HBV/HIV co-infection: The dynamics of HBV in South African patients with AIDS

Mayaphi, Simnikiwe H.; Roussow, Theresa M; Masemola, Difuro P; Olorunju, Steve; Mphahlele, M. Jeffrey; Martin, Des

doi:10.7196/samj.4944

Cited by 41 publications

(38 citation statements)

References 22 publications

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“…However, a recent South African study showed a higher HBV prevalence in AIDS patients with CD4+ cell count <100 cells/µl. [15] The study also showed that as much as 60% of HIV patients were exposed to HBV. All the patients analysed for the study were born at a time when vaccination against HBV was not part of the childhood vaccination programme.…”

Section: Discussionmentioning

confidence: 87%

Hepatitis B virus in HIV-infected patients in north-eastern South Africa: Prevalence, exposure, protection and response to HAART

Ayuk

Mphahlele

2013

S Afr Med J

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Objective. Hepatitis B virus (HBV) and HIV are endemic infections in many African countries. The objectives of this study were to determine the levels of exposure to, and protection from, HBV, as well as the prevalence of HIV/HBV co-infection and the response of HBV to highly active anti-retroviral therapy (HAART) in a cross-section of HIV-infected patients in north-eastern South Africa. Study design. This was a laboratory-based, unmatched study. Three hundred and eighty patients were screened by ELISA for HBsAg, anti-HBc and anti-HBs. Samples non-reactive for HBsAg but reactive for anti-HBc were examined for occult HBV infection. Response to HAART was assessed by measuring HBV viral loads, seroconversion from HBeAg to anti-HBe, and levels of aminotransferase. Results. Of the study population of 380, 60% (95% CI 54.8 -64.9) were exposed to HBV based on HBsAg, anti-HBs or anti-HBc; 20% (95% CI 16.1 -24.4) had active HBV infection, based on HBsAg serology, and 30% (95% CI 25.2 -35.2) were protected, based on anti-HBs levels ≥10 IU/l. Of 181 HBsAg-negative individuals, 61 had HBV occult infection (33.7%, 95% CI 26.9 -41.1). The differences in prevalence were not statistically significant when gender, marital status and CD4+ cell counts were considered. Of 21 patients analysed, 80% showed adequate response to the first-line HAART regimen (stavudine/lamivudine/efavirenz or nevirapine) after 12 months of use. Conclusion. The study confirms the higher level (60%) of exposure to HBV in HIV patients in Limpopo Province, as well as the high (20%) prevalence of HBsAg positivity and occult hepatitis B (33.7%). However, further studies are warranted to corroborate the benefit of lamivudine-containing HAART regimens, as HIV/HBV co-infected patients have a higher liver-related mortality if hepatitis B is not treated.

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Section: Discussionmentioning

confidence: 87%

Hepatitis B virus in HIV-infected patients in north-eastern South Africa: Prevalence, exposure, protection and response to HAART

Ayuk

Mphahlele

2013

S Afr Med J

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“…The higher HBV infectivity demonstrated in HBV/ HIV co-infected pregnant women in our study is consistent with other recent studies, and suggests that mother-to-child transmission (MTCT) of HBV may be more common in this country than has previously been thought. [3,6,15] Perinatal HBV transmission often results in an asymptomatic neonatal infection, and 70 -90% of these neonates remain chronically infected if HBV immunoprophylaxis is not given at birth. [16] They will subsequently contribute to the reservoir of asymptomatic HBV carriers as adults.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis B and HIV co-infection in pregnant women: Indication for routine antenatal hepatitis B virus screening in a high HIV prevalence setting

et al. 2014

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Background. Sub-Saharan Africa is endemic for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections. HBV/HIV co-infection in women of reproductive age is of clinical and public health importance because these women constitute a significant reservoir for horizontal and perinatal HBV transmission. Childhood HBV vaccination from 6 weeks of age protects most children against chronic HBV infection. However, infants born to HBV/HIV co-infected women are more likely to be infected perinatally, with an increased risk of chronic hepatitis, than infants born to HBV mono-infected women. Objectives. The aim of our study was to establish the prevalence of HBV infection and HBV/HIV co-infection in pregnant women in KwaZulu-Natal, South Africa, to inform antenatal HBV screening and childhood immunisation policies in South Africa. Methods. Stored plasma specimens obtained from 570 pregnant women were tested for hepatitis B surface antigen (HBsAg) and HBV infectivity, as characterised by the presence of hepatitis B e antigen (HBeAg) and/or HBV DNA load. Results. The antenatal HIV prevalence and HBsAg prevalence in this study were 41.6% and 5.3% (95% confidence interval (CI) 3.4 -7.1), respectively. Overall, 3.1% (95% CI 1.7 -4.6) of pregnant women were HBV/HIV co-infected, with HBeAg positivity and the HBV DNA load being significantly higher in co-infected women. Conclusion. We report a 5.3% HBV prevalence and a 3.1% HBV/HIV co-infection prevalence in pregnant women from this HIV-endemic region. Routine antenatal HBV screening will allow early identification of neonates who require HBV active-passive immunoprophylaxis at birth. This strategy, together with antenatal antiretrovirals, will reduce the risk of perinatal HBV transmission, especially in high-risk HBV/ HIV co-infected pregnant women.

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“…Among unimmunised adults, patients with AIDS were reported to have significantly decreased antiHBs titres compared with a control group of HIVnegative adults. [22] Adults with HBV/HIV coinfection have significantly higher HBV viral loads and for this reason are highly infectious, with an increased risk of transmitting HBV to close contacts and susceptible health workers. [22] This is especially relevant and dangerous in a paediatric haematology and oncology unit where patients are continuously in close contact with each other and where there have been previous reports of HBV transmission.…”

Section: Discussionmentioning

confidence: 99%

“…[22] Adults with HBV/HIV coinfection have significantly higher HBV viral loads and for this reason are highly infectious, with an increased risk of transmitting HBV to close contacts and susceptible health workers. [22] This is especially relevant and dangerous in a paediatric haematology and oncology unit where patients are continuously in close contact with each other and where there have been previous reports of HBV transmission. [7] Patients with underlying HIV disease at the time of cancer diagnosis should be given combined passiveactive immunisation to offer the best possible protection against HBV infection.…”

Section: Discussionmentioning

confidence: 99%

Investigating hepatitis B immunity in patients presenting to a paediatric haematology and oncology unit in South Africa

et al. 2014

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HBV/HIV co-infection: The dynamics of HBV in South African patients with AIDS

Cited by 41 publications

References 22 publications

Hepatitis B virus in HIV-infected patients in north-eastern South Africa: Prevalence, exposure, protection and response to HAART

Hepatitis B virus in HIV-infected patients in north-eastern South Africa: Prevalence, exposure, protection and response to HAART

Hepatitis B and HIV co-infection in pregnant women: Indication for routine antenatal hepatitis B virus screening in a high HIV prevalence setting

Investigating hepatitis B immunity in patients presenting to a paediatric haematology and oncology unit in South Africa

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