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) diagnostic results for HCV and HTLV-I.\u003c/p\u003e\u003cp\u003ePatients who had given their consent to participate in the study (or consent from the guardian) received a sample of 5 ml of whole blood in an EDTA tube at the CMMASS and then brought in the cold to the Molecular Biology laboratory. from the Faculty of Medicine (LBFMM) of the University of Kinshasa.\u003c/p\u003e\u003cp\u003eRNA extraction was carried out at LBMFM from plasma using the QiaGEN QIAmp®Viral RNA Mini ® extraction kit, following the manufacturer's recommendations.\u003c/p\u003e\u003cp\u003eTwo classic RT-PCRs were launched, one for the diagnosis of HCV and the other for HTLV-I following the diagram below:\u003c/p\u003e\u003cp\u003eObtaining the cDNA from the retrotranscriptase (Luna script RT super mix) with the RNA extract from each sample (see Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) in the micro-PCR tubes placed in the thermal cycler under the following conditions: 25 °c for 2 minutes; 55°c for 10 minutes; 95°c for 1 minute to obtain the cDNA (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRT (Retrotranscriptase) composition.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrepared tubes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLuna script RT super mix\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 µL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRNA sample\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 µL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 µL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eStart the PCR: primers, reaction composition and amplification cycle as described in Tables \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e,\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e for HCV and Tables \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e,\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e for HTLV-I.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHCV and HTLV-I primers\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eREGIONS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePRIMER\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSEQUENCES\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5’-UTRs of HCV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eForward primer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5’-TGCACGGTCTACGAGAC-3’ 322e339\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5’-UTRs of HCV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReverse primer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5’-GCCTTGTGGTACTGCCTGAT-3’ 277e297\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eENV of HLTV-1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eForward primer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5-GAACGCTCTAATGGCATTCTTAAAACC-3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eENV of HLTV-1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReverse primer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5-GTGGTTGATTGTCCATAGGGCTAT-3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComposition of the PCR mix (HCV AND HTLV-I)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrepared tubes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFl/sample reaction\u0026nbsp;flight\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ5 master mix\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12,5 µL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimer Solution\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,1 µL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCR Water\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8,9 µL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22,5 µL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ethe stages of the thermal cycle for HCV and for HTLV-I.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eHCV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eHTLV-I\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSteps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTempérature\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTimes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCycle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTempérature\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTimes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCycle\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInitial Dénaturation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95°C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95°C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDénaturation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95°C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30sec\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95°C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30sec\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHybridization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55°C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30sec\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e40\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50°C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30sec\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e40\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElongation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72°C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30sec\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72°C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30sec\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElongation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72°C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72°C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4°C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4°C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eEach PCR product was mixed with bromophenol blue and placed in each well of 1% agarose gel.