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Peer-reviewedCC BY 4.0PLOS One

Early inflammation-driven damage and delayed viral clearance are associated with prolonged biliary perturbation in a Cameroonian cohort of COVID-19 patients

  • Modeste R. Ngamaleu1
  • Hillary Tene2
  • Romeo Djounda3
  • Rachel Minomo4
  • Micheal Besong5
  • Honore Awanakam6
  • Christela Djeukeng7
  • Kevine Tchamda8
  • Reine Seumko’o
  • Tatiane Feugo
  • Antonin Wilson Ndjitoyap Ndam
  • Antoine B. Siafa
5 more authors
  • Eleonore Ngounoue
  • Rene Essomba
  • Charles Kouanfack
  • Jude Bigoga
  • Forgu Esemu Livo
8 affiliations
  1. 1Department of Biochemistry, University of Yaoundé I, Yaoundé, Cameroon
  2. 2Centre for Research on Emerging and Re-emerging Diseases, Institute of Medical Research and Medicinal Plant Studies, Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
  3. 3Catholic University of Central Africa, Higher School of Health Sciences, Yaoundé, Cameroon
  4. 4Immunology laboratory, The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
  5. 5Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
  6. 6University Teaching Hospital Centre of Yaoundé, Yaoundé, Cameroon
  7. 7Department of Biomedical Sciences, Faculty of Health Sciences, University of Buea, Buea, Cameroon
  8. 8National Public Health Laboratory, Ministry of Public Health, Yaoundé, Cameroon
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Abstract

Although COVID-19-associated liver abnormalities are documented, the link between delayed viral clearance, IgG seroconversion, and inflammation remains poorly defined, particularly in Sub-Saharan African populations, where baseline liver enzymes differ from Western standards. In 38 SARS-CoV-2-positive individuals monitored at D0, D14, and D30, we quantified liver biomarkers (ALT, AST, BILT, BILD) by spectrophotometry (COBAS), plasma IL-6 by Luminex, viral load (N and ORF1ab genes) by RT-qPCR, and IgG/IgM serology. Analyses were performed in GraphPad Prism v9.0. ALT and AST rose transiently at D14, returning to baseline by D30. IL-6 peaked at D14 and correlated positively with BILT (r = 0.64, p = 0.001) and BILD (r = 0.54, p = 0.006). ORF1ab Ct at D14 correlated negatively with ALT at D0 (r = −0.67, p = 0.004) and D14 (r = −0.71, p = 0.006); N gene Ct at D14 correlated with ALT at D0 (r = −0.61, p = 0.011). Mixed-effects models identified IL-6 as the sole independent predictor of AST (β = 3.04, p = 0.005) and Ct N gene as an independent predictor of direct bilirubin (β = −0.003, p = 0.025), supporting a dual-pathway model of COVID-19-associated cholestasis. Paradoxically, IgG seropositivity independently predicted higher direct bilirubin (β = 0.06, p = 0.030) but did not mark biliary normalisation. Elevated ALT and BILT at D0 were associated with detectable viral RNA beyond D14 (P = 0.03). Participants aged >30 years drove rising BILD, with significant increases at D14 (P = 0.03) and D30 (P = 0.04) versus D0. COVID-19 liver injury follows a biphasic course: D14 alterations are inflammation-driven (IL-6), while D30 abnormalities track with delayed viral RNA clearance independent of IgG seroconversion. Extended hepatic monitoring is warranted, especially in older patients with delayed viral clearance in resource-limited settings.

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Cite

BibTeXRIS
BibTeX
@article{ngamaleu2026early,
  title = {{Early inflammation-driven damage and delayed viral clearance are associated with prolonged biliary perturbation in a Cameroonian cohort of COVID-19 patients}},
  author = {Modeste R. Ngamaleu and Hillary Tene and Romeo Djounda and Rachel Minomo and Micheal Besong and Honore Awanakam and Christela Djeukeng and Kevine Tchamda and Reine Seumko’o and Tatiane Feugo and Antonin Wilson Ndjitoyap Ndam and Antoine B. Siafa and Eleonore Ngounoue and Rene Essomba and Charles Kouanfack and Jude Bigoga and Forgu Esemu Livo},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0357503},
  url = {https://doi.org/10.1371/journal.pone.0357503},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Early inflammation-driven damage and delayed viral clearance are associated with prolonged biliary perturbation in a Cameroonian cohort of COVID-19 patients
AU  - Modeste R. Ngamaleu
AU  - Hillary Tene
AU  - Romeo Djounda
AU  - Rachel Minomo
AU  - Micheal Besong
AU  - Honore Awanakam
AU  - Christela Djeukeng
AU  - Kevine Tchamda
AU  - Reine Seumko’o
AU  - Tatiane Feugo
AU  - Antonin Wilson Ndjitoyap Ndam
AU  - Antoine B. Siafa
AU  - Eleonore Ngounoue
AU  - Rene Essomba
AU  - Charles Kouanfack
AU  - Jude Bigoga
AU  - Forgu Esemu Livo
PY  - 2026
DA  - 2026/10/16
JO  - PLOS One
DO  - 10.1371/journal.pone.0357503
UR  - https://doi.org/10.1371/journal.pone.0357503
AB  - Although COVID-19-associated liver abnormalities are documented, the link between delayed viral clearance, IgG seroconversion, and inflammation remains poorly defined, particularly in Sub-Saharan African populations, where baseline liver enzymes differ from Western standards. In 38 SARS-CoV-2-positive individuals monitored at D0, D14, and D30, we quantified liver biomarkers (ALT, AST, BILT, BILD) by spectrophotometry (COBAS), plasma IL-6 by Luminex, viral load (N and ORF1ab genes) by RT-qPCR, and IgG/IgM serology. Analyses were performed in GraphPad Prism v9.0. ALT and AST rose transiently at D14, returning to baseline by D30. IL-6 peaked at D14 and correlated positively with BILT (r = 0.64, p = 0.001) and BILD (r = 0.54, p = 0.006). ORF1ab Ct at D14 correlated negatively with ALT at D0 (r = −0.67, p = 0.004) and D14 (r = −0.71, p = 0.006); N gene Ct at D14 correlated with ALT at D0 (r = −0.61, p = 0.011). Mixed-effects models identified IL-6 as the sole independent predictor of AST (β = 3.04, p = 0.005) and Ct N gene as an independent predictor of direct bilirubin (β = −0.003, p = 0.025), supporting a dual-pathway model of COVID-19-associated cholestasis. Paradoxically, IgG seropositivity independently predicted higher direct bilirubin (β = 0.06, p = 0.030) but did not mark biliary normalisation. Elevated ALT and BILT at D0 were associated with detectable viral RNA beyond D14 (P = 0.03). Participants aged >30 years drove rising BILD, with significant increases at D14 (P = 0.03) and D30 (P = 0.04) versus D0. COVID-19 liver injury follows a biphasic course: D14 alterations are inflammation-driven (IL-6), while D30 abnormalities track with delayed viral RNA clearance independent of IgG seroconversion. Extended hepatic monitoring is warranted, especially in older patients with delayed viral clearance in resource-limited settings.
SN  - 1932-6203
ER  -