Abstract
BackgroundWHO hepatitis B guidelines recommend testing all new HIV patients, treating them accordingly or providing immunization. At the Infectious Diseases Institute (IDI) following an audit done in 2012, only 46% patients had been screened for hepatitis B with variable management plans therefore new internal guidelines were implemented. This study describes the uptake of hepatitis B screening and management of patients with hepatitis B and HIV con-infection after the implementation.MethodsData included for all HIV positive patients in care at IDI by October 2015. Data are expressed as median with interquartile range (IQR) and percentages were compared using the chi square test. Statistical analysis was performed using STATA version 13. The IDI laboratory upper limit of normal for alanine aminotransferase (ALT) and aspartate aminotransferase (ASTs) was 40 IU/ml.ResultsNumber of hepatitis B screening tests increased from 800 by 2012 to 1400 in 2015. By 2015 8042/8604(93.5%) patients had been screened for hepatitis B. Overall hepatitis B positive were 359 (4.6%). 166 (81.4%) hepatitis B positives were switched to a tenofovir (TDF) containing regimen.ConclusionOur study confirms the importance of screening for hepatitis B and of using ART regimens containing tenofovir in hepatitis B co-infected patients. Whilst our program has made improvements in care still 18.6% of patients with hepatitis B were not on tenofovir regimens, 98.1% had no hepatitis B viral loads done. Clinicians should recognize the potential for hepatitis B in HIV positive patients and the importance of early diagnosis and treatment to ensure optimal management of cases and follow up.
Highlights
WHO hepatitis B guidelines recommend testing all new HIV patients, treating them or providing immunization
Chronic hepatitis B virus infection affects 5–20% of the 36 million people living with HIV worldwide, and the burden of HIV- hepatitis B co-infection is greatest in low and middle income countries, in subSaharan Africa
During the repeat audit in October 2015, there were 8042 (93.5%) active HIV infected patients screened for hepatitis B at Infectious Diseases Institute (IDI)
Summary
WHO hepatitis B guidelines recommend testing all new HIV patients, treating them or providing immunization. At the Infectious Diseases Institute (IDI) following an audit done in 2012, only 46% patients had been screened for hepatitis B with variable management plans new internal guidelines were implemented. This study describes the uptake of hepatitis B screening and management of patients with hepatitis B and HIV con-infection after the implementation. Chronic viral hepatitis is an increasing cause of morbidity and mortality among HIV confected persons, including those on ART, as persons with HIV continue to live longer [1,2,3]. The consequences of coinfection include higher rates of chronicity, less spontaneous clearance, accelerated fibrosis progression with increased risk of cirrhosis and hepatocellular carcinoma, higher liver-related mortality, and decreased treatment response [4,5,6]. It is estimated that 2.6 million are HIV- hepatitis B co-infected [12].
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