Abstract
ObjectivesPrompted by international targets for elimination of hepatitis B virus (HBV), we set out to characterise individuals with HBV monoinfection vs. those coinfected with HBV/HIV, to evaluate the impact of therapy and to guide improvements in clinical care. MethodsWe report observational data from a real world cross-sectional cohort of 115 adults with chronic hepatitis B infection (CHB), at a university hospital in Cape Town, South Africa. HIV coinfection was present in 39 (34%) subjects. We recorded cross-sectional demographic, clinical and laboratory data. ResultsCompared to those with HIV coinfection, HBV monoinfected adults were less likely to be HBeAg-positive (p=0.01), less likely to have had assessment with elastography (p<0.0001), and less likely to be on antiviral treatment (p<0.0001); they were more likely to have detectable HBV viraemia (p=0.04), and more likely to have features of liver disease including moderate/severe thrombocytopaenia (p=0.007), elevated bilirubin (p=0.004), and elevated APRI score (p=0.02). Three cases of hepatocellular carcinoma all arose in HBV monoinfection. ConclusionsOur data demonstrate that individuals with HBV monoinfection may be disadvantaged compared to those with HIV coinfection, highlighting potential systematic inequities in referral, monitoring and treatment.
Highlights
The burden of chronic infection with hepatitis B virus (HBV) in southern Africa is high, and in this setting the distribution overlaps with populations in which HIV infection is prevalent.[1]
A traditional paradigm suggests that individuals with HBV/HIV coinfection might have a worse prognosis from chronic liver disease than those with HBV monoinfection, typically linked with higher rates of HBeAg-positivity and higher viral loads,[1,3] lower CD4+ T cell counts, increased incidence of liver fibrosis[4] and hepatocellular carcinoma (HCC), higher rates of vertical HBV
It seems likely that the broad patterns we observe are generalisable across southern Africa, given the widespread investment that has been made in HIV infrastructure versus the lack of consistent HBV services
Summary
The burden of chronic infection with hepatitis B virus (HBV) in southern Africa is high, and in this setting the distribution overlaps with populations in which HIV infection is prevalent.[1]. Development Goals set targets for elimination of HBV as a public health problem by the year 2030.2 Developing insights into the characteristics and outcomes of chronic HBV (CHB) monoinfection and HBV/HIV coinfection in real world settings, including lower/middle income countries (LMIC), will underpin improved strategies for monitoring, prognostication, patient stratification and therapy. A traditional paradigm suggests that individuals with HBV/HIV coinfection might have a worse prognosis from chronic liver disease than those with HBV monoinfection, typically linked with higher rates of HBeAg-positivity and higher viral loads,[1,3] lower CD4+ T cell counts, increased incidence of liver fibrosis[4] and hepatocellular carcinoma (HCC), higher rates of vertical HBV. This picture is not consistent between populations (even within individual studies)[6] and the interplay between viruses may be affected by specific characteristics of the host or viral population,[7] as well as by changes in treatment guidelines over time
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