Hepatitis B and HIV co-infection is still treated using lamivudine-only antiretroviral therapy combination in Uganda

Abstract

Background: Hepatitis B virus (HBV) and HIV are endemic in Uganda. Co-infection is common and leads to rapid progression of liver disease. Burden of co-infection is unknown yet most patients are on lamivudine-only ART where resistance is frequent. Most patients are initiated on antiretroviral therapy (ART) without knowing their HBV status. Objectives: To determine burden of co-infection and HBV viral suppression among patients on ART in NorthernUganda. Methods: We recruited HIV infected adult patients on ART in a cross-sectional study. Age, sex, ART regimen and duration were recorded. Hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBcAb) and liver panel were performed. For those HBsAg+, hepatitis B e antigen (HBeAg) and HBV DNA were performed. CD4 cell count was recorded. Results: Three hundred patients were recruited. Twenty (6.7%) were co-infected, while 41% were anti-HBcAb+. Overall 188 (62.7%) were on lamivudine-only HBV active drug. Median ART duration 2 years (IQR 1-5), mean CD4+ cell count 317 cells/microlitre (SD 255-557). Of 20 HIV/HBV co-infected, 11/20 (55%) were on lamivudine-only ART, median duration 1.5 years. Nineteen (95%) had undetectable HBV DNA. Seventeen (85%) were HBeAg negative. Mean CD4+ cell count 327 cells/microlitre . Conclusion: A large proportion of patients were on lamivudine-only HBV-active ART. Resistance may occur long term thus testing for HBV and correct ART is recommended

Prevalence and Profile of Hepatitis B Virus Infection among HIV-Infected Adults at Panzi Referral Hospital, in the Post-Conflict South Kivu Province, Eastern Democratic Republic of Congo

“…A major limitation in this study is that we could not investigate occult HBV infections in participants who were HBsAg-negative but anti HBc-positive by were infected with HBV long before HIV infection. The prevalence of chronic replicative hepatitis infection is similar to that reported in Ghana by Geretti et al [26] and in Zambia by Wandeler et al [16] but higher than the 15% prevalence that was described in a study conducted in Uganda [17]. It was lower than the 62% reported in a second Ghana study [42].…”

“…Male sex was associated to co-infection significantly with co-infection as has been reported in Benin [28], Nigeria [31], South Africa [27], Rwanda [29] and Cameroon [19]. Other authors have reported a female predominance in Mozambique and Zambia [16] [23], Uganda [17], and in South Kivu [12]. In observing our study population, there were a large number of female than male patients.…”

HBV infection in untreated HIV-infected adults in Maputo, Mozambique

“…Additionally, based on WHO guidelines, patients with HIV/HBV coinfection should start ART regimen with at least two active drugs for HBV infection, such as tenofovir (TDF) with emtricitabine (FTC) or lamivudine (3TC). As a result of the rapid growth of ART programs in sub-Saharan Africa and of the unknown status for HBV infection, when the therapy starts, a general concern has been raised about HBV mutations causing 3TC-resistance [ 22 – 24 ]. In spite of this, data regarding the primary resistance of HBV to 3TC in Southern African countries is still insufficient.…”

Early childhood transmission of hepatitis B prior to the first hepatitis B vaccine dose is rare among babies born to HIV-infected and non-HIV infected mothers in Gulu, Uganda

“…However the chronic carrier prevalence varies widely across the country, being highest in the North and Northeast (18–24%) and lowest in the Southwestern region (4%) [4,5]. Relatedly, infection with human immune deficiency virus (HIV) is estimated to be 6.4% in Uganda and the prevalence of coinfection with HIV and HBV ranges from 7–17% [6,7]. Co-infection accelerates progression of liver disease to cirrhosis and its complications [8].…”