Abstract
BackgroundData on prevalence and incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in Rwanda are scarce.MethodsHBV status was assessed at baseline and Month 12, and anti-HCV antibodies at baseline, in a prospective cohort study of HIV-infected patients in Kigali, Rwanda: 104 men and 114 women initiating antiretroviral therapy (ART) at baseline, and 200 women not yet eligible for ART.ResultsBaseline prevalence of active HBV infection (HBsAg positive), past or occult HBV infection (anti-HBc positive and HBsAg negative) and anti-HCV was 5.2%, 42.9%, and 5.7%, respectively. The active HBV incidence rate was 4.2/1,000 person years (PY). In a multivariable logistic regression model using baseline data, participants with WHO stage 3 or 4 HIV disease were 4.19 times (95% CI 1.21–14.47) more likely to have active HBV infection, and older patients were more likely to have evidence of past exposure to HBV (aRR 1.03 per year; 95%CI 1.01–1.06). Older age was also positively associated with having anti-HCV antibodies (aOR 1.09; 95%CI 1.04–1.14) while having a higher baseline HIV viral load was negatively associated with HCV (aOR 0.60; 95% CI 0.40–0.98). The median CD4 increase during the first 12 months of ART was lower for those with active HBV infection or anti-HCV at baseline. Almost all participants (88%) with active HBV infection who were on ART were receiving lamivudine monotherapy for HBV.ConclusionHBV and HCV are common in HIV-infected patients in Rwanda. Regular HBsAg screening is needed to ensure that HIV-HBV co-infected patients receive an HBV-active ART regimen, and the prevalence of occult HBV infection should be determined. Improved access to HBV vaccination is recommended. Active HCV prevalence and incidence should be investigated further to determine whether HCV RNA PCR testing should be introduced in Rwanda.
Highlights
In sub-Saharan Africa, 65–98% of the population will have lifetime exposure to hepatitis B virus (HBV) and 8–20% will become a chronic carrier [1]
Lamivudine, emtricitabine, and tenofovir have been approved for the management of HIV/HBV co-infection
The analysis sample consisted of 402 participants at baseline, and 253 of them (63%) had HBV test results at 12 months of follow up
Summary
In sub-Saharan Africa, 65–98% of the population will have lifetime exposure to hepatitis B virus (HBV) and 8–20% will become a chronic carrier [1]. Sexual and vertical transmission of HCV is considered inefficient but co-infection of HIV and HCV increases the risk of perinatal transmission of either virus [5]. Lamivudine, emtricitabine, and tenofovir have been approved for the management of HIV/HBV co-infection. This raises a number of possibilities and concerns related to the management of these infections. Studies have demonstrated that anti-HBV-active ART makes it possible to achieve suppression of HBV replication in a significant number of co-infected patients [11]. Mono-therapy with lamivudine has been shown to induce HBV resistance in 24% of HBV mono-infected patients after one year, increasing to 71% after 5 years of treatment [12]. Data on prevalence and incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in Rwanda are scarce
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