Hepatitis B and HIV coinfection in Northern Uganda: Is a decline in HBV prevalence on the horizon?

Abstract

Background The available data concerning hepatitis B virus (HBV) infection in Uganda are limited, particularly in the case of people living with HIV/AIDS (PLWH). HBV is not routinely tested when starting antiretroviral therapy (ART). We aimed to determine the prevalence, the correlates of the risk of HBV infection, and the association with outcomes of ART among PLWH attending a busy HIV clinic in a referral hospital in Northern Uganda. Patients and methods From April to June 2016, a random sample of 1000 PLWH attending the outpatients’ clinic of St. Mary’s Hospital, Gulu, Uganda were systematically selected to undergo a rapid hepatitis B surface antigen (HBsAg) test after administering a questionnaire in this cross-sectional study. HIV care parameters were obtained from client files. Multivariate logistic regression and general linear model were used for the analysis. Results 950 of the 985 evaluable patients (77% females; mean age 42.8 years) were receiving ART. The overall prevalence of HBsAg was 7.9% (95% confidence interval [CI] 6.2–9.6%), and was significantly lower among the females (6.8% vs 11.7%; p = 0.020). The factors independently associated with higher HBV infection were having lived in an internally displaced persons’ camp (adjusted odds ratio [aOR] 1.76, 95% CI 1.03–2.98; p = 0.036) and having shared housing with HBV-infected people during childhood (aOR 3.30, 95% CI 1.49–7.32; p = 0.003). CD4+ T cell counts were significantly lower in HBV patients (p = 0.025), and co-infection was associated with a poorer CD4+ T cell response to ART (AOR 0.88; 95% CI 0.79–0.98; p = 0.030). Conclusions The observed prevalence of HBV among the PLWH may be underestimated or a signal of HBV decline in the region. The factors favouring horizontal HBV transmission identified suggest extending HBV screening and vaccine prophylaxis among PLWH.

Prevalence of Sexually Transmitted Infections and Factors Associated With Hiv Status Among Vulnerable Women in Northern Uganda: Baseline Results From Pe Atye Kena Cohort Study

“…Therefore, the results are not generalizable to all Gulu female population, but, noteworthy, the burden of co-infections between HIV and other STIs in Subsaharan Africa remain controversial. 33,34 Our study has several limitations. First, as mentioned above, the reported prevalence of HIV and other sexually transmitted diseases is not generalizable to the overall population due to both outreach targets and small sample size.…”

“…Therefore, the results are not generalizable to all Gulu female population, but, noteworthy, the burden of co-infections between HIV and other STIs in Sub-saharan Africa remain controversial. 33 , 34 …”

Cango Lyec (Healing the Elephant): Chronic Hepatitis B Virus among post-conflict affected populations living in mid-Northern Uganda

“…In addition, evidence indicates that HIV–HBV co-infection promotes a more aggressive disease course of HBV, including increased risk of acute liver failure, progression of fibrosis and cirrhosis, and hepatocellular carcinoma [ 9 ]. While not yet well understood, linkages between war-related experiences and HBV have also recently been observed in study involving 1000 people living with HIV attending St Mary’s Hospital in Gulu, Northern Uganda [ 24 ]. Given high liver-related morbidity and mortality among individuals who are co-infected with HIV-HBV, availability of trauma-informed antiviral care for those who have survived the war–especially those who experienced abduction–is critical [ 5 , 9 ].…”

“…HIV attending St Mary's Hospital in Gulu, Northern Uganda [24]. Given high liver-related morbidity and mortality among individuals who are co-infected with HIV-HBV, availability of trauma-informed antiviral care for those who have survived the war-especially those who experienced abduction-is critical [5,9].…”

Chronic liver disease: Global perspectives and future challenges to delivering quality health care

“…Chiesa and colleagues report that HBsAg prevalence was 7.9% in a population of HIV-infected individuals in Uganda (77% females; mean age 42.8 years), with men having a significantly higher prevalence than women (11.7% vs 6.8%). The authors also found that a prior history of residing in an internally displaced persons’ camp was an important risk factor for infection [ 12 ], underscoring the need to introduce better preventive interventions to this type of emergency setting. Lawal and colleagues report, however, that among Nigerian children age 2 months to 13 years, the prevalence of HBV and HCV was similar irrespective of HIV infection status, with 5.3% and 4.8% HBV prevalence in HIV-positive and HIV-negative children, respectively, suggesting that HIV-infected children are not more predisposed to viral hepatitis than healthy children [ 13 ].…”