Susceptibility to hepatitis B infection, hepatitis B/HIV co-infections and hepatitis B immunity in HIV-positive patients starting HAART in Durban, South Africa

Abstract

Background: HIV/HBV co-infection remains a global threat to HIV management despite the available effective hepatitis B vaccine and hepatitis B covering antiretroviral therapy. Many studies done in South Africa and internationally showed high prevalence of HIV/hepatitis B co-infection, which mandated routine screening for both infections before initiating HAART. Fewer studies have highlighted the prevalence of hepatitis B susceptibility in the general population starting HAART and most of them were limited to children and high-risk groups. The aim of this study was to demonstrate the extent of hepatitis B susceptibility, hepatitis B/HIV co-infections and hepatitis B immunity in general HIV-infected patients.Method: This was a retrospective review of 1 066 randomly sampled files of patients initiated on HAART between January 2012 and December 2014 at two Durban hospitals. Data collection included demographic characteristic, CD4 counts and hepatitis B serology. Data were analysed for the prevalence of hepatitis B susceptibility, HIV/HBV co-infection and hepatitis B immunity, while correlations between age, CD4 count and these three groups were demonstrated. Statistical analysis was performed using SAS version 9.3.Results: Total prevalence of HBV susceptibility was 69.7%, HBV immunity was 26.9% and true chronic HIV/HBV co-infection was 3.4%, while HBVsAg positivity accounted for 8.4% of the participants. Adults were more susceptible to HBV than children, with a median age of 36 years. Stratified for age, children were more immune (90%) to HBV than adults.Conclusion: This study demonstrated a significantly high number of HIV-infected persons who were susceptible to hepatitis B infection in Durban, South Africa, where both HIV and HBV are endemic, co-infection is high, and safe and effective HBV vaccine is available. Hepatitis B vaccination of the hepatitis B susceptible patients initiating HAART in South Africa is recommended to prevent further HIV/HBV co-infection.

Laboratory Markers and Characteristics of New HIV Infections Among Adolescents in Zambia

“…Because HBV is more infectious and adolescence is a period of increased sexuality, most infections have been found to occur in adolescents and young adults (50). Our ndings align with several studies in Africa that have established increased Hepatitis B virus vulnerability in HIV-positive persons (51)(52)(53)(54)(55). Clinically, HBV belongs to a variety of heterologous viruses that have been shown to enhance HIV replication (36).…”

Prevalence of hepatitis-B virus co-infection among people living with HIV in Mthatha region of South Africa

“…Some studies from South Africa also reported a higher prevalence of HBV co-infection. A study conducted by Chonco and Rangiah reported a much higher (25%) prevalence of HBV co-infection among PLWH in Durban 7 .…”

“…Both diseases have the same route of transmission and are endemic in sub-Saharan Africa 7 . There has been recent clinical interest in HBV co-infection among PLWH owing to its chronicity.…”

“…There has been recent clinical interest in HBV co-infection among PLWH owing to its chronicity. Furthermore, there is evidence that HBV/HIV co-infection is associated with higher morbidity and mortality than the individual infection on its own 7 . Although the recent success of ART has dramatically decreased opportunistic infection and increased the survival rate among PLWH, the previously unrecognized chronic HBV infection in these groups resurfaced.…”