\u003c/p\u003e\u003cp\u003eStatistical analysis\u003c/p\u003e\u003cp\u003eInformation on the subjects participating in the study as well as the results were recorded on the survey sheets. The data collected was entered on Windows Excel version 2016. The analysis of the results was carried out on SPSS version 2020 for Windows. The statistical tests used in this work are: the student test for quantitative variables and the chi-square test (x²) for qualitative variables.\u003c/p\u003e\u003cp\u003eThe results are expressed as mean standard deviation. The tables are reformatted in Excel.\u003c/p\u003e\u003cp\u003eEthical consideration\u003c/p\u003e\u003cp\u003eThe present study obtained the approval of the Ethics Committee of the School of Public Health of the Faculty of Medicine, University of Kinshasa (ESP/CE/1108/2021) and the agreement of those responsible for CMMASS before its start.\u003c/p\u003e\u003cp\u003ePolytransfused sickle cell patients were informed of the study and gave their signed consent on an informed consent form before collecting the data. Guardian consent was sought for those under 18 years old.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e90 samples out of 90 polytransfused sickle cell patients who consulted at CMMASS/Yolo during the work period and who freely agreed to participate in the study, were amplified. Or an amplification rate of 100%.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Age, Gender and Number of transfusions (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of polytransfused sickle cell patients according to age in year, \u003cb\u003eGender and Number of transfusion\u003c/b\u003e .\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in year\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;90\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e06\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37,8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46,7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13,3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e46\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;90\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48,9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51,1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of transfusion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;90\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e02\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54,40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31,11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6,66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e29\u0026ndash;37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5,55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e38\u0026ndash;46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMost polytransfused sickle cell patients are in the age group of 16 to 25 years at 46.7% followed by the age group of 6 to 15 years at 37.8% then the age group of 26 to 35 years. at 13.3%, finally the age group of 36 to 45 years and the age group of 46 to 55 years each have 1.1%. The median age was 29 years with a range of 6 to 50 years.\u003c/p\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe female gender is in the majority at 51.1% compared to 48.9% of the male gender, giving a sex ratio of 1.04.\u003c/p\u003e\u003cp\u003eNumber of transfusions\u003c/p\u003e\u003cp\u003eThe majority of polytransfused sickle cell patients have a history of 2 to 10 transfusions at 54.4% followed by those with a history of 11 to 19 transfusions at 31.11% then those with a history of 20 to 28 transfusions at 6.6% finally. those with a history of 29 to 37 transfusions at 5.5% and a history of 38 to 46 transfusions at 2.2%. The median number of transfusions was 24.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Molecular diagnosis of HCV\u003c/h2\u003e\u003cp\u003e\u003cb\u003eFrequency\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003e11.1% of polytransfused sickle cell patients have HCV infection (Table ).\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency of HCV infections in polytransfused sickle cell patients.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResult\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11,1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN\u0026eacute;gative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88,9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003cp\u003e50% of polytransfused sickle cell patients are infected in the age group of 16 to 25 years, followed by 30% in the age group of 26 to 35 years and finally 20% in the age group of 6 to 15 years.\u003c/p\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThere is a female predominance with female/male sex ratio of 4/1\u003c/p\u003e\u003cp\u003eNumber of transfusions\u003c/p\u003e\u003cp\u003eThe number of 2 to 10 transfusions and 11 to 19 transfusions each represent 30% of polytransfused sickle cell patients and the number of 29 to 37 transfusions represents 20%. The number 20 to 28 transfusions and the number 38 to 46 each represent 10%.\u003c/p\u003e\u003cp\u003eThese data above are shown in Table \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of HCV infections according to age, sex and number of transfusions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in year\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;10\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e06\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e46\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;10\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of transfusion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;10\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e02\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e29\u0026ndash;37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e38\u0026ndash;46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eA.3.Diagnosis of HTLV-1 infection\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFrequency\u003c/b\u003e\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e5.5% of polytransfused sickle cell patients are infected with HTLV-1 (Table \u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency of HTLV-1 infections in polytransfused sickle cell patients.