Abstract
Progression of chronic HBV to cirrhosis, end-stage liver disease (ESLD), and hepatocellular carcinoma (HCC) is more rapid in HIV positive individuals than those with HBV alone; however, the distribution of HBV seromarkers in HIV infected individuals on antiretroviral therapy (ART) is not well described. To address this problem, we assessed the distribution of hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs) among HIV infected adults on ART in Eastern Ethiopia. A cross-sectional study was conducted from September 2017 to February 2018. Socio-demographic, behavioral and health related factors, and clinical data were collected using questionnaire and checklist. Plasma samples were tested for HBsAg, anti-HBc and anti-HBs seromarkers using ELISA. Data were double entered into EpiData 3.1, cleaned, exported to and analyzed using STATA 13. Descriptive and logistic regression analysis were conducted and statistical significance was decided at p≤0.05. A total of 901 participants were included and the prevalence of HBsAg was found to be 11.7% [95%CI (10, 14)]. Among the co-infected, 47.6% were also positive for anti-HBc, of which 58% were on an ART containing tenofovir (TDF). Among those screened for the three seromarkers, 38.1% were negative for all and 21% were positive only for anti-HBc (IAHBc). Being single, history of genital discharge and taking ART with TDF combination were significantly associated with HBV co-infection (p≤0.05). There is high burden HBV co-infection among individuals on ART. The unmet need of HBV screening prior to ART initiation leaves many co-infected individuals without appropriate management including therapy, close monitoring or vaccination when indicated, impacting disease prevention.
Highlights
37.9 million (32.7 million-44.0 million) people were living with HIV in 2018, of which 20.6 million (18.2 million–23.2 million) were from the eastern and southern Africa region [1]
The study was conducted in antiretroviral therapy (ART) clinics of three selected public hospitals (Hiwot Fana Specialized University Hospital, Dilchora General Hospital, and Karamara General Hospital located in Harar, Dire Dawa and Jigjiga towns, respectively), in Eastern Ethiopia
Among the total participants screened for the three seromarkers, 38.1% were negative for all, and 21% were positive only for anti-HBc (IAHBc), and 96% of the participants were on ART for more than 6 months
Summary
37.9 million (32.7 million-44.0 million) people were living with HIV in 2018, of which 20.6 million (18.2 million–23.2 million) were from the eastern and southern Africa region [1]. The proportion and risk factors of HBV co-infection vary widely with geographical location: 5–10% in North America, Europe and Australia, and 20–30% in sub-Saharan Africa (SSA) and Asia [2, 3]. Hepatitis B virus seromarkers among HIV infected adults on ART
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