Abstract
BackgroundDespite the development of a safe and efficacious hepatitis B vaccine in 1982, the hepatitis B virus (HBV) remains a public health burden in sub-Saharan Africa. Due to shared risk factors for virus acquisition, men who have sex with men (MSM) and transgender women (TGW) living with HIV are at increased risk of HBV. We estimated the prevalence of HBV and associated factors for MSM and TGW living with or without HIV in Nigeria.MethodsSince March 2013, TRUST/RV368 has recruited MSM and TGW in Abuja and Lagos, Nigeria using respondent driven sampling. Participants with HIV diagnosis, enrollment as of June 2015, and available plasma were selected for a cross-sectional study and retrospectively tested for hepatitis B surface antigen and HBV DNA. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with prevalent HBV infection.ResultsA total of 717 MSM and TGW had a median age of 25 years (interquartile range [IQR]: 21–27), 5% self-reported HBV vaccination, 61% were living with HIV, 10% had prevalent HBV infection and 6% were HIV-HBV co-infected. HIV mono-infected as compared to HIV-HBV co-infected had a higher median CD4 T cell count [425 (IQR: 284–541) vs. 345 (IQR: 164–363) cells/mm3, p = 0.03] and a lower median HIV RNA viral load [4.2 (IQR: 2.3–4.9) vs. 4.7 (IQR: 3.9–5.4) log10copies/mL, p < 0.01]. The only factor independently associated with HBV was self-report of condomless sex at last anal intercourse (OR: 2.2, 95% CI: 1.3, 3.6). HIV infection was not independently associated with HBV (OR: 1.0, 95% CI: 0.7–1.6).ConclusionHBV prevalence was moderately high but did not differ by HIV in this cohort of MSM and TGW. Recent condomless sex was associated with elevated HBV risk, reinforcing the need to increase communication and education on condom use among key populations in Nigeria. Evaluating use of concurrent HIV antiretroviral therapy with anti-HBV activity may confirm the attenuated HBV prevalence for those living with HIV.
Highlights
Despite the development of a safe and efficacious hepatitis B vaccine in 1982, the hepatitis B virus (HBV) remains a public health burden in sub-Saharan Africa
Of the 771 participants enrolled from March 2013 to June 2015, 717 had real-time HIV and retrospective HBV testing results available and were included in our study
Among participants living with HIV, 51% (223/ 438) had been told by a physician or healthcare provider before enrolling in TRUST/RV368 that they needed to begin treatment for HIV
Summary
Despite the development of a safe and efficacious hepatitis B vaccine in 1982, the hepatitis B virus (HBV) remains a public health burden in sub-Saharan Africa. Due to shared risk factors for virus acquisition, men who have sex with men (MSM) and transgender women (TGW) living with HIV are at increased risk of HBV. Despite the development of a safe and efficacious hepatitis B vaccine in 1982 [1], the hepatitis B virus (HBV) remains a public health burden in sub-Saharan Africa with a reported prevalence of about 6% [2, 3]. While mortality in sub-Saharan Africa from the World Health Organization (WHO)-targeted infectious diseases (i.e. HIV, tuberculosis and malaria) is declining, morbidity and mortality due to viral hepatitis is increasing [2]. A more sensitive diagnostic assay that quantifies HBV-DNA rather than circulating antibodies is the polymerase chain reaction (PCR)-based molecular diagnostic assay that has served as a confirmatory and treatment progress-monitoring test for active HBV [8, 9]
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