Increased detection of HBV DNA in HBsAg‐positive and HBsAg‐negative South African HIV/AIDS patients enrolling for highly active antiretroviral therapy at a Tertiary Hospital

Abstract

This retrospective study investigated the prevalence of hepatitis B virus (HBV) in 192 stored sera from human immunodeficiency virus (HIV) positive South African patients initiating antiretroviral therapy (ART), and explored the implications of HBV-HIV co-infection on laboratory diagnosis of HBV. HBV serology (HBsAg, anti-HBs and anti-HBc) and nested HBV PCR assays targeting the HBV polymerase gene were performed, with HBV DNA positive samples being quantified with Cobas Taqman HBV test 48 assay (Roche Diagnostics). The study found that 63% (121/192) of patients had past or present HBV infection, and 40.6% (78/192) had detectable HBV DNA. Also, 22.9% (44/192) of patients were HBsAg positive and HBV DNA positive, while 23% (34/148) of HBsAG negatives had occult HBV infections. Of the 78 HBV DNA positive samples, 62.8% had viral loads ranging from 10(2) to > or =10(8) IU/ml, and 37.2% had HBV viral loads <200 IU/ml. There was a statistically significant positive association between HBsAg-positivity and high viral loads, with 27% (12/44) of HBsAg positives having HBV viral loads between 10(4) and > or =10(8) IU/ml, compared to only 5.9% (2/34) of HBsAg negatives (relative risk: 4.64; 95% confidence interval: 1.11, 19.35; chi-square P-value = 0.015). The study shows that the majority of HIV/AIDS patients initiating ART have either acute or chronic HBV infections, and further confirms that HIV remains a risk factor for occult HBV infections in South African patients as previously shown. The findings strongly support HBV screening in all HIV-positive patients initiating ART in South Africa, considering that current ART regimens include drugs with anti-HBV activity (e.g., lamivudine).

Epidemiological and Evolutionary Profile of HIV-HBV Co-Infected Patients Followed at Ambulatory Treatment Center in Fann Hospital Dakar-Senegal

“…Tremeau-Bravard, A. et al in Nigeria in 2012, Muriuki et al in Kenya in 2013, Kapembwa et al in Zambia in 2011(Tremeau-Bravard, Ogbukagu, Ticao, & Abubaka, 2012Beatrice, Michael, Dorcas, Anthony, & Samoel, 2013;Kapembwa et al, 2011), who found respectively 7,9%; 6%; 9.9%. On the other hand, Lukhwareni et al (Lukhwareni, Burnett, Selabe, Mzileni, & Mphahlele, 2009) in South Africa in 2009, found a much higher prevalence than ours (22.9%).…”

Hepatitis B virus in HIV-infected patients in north-eastern South Africa: Prevalence, exposure, protection and response to HAART

“…Previous studies in South Africa have shown that HBV DNA is significantly higher in HIV-infected than in HIV-negative patients, suggesting that HIV infection may be a risk factor for occult HBV infections. [12,16] This finding highlights the level of undetected active HBV infections that have the potential to affect antiretroviral therapy (ART) as their presence increases hepatotoxicity of ART with consequent limitation of their use. [17,18] Anti-HBs are known to confer protection against HBV at plasma levels ≥10 IU/ml.…”

“…This was followed by amplification of HBV core gene using an in-house nested polymerase chain reaction (PCR) protocol as previously described. [12] The nested PCR amplification product was verified for expected fragment size by a 1% ethidium bromide-stained agarose gel electrophoresis at a constant voltage of 100 V for 40 minutes, and viewed by UV transillumination.…”

Nurses at risk for occupationally acquired blood-borne virus infection at a South African academic hospital

“…Of HIV-infected individuals, 66% 10,11 have evidence of either past or present infection with HBV. Because HBV vaccine has been included in the Expanded Programme on Immunization (EPI) in South Africa only since 1995, these individuals would not have been immunised at birth and would therefore have been susceptible to HBV infection.…”

“…14 Deaths among HIV-infected people with chronic HBV and HCV infections, now seen as a result of end-stage liver disease, have increased worldwide. 15 Studies by Lukhwareni et al 10 strongly support the policy that all HIV-positive patients initiating highly active antiretroviral therapy (HAART) in South Africa be screened for HBV, and the Centers for Disease Control (CDC) in the USA recommend that all HIV-infected HCWs be vaccinated against HBV. 16 Studies on the impact of HIV/AIDS on the health sector in four provinces in South Africa in 2002 and in two public hospitals in Johannesburg in 2005 estimated the HIV seroprevalence among HCWs to be 15.7% 17 and 11.5% 18 respectively.…”