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.

The effect of substance uses on antiretroviral treatment adherence in primary health care

“…These findings are aligned with other national and international studies. 35,36,37 The authors also found that disclosing one's HIV status significantly affects adherence. The study found that people who disclosed their status had an average of 9.3 times higher adherence than the non-disclosure group.…”

Epidemiology and Challenges of HBV/HIV Co-Infection Amongst HIV-Infected Patients in Endemic Areas: Review

“…7 , 14 In Africa, HBV–HDV co-infection is more prevalent in western and middle African countries. 4 , 6 , 28 The proportion of triple infection (HBV–HDV–HIV) ranges from 1.4% to 19.7% among HIV patients on ART follow up in different countries. 14 , 16 , 17 , 7 , 27 …”

“… 32 Adult individuals are more susceptible for HBV infection than children because 90% of children are immune for HBV infection or develop a protective immune mechanism for HBV infection as a result of subsequent infection and vaccination. 28 …”

“…Impaired immune response to HIV is an increased risk for liver-related disease progression among HBV–HIV co-infected patients on HBV active ART regimen. 7 , 28 , 38 Moreover, the rate of HBV–HIV co-infection is increased in HIV patients with impaired immune response compared to individuals with optimum immune restoration. 23 , 32 , 34 , 43 The proportion of liver-related mortality is higher among HBV–HIV co-infected subjects than HBV mono-infected only.…”