Pregnant women, HIV and hepatitis in Guinea: the study by Dr Thierno Amadou reveals a blind struggle

In Guinea, talking about HIV and viral hepatitis means talking about diseases that are still very present, but also about realities that are often invisible in public debate. In pregnant women, these infections take on a particular dimension: they concern both the health of the mother and that of the unborn child.

The results presented in this article do not come from isolated observations. They come from rigorous scientific work, published in international peer-reviewed scientific journals, in the fields of virology, epidemiology and molecular genetics, particularly MDPI or even Virology Problems. These studies were conducted by the Guinean researcher Dr Thierno Amadou Labé Baldé, researcher at the Institute of Applied Biology Research of Guinea (IRBAG) in collaboration with the Pasteur Institute of Saint Petersburg.

As the researcher himself summarizes, « the absence of solid local data strongly limits the effectiveness of prevention and management strategies for blood-transmitted infections in Guinea ».

This work combines biological screening, in-depth genetic analyzes and epidemiological interpretation, thus providing a rare scientific snapshot of the circulation of HIV and viral hepatitis B and C among pregnant Guinean women.

HIV: an infection still very present among pregnant women

The results are clear. By analyzing samples from more than 1,800 pregnant women from different regions of the country, researchers revealed an HIV prevalence varying between 6% and more than 11%, depending on the areas studied. In certain regions, notably in Kindia, the rates observed are particularly high.

These figures remind us that HIV remains a central public health concern in Guinea. « Pregnancy remains one of the key moments for detecting HIV infection and preventing its transmission to the child. », underlines Dr Labé Baldé. But beyond the prevalence, researchers were interested in the very nature of the virus that is circulating.

Genetic analysis reveals that the majority of strains belong to a recombinant form of HIV, called CRF02_AG, widely distributed in West Africa. This genetic diversity is not trivial, it influences the transmission of the virus, its evolution and sometimes the effectiveness of treatments.

A result which gives rise to particular concern. « We identified a significant proportion of resistance mutations in women who have never received antiretroviral treatment », explains the researcher. Nearly 27% of infected pregnant women already have antiretroviral drug resistance mutations. Even more surprising, these mutations are sometimes found in women who have never received treatment. In other words, some women may be infected with partially resistant HIV from the start, making it difficult to prevent mother-to-child transmission.

Hepatitis B: a massive but often silent infection

While HIV remains highly publicized, hepatitis B appears, upon reading this work, to be an even more widespread threat. « Hepatitis B is today one of the quietest but most dangerous viral infections for pregnant women in Guinea. », alerts Dr. Labé Baldé. More than a quarter of the pregnant women studied carried the hepatitis B virus. In many cases, the infection went unnoticed because it took a so-called form. “occult”, difficult to detect with traditional tests.

Genetically, the virus identified is mainly of genotype E, a genotype characteristic of West Africa. But here again, molecular analysis reveals worrying elements. In some women, mutations associated with resistance to antiviral treatments have been detected. Even more frequently, so-called mutations of“immune escape” were observed. These allow the virus to bypass the immune system and, in some cases, escape detection.

This situation exposes pregnant women and their children to a double risk. « Certain mutations can lead to false negatives during traditional screening », specifies the researcher, that of not being correctly diagnosed and that of receiving inappropriate care.

Hepatitis C: less common, but genetically complex

Unlike HIV and hepatitis B, hepatitis C appears less prevalent among pregnant women in Guinea. Studies show that just over 3% have antibodies, and less than 1% have an active infection confirmed by molecular biology.

However, this low prevalence should not mask a more complex reality. « The genetic diversity of the hepatitis C virus observed in Guinea is much broader than previously available data suggested. », notes Dr. Labé Baldé. All identified strains belong to genotype2, typical of West Africa, but with a great diversity of subtypes. Some isolates observed could even correspond to variants never before described.

No major resistance to antiviral treatments has been identified at this stage. Nevertheless, the researchers highlight the presence of numerous natural polymorphisms, which could, ultimately, influence the effectiveness of drugs if these treatments were to be widely used in Guinea.

What these results say about the Guinean health system

Taken as a whole, this work paints a portrait of a complex health situation. Pregnant women in Guinea are highly exposed to HIV and hepatitis B, sometimes without knowing it. The viruses circulating present significant genetic diversity, and certain strains already carry resistance mutations.

These findings highlight the limits of current screening and treatment strategies, often based on standard tools which do not always take into account local genetic reality. « Without genetic surveillance, programs to fight these infections risk being out of step with the reality on the ground. », insists the researcher.

Ways to better protect mothers and children

Researchers emphasize the need to strengthen prenatal screening, by integrating more sensitive methods capable of detecting occult forms of infections. They also underline the importance of regular genetic monitoring of viruses, in order to adapt therapeutic protocols. The generalization of vaccination against hepatitis B from birth, as well as the strengthening of programs to prevent mother-to-child transmission of HIV, appear to be essential levers for sustainably reducing the impact of these diseases.

In addition to these possible solutions, Dr Baldé calls for strengthening the capacities of young researchers, to perpetuate the achievements.

When local search becomes a decision-making tool

This scientific work, carried out by a Guinean researcher and supported by international collaborations, shows the extent to which local research is essential to guide public health policies. They also remind us that behind the figures and genetic analyzes there are major human issues; the health of mothers, that of children, and the health future of the country.

However, for a more global impact it would be necessary to carry out this type of study on a larger sample within the local population.

Alpha Oumar Bagou Barry