Impact of Hepatitis B Virus Infection on Human Immunodeficiency Virus Response to Antiretroviral Therapy in Nigeria

Abstract

Background As HAART is introduced into areas of the world with high hepatitis B virus (HBV) endemicity, it is important to determine the influence of HBV on HIV-HBV co-infected persons receiving antiretroviral therapy (ART). Methods We studied 1,564 HIV-infected subjects in Jos, Nigeria who initiated ART. HIV-HBV co-infected participants had HBeAg and HBV DNA status determined. CD4+ T-cell count and HIV viral load at ART initiation were compared between HIV mono-infected and HIV-HBV co-infected subjects using univariate methods. Regression analyses were used to determine if HBeAg status or HBV DNA at ART initiation were associated with baseline HIV parameters or ART response. Results The CD4+ T-cell counts of the 262 (16.7%) HIV-HBV co-infected participants was 107 cells/mL compared to 130 cells/mL in HIV monoinfected participants (p <0.001) at ART initiation. HIV-HBV co-infected participants also had higher HIV viral loads than HIV monoinfected subjects (4.96 vs. 4.75 log10 copies/mL; p = 0.02). Higher HBV DNA and detectable HBeAg were independently associated with lower CD4+ T-cell counts at ART initiation but not with higher HIV viral load. In a multivariable model, HBeAg-positive subjects were less likely to suppress HIV replication to ≤400 copies/ml (OR 0.54, p=0.03) at 24 weeks, but they had similar CD4+ T cell increases. At 48 weeks, there was no significant effect of HBeAg status on ART response. Conclusions In HIV-infected Nigerian individuals, HBV co-infection, especially in those with high levels of HBV replication, was associated with lower CD4+ T-cell counts at ART initiation independent of HIV RNA level. Subjects with HBeAg positive status had a slower virological response to ART. Further work is needed to understand the effects of HBV on CD4+ T-cells.

Impact of HIV and HIV with HBV co-infection on hepatic transaminases and CD4+ T cell counts in Sokoto, North Western Nigeria

“…Elevated ALT and AST levels were also more common in patients with immunologically defined AIDS compared to patients with CD4 + T lymphocyte counts > 200 cells/mm³, and this represents about 21% and 31% of total patients with elevated ALT and AST levels respectively. Idoko et al, (2009), observed 18% of the cohort with elevated ALT levels in their study [8] and this is comparable to the value obtained in the current study. Higher mean and elevated ALT and AST levels among immunologically defined AIDS patients is not unexpected as some opportunistic infections in AIDS patients may secondarily infect liver cells and result to high hepatic transaminases levels due to liver cell injury.…”

“…Idoko et al, (2009) in their studies observed similar finding with regard to CD4 + T cell counts, however observed significant difference in relation to ALT levels [8] . Olawumi et al, (2014) in their studies documented similar results with regard to CD4 + T cell counts and AST levels [9] .…”

Profile and prevalence of HBV among HIV affected individuals attending the largest public HIV care center in India

“…Areas where HBV is highly endemic usually overlap with areas having high rates of HIV infection [10]. Being a moderate HBV endemic country having a large population of people living with HIV/AIDS, India presents an ideal setting for increased transmission and occurrence of HIV-HBV co-infections.…”

Chronic Hepatitis B: Management Challenges in Resource-Poor Coun-tries

“…This is because CHB is a disease that requires adequate explanation, counseling, and individualized assessment for successful anti-HBV therapy. The Society for Gastroenterology and Hepatology in Nigeria identified this lack of knowledge among health care providers and took a positive step towards addressing the situation by publishing the first edition of a treatment guideline for Hepatitis B and C in Nigeria in 2009 (10). The circulation of this document needs to be widened so that doctors and other health workers will begin to implement the guideline provisions.…”

“…Over 70% of the population shows evidence of past infection with the virus and 7.3-24% of the population has serological evidence of current infection (average 13.7%). Thus, 19 million Nigerians are currently infected and approximately 5 million will die of causes related to HBV infection (10).…”