Hepatitis B infection among HIV infected individuals in Gabon: Occult hepatitis B enhances HBV DNA prevalence.

Berthold Bivigou-Mboumba,Samira Zoa-Assoumou,Angélique Ndojyi-Mbiguino,Guy Francis Nzengui-Nzengui,Richard Njouom,Marie Amougou-Atsama,Hervé M’Boyis Kamdem,Sandrine François-Souquière,Yury E Khudyakov

doi:10.1371/journal.pone.0190592

Abstract

In Gabon, a central African country, human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are endemic. In a recent study, conducted in a semi-urban area (Franceville, Gabon), HBV infection was found to be more prevalent among HIV infected individuals. This study aims to investigate the prevalence and genetic diversity of hepatitis B virus infection among HIV infected individuals, predominantly under antiretroviral therapy, living in fully urbanized area: Libreville, capital of Gabon. Serological and molecular tests were performed to detect HBV infection among patients living with HIV/AIDS (PLHA). We used Monolisa HBsAg ULTRA, Anti-HBc Plus and Anti-HBs Plus EIA kits for serological analyses. HBV DNA viral load (HBV DNA VL) was determined by real time PCR and molecular characterization of HBV strains was performed by sequencing and phylogenetic analysis of partial HBV surface and core genes. At all, 70.2% of patients were under antiretroviral therapy. The prevalence of HBsAg was 8.8% (43/487). Detectable HBV DNA was found in 69.7% (30/43) of HBsAg positive patients and in 17.5% (24/137) HBsAg negative patients. HBV DNA VL was significantly higher among patient with CD4 cell counts less than 200 cells/mm3 than those with CD4 cell counts greater than 500 cells/mm3 (p = 0.008). We confirmed the presence of HBV sub-genotypes QS-A3 (40%), and A4 (20%) and HBV-E genotype (40%). The percentage of resistance to Lamivudine was high (40%) and varied according to the M204V/I motif. Occult hepatitis B infection (OBI) was found in patients with isolated HBcAb and among patients who had completed their HBsAg seroconversion. We detected HBV DNA for one patient without any HBV serological marker. This study provides a new landmark for the comprehension of HBV infection in PLHA in urban areas. OBI enhances HBV DNA prevalence and should be investigated in all HBsAg negative individuals.

Highlights

The emergence of chronic infection due to Hepatitis B Virus (HBV), in the context of immunosuppression in patients infected with Human immunodeficiency virus (HIV), remains a public health problem
Due to its highly contagious capacity and some transmission routes in common with HIV, HIV-HBV co-infection is frequent in resource-limited settings (RLS), where 10% of HIV infected are co-infected with HBV [3]
This study provides a new landmark in the global understanding of HIV-HBV co-infection in Gabon, with supplemental information on an urban area which is an important mix of different populations and culture (Libreville, capital of Gabon)

Summary

Introduction

The emergence of chronic infection due to Hepatitis B Virus (HBV), in the context of immunosuppression in patients infected with Human immunodeficiency virus (HIV), remains a public health problem. According to the World Health Organization (WHO-2015), nearly 36.7 million people in the world, are living with HIV/AIDS (PLHA) and 2/3 of those are living in Sub-Saharan Africa [1]. This area is hyper endemic for HBV with an exposure rate up to 90% [2]. Studies highlight the negative impact of co-infection [5,6]. Studies show that HIV promotes an expansion of HBV DNA VL and increases the risk of liver-related disease among patients with low CD4 cell counts (less than 200 cells/mL) [8,9]. HIV/HBV coinfection negatively impacts immunological recovery as compared to HBV mono-infection

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