Abstract
There is progressive concern about the evolving burden of morbidity and mortality caused by coinfection with HIV-1 and hepatitis B virus (HBV) in sub-Saharan Africa, but the epidemiology and impact of this problem are not well defined. We therefore set out to assimilate more information about the nature of HBV/HIV coinfection in this region by undertaking a retrospective observational study of southern African adult women. We used samples from previously recruited HIV-1 positive women attending antenatal clinics in three settings in South Africa and Botswana (n = 950) and added a small cohort of HIV-negative antenatal South African women for comparison (n = 72). We tested for HBsAg and followed up HBsAg-positive samples by testing for HBeAg, HBV DNA, HBV genotype, presence of drug-resistance associated mutations (RAMs) and HDV. We identified HBsAg in 72 individuals (7% of the whole cohort), of whom 27% were HBeAg-positive, and the majority HBV genotypes A1 and A2. We did not detect any HDV coinfection. HBV prevalence was significantly different between geographically distinct cohorts, but did not differ according to HIV status. Among adults from South Africa, HBV/HIV coinfected patients had lower CD4+ T cell counts compared to those with HIV-monoinfection (p = 0.02), but this finding was not replicated in the cohort from Botswana. Overall, these data provide a snapshot of the coinfection problem at the heart of the HIV/HBV co-epidemic, and are important to inform public health policy, resource allocation, education, surveillance and clinical care.
Highlights
There has been a recent revival of political and clinical interest in the problem of infection with Hepatitis B Virus (HBV) in sub-Saharan African populations in whom Human Immunodeficiency Virus (HIV) is frequently endemic [1, 2]
Important information can be gained from studying HBV virological markers, such as hepatitis B e-antigen (HBeAg) status, this information is not available for the majority of studies published from African cohorts [11]
HIV-1 RNA viral loads were higher in the South African cohorts than in Botswana
Summary
There has been a recent revival of political and clinical interest in the problem of infection with Hepatitis B Virus (HBV) in sub-Saharan African populations in whom Human Immunodeficiency Virus (HIV) is frequently endemic [1, 2]. There is increasing evidence that chronic HIV/HBV coinfection is associated with long-term morbidity and mortality that exceeds the impact of infection with either one of these viruses alone in African populations [5,6,7,8]. Adding to the scale of the problem, many individuals in Africa are vulnerable to liver disease for a variety of other reasons including diet, genetics, and exposure to toxins and other pathogens [6, 7, 11]. Despite these concerns, the burden and impact of HIV/HBV coinfection in sub-Saharan Africa have not been well characterized. Important information can be gained from studying HBV virological markers, such as hepatitis B e-antigen (HBeAg) status, this information is not available for the majority of studies published from African cohorts [11]
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