High incidence and persistence of hepatitis B virus infection in individuals receiving HIV care in KwaZulu-Natal, South Africa

Abstract

Background Hepatitis B virus (HBV), Human Immunodeficiency virus (HIV) and Tuberculosis (TB) are common infections in South Africa. We utilized the opportunity of care provision for HIV-TB co-infected patients to better understand the relationship between these coinfections, determine the magnitude of the problem, and identify risk factors for HBV infection in HIV infected patients with and without TB in KwaZulu-Natal, South Africa. Methods This retrospective cohort analysis was undertaken in 2018. In-care HIV infected patients were included in the analysis. Results from clinical records were analysed to determine the prevalence, incidence, persistence and factors associated with HBsAg positivity in HIV-infected patients with or without TB co-infection. Results A total of 4292 HIV-infected patients with a mean age of 34.7 years (SD: 8.8) were included. Based on HBsAg positivity, the prevalence of HBV was 8.5% (363/4292) [95% confidence interval (CI): 7.7–9.3] at baseline and 9.4% (95%CI: 8.6–10.3%) at end of follow-up. The HBV incidence rate was 2.1/100 person-years (p-y). Risk of incident HBV infection was two-fold higher among male patients (HR 2.11; 95% CI: 1.14–3.92), while severe immunosuppression was associated with a greater than two-fold higher risk of persistent infection (adjusted risk ratio (RR) 2.54; 95% CI 1.06–6.14; p = 0.004. Additionally, active TB at enrolment was associated with a two-fold higher risk of incident HBV infection (aHR 2.38; 95% CI: 0.77–7.35). Conclusion The provision of HIV care and treatment in high HBV burden settings provide a missed opportunity for HBV screening, immunization and care provision.

Prevalence of Hepatitis B viral infection and associated factors among adults in Moyo district, North-Western Uganda

“…Similarly, a study conducted in Nigeria noted that sexually active adults with STIs are at high risk of acquiring Hepatitis B viral infections [17]. Agrawal et al and Govindan et al found a lower prevalence of HBV among patients infected with syphilis [18, 19], other studies have noted a high prevalence of syphilis, HIV, HCV and Hepatitis B co-infection [20, 21, 22, 23, 24, 25, 26].…”

Low prevalence of hepatitis B virus infection in HIV-uninfected pregnant women in Cape Town, South Africa: implications for oral pre-exposure prophylaxis roll out

“…Previous studies on hepatitis B in the post-vaccination era have largely been conducted in health-care facilities or from tertiary healthcare facilities, with the majority of patients drawn from one or two provinces (Gauteng and KwaZulu Natal) or were among people living with HIV in care [16][17][18]. National sentinel studies reported HBsAg prevalence ranging from 2.9% in HIV-uninfected pregnant women in Western Cape in 2008 to 9.4% in HIV infected patients seeking treatment and care services in South Africa [9]. The national HBsAg test positivity rate declined annually, from 9.77% in 2015 to 8.09% in 2019, with a significant strong negative association over time [2].…”

“…A recent study in people receiving HIV care in South Africa found high incidence and persistence of HBV. The prevalence of hepatitis B surface antigen was 8.5% [95% confidence interval (CI): 7.7-9.3] at baseline and 9.4% (95% CI: 8.6-10.3%) at end of follow-up among people living with HIV [9].…”

Persistent Hepatitis B Viraemia with Polymerase Mutations among HIV/HBV Co-Infected Patients on HBV-Active ART in KwaZulu-Natal, South Africa

“…Although a history of TB was found to have 1.7-fold odds of association with persistent HBV viraemia at follow up, this was not statistically significant during multivariate analysis. In another South African large-cohort study, which studied factors associated with the incidence and persistence of HBV infection in patients receiving HIV care, a history of TB was found to be associated with a higher incidence of HBV infection [34].…”