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResult\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFr\u0026eacute;quency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5,55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN\u0026eacute;gative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e94,45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAge.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe age group of 26 to 35 represents 40% of infected polytransfused sickle cell patients followed by the following three groups 6 to 15 years, 16 to 25 years and 46 to 55 years. Each has 20%.\u003c/p\u003e\u003cp\u003e\u003cb\u003eb. Gender\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThere is a female predominance with a sex ratio of 4/1\u003c/p\u003e\u003cp\u003ef. Number of transfusions\u003c/p\u003e\u003cp\u003eThe number of 20 to 28 transfusions represents 40% of polytransfused sickle cell patients and the numbers of 2 to 10, 29 to 37 and 38 to 46 transfusions each represent 20%.\u003c/p\u003e\u003cp\u003eThe number of transfusions greater than 20 represents 80% of polytransfused diagnoses.\u003c/p\u003e\u003cp\u003eThese data above are shown in Table \u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of HTLV-1 infections according to age, sex and number of transfusions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in year\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e06\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e46\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of transfusion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e02\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e29\u0026ndash;37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e38\u0026ndash;46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eA.4. HCV and HTLV-1 coinfection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study noted a prevalence of 2.22% (2/90) of polytransfused sickle cell patients coinfected with HCV and HTLV-1. The 2 cases are female and are all aged 26. They received more than 20 transfusions (table 10,11).\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003cimg 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UPnM2yhRF9CA0hgRqHW9cN2Frv/4/rTaGiUaLipAjofl0fARfJbKAFW7Az0slCnyCj05uaGkrYoyNm1vdBfyHjcquYenS1sZ5oaCGw22Q1mNPBx5OtuKl+pD9EiVQWFWXqu4OWo71nlQN+T6L+9v3uB0q4+5Dz13nFM8deizqXfQyNxxNxIZPwKvPrkhYDy6nMmoudetNM1dvvSliMCnrXKkIqG85RukKFdDd4PRi5ADIsrdtHd1bWiM4vvTPGbIOBe+T49BRl3Sdu5tN3WcazzaBI0WvQ8o73ypQ9qCNu0OPFaLR1qUsa0Sj7PKR2chymmJPE9+jmPjZiJeD8plOsa7trMo9PhQtvK+OUbKZ9RRud0nKG3rRZ8V9ULfo2LeTSMdA0Ft1GnUEV3B21Ye87TiCeSQTQVonGgOyqj42Gl0RzKwjITN8xDPf6MrmPlsq+/RR1xY1p3lRTtpWZHfqRxz+YmghfIWZYch7tajYqM8tfWKEUBRzvJ7YUxHgzCP+EX3vC9cUw/QEMTxMNBz0HZMVMzl+6zMix9HgHPk3NkOdVLudeQ4t7LXQTuPoCjnpdwY884ZeWCaBpnv8f24eYjtTSvas7YbgrjJyn+mhraS8p6fPNFWRjlHlInt6vVh/5wHxxrnT+9jtOFcy9zuczy5vG0G1yFejYoh2n72EWWcAXFzSD0U9WYOLMNWHvM0SEPqaPSl38oafYaStCQIULlznqc3nTtsGlurPY1BDjZmRfDID3tyMKcvy6Z60CRpu0VPetud8ZD4Bas0BvQ8x6P4Wc3652y0fOxBk7R05u154HEGwd1WPxaSpsVjOl5PmOUVA3qCCc58J/vLZoAmSZI0Mj7ilCRJGhkDNEmSpJExQJMkSRoZAzRJkqSRMUCTJEmd+Jtr8ctpfkEaf+A1/wFg5PXiD9Rrfv6KU5Ikdcp/noY/C8L/JMB/McX/LhAhRNuf/uA/oGfeLH9CRN+wB02SJLXif+4gEIu/HUigRnDGNPPjD0YTiJV/dJd5BHOajwGaJElqxf97y/91GwjK4v8BjV41Hmvy/1+WfwD68OHD9f+LOs//+iEDNEmS1IFesePHjzdTVf2/HvD/2fLYk/9EnR42ArD4z9OzCNgioNNsDNAkSVIresky3ifjvTMGxs+dO1f/l2u8bxY/Hsjocfvw4UMzpVkYoEmSpE579+5txjYiKKMXLXrICNpu3Lix/kvO8P79+2ZMszBAkyRJndp6wHi0ySNMetFYHo8z9+3bV39mbfM0zABNkiS14hFliXfO4tEm6GGLX3CWvWU8Iu3qgVM/AzRJktSKX3DyS86Meaurq81UVR09erT++2i8f3b16tX1wC1+vcmf5dDsDNAkSVIrfsFZ/n0z/hgtQVn2+PHj9R8PhFevXm34G2qajf+TgCRJ6pT/J4FZ8COCEydOtP4JDg0zQJMkSZ3iV5nx6HIaPN6k98wQY34GaJIkSSPjO2iSJEkjY4AmSZI0MgZokiRJI2OAJkmSNDIGaJIkSSNjgCZJkjQyBmiSJEkjY4AmSZI0MgZokiRJI2OAJkmSNDIGaJIkSSNjgCZJkjQyBmiSJEkjY4AmSZI0MgZo0pJ4+PBhdfr06WZqHFZWVqq3b982U9L2o0xQNrbToUOHqhcvXjRTynYiPS5fvlzXRW31UU6rMdahfWYK0DixuAgMnPhmsZ2bN2/W41xEpjMu/CL2I+2UyNdtFUOuWBj6gp1r167VQxbfb6sQ2RbLpik/Q+t27efSpUvVo0ePmilp88p2hqErGGL+69evq7Nnz9bTkY9j6GuMh9Yty2Y+hosXL1b3799vpr5slPl8HfqCr6H04Jp2GVq3TA/WB/t8+vRptba2Vt24caO6detWPR98h7Q6evRoPc1xPXnyZP27ozc5qamdOnVqbXIBmqlP0wyLsrq6ujbjIUmjFmWEclOWFebl/F5OZ2XZePPmTT394MGDtYMHD9af2SRwWp/PZ5++dYf2w3ENbV+aRZSXaZB3GQLfJU8i5902fesyP5fXKCMh1t8N8nlyfZjm/NvsRHqwTizL65XfCXx32vy102bKYZxsPjEuQE68mI4hJ1S5jGlEpR8Jnwewv7jIbQ1E3hb7K78vjUHOx6ErP5fz0Pb90LadwPyoyIYMrdu1n1wGpc0q25k+fXkfs2yrb91ov7KhfX+p+sr7TqQH41Fvse+IO1jeFkiyTqw/dgt7B41uxmPHjlWTi8VVq4c7d+6sP768cOFCNbkw68uiyzHQ9ch3EeuUTp48Wd27d6+Z+tT1OrnQ9bbYT3RzMkwStrd7W9ppk8qj2rt3bzP1Cfn5/fv3zdQ3nj17Vp04caKZGheO+cOHD82UtHlXr17tfNQVeExFGTp8+HAzZyPaJB5nnTlzppnTbWjd69ev14/zM14HaCurX7J4NLhnz576MxtKD/D4c9++fc1Uv751qW+od0D7T1qQV86dO1fdvn27bvuJNw4cOFCvk1HncpzLYFMBGkFXZFqexzOeAy+CJBqW8Pz582ZsPufPn9/w/JhgjefLuHv3bl2IAgVtqZ41SxNd74BRWY3VbmyotHUeP368fqNNQ5pv9LOPHz82YxtFYBcdBm2NdOhbl33GctDwZ6z77t27Zmp3IFimnW+7pl3pESIN4/20PkPrEojl9j7nmXhHjkAx0i8H+RFcLkNsMHOAlu9s6NHKmXb//v3N2CdEv9Gw8EkPF9+bt2eL4I+o+dWrV/XFLe94SLQ4toiupWXSF4hNe+e5E3ZbQ6XtQSBAQJBv9EtlsBANNQOdCH3tTd+6V65c2bCMdoWetmw3dQAQNFE/lYFqqS1447oROxADDBlalzQiT7QFb6QHcQABGz8WiKd2bKtMu6GAcgxmDtDoFYtMWyZUWUlzV517BEhcvsdn2x3RNOgxo+eMIO3UqVMbMkN+hBpDW2aRxqDt0SA9BkeOHGmmNhpzL1V5cyYtUl893hck0cvSd9OT9a1LMNBWXndL+0J7TdA0zbUs04PAaJreTAytGwF0V5BIT1m8KsVxxCskbU8m2h7Tjs3C3kHj8SNd0TlKJUG58yh1PcaZpusxHl3y5wbytgncyj9BII0ZPdA5z1IJ0giU72eiq8zMg/LV1hswLyrtMffuaXmQJ/PjKKZpV2hfSm0NLPk642Y+lx2WxyOwvnUpi7kTgePg5im/M0o52g03JqQHrxDR4dGnLT241gRcXLu2ei2nx9C6pA1BG71jbUgvlsd3GX/58mU9ngPL6DkbChZHYXLRpzb0Cwx+HcEmY2Aakwu+YT7bCZMGacOvPljGOswH+8vrI9YpXSp+xRnbkHZK5NU85PxcLu9SloOyTMUQZaksCwxRHiZ3mPU020DfukP7AdNsU1oE8l7Oa315i3VzXqSc5O+2lZnYXt+6yMsYyuMo9/0l6ir/5bUK5TUp0zIGlOnRty7bbFsW8Qjb4PtZPnbquMC2ynXHaoV/JicgacS4g+fuchHFNXooht4lmcYij0ua1Sx5mR4W3mXr6oGZBb1nk0a+7u1Zip6YbbJT6TGLRdZ/W80ATVoSdPHzGKat+39a0bAsqtgvU2WnLw83CLzqMs27UTxOW1RAtVPBxdjtVHrMgv2urq5uqh7dLgZo0pIYY6OwU5WsFLhx4QX/af58w6Is4mbpS7UT6TEt3nMj3ZYlsDZAkyRJGpmF/YpTkiRJi2GAJkmSNDIGaJIkSSNjgCZJkjQyBmiSJEkjY4AmSZI0MgZokiRJI2OAJkmSNDIGaJIkSSNjgCZJkjQyBmiSJEkjY4AmSZI0MgZokiRJI2OAJkmSNDIGaJIkSSOzpQHaw4cPq5WVlert27fNHEnzojydPn26mZI0xDIzLmNMjzHHKDMFaFxYToaLnDH/5s2bzdQnnPC5c+eqtbW16sCBA83c+R06dGjDfhk3+NPYkT/JpzGQj7PLly9vWN6Xn69du1YPgTKXv1uWwbyMoU/fukP7kRapr8wwnpfFULZJoSwzZXl78eJFs+QTpvPyvmBiaN1oL2Mo97UshuqwWc5z2vQo95mHso4cWrfcRwzMx6VLl6pHjx7V46MzCaCmdurUqbWDBw+ulV9j/o0bN5qprcF+Hzx40ExJy4GykvMtZWVSIdTjlJlclsrpbHV1dcMytpmn37x5U0+zHigvuUyyT/bdpm/dof1Ii0b+6iozpbJcZOWysnyVeTvWJ48PGVq375iXDefZlR5lvVJe02zW9Cixft5Xn6F12Q/HAz6pA8do5kecFy9erCYn03sXXd5x54i3LZqNu5/ye4HxSUGoe+Ri/bh7AduMaDjkXr3obYthWe9ktJz27t3bjFUbepPv3r1bTSqlZqqqrly5Un+29Qa8fPmymlQ4zdQnlMPQ1ku9b9++Zqyq9u/f34y161t3aD/SonWVmdL169frHpA2ZZl59uxZNWm4m6mqOnv2bJ23o7yxLcrjNHm8b13al9evX1e3b99u5iy/vvTI03m90qzpUbp69Wp14cKFZqpf37rEBezn6NGj9TSfxBejjAuaQG0qRKREphHpxt1DzEcZBTM9uRjr43kZ8/P38h0H28zTrMs6IUfj5XY5rji+8k6njOKlrUT+jvwX44HxuIsLuUxkuYwF1mV+jOfyEmWC7cd4lIHS0Lp9+5EWra/MZGXdXirLDPmW/JvlddgWy/mMoSyfoW9dtlcui/KzjPrSg3lMMz/GqUPazJoeGfPKdbsMrdt2jKzfddw7aaZIJV88xqOiLueXF5gLQuZlPssD3++q7Mt1ywsYhTPki56/27aPsSaGvkzkNfJnlINQTqOt/IA82zaf9dlOW4UUZYRhKL8Prdu3H2nRuspMRp7saj/QVmaYF9uNIdZhPOd95jOvTd+6jJflJO9nGQ2lRyxbZHpkzG+rl9r0rduWNuiqd3fa3L/ipPv2zp07rd2CdC/mR4qBxyhPnjxppqrq6dOnGx6n5JcN2cYsJhmjev78eT3Oo6Pcvclx5uOZRPrNEmlr8UIt+XJS1urh2LFjnz2Oz3g00iU/hoxH/Lxwy3Z55MJ0lEfKEvNiv6zHvDZ96w7tR1q0acoMr83Qlpw/f76Z0y6XGVC+YrsMk8Z6wzr5Ed2ZM2fqz/Kl9NC3bvkiPe3Tu3fvmqnl0pce8VpSLAPTXWZND8QjTx6BDhlal9iA17TajDF95g7QeO5MpqPCLk0i0Q0XnSGe94IEZCDh472bSPBYn23MgoJKIEYBIQDLCcRx5mNhmCaxpc2IyiK/izK5+6zzKaiMPnz4UI8H8u6RI0eaqY3ev3/fjH16B4YyEuWK/Ew+v3//fh080Xg9fvy4XgZuhphXNjZD6/btR1q0oTITbt26Vb/PlNuVNrnMlMj7lLfDhw/X023lsUvfugQYfTday2QoPehIYTqwHtcmvleaJT0CN4fTxgN963JMbD9ijtLQe7o7YVN/B43EoCJnCPRcdfV+EYVz8SJIyo0C8suGRLoZwVxf4lJQyRgnT56sG5CQAzdpO3GHTYWQe5sIbMinIK9SoYTy5dWsvCOnrJRlhHxOJbNnz556OleS8TNyvkdZiF6woXX79iMt2lCZAfmXPJjLTpuyzJToCaKtiHanLI8RBJZlBn3rEmBwDlGm4niHevvGaCg9+Mw3a6zH+rl3McyaHugKqsr0wFAA1he8EVCXPXejMAmUptb2nDaeTbc9j89DKOdPEqRZsnEZ89lfKJ+BMzCexX5ZluXvxjBJyGaptHX6ygLI413LMraTywMmleOG7+ay1Jfno+zE9FD56NuPtGhDZYb8R54cUpaZcrtt+Tjn9byPssyga12UZYrpZdWXHlyPclnXuc6bHm3zu9Kjq26K9MjrZywr44YxWOGfycFtC95rOXHixIYIlyh4cmEGu6ql3Yw7Re4wF1Fc43WC/NhC+tJYZsZlrOmxyONatG0N0Oji5J2WeP+LbspJ1Ft3S+ZuTUmfo/zcu3dvUzczUebGWBlJi2aZGZcxpseYg+9tDdDiwmb2nknT4R01/rhj+e6mpHaWmXEZY3rwFG+snUTbGqBJkiRp2KZ+xSlJkqTFM0CTJEkaGQM0SZKkkTFAkyRJGhkDNEmSpJExQJMkSRoZAzRJkqSRMUCTJEkaGQM0SZKkkTFAkyRJGhkDNEmSpJExQJMkSRoZAzRJkqSRMUCTJEkaGQM0SZKkkRltgLayslK9ePGimZJ2p8uXL1c3b95sprbGw4cPq9OnTzdT0nKzzIyL6bEJa1M6ePDgGqu3Daurq81a3U6dOrV248aNZmrYtNuVxow8nMvKpUuXmiWfMJ2Xv3nzplmyVo8zrxRlMa+Lcl9lectlmPGMeeX2pJ1gmRkX02PnTB2gZVwILuQsDNC020Tl9ODBg2bOp3wd05QHpkPbNOUm8L0oF3y2VYSx7XKa7eRtldNUsrOUT2krWGbGxfTYWd9cyRnEBS5xsVgWQ1z8HPUyxEWMxIohJxbTBmhaZuTv8i4vV1gsi8onkO9zhdRW4UTFlctLWRGCCot5beuXFWTbsUrbzTIzLqbHzlrYO2jx/HeyzXqYXOxqcrHqea9fv64mF7mex7IrV67U75fdu3dvff1JQtTPqqUvxd69e6tJ5bHhXcp9+/bV5QEsY52MMvP+/ft6/MmTJ9WRI0fq8SHv3r2rDhw40Ex9sn///npfHz9+rKfz8j179tSfsSyOVdpJlplxMT121kICtLdv39YJcfv27WZOVQdh6HrR/+jRo9Xjx4+bqao6fvz4eqJLXwLyODclx44dq3/0wnDu3LlmabtDhw7Vn5SpzaIi7VJWhFHZLWK/0rwsM+Nieuyshf6Ks7xgRNIfPnxopj5Hj9m0iS4tI25UopeYgcouKrA25U1KVDrziLvYNl2VWNyNSjvFMjMupsfOWWiAVl6wtu7PwM9unz59up7oDx48aJZIX667d+9WJ06cqMfbbmAoM/mRwLSVDY8CyvLHI4OTJ0+23lnGdrlDzjZTmUpbwTIzLqbHNpoERzPja+UL/LzIl1/wm0TZG17Y42U/hsDyvD7jef22fUjLjPyfixzTOc+XZaarDEwqwA0vxyJemI31Y52YZru5/FHe8nR8XxoTy8y4mB7ba66z6broXECWMeREQlw8hviFR16/TGjmte1DWhZRweShRCXTtZxlVHiBcpPXjSEquXJ5lLOQl7HtjHXLMittN8vMuJgeO2uFfyYnK2lkeA3g2bNnG35Ms1XiF9T5hz7SsrHMjIvpsTkGaNJI8b7F5I6QW9Jmztbhhzqrq6ufvc8hLRPLzLiYHpvzf//fRDMuaUS+9a1vVf/4xz/ql2F/9KMfNXMXj//H7n//+1/19ddfN3Ok5WSZGRfTY3PsQZMkSRqZhf6ZDUmSJG2eAZokSdLIGKBJkiSNjAGaJEnSyBigSZIkjYwBmiRJ0sgYoEmSJI2MAZokSdLIGKBJkiSNjAGaJEnSyGz4r574z0YlSZK0k6rq/wNWTcoVCKCrCAAAAABJRU5ErkJggg==\"\u003e\u003c/p\u003e\n\u003cp\u003eTableau 11\u0026nbsp;: Distribution of HCV and HTLV-1 co-infection according to age, sex and number of transfusions\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe objective of this work is to use Molecular Biology techniques to investigate HTLV-1 and HCV infections in polytransfused sickle cell patients in the city of Kinshasa.\u003c/p\u003e\u003cp\u003eNinety polytransfused sickle cell patients were included in the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAge, Gender and Number of transfusions\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe age of polytransfused sickle cell patients varies between 6 to 50 years. The age group of 16 to 25 is more dominant with 46.7%. The median age was 29 years. These data corroborate with those carried out by Mwanaut I in Kinshasa over a period of 11 years, in 180 polytransfused sickle cell patients from the CMMASS whose median age was 28 years [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and those of the Ngo SF study in Dakar, carried out on a period of 13 years, in 129 polytransfused sickle cell patients in the clinical hematology department of the National Blood Transfusion Center in Dakar; the median age was 27 years [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt is important to note that hemoglobin S almost completely replaces hemoglobin F around 12 to 48 months. This thus promotes the occurrence of sickle cell crises indicating a blood transfusion, which are often more serious