Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia

Abstract

BackgroundFew data on the virological determinants of hepatitis B virus (HBV) infection are available from southern Africa.MethodsWe enrolled consecutive HIV-infected adult patients initiating antiretroviral therapy (ART) at two urban clinics in Zambia and four rural clinics in Northern Mozambique between May 2013 and August 2014. HBsAg screening was performed using the Determine® rapid test. Quantitative real-time PCR and HBV sequencing were performed in HBsAg-positive patients. Risk factors for HBV infection were evaluated using Chi-square and Mann-Whitney tests and associations between baseline characteristics and high level HBV replication explored in multivariable logistic regression.ResultsSeventy-eight of 1,032 participants in Mozambique (7.6%, 95% confidence interval [CI]: 6.1–9.3) and 90 of 797 in Zambia (11.3%, 95% CI: 9.3–13.4) were HBsAg-positive. HBsAg-positive individuals were less likely to be female compared to HBsAg-negative ones (52.3% vs. 66.1%, p<0.001). Among 156 (92.9%) HBsAg-positive patients with an available measurement, median HBV viral load was 13,645 IU/mL (interquartile range: 192–8,617,488 IU/mL) and 77 (49.4%) had high values (>20,000 UI/mL). HBsAg-positive individuals had higher levels of ALT and AST compared to HBsAg-negative ones (both p<0.001). In multivariable analyses, male sex (adjusted odds ratio: 2.59, 95% CI: 1.22–5.53) and CD4 cell count below 200/μl (2.58, 1.20–5.54) were associated with high HBV DNA. HBV genotypes A1 (58.8%) and E (38.2%) were most prevalent. Four patients had probable resistance to lamivudine and/or entecavir.ConclusionOne half of HBsAg-positive patients demonstrated high HBV viremia, supporting the early initiation of tenofovir-containing ART in HIV/HBV-coinfected adults.

HBV Infection in HIV-Driven Immune Suppression

“…Accelerated liver disease progression and HCC evolution, which has been documented in HIV/HBV infected patients, is likely to be related to high HBV-DNA levels [27] and poor immunological control of HBV replication associated with the low CD4 positive cell counts, which are typical of HIV/HBV coinfected subjects. A greater tendency to synchronize HBV infection with poor HBeAg seroconversion has been demonstrated in coinfected Nigerian people before the onset of cART [12]. In this study, higher HBV DNA and detectable HBeAg levels were independently associated with lower CD4+ T cell counts.…”

“…Functional cure more frequent in HIV/HBV patients and correlated with low pre-treatment HBsAg levels [12][13][14][15][16][17][18] Increase OBI •• condition OBI associated with low CD4 cells, high ALT elevation and more frequent AIDS illness [8,9,11,19]…”

Awareness and management of elevated blood pressure among human immunodeficiency virus–infected adults receiving antiretroviral therapy in urban Zambia: a call to action

“…A prospective HIV cohort was established in 2013 at two public-sector clinics in Lusaka to investigate viral hepatitis–HIV co-infection [12,13]. From 1 October 2013, to 15 August 2014, HIV-infected and ART-eligible adults (>18 years old) who initiated ART under MoH guidelines were prospectively enrolled [11].…”

Field performance of the Determine HBsAg point-of-care test for diagnosis of hepatitis B virus co-infection among HIV patients in Zambia

“…7,9 At linkage and initial enrollment in HIV care, phlebotomy was performed for CD4+ count, creatinine, and HBsAg using a central laboratory Enzyme Linked Immunosorbent Assay (ELISA) that has ≥99.5% sensitivity and specificity (Access 2 Analyzer; Beckman Coulter Inc). HIV-infected adults (18+ years old) who were antiretroviral therapy (ART) eligible (CD4+ count <500 cells/mm 3 or WHO stage 3/4 conditions) were enrolled consecutively at two large public sector HIV clinics.…”

“…4 Building on this and several other studies, 5,6 we investigated the field performance of the Determine HBsAg test among HIV-infected individuals in Zambia, a group at increased risk for chronic HBV infection. Leveraging a prospective cohort where HBV virology and liver disease were well-characterized, 7,8 we evaluated assay performance as well as the clinical relevance of false negative results.…”