Hepatitis B Virus and Tuberculosis Are Associated with Increased Noncommunicable Disease Risk among Treatment-Naïve People with HIV: Opportunities for Prevention, Early Detection and Management of Comorbidities in Sierra Leone

Abstract

Noncommunicable diseases (NCDs) are a growing public health concern in low- and middle-income countries and disproportionately affect people living with HIV (PWH). Hepatitis B virus (HBV) and tuberculosis (TB) coinfection are presumed risk factors in endemic settings; however, supporting evidence is conflicting. We analyzed baseline data of newly diagnosed PWH prospectively enrolled in the Sierra Leone HIV Cohort Study in Freetown, Sierra Leone, from March to September 2021. Logistic regression was used to identify associations between NCDs, HBV and TB. A total of 275 PWH aged ≥18 years were studied (55% female, median age 33 years, median CD4 307 cells/mm3, 15.3% HIV/HBV, 8.7% HIV/TB). NCDs were bimodally distributed, with 1 in 4 PWH clustered around liver disease (fibrosis/cirrhosis), diabetes/prediabetes and obesity/preobesity, while 1 in 8 had renal impairment or hypertension (HTN). Overall, 41.5% had ≥1 NCD, while 17.5% were multimorbid (≥2 NCDs). After adjusting for age, sex, sociodemographic factors and CD4 count, liver fibrosis/cirrhosis was strongly associated with HBV (aOR 8.80, 95% CI [2.46–31.45]; p < 0.001) and diabetes/prediabetes (aOR 9.89, 95% CI [1.14–85.67]; p < 0.037). TB independently predicted diabetes/prediabetes (aOR 7.34, 95% CI [1.87–28.74]; p < 0.004), while renal impairment was associated with proteinuria (aOR 9.34, 95% CI [2.01–43.78]; p < 0.004) and HTN (aOR 6.00, 95% CI [1.10–35.39]; p < 0.049). Our findings warrant the implementation of NCD-aware HIV programs for the prevention, early detection and management of comorbidities.

Measuring stigma associated with hepatitis B virus infection in Sierra Leone: Validation of an abridged Berger HIV stigma scale

“…Survey questionnaire and stigma instrument development were informed by our experiences gained from interactions with PWHB in the clinical and community settings in Sierra Leone, our preliminary work describing the epidemiological, clinical, and social aspects of the HBV epidemic in Sierra Leone 11,29–33 and the broad literature on measuring HIV‐related stigma, 34,35 which has been adapted to inform studies in understanding HBV‐related stigma 4,5 …”

“…Survey questionnaire and stigma instrument development were informed by our experiences gained from interactions with PWHB in the clinical and community settings in Sierra Leone, our preliminary work describing the epidemiological, clinical, and social aspects of the HBV epidemic in Sierra Leone 11,[29][30][31][32][33] and the broad literature on measuring HIV-related stigma, 34,35 which has been adapted to inform studies in understanding HBV-related stigma. 4,5 The first section of the survey tool entailed a questionnaire capturing the sociodemographic characteristics and HBV-related history of the study participants, i.e., HBV status disclosure, duration since diagnosis, and having family/friends who were PWHB.…”

Measuring Stigma Associated with Hepatitis B Virus Infection in Sierra Leone: Validation of an Abridged Berger HIV Stigma Scale

“…Survey questionnaire and stigma instrument development was informed by our experiences gained from interactions with PWHB in the clinical and community settings in Sierra Leone, our preliminary work describing the epidemiological, clinical and social aspects of the HBV epidemic in Sierra Leone [11,[29][30][31][32][33] and the broad literature on measuring HIV-related stigma [34,35], which has been adapted to inform studies in understanding HBV-related stigma [4,5].…”

Prevalence and Burden of Chronic Hepatitis B Virus Infection in Sierra Leone, 1997-2022: Evidence from a 25-Year Systematic Review and Meta-Analysis

“…Notwithstanding, there is limited understanding of the national prevalence, burden and overall impact of HBV due to insufficient surveillance systems. In hyperendemic settings such as Sierra Leone, HBV is most commonly acquired through vertical (mother-to-child) transmission or horizontal