HBV infection in untreated HIV-infected adults in Maputo, Mozambique

Abstract

BackgroundHIV/ HBV coinfected patients are at high risk of developing chronic HBV infection, liver cirrhosis and hepatocellular carcinoma. In Mozambique, where HIV prevalence is one of the highest in the world, HIV-infected patients are scarcely characterized in terms of HBV coinfection and 3TC-resistance mutations profile.MethodsTo characterize ART-naïve HIV-infected adults, with and without HBV coinfection, a cross-sectional study was conducted between May and November 2012 in two health centers from Maputo city, Mozambique. Subjects were consecutively enrolled in the study and, then, tested for hepatitis B surface antigen (HBsAg). Moreover, CD4+ T cells count, HBV DNA in plasma, HBV genotyping and 3TC-resistance mutations profile of HBV were assessed in HIV/HBV coinfected patients.ResultsIn total, 518 patients were enrolled in the study. The median age was 33 years old and 66.8% were women. The median CD4+ T cells count was 361 cells/mm3 and 47 (9.1%) were coinfected with HBV. Out of 46 coinfected patients, 24 (55.2%) had HBV DNA ≥ 20 - < 20 000 and 12 (26.1%) had HBV-DNA ≥20 000. APRI > 2.0 was reported in 4.3% of coinfected and 1.7% of monoinfected patients (p = 0.228), while FIB-4 > 3.25 was reported in 4.4% of coinfected and 1.3% of monoinfected patients (p = 0.112). Genotype A was the most frequent, identified in 25/27 (92.6%) patients, whereas genotype E was present in 2/27 (7.4%) patients. No patient had 3TC-resistance mutations.ConclusionsThis study showed that HBV coinfection was prevalent among ART-naïve HIV-infected adults in Mozambique. Overall, these data highlight the importance of screening HBV coinfection as an integrated measure of HIV routine care to improve health conditions and treatment of HIV/HBV coinfected patients.

Prevalence and Profile of Hepatitis B Virus Infection among HIV-Infected Adults at Panzi Referral Hospital, in the Post-Conflict South Kivu Province, Eastern Democratic Republic of Congo

“…prevalence in other cohorts of co-infected treated patients [10] [14] [24] [44] but similar to that between 50% and 71% in patients infected with HBV alone [31] [45] [46]. Also, these prevalences data are higher than those reported from Maputo, where less than 1% of co-infected subjects carried the marker for HBV immunization [23]. This loss of immunity against hepatitis B was explained by the fact that HIV infection leads to immunosuppression which would reduce the reaction.…”

“…Male sex was associated to co-infection significantly with co-infection as has been reported in Benin [28], Nigeria [31], South Africa [27], Rwanda [29] and Cameroon [19]. Other authors have reported a female predominance in Mozambique and Zambia [16] [23], Uganda [17], and in South Kivu [12]. In observing our study population, there were a large number of female than male patients.…”

Prevalence and molecular characterization of occult hepatitis B virus in pregnant women from Gondar, Ethiopia

“…Clinically relevant HBV variants include the presence of nucleot(s)ide analogue (NA) resistance mutations (or drug-resistance mutations [DRM]), vaccine escape mutants (VEM), diagnostic escape mutants (DEM), and pre-core (PC)/basal core promoter (BCP) variants that are often reported in association with HCC and risk of cirrhosis (21,22). Moreover, as a result of the HIV epidemic in Sub-Saharan Africa and shared routes of transmission, HBV and HIV co-infection is common (5,(23)(24)(25). Although some HIV antiretroviral medications also have activity against HBV, patients on first-generation anti-HBV therapy with a lower genetic barrier to resistance (ie, lamivudine) may drive selection of HBV-resistant variants (5,(26)(27)(28).…”

First report of occult hepatitis B infection among ART naïve HIV seropositive individuals in Maputo, Mozambique

“…In Mozambique, which has the eighth highest HIV prevalence in the world [ 15 ], the most recent HIV survey showed that the epidemics is getting even worse [ 16 ]. Few studies have been conducted to determine the prevalence of HBV in Mozambique, and they have been conducted in specific groups such as refugees [ 17 ], blood donors [ 18 – 20 ], HIV infected individuals [ 21 , 22 ] or high risk groups [ 23 ] and showed that the rate varied between 7% and 13%. OBI has received new attention as a serious public health problem.…”