and more frequent during early childhood and adulthood. The number of blood transfusions also increases with age due to the absence of fetal hemoglobin and because of the vulnerability of these patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe female gender is in the majority at 51.1% with a sex ratio of 1.04. This predominance is also found in the study by Mwanaut I in Kinshasa [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], Ya Pongombo S.M in Lubumbashi [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and Nacoulma in Ouagadougou in Mali [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. On the other hand, other authors in the DRC including Abdala K.A [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and Mashako MR [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and in Africa Diagne and Mabiala report a slight predominance of the male sex [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Finally, others see no predominance between the two sexes; this is the case of Thuilliez [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and Dreux [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. These differences would be related to the demographic data of each country because the transmission of sickle cell disease is not linked to sex [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eNumber of transfusions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe median number of transfusions was 24. It is probably high because medications that increase fetal hemoglobin and vaccination are not systematic.\u003c/p\u003e\u003cp\u003eThe following authors (Tshilolo, Mukinayi BM [27] and Ya Pongombo [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] SM show that in Africa as in the DRC the first transfusion takes place around 2 years of age. The number of blood transfusions increases with age due to the absence of fetal hemoglobin and because of the vulnerability of these patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e4.3. Molecular diagnosis of HCV infection\u003c/h2\u003e\u003cp\u003eThis study noted a prevalence of 11.1% of polytransfused sickle cell recipients infected with HCV with a female predominance (80%) in the age groups of 16 to 35 years.\u003c/p\u003e\u003cp\u003eThis prevalence is higher than the prevalence of the general population of donors in the DRC (1.21%), polytransfused sickle cell patients from Kisangani in the DRC (7.9%), those from the South-West of Nigeria (2.2%)., from Lagos (5%), to Jalingo (5%), in Taraba State, to Benin City (5%) but it is lower than that of Bahia (13.4%) in Brazil [\u003cspan additionalcitationids=\"CR29 CR30 CR31 CR32 CR33\" citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e] .\u003c/p\u003e\u003cp\u003eThis can be explained by the fact that this study uses the molecular test. The other studies use serological tests which have the problem of residual risk, false positives and indeterminate results. The relatively small sample size may have contributed to the higher rate reported in the present study.\u003c/p\u003e\u003cp\u003eCompared to the general population of donors, it could be normal that this result is higher because the more the patient is transfused, the more he runs the risk of becoming contaminated with HCV, especially since transfusion safety in sub-Saharan Africa in general and in the Democratic Republic of Congo in particular is faced with the problem of shortage of biological analysis inputs [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and the use of tests incapable of detecting virus antibodies before the seroconversion period [\u003cspan additionalcitationids=\"CR36\" citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCompared to the results from Kisangani [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e], all infected polytransfused sickle cell patients were those who received blood before the introduction of HCV screening tests in 2004. This is not necessarily the case in this study because the infected patients had for some under 20 years old and the DRC often experiences problems with shortages of inputs linked to transfusion safety.\u003c/p\u003e\u003cp\u003eThis study is cross-sectional and cannot attribute this high prevalence to transfusion alone because there are studies (cohort and control cases) which have concluded a higher prevalence of HCV infection among those never transfused than those with a history of transfusion [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This would suggest that blood transfusion cannot be considered the main mode of transmission of HCV [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study noted a female predominance unlike other studies [\u003cspan additionalcitationids=\"CR30 CR31\" citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This is due to chance because the viral transmission of HCV is not linked to sex.\u003c/p\u003e\u003cp\u003eThe results of this study show that adults are more affected than children as in other studies [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study shows that from the history of 2 transfusions that one can be infected with HCV.\u003c/p\u003e\u003cp\u003eThe number of transfusions increases with age and adults are more affected than children.\u003c/p\u003e\u003cp\u003eThe search for HCV is all the more important when we know that the presence of HCV and iron overload is directly linked to the number of blood transfusions in sickle cell patients, contributing to the increase in iron absorption, chronic hemolysis and direct liver damage due to tissue hypoxia during sickle cell disease-related vascular occlusion [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMolecular diagnosis of HTLV-I infection\u003c/h3\u003e\n\u003cp\u003eThis study noted a prevalence of 5.5% of polytransfused sickle cell recipients infected with HTLV-I with a female predominance (80%) in the age groups of 26 to 35 years (40%).