Hepatitis B Virus and Malaria Co-infection Causing Significant Changes in Hematological and Liver Function Indices in a Cohort of Subjects in Ilorin, Nigeria

Abstract

Background: Malaria and Hepatitis B virus (HBV) are among the most common infectious diseases in Nigeria and other developing countries. Their high prevalence as mono-infections brings to the fore their infectious ability as co-infections. Objectives: This study was undertaken to assess the prevalence and effect of HBV and malaria infections on the liver function and hematological parameters in a cohort of subjects both as mono-infections and as co-infections. Methods: Blood samples from 200 febrile patients were collected and analyzed for the presence of HBV surface antigen (HBsAg) and malaria infection. Hematological parameters and liver function tests such as bilirubin, albumin, alkaline phosphatase (ALP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were carried using automated systems. Malaria parasite test was carried out using CareStart TM while HBsAg detection was done using MonolisaTM immunoassay. Descriptive statistics were carried out to ascertain the relationship between the prevalence of the infections and these parameters. Results: 62 (31.0%) subjects were positive for malaria parasite infection while 138 (69%) were negative. There were no significant changes in the hematological parameters of the subjects with respect to the prevalence of malaria. In addition, 38 (19.0%) subjects were found to be positive for HBsAg and 162 (81.0%) were negative. Of all the liver function tests carried out, only alkaline phosphate was found to be significantly affected (P value = 0.003) by the prevalence of HBsAg. The results further revealed that co-infection among the subjects significantly affected the hematological parameters such as Neutrophils (P value = 0.0134), lymphocytes (P value = 0.0002), eosinophils (P value = 0.0367), and white blood cells (P value = 0.01), as well as liver function indices such as ALT (P value = 0.001), ALP (P value = 0.001), bilirubin (P value = 0.01), and conjugated bile (P value = 0.021). Conclusions: Individuals with HBV and malaria co-infection tend to have a higher level of changes in their disease conditions compared to those with mono-infections. Hence, there is a need for continuous monitoring of individuals presenting with febrile illnesses in the areas where HBV and malaria infections are co-endemic.