Hepatitis B virus and human immunodeficiency virus co‐infection in sub‐Saharan Africa: a call for further investigation

Abstract

A growing body of evidence indicates that human immunodeficiency virus (HIV)-positive individuals are more likely to be infected with hepatitis B virus (HBV) than HIV-negative individuals, possibly as a result of shared risk factors. There is also evidence that HIV-positive individuals who are subsequently infected with HBV are more likely to become HBV chronic carriers, have a high HBV replication rate, and remain hepatitis Be antigen positive for a much longer period. In addition, it is evident that immunosuppression brought about by HIV infection may cause reactivation or reinfection in those previously exposed to HBV. Furthermore, HIV infection exacerbates liver disease in HBV co-infected individuals, and there is an even greater risk of liver disease when HIV and HBV co-infected patients are treated with highly active anti-retroviral therapy (HAART). Complicating matters further, there have been several reports linking HIV infection to 'sero-silent' HBV infections, which presents serious problems for diagnosis, prevention, and control. In sub-Saharan Africa, where both HIV and HBV are endemic, little is known about the burden of co-infection and the interaction between these two viruses. This paper reviews studies that have investigated HIV and HBV co-infection in sub-Saharan Africa, against a backdrop of what is currently known about the interactions between these two viruses.

Prevalence of Hepatitis B and Hepatitis C Coinfections in an Adult HIV Centre Population in Gaborone, Botswana

“…7 The subgroup prevalence of 4.6% among childbearingaged females (ages suggests that a substantial number of infants born to HIV-infected mothers in Botswana are at risk of perinatally transmitted HBV as well as, of course, HIV.…”

“…1,7 Although HBV and HCV seem to have little or no effect on HIV progression, HIV may profoundly affect the course of HBV and HCV.…”

“…21 Some data, including from South Africa, suggest that HBV prevalence may be higher in rural and pediatric populations. 7,22 As defined by a positive test for hepatitis C antibodies (antihepatitis C IgG), the prevalence of hepatitis C in the general population in sub-Saharan Africa was recently estimated at approximately 3%. 23 Data from HIV-infected individuals include a small Zimbabwean study showing a 0.6% rate of HCV coinfection.…”

“…7 Accordingly, the additional prevalence and clinical significance of occult hepatitis B coinfection merits additional study. Other aspects of HBV and HCV coinfection with HIV in resource-limited settings that merit additional study include the effect of TDF-FTC-containing ART regimens in pregnancy on perinatal HBV transmission, the morbidity associated with reactivation hepatitis in the setting of intermittent poor adherence to TDF-and/or 3TC/FTC-containing ART, and the changes in HBV coinfection prevalence created by the recent adoption of universal infant HBV vaccination in some countries in many resource-limited settings.…”

Prevalence of hepatitis B and hepatitis C virus infection in repeatedly transfused thalassemics in a tertiary care hospital in eastern India

“…11 The global prevalence of HBV infection varies widely; and its endemicity ranges from high (≥8%) to intermediate (2-7%) and low (<2%). 12,13 In India, HBsAg prevalence among general population ranges from 2% to 8%, placing India in intermediate HBV endemicity zone and the number of HBV carriers is estimated to be 50 million. Compared to other parts of India, the distribution patterns of HBV genotypes/subgenotypes and mutants is characteristically distinct in eastern part, where in addition to HBV genotypes A and D, genotype C is also present in a comparable proportion.…”