\u003c/p\u003e\u003cp\u003eThe number of blood transfusion is 20 or more.\u003c/p\u003e\u003cp\u003eThis prevalence is similar to the results of the study by Diarra et al. In Mali in multi-transfused patients (2.8% and 7.5%) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and by Jose P et al in Bahia (4.7%) in Brazil [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This can be explained firstly by the fact that this study uses the molecular test which does not have the problem of residual risk, false positives and indeterminate results [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Malian study used Elisa during screening and did not confirm positive sera by Western blot or PCR while a study carried out in Ivory Coast showed 37% (6/16) false positives using Elisa for screening and PCR as a comparator [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Another study among blood donors in Mozambique showed that out of 21 sera positive by Elisa (Murex) only nine were positive by WB and PCR [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. It is possible that the seroprevalence is lower than that reported in the Malian study.\u003c/p\u003e\u003cp\u003eSub-Saharan Africa is an area of ​​high endemicity and seroprevalence may be underestimated by studies on blood donors [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe strength of this study is to prove that polytransfused sickle cell recipients are infected by HTLV-I and this encourages us to adopt a strategy of leukoreduction of blood products which contributes to better blood safety and to adopt PCR as a means of diagnosis. on.\u003c/p\u003e\u003cp\u003eHTLV-I research in sickle cell patients is also important because HTLV-I infection is associated with or aggravates osteoporosis, respiratory disorders [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e43\u003c/span\u003e] and contributes to increasing certain parameters such as hemoglobin, hematocrit and red blood cells. Blood cells may contribute to worsening bone disorders through an increase in blood viscosity secondary to infection [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe female predominance is found in several studies including those carried out in South Africa, and the older age but the small size of our study and the lifespan of sickle cell patients pushes us to have reserve. Female predominance is often mentioned in sexual contamination.\u003c/p\u003e\u003cp\u003eThis study is cross-sectional and cannot attribute this high prevalence to transfusion alone.\u003c/p\u003e\u003cp\u003e\u003cb\u003eA.4. HCV and HTLV-1 coinfection\u003c/b\u003e\u003c/p\u003e\u003cp\u003ehas. Prevalence.\u003c/p\u003e\u003cp\u003eThis study noted a prevalence of 2.22% (2/90) of polytransfused sickle cell patients coinfected with HCV and HTLV-1. The 2 cases are female and are all aged 26. They received more than 20 transfusions.\u003c/p\u003e\u003cp\u003eThis prevalence is lower than that encountered in Bahia in Brazil where in a retrospective study of 1415 sickle cell patients, they diagnosed 45 cases of HCV and HTLV-1 infections, i.e., 3.1% [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. These cases of coinfection were found in sickle cell patients who have a history of leg ulcers.\u003c/p\u003e\u003cp\u003e\u003cb\u003eA.5. Study limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study, using RT-PCR, demonstrates the presence of an emerging HTLV-1 virus and a non-emergent HCV virus in patients with multiple sickle cell disease (SCD) in the DRC.\u003c/p\u003e\u003cp\u003eIt did not establish a link between transfusion and HTLV-1 and HCV infections in patients with multiple sickle cell disease.\u003c/p\u003e\u003cp\u003eA cohort or case-control study is important.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003ePolytransfused sickle cell patients are a population at risk for HCV infections (11.1%), HTLV-1 (5.5%) and co-infection with both (2.22%). Hence the need to introduce molecular tests and leukoreduction into transfusion safety and the management of sickle cell disease.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThanks\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors thank the staff and patients of the SS Mixed Medicine and Anemia Center (CMMASS) for contributing to the completion of this study.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAIKK. EKN initiated the study and wrote study protocol. AIKK.CMK carried out the data and sample collection, performed lab analysis and data interpretation. AIKK.EKN carried out the statistical analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAIKK.EKN and BKO drafted the manuscript and were major contributors in writing the manuscript. All authors read and approved the final version of manuscript.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding Authors\u003c/strong\u003e :\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlain Ilunga Kabongo Katamba. and Erick Kamangu Ntambwe.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Statements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe protocol for this study and the informed consent form were approved by the Ethics Committee of the School of Public Health, University of Kinshasa (Approval No.: ESP/CE/1108/2021). All subjects aged 18 and over signed informed consent for their inclusion, and for those under 18, their guardians signed. The data collected were fully anonymized. This study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eConsent for publication ;\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003eCompeting interests ; The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003ethere was no Funding,\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eProgramme National de Lutte Contre la Dr\u0026eacute;panocytose (PNLCD), Minist\u0026egrave;re de Sante publique et Hygi\u0026egrave;ne, R\u0026eacute;publique D\u0026eacute;mocratique du Congo, avec l\u0026rsquo;appui de l\u0026rsquo;Organisation Mondiale de la Sant\u0026eacute; (OMS) (2016) Protocole National de Prise en Charge de la Dr\u0026eacute;panocytose en R\u0026eacute;publique D\u0026eacute;mocratique du Congo. 