{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:51:24Z","timestamp":1792173084101,"version":"4.4.0"},"reference-count":56,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>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\u2009=\u20090.64, p\u2009=\u20090.001) and BILD (r\u2009=\u20090.54, p\u2009=\u20090.006). ORF1ab Ct at D14 correlated negatively with ALT at D0 (r\u2009= \u22120.67, p\u2009=\u20090.004) and D14 (r\u2009= \u22120.71, p\u2009=\u20090.006); N gene Ct at D14 correlated with ALT at D0 (r\u2009= \u22120.61, p\u2009=\u20090.011). Mixed-effects models identified IL-6 as the sole independent predictor of AST (\u03b2\u2009=\u20093.04, p\u2009=\u20090.005) and Ct N gene as an independent predictor of direct bilirubin (\u03b2\u2009= \u22120.003, p\u2009=\u20090.025), supporting a dual-pathway model of COVID-19-associated cholestasis. Paradoxically, IgG seropositivity independently predicted higher direct bilirubin (\u03b2\u2009=\u20090.06, p\u2009=\u20090.030) but did not mark biliary normalisation. Elevated ALT and BILT at D0 were associated with detectable viral RNA beyond D14 (P\u2009=\u20090.03). Participants aged &gt;30 years drove rising BILD, with significant increases at D14 (P\u2009=\u20090.03) and D30 (P\u2009=\u20090.04) 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.<\/jats:p>","DOI":"10.1371\/journal.pone.0357503","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:21:49Z","timestamp":1792171309000},"page":"e0357503","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early inflammation-driven damage and delayed viral clearance are associated with prolonged biliary perturbation in a Cameroonian cohort of COVID-19 patients"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5373-6222","authenticated-orcid":true,"given":"Modeste R.","family":"Ngamaleu","sequence":"first","affiliation":[{"name":"University of Yaound\u00e9 I","place":["Yaound\u00e9, Cameroon"],"department":["Department of Biochemistry"]},{"name":"Centre for Research on Emerging and Re-emerging Diseases, 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