Hepatitis B infection among pregnant and post-partum women living with HIV and on antiretroviral therapy in Kinshasa, DR Congo: A cross-sectional study

Abstract

Background Hepatitis B virus (HBV) co-infection in HIV-infected individuals increases the risk of hepatic complications and mortality. Further, the risk of perinatal HBV transmission increases among HBV/HIV co-infected pregnant women. Although HBV is endemic in the Democratic Republic of Congo, there is little data on HBV/HIV co-infection. We aimed to assess the burden and risk factors of HBV surface antigen (HBsAg) positivity among HIV-infected pregnant and post-partum women. Methods This cross-sectional study was conducted as part of an ongoing trial to assess the effect of data-driven continuous quality improvement interventions (CQI) for optimal prevention of mother-to-child transmission (PMTCT) of HIV (CQI-PMTCT study, NCT03048669). In each of the 35 health zones of Kinshasa province, all HIV-infected pregnant or breastfeeding women (≤1 year post-delivery) presenting for care in one of the three busiest maternal and child health clinics of the health zone were tested for HBsAg using Alere Determine, Japan. We used logistic regression with general estimating equation accounting for within-clinic clustering to assess risk factors of HBsAg positivity. Results Between November 2016 and June 2018, a total of 1377 women, all on antiretroviral therapy, were tested for HBsAg. Overall, 4.7% [95% binomial confidence interval (CI): 3.7%-5.7%] tested positive for HBsAg. HBsAg prevalence was 3.3% (95% CI: 2.1%-4.8%) for women tested during pregnancy, 4.5% (2.5%-7.4%) for those tested at delivery, and 8.5% (5.6%-12.2%) for those tested post-partum ( P trend = 0.001). In multivariate models including socio-economic status (SES), type of care facility, duration of antiretroviral therapy, HIV viral load, and self-reported intimate partner violence (IPV), lowest tertile of SES, ≤ 6 months of ART, and IPV were all consistently and positively associated with higher prevalence of HBsAg across pregnancy, delivery, and postpartum period while been tested in a health centre or having a viral load ≥ 1000 copies/mL were consistently associated with lower prevalence. However, only the association with IPV (OR = 2.74, 95% CI: 1.10–6.84) and viral load between 40–1000 copies/ml (OR = 4.28, 95% CI: 1.22–15.01) achieved statistical significance among pregnant women. Conclusion This study revealed an overall high prevalence of HBsAg among HIV-infected pregnant and post-partum women in Kinshasa with the latter showing the highest HBsAg prevalence. Among pregnant women, intimate partner violence was independently and statistically associated with HBsAg positivity, requiring further investigation.

Hepatitis B virus infection and its determinants among HIV positive pregnant women: Multicenter unmatched case-control study

“…This might be because higher HIV viral load increased the susceptibility of infection by other viruses including HBV infections. The study is supported by other similar studies conducted in southeastern Ethiopia, in Jos Nigeria, and Kinshasa, the democratic republic of Congo [ 27 , 34 , 42 ]. The odds of having hepatitis B virus infection among pregnant women with CD4 less than 200, from 200–350, and 351–499 cells/mm3 was much higher than women with CD4 greater than 500 cells/mm3.…”

Prevalence and associated factors of hepatitis B virus infection among pregnant women attending antenatal care at Agena health center, South Ethiopia, 2019: a cross sectional study

“…In this study the prevalence of HBV infection among pregnant women in Agena health center was 4.1%. This finding was relatively comparable with study reported from Dawuro Zone, south Ethiopia, Arba Minch Hospital, Bahir Dar city, Southwest Ethiopia and Kinshasa, Congo in which prevalence of HBV infection among pregnant women were 3.5%, 4.3%, 3.8% and 4.7% respectively [16,18,19,21].…”

Seroprevalence of Viral Hepatitis B and C and Knowledge of the Hepatitis B Virus among Pregnant Women Attending Prenatal Care in the Democratic Republic of Congo

“…This seroprevalence is also lower than that found among pregnant and postpartum women living with HIV and among those undergoing antiretroviral therapy in Kinshasa (4.7%), which is in the western DRC. 4 This figure is also lower than the results pertaining to a systematic review of 28 studies ( 18studies from blood donors) that included data from 154,926 subjects. 12 However, the seroprevalence data are similar (3.3%) to the results found in national, representative dried blood spot samples that were collected during the 2013-2014 Demographic and Health Survey, which sought to determine the HBV prevalence among adults and children living in the DRC.…”

“…Although some studies that confirm the burden of viral hepatitis in the pregnant women population in several African countries are available, only very limited data are available that focus on the DRC. So far, only three studies on HBV have been identified: two conducted in urban regions 4,5 and one combining rural and urban regions. 6 The studies conducted in urban regions were performed among pregnant women living with HIV in Kinshasa or Lubumbashi, and the latter study was conducted in Kindu in the province of Maniema.…”