The HIV/HBV co-infected patient: Time for proactive management

Andersson, MI; Preiser, Wolfgang; Rensburg, Christo van; Taljaard, Jantje; Hoffmann, Christopher J.

doi:10.7196/samj.8907

Cited by 3 publications

(2 citation statements)

References 7 publications

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“…The prevalence of hepatitis B virus co-infection among HIV infected children is low among HIV infected children enrolled into care at CCFCC of KCMC, but this should not be underestimated. It is important to strengthen the implementation of the universal infant's hepatitis B virus vaccination, as early as possible after birth to prevent mother to child transmission and introduction of immunization to all HIV infected children and adolescents with negative HBsAg [19]. The screening of HIV infected children for hepatitis B virus co-infection is still important whenever possible.…”

Section: Resultsmentioning

confidence: 99%

Seroprevalence and Associated Risk Factors of HBV Co-infection Among HIV Infected Children Enrolled into Care at Kilimanjaro Christian Medical Centre, Tanzania

Mende¹

2015

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Sub-Saharan Africa remains the region most affected with HIV. The wide use of highly active anti-retroviral therapy has led to improvement in life expectancy among HIV infected individuals. However, hepatitis B virus related complications like liver cirrhosis and liver failure are now becoming common causes of morbidity and mortality in this group. The aim of this study was to determine the seroprevalence and risk factors of HBV/HIV co-infection among HIV infected children enrolled into care at Kilimanjaro Christian Medical Centre (KCMC). This cross sectional analytical study was conducted among 323 HIV infected children at KCMC between February 2013 and May 2013. Investigations included interviews, physical examination and HBsAg analysis. HIV serostatus and CD4 counts/percentages were obtained from patients records. In addition, information on hepatitis vaccine status was recorded. Among 323 HIV-infected children enrolled, 177 (54.8%) were males. The prevalence of hepatitis B virus and HIV co-infection was found to be 1.2% (n=4). Hepatitis B virus co-infection was not significantly associated with any of the sociodemographic or behaviour risk factors which were assessed. CD4 counts were significantly associated with hepatitis B virus status whereby children with CD4 counts less than 350 cells/mm3 were 14 times more likely to have hepatitis B virus co-infection as compared to those who had CD4 counts greater than 350 cells/mm3. All of the hepatitis B virus co-infected children had no records of hepatitis B virus immunization, though one was born during the period of universal infant's hepatitis B vaccination (<4 years old). The frequency of hepatitis B virus co-infection with HIV infection was low among HIV infected children in our set up. It is important to strengthen the implementation of the universal infant's hepatitis B virus vaccination. The screening of HIV infected children for hepatitis B virus co-infection is still important whenever possible with immunization of all HIV infected children and adolescents with negative HBsAg.

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Section: Resultsmentioning

confidence: 99%

Seroprevalence and Associated Risk Factors of HBV Co-infection Among HIV Infected Children Enrolled into Care at Kilimanjaro Christian Medical Centre, Tanzania

Mende¹

2015

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“…Further research with phenotypic studies is needed to determine the impact of persistent viraemia in patients receiving high genetic-barrier treatment such as TDF, to inform better dosing strategies or regimen combinations for better treatment outcomes. Clarion calls have been made for the reprioritization of HIV/HBV management in South Africa [46] and sub-Saharan Africa [19] because of the unique challenges created by the syndemic of HIV and HBV in these parts of the world. Therefore, in response to these calls and the WHO strategy to eliminate viral hepatitis as a public health problem by 2030 [47], this study highlights the drivers of HBV infection in settings where HIV is a major confounder.…”

Section: Discussionmentioning

confidence: 99%

Persistent Hepatitis B Viraemia with Polymerase Mutations among HIV/HBV Co-Infected Patients on HBV-Active ART in KwaZulu-Natal, South Africa

