Hepatitis B serological markers and plasma DNA concentrations.

Huw Price,James Hakim,Moira Spyer,Michael Chirara,Richard Gilson,David Dunn,Tamale Zachary,Paula Munderi,Tobias Vudriko,Pontiano Kaleebu,Deenan Pillay,Cissy Kityo,Charles Gilks

doi:10.1097/qad.0000000000001454

Abstract

Objectives:To examine hepatitis B (HBV) serological markers and plasma DNA concentrations in a large group of untreated HBV/HIV-coinfected individuals in two sub-Saharan settings.Design:Baseline analysis of a randomized controlled trial.Methods:DART was a large trial of treatment monitoring practices in HIV-infected adults with advanced disease starting antiretroviral therapy at centres in Kampala or Entebbe, Uganda (n = 2317) and Harare, Zimbabwe (n = 999). HBV serological markers [antibody to HBV core antigen, HBV surface antigen (HBsAg), antibody to HBV surface antigen, HBV ‘e’ antigen (HBeAg), and antibody to hepatitis B ‘e’ antigen] and plasma HBV DNA viral load were measured retrospectively on stored baseline samples. Logistic regression was used to examine associations with baseline demographic and clinical factors.Results:The rate of HBsAg positivity was significantly higher in Zimbabwe than Uganda (12.2 vs. 7.7%, adjusted odds ratio = 1.54, P < 0.001) despite a similar prevalence of antibody to HBV core antigen (56.3 vs. 52.4%) in the two settings. Overall, HBsAg positivity was associated with male sex (adjusted odds ratio = 1.54, P < 0.001) but not with age, WHO disease stage, or CD4+ cell count. HBeAg was detected among 37% of HBsAg-positive patients, with higher rates among those with advanced WHO stage (P = 0.02). Also in HBsAg-positive patients, HBV DNA was undetectable in 21%, detectable but below the level of quantification in 14%, and quantifiable in 65%. A total of 96% of HBeAg-positive and 70% of HBeAg-negative patients had detectable HBV DNA; 92 and 28% of patients, respectively, had HBV DNA viral load more than 2000 IU/ml.Conclusion:High rates of HBV coinfection were observed, highlighting the importance of ensuring that coinfected patients receive an antiretroviral regimen, whether first-line or not, that is active against both viruses.

Highlights

In the era of antiretroviral treatment (ART), death rates from AIDS-related causes have declined dramatically in both resource-limited and resource-rich regions
The rate of anti-HBc positivity was similar in participants from the sites in Uganda (52%) and Zimbabwe (56%)
Men were significantly more likely to test positive than women [adjusted odds ratio 1.39, 95% confidence interval (CI) 1.19–1.61], this difference was more marked in Zimbabwe than Uganda (P 1⁄4 0.005, test for interaction)

Summary

Introduction

In the era of antiretroviral treatment (ART), death rates from AIDS-related causes have declined dramatically in both resource-limited and resource-rich regions In this context, liver disease has emerged as a major cause of death in HIV-infected individuals, the absolute rates of liver-related mortality have declined [1,2,3]. We measured a comprehensive set of HBV serological markers and plasma HBV DNA viral load in archived baseline samples from over 3000 HIV-infected participants in the DART trial. This has allowed a detailed characterization of HBV/HIV coinfection in the regions from where participants were recruited, namely, Kampala/Entebbe, Uganda and Harare, Zimbabwe

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Conclusion