Hepatitis B and C infections in HIV-1 patients on combination antiretroviral therapy (cART) in Ghana: implications for immunologic recovery, clinical response to treatment, and hepatotoxicity

Abstract

Background Viral hepatitis could have an impact on the treatment response in HIV patients. In this study, we sought to determine the prevalence of hepatitis B and C infections and examine the effect on the treatment response in HIV-1 patients attending antiretroviral therapy (ART) centers in the Volta and Oti Regions of Ghana. Method A longitudinal study design was employed. A cohort of 200 newly diagnosed HIV-1 positive adults who met the inclusion criteria (CD4 count ≤350 cells/μl) were enrolled at three ART Centers and initiated on the combination Antiretroviral Therapy (cART) from January 2014 to December 2015. Blood samples obtained from each participant were subsequently screened for the presence of hepatitis B surface antigen (HBsAg) and hepatitis C antibody. Out of the 200 study respondents recruited, 93 HIV mono-infected were randomly selected plus all 17 HIV co-infected were prospectively followed for twelve months. Using standard methods, three consecutive measurements of CD4 cells, haemoglobin, and liver enzymes [(aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP)] as well as weight measurements were performed at baseline, six months and twelve months, respectively, after treatment initiation. Result The overall HIV-viral hepatitis sero-positivity was 8.5%. HBV and HCV co-infections were 7.0% and 1.5% respectively. Among HIV mono-infected CD4 cell count, haemoglobin, and weight significantly increased from baseline to the twelfth month while levels remained statistically comparable in the HIV co-infected patients. The levels of AST, ALT, and ALP were more pronounced (hepatotoxicity) in the HIV co-infected compared to the HIV mono-infected at various time points within the twelve month. Conclusion The frequency of HIV-hepatitis co-infection was high. This correlates with poor immunological outcome, clinical response to treatment and pronounced hepatotoxicity. The findings, therefore, underscore the need for regular screening of HIV patients for early detection and appropriate management.

Prevalence of occult hepatitis B infection among treatment-naive persons living with HIV in Ghana

“…OBI in PLHIV is important to consider because the choice of ART regimen among PLHIV is influenced by the presence of HBV co-infection, with Tenofovir in addition to a second antiviral agent known to have activity against both viruses being the recommendation regimen for achieving global targets towards hepatitis B elimination in PLHIV [ 25 ]. In Ghana, tenofovir-emtricitabine/lamivudine combination is adopted as a first line option for HIV-HBV coinfected persons [ 26 ].…”

Evaluation of Clinical Biomarkers Related to CD4 Recovery in HIV-Infected Patients—5-Year Observation

“…In general, recent studies suggest that in patients with HIV infection coinfected with HCV or HBV, CD4 recovery rates are lower than in patients with HIV mono-infection [ 51 ].…”

Contagious order as a risk factor for liver fibrosis progression in co-infection with human immunodeficiency virus, hepatitis B and C viruses

“…В исследовании Kwofie et al [8] при обсуждении эффективности лечения вирусных гепатитов у ВИЧ-инфицированных лиц ссылаются на механизмы, лежащие в основе коинфекции ВИЧ-ВГС/ ВГВ, которые включают пролиферацию ВГС и подавление Т-хелперных клеток, тогда как инфекция ВГВ связана с усилением апоптоза Т-клеток. При этом отмечается значение гепатотоксичности, связанной с применением антиретровирусной терапии и являющейся причиной повышенной заболеваемости и смертности у ВИЧ-инфицированных пациентов.…”