Msomi

Parboosing

Wilkinson

et al. 2022

Viruses

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To understand the problem of persistent Hepatitis B virus (HBV) viraemia in HIV/HBV co-infected patients on HBV-active antiretroviral therapy (ART), we assessed the rate of HBV virological response in patients on HBV-active ART in KwaZulu-Natal, South Africa, and analysed factors associated with persistent HBV viraemia. One hundred and fifty eligible participants with a chronic HBV diagnosis, with or without HIV coinfection, were enrolled and followed up after 6 months. The HBV pol gene was sequenced by next-generation sequencing and mutations were determined using the Stanford HBVseq database. Logistic regression analysis was used to assess factors associated with HBV viraemia at 6-month follow-up. The mean duration of HBV-active ART was 24 months. Thirty-seven of one hundred and six (35%) participants receiving HBV-active ART for longer than 6 months had virological failure. Advanced immunosuppression with CD4+ cell counts <200 cells/μL was independently associated with persistent HBV viraemia, aOR 5.276 (95% CI 1.575–17.670) p = 0.007. A high proportion of patients on HBV-active ART are unsuppressed, which will ultimately have an impact on global elimination goals. Better monitoring should be implemented, especially in HIV-coinfected patients with low CD4+ cell counts and followed by early HBV drug-resistance testing.

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Comparison of Hepatitis B Virus Infection in HIV-Infected and HIV-Uninfected Participants Enrolled in a Multinational Clinical Trial: HPTN 052

Greer

Wilson

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective Data comparing hepatitis B virus (HBV) infection in HIV-infected [HIV(+)], and HIV-uninfected [HIV(−)] individuals recruited into the same study are limited. HBV infection status and chronic hepatitis B (cHB) were characterized in a multi-national clinical trial: HIV Prevention Trials Network (HPTN 052). Method HBV infection status at enrollment was compared between HIV(+) (N=1241) and HIV(−) (N=1232) from seven HBV-endemic countries. Hepatitis B e antigen (HBeAg) and plasma HBV DNA were determined in cHB. Median CD4, median plasma HIV RNA, and prevalence of transaminase elevation were compared in HIV(+) with and without cHB. Significance was assessed with Chi-square, Fisher’s exact, and median tests. Results Among all participants, 33.6% had HBV exposure without cHB (8.9% isolated HBV core antibody, “HBcAb”; 24.7% HBcAb and anti-HB surface antibody positive, “recovered”), 4.3% had cHB, 8.9% were vaccinated, and 53.5% were uninfected. Data were similar among HIV(+) and HIV(−) except for isolated HBV core antibody (HBcAb), which was more prevalent in HIV(+) than HIV(−) [10.1% vs. 7.7%, P=0.046]. Median HBV DNA trended higher in HIV(+) than in HIV(−). In HIV(+) with cHB versus those without cHB, transaminase elevations were more prevalent (ALT ≤ Grade 2, 12% vs. 5.2%, P=0.037; AST ≤ Grade 2, 26% vs. 6.0%, P<0.001), CD4 trended lower, and HIV RNA was similar. Conclusions HBV infection status did not differ by HIV infection status. HIV co-infection was associated with isolated HBcAb and a trend of increased HBV DNA. In HIV, cHB was associated with mild transaminase elevations and a trend toward lower CD4.

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The HIV/HBV co-infected patient: Time for proactive management

Cited by 3 publications

References 7 publications

Seroprevalence and Associated Risk Factors of HBV Co-infection Among HIV Infected Children Enrolled into Care at Kilimanjaro Christian Medical Centre, Tanzania

Seroprevalence and Associated Risk Factors of HBV Co-infection Among HIV Infected Children Enrolled into Care at Kilimanjaro Christian Medical Centre, Tanzania

Persistent Hepatitis B Viraemia with Polymerase Mutations among HIV/HBV Co-Infected Patients on HBV-Active ART in KwaZulu-Natal, South Africa

Comparison of Hepatitis B Virus Infection in HIV-Infected and HIV-Uninfected Participants Enrolled in a Multinational Clinical Trial: HPTN 052

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