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

Abstract

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.

High sero-prevalence of hepatitis B virus and human immunodeficiency virus infections among pregnant women attending antenatal clinic at Temeke municipal health facilities, Dar es Salaam, Tanzania: a cross sectional study

“…Furthermore, the prevalence of HBV/HIV co-infection among pregnant women found in our study was higher than the previous reports in Nigeria (0.24%), Ethiopia (0.6%) and Cameroon (1.5%) [24, 33, 34]. However, the prevalence of HBsAg in the current study was lower than that reported from a recent study among pregnant women in South Africa (3.1%) [35]. The observed low HBV/HIV co-infection rates in settings of high HBV endemicity could be explained by the fact that the main routes of transmission of HBV in Sub-Saharan Africa could be vertical and likely occurs in early childhood.…”

Hepatitis B Prevalence among Pregnant Women in Central and West Nile regions of Uganda: Is there a Need to prioritize Prevention of Mother to Child hepatitis B transmission?

“…It is also noteworthy, that none of the HBV infected pregnant women in our study sample had HIV co-infection. Unlike our finding, other studies within the region have reported HIV among HBV infected pregnant women (37,38). Our result might be explained by the fact that all our HIV infected women were already taking ART.…”

Screening, characterisation and prevention of Hepatitis B virus (HBV) co-infection in HIV-positive children in South Africa

“…Routine maternal screening for HBV during pregnancy would yield benefits for both mother and child, including clinical assessment and appropriate treatment for adult infection, and implementation of measures to reduce both vertical and within-household transmission [11]. Ongoing evaluation of the risks and benefits of the timing of the first HBV vaccine dose is required.…”