2eme Edition.\u003c/li\u003e\n\u003cli\u003eBadibabi B. L., Kamangu E. N., J. Masumu J., Tebandite E. K., Mbuyi J. M., P. T. Lukusa P. T. 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Pan African Medical Journal. 2014 ; 19: 71. https://www.doi.org/10.11604/pamj.2014.19.71.3684 \u003c/li\u003e\n\u003cli\u003eNacoulma EWC, Sakande J, Kafando E, Kpowbi\u0026eacute; ED, Guissou IP. Profil h\u0026eacute;matologique et biochimique des dr\u0026eacute;panocytaires SS et SC en phase stationnaire au Centre Hospitalier National Yalgado Ou\u0026eacute;draogo de Ouagadougou. Mali Medical. 2006 ; 21 (1) : 8-11. \u003cu\u003e \u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eAbdala KA, Mabiala Babela JR, Shindano ME. Aspects \u0026eacute;pid\u0026eacute;miologiques, cliniques et th\u0026eacute;rapeutiques de la dr\u0026eacute;panocytose chez l\u0026rsquo;enfant \u0026agrave; l\u0026rsquo;H\u0026ocirc;pital g\u0026eacute;n\u0026eacute;ral de r\u0026eacute;f\u0026eacute;rence de Kindu (HGRK) Rev. Afr. M\u0026eacute;d. 2018 ; 1 (2) \u003c/li\u003e\n\u003cli\u003eMashako MR, Bitwe RM, Nsibu CN, Mashako YK. 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Education th\u0026eacute;rapeutique pour les enfants dr\u0026eacute;panocytaires : justifications \u0026agrave; la mise en place et initiation de ce projet au CHU de Grenoble. Th\u0026egrave;se de m\u0026eacute;decine, Universit\u0026eacute; Joseph Fournier. Grenoble (France), 2012. \u003c/li\u003e\n\u003cli\u003eNacoulma EWC, Bonkoungou P, Dembelele, Ye D, Kam L. Les dr\u0026eacute;panocytoses majeures dans le service de p\u0026eacute;diatrie du centre hospitalier universitaire Sounou Sanon de Bobo-Dioulasso. Med Afr Noire. 2006 ; 53 (12) :694-98. \u003c/li\u003e\n\u003cli\u003eTolo A, Tour\u0026eacute; A, N\u0026rsquo;dhatz E, Nanho DC, Kouakou B, Sanogo I, Sangare A. Profil \u0026eacute;volutif de la dr\u0026eacute;panocytose homozygote suivie : exp\u0026eacute;rience du service d\u0026rsquo;h\u0026eacute;matologie clinique du CHU de Yopougon. M\u0026eacute;d Afr Noire. 2006 ; 53 (1) :5-10. \u003c/li\u003e\n\u003cli\u003eMukinayi BM, Cibeyibeyi GK, Tumba GD, Gulbis B. Families affected by sickle cell disease: \u0026agrave; local survey. The Pan African Medical Journal. 2018. 29 :24 https://www.doi.org/10.11604/pamj.2018.29.24.12276 \u003c/li\u003e\n\u003cli\u003eAlain K. Ilunga, Pacifique Misingi, Paul Kabamba, Christine M. Katuanda, Botha Greeta, Berry I. Bongenia and Erick N. Kamangu: Evaluation of Flagship Transfusion Safety Indicator from 2010 to 2020 in the Democratic Republic of Congo. Insights Blood Disord. 2022 ; 1(1) : 1 6.\u003c/li\u003e\n\u003cli\u003eBatina Agasa S, Dupont E, Kayembe T, Molima P, Malengela R, Kabemba S, Andrien M, Lambermont M, Cotton F, Vertongen F, Gulbis B. : Multiple transfusions for sickle cell disease in the Democratic Republic of Congo : the importance of the hepatitis C virus. Transfus Clin Biol 2010 ; 17(4) :254\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eA.G. (2021) Paper Title. World Journal of AIDS, 11, 101-119.https://doi.org/10.4236/wja.2021.113009\u003c/li\u003e\n\u003cli\u003eLesi, O. and Kehinde, M. (2003) Hepatitis C Virus Infection in Patients with Sickle Cell Anaemia at the Lagos University Hospital. The Nigerian Postgraduate Medical Journal, 10, 79-83.\u003c/li\u003e\n\u003cli\u003eOmote, V., Kashibu, E., Ojumah, I., Adda, D., Etaghene, J. and Ukwamedua, H. (2018) Serological Screening of Hepatitis B Virus and Hepatitis C Virus among Patients Attending a Tertiary Hospital in Jalingo, Taraba State, Nigeria. Saudi Journal for Health Sciences, 7, 167-171. https://doi.org/10.4103/sjhs.sjhs_39_18\u003c/li\u003e\n\u003cli\u003eEjiofor, O.S., Emechebe, G.O., Igwe, W.C., Ifeadike, C.O. and Ubajaka, CF. (2010) Hepatitis C Virus Infection in Nigerians. Nigerian Medical Journal, 51, 173-176.\u003c/li\u003e\n\u003cli\u003eOlusola, B.A., Gometi, E.A., Ogunsemowo, O., Olaleye, D.O. and Odaibo, G.N. (2017) High Rate of Hepatitis B Virus Infection among Hairdressers in Ibadan, Nigeria. Journal of Immunoassay \u0026amp; Immunochemistry, 38, 322-332.\u003c/li\u003e\n\u003cli\u003eJose P. Moura Neto, Isa Menezes Lyra, Mitermayer G. Reis, Marilda S. Goncalves : The association of infection and clinical severity in sickle cell anaemia patients ; Transactions of the Royal Society of Tropical Medicine and Hygiene 105 (2011) 121\u0026ndash;126 https://doi.org/10.1080/15321819.2016.1260585\u003c/li\u003e\n\u003cli\u003eDiarra AB, Kouriba B, Guindo A, Maiga D.T, Diabat\u0026eacute; I, Douyon S.I, Diawara B.A. Tour\u0026eacute; S. Fonkoro E.L. Murphy D.A. Diallo.: Prevalence of HTLV-I virus in blood donors and transfusion in Mali: Implications for blood safety. Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine 2014 ; 21 : 139\u0026ndash;42.\u003c/li\u003e\n\u003cli\u003eLuis Bai\u0026atilde;o Peliganga , Vinicius Motta Mello , Paulo Sergio Fonseca de Sousa , Marco Aurelio Pereira Horta, \u0026Aacute;lvaro Domingos Soares, Jo\u0026atilde;o Pedro da Silva Nunes, Miguel Nobrega and Lia Laura Lewis-Ximenez Transfusion Transmissible Infections in Blood Donors in the Province of Bi\u0026eacute;, Angola, during a 15-Year Follow-Up, Imply the Need for Pathogen Reduction Technologies \u003cem\u003ePathogens\u003c/em\u003e 2021, \u003cem\u003e10\u003c/em\u003e(12), 1633; https://doi.org/10.3390/pathogens10121633\u003c/li\u003e\n\u003cli\u003eCuster B, Agapova M, Martinez RH. The cost-effectiveness of pathogen reduction technology as assessed using a multiple risk reduction model. \u003cem\u003eTransfusion \u003c/em\u003e\u003cstrong\u003e2010\u003c/strong\u003e, \u003cem\u003e50\u003c/em\u003e, 2461-2473.