Incidence of hepatitis B virus infection among human immunodeficiency virus-infected treatment naïve adults in Botswana

Abstract

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection is highest in sub-Saharan Africa and results in accelerated clinical outcomes compared with HBV or HIV mono-infection. HBV clearance rates are higher in healthy adults; however, in sub-Saharan Africa, there are limited data on clearance of incident HBV in HIV-infected adults. Therefore, we sought to estimate HBV incidence and HBV surface antigen (HBsAg) clearance in HIV-infected adults in Botswana. This was a retrospective longitudinal study of 442 HIV-1C infected treatment naïve patients enrolled in a previous Botswana Harvard AIDS Institute Partnership study. Archived plasma samples from 435 HIV-infected treatment naïve participants were screened for HBsAg and HBV core antibody (anti-HBc). HBsAg was evaluated annually over a 4-year period, and HBV deoxyribonucleic acid (DNA) levels of HBsAg-positive chronic and incident patients were quantified. Baseline median CD4+ T-cell count was 458 cells/μL [Q1, Q3: 373, 593], and median HIV viral load was 4.15 copies/mL [Q1, Q3: 3.46, 4.64]. Twenty two HBV incident cases occurred, representing an incidence of 3.6/100 person-years [95% CI: 2.2–5.6]. All incident HBV cases with a follow-up sample available for screening (13/22) cleared HBsAg. Detectable HBV viral loads among chronic and incident cases ranged between 5.15 × 10 1 to 1.4 × 10 7 IU/L and 1.80 × 10 1 to 1.7 × 10 8 IU/mL, respectively. We report high HBV incidence associated with elevated HBV DNA levels despite high CD4+ T-cell counts in HIV-infected patients in Botswana. These incidence cases represent a potential source of HBV transmission in the population. Scaling-up of HIV treatment strategies utilizing antiretroviral therapy regimens with anti-HBV activity coupled with screening for HBV infections in households of the HBsAg-positive cases is recommended.

Factors associated with clearance of hepatitis B virus surface antigen in patients infected with human immunodeficiency virus

“…[ 15 ] Most of these patients were seropositive only for HBcAb and seronegative for HBsAg, indicating that these patients were previously infected with HBV and had cleared HBsAg, indicating their “functional cure.” The number of patients who presented HBsAg-seropositive at least once in their clinical courses was 57, 7.9% among patients examined for HBV-related laboratory tests. This rate was a little bit higher than that reported by Phinius et al [ 16 ] showing 27 (6.2%) among 435 HIV-infected patients in Botswana experienced HBsAg-seropositive during 4-year period, possibly due to the difference in the observation period. Among the 57 male patients who were previously HBsAg-seropositive, 27 became HBsAg-seronegative afterward and 21 remained HBsAg-seropositive until recently.…”

Chronic Hepatitis B and HIV Coinfection: a Continuing Challenge in the Era of Antiretroviral Therapy

“…Nationally in the US, rates of HBV have risen in regions where opioid use has been prevalent [43]. HBV incidence has also been shown to be moderately high in HBV-endemic settings among PLWH with relatively preserved CD4 cell counts [44]. HBV burden is also higher among marginalized populations such as those who inject drugs or are imprisoned, who are also at greater risk of HIV [2,45].…”

Atypical Hepatitis B Virus Serology Profile—Hepatitis B Surface Antigen-Positive/Hepatitis B Core Antibody-Negative—In Hepatitis B Virus/HIV Coinfected Individuals in Botswana

“…Worse-off clinical outcomes may be more pronounced in people with concomitant HBV/human immunodeficiency virus (HIV) than in those with either mono-infection [2,3]. Botswana has an HBV prevalence ranging from 1.1% to 10.6% in different populations [3][4][5][6], with an HBV incidence of Viruses 2023, 15, 1544 2 of 9 3.6/100 person-years in people with HIV (PWH) [7]. HIV prevalence in Botswana is 20.8%, and the country has a successful national HIV management program that has resulted in Botswana surpassing the UNAIDS 95-95-95 goals [8].…”