Hepatitis B infection among HIV infected individuals in Gabon: Occult hepatitis B enhances HBV DNA prevalence

Abstract

In Gabon, a central African country, human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are endemic. In a recent study, conducted in a semi-urban area (Franceville, Gabon), HBV infection was found to be more prevalent among HIV infected individuals. This study aims to investigate the prevalence and genetic diversity of hepatitis B virus infection among HIV infected individuals, predominantly under antiretroviral therapy, living in fully urbanized area: Libreville, capital of Gabon. Serological and molecular tests were performed to detect HBV infection among patients living with HIV/AIDS (PLHA). We used Monolisa HBsAg ULTRA, Anti-HBc Plus and Anti-HBs Plus EIA kits for serological analyses. HBV DNA viral load (HBV DNA VL) was determined by real time PCR and molecular characterization of HBV strains was performed by sequencing and phylogenetic analysis of partial HBV surface and core genes. At all, 70.2% of patients were under antiretroviral therapy. The prevalence of HBsAg was 8.8% (43/487). Detectable HBV DNA was found in 69.7% (30/43) of HBsAg positive patients and in 17.5% (24/137) HBsAg negative patients. HBV DNA VL was significantly higher among patient with CD4 cell counts less than 200 cells/mm3 than those with CD4 cell counts greater than 500 cells/mm3 (p = 0.008). We confirmed the presence of HBV sub-genotypes QS-A3 (40%), and A4 (20%) and HBV-E genotype (40%). The percentage of resistance to Lamivudine was high (40%) and varied according to the M204V/I motif. Occult hepatitis B infection (OBI) was found in patients with isolated HBcAb and among patients who had completed their HBsAg seroconversion. We detected HBV DNA for one patient without any HBV serological marker. This study provides a new landmark for the comprehension of HBV infection in PLHA in urban areas. OBI enhances HBV DNA prevalence and should be investigated in all HBsAg negative individuals.

A systematic review of hepatitis B virus (HBV) drug and vaccine escape mutations in Africa: A call for urgent action

“…HBV/HIV coinfected patients: (n = 28 studies), [ 8 – 10 , 12 – 14 , 20 , 43 – 48 , 50 – 56 , 58 – 62 , 64 , 67 , 70 ];…”

“…Mixed regimen where some received 3TC, others TDF, while others left untreated; (n = 7 studies), [ 12 , 50 , 54 , 56 , 60 , 62 , 66 ];…”

“…Although 35 studies specified the HBV genotype, it was only possible to group RAMs according to genotype in fourteen studies [ 8 , 9 , 13 , 14 , 44 , 46 , 47 , 50 , 51 , 56 , 60 – 62 , 69 ] ( S1 Fig ; S2 Fig ). The remaining 21 studies generally reported the genotypes identified, but did not specifically state the genotype of HBV within which RAMs were identified.…”

“…The most common VEM was the triple mutation rtV173L + rtL180M + rtM204I/V, found in the Pol gene. This suite of mutations was identified in 14 studies [ 12 , 13 , 20 , 44 , 50 – 55 , 58 – 60 , 62 ], at a pooled prevalence of 4% (57/1462). Another significant VEM, sG145K/R [ 16 ], was identified in six studies [ 12 , 42 , 47 , 57 , 60 , 62 ] and sM133L/T, associated with VEM, immunoglobulin and diagnostic escape mutation [ 12 , 48 ], was identified in seven studies [ 12 , 41 , 47 , 48 , 57 , 62 , 70 ] ( Fig 2 ).…”

Characterization of occult hepatitis B in high-risk populations in Kenya

“…HBV is present at intermediate endemicity (2% to 7%) throughout sub-Saharan Africa, at approximately 6.1% [6] and has been suggested to be a neglected tropical disease disproportionately affecting this region [7]. Understandably then, OBI is fairly prevalent throughout Africa, ranging from approximately 7% to 50% in 'low-risk' populations comprised of blood donors or healthcare workers [8][9][10][11] to approximately 6% to 30% in HIV infected populations [12][13][14][15]. The prevalence of HBV infection in Kenya is estimated to be between 1% to 5% [16], although rates among specific high-risk populations (HIV co-infected, PWID, jaundiced patients seeking medical care) are much higher [17][18][19].…”