\u003c/li\u003e\n\u003cli\u003eCalvignac-Spencer S, Adjogoua EV, Akoua-Koffi C, Hedemann C, Schu-bert G, Ellerbrok H, et al. Origin of human T-lymphotropic virus type 1 inrural Cote d\u0026rsquo;Ivoire. Emerg Infect Dis 2012 ;18 :830\u0026ndash;3.\u003c/li\u003e\n\u003cli\u003eEduardo Samo Gudo\u003csup\u003e \u003c/sup\u003e, Celina M Abreu, Tuf\u0026aacute;ria Muss\u0026aacute;, Angelo do Ros\u0026aacute;rio Augusto, Koko Otsuki, Evelina Chambo, N\u0026aacute;dia Amade, Am\u0026iacute;lcar Tanuri, Orlando C Ferreira Jr, Ilesh V Jani;. Serologic and molecular typing of human T-lymphotropic virus among blood donors in Maputo City, Mozambique. Transfusion 2009 ;49 :1146\u0026ndash;50.\u003c/li\u003e\n\u003cli\u003eGessain A. [Human retrovirus HTLV-1: descriptive and molecular epidemiology, origin, evolution, diagnosis and associated diseases]. Bull Soc Pathol Exot 2011 ;104 :167\u0026ndash;80.\u003c/li\u003e\n\u003cli\u003eEriko Atsumi\u003csup\u003e \u003c/sup\u003e, Satomi Yara, Futoshi Higa, Tetsuo Hirata, Shusaku Haranaga, Masao Tateyama, Jiro Fujita Influence of human T lymphotropic virus type I infection on the etiology of community-acquired pneumonia. Intern Med 2009 ;\u003cstrong\u003e48\u003c/strong\u003e :959\u0026ndash;65.\u003c/li\u003e\n\u003cli\u003eLittleton ET, Man WD, Holton JL, Landon DN, Hanna MG, Polkey Ml, G P Taylor . Human T cell leukaemia virus type I associated neuromuscular disease causing respiratory failure. J Neurol Neurosurg Psychiatry 2002 ;\u003cstrong\u003e72\u003c/strong\u003e :650\u0026ndash;2.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Polytransfused sickle cell patients, RT-PCR, HTLV-1, HCV, Kinshasa","lastPublishedDoi":"10.21203/rs.3.rs-7494059/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7494059/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eContext\u003c/b\u003e: Sickle cell patients present with permanent hemolytic anemia very often requiring transfusions. These transfusions put sickle cell patients at risk of HTLV-I and HCV infection.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e: To determine the prevalence of HTLV-1 and HCV infection among polytransfused sickle cell patients in Kinshasa.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e: This is a cross-sectional study with a descriptive aim in polytransfused sickle cell patients followed at the SS Mixed Medicine Center for Anemia (CMMASS). The parameters of interest were age, gender, number of transfusions. Molecular diagnosis of HTLV-I and HCV was carried out by conventional amplification.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e: The median age of polytransfused sickle cell patients is 29 years. The female gender is in the majority 51.1% and the median number of transfusions is 24.\u003c/p\u003e\u003cp\u003e11.1% of polytransfused sickle cell patients are infected with HCV with a female predominance (80%). 60% of cases infected with HCV received 2 to 19 transfusions.\u003c/p\u003e\u003cp\u003e5.5% of polytransfused sickle cell recipients are infected with HTLV-I with a female predominance (80%). 80% of cases infected with HTLV-I received more than 20 transfusions.\u003c/p\u003e\u003cp\u003e2.22% (2/90) of polytransfused sickle cell patients are coinfected with HCV and HTLV-1. The 2 cases are female and are all aged 26. They received more than 20 transfusions at 80%.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e: Polytransfused sickle cell patients are a population at risk for HCV (11.1%) and HTLV-1 (5.5%) infections. Hence the need to introduce molecular tests and leukoreduction into transfusion safety.\u003c/p\u003e","manuscriptTitle":"Molecular Diagnosis of Htlv-1 and Hcv Infection in Polytransfused Sickle Cell Disease in Kinshasa: Case of Cmmass","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-16 11:17:35","doi":"10.21203/rs.3.rs-7494059/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-09T04:32:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-04T18:32:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-30T12:24:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42198315076469075036100634501138197620","date":"2025-11-29T20:02:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205292456418577589878512743283964145875","date":"2025-11-29T10:42:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209174066663152887306165722498700121801","date":"2025-11-02T19:34:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-19T17:47:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164062656628630739722995907308305070529","date":"2025-10-01T14:36:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"17166045140354230489746681494149140882","date":"2025-09-25T13:29:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-09T13:54:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-09T13:43:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-08T13:19:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-04T16:08:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-09-04T16:05:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"03d3592d-2d4b-4cb0-be41-113d63e85576","owner":[],"postedDate":"September 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-26T16:05:49+00:00","versionOfRecord":{"articleIdentity":"rs-7494059","link":"https://doi.org/10.1186/s12879-026-12612-3","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2026-01-22 15:58:53","publishedOnDateReadable":"January 22nd, 2026"},"versionCreatedAt":"2025-09-16 11:17:35","video":"","vorDoi":"10.1186/s12879-026-12612-3","vorDoiUrl":"https://doi.org/10.1186/s12879-026-12612-3","workflowStages":[]},"version":"v1","identity":"rs-7494059","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7494059","identity":"rs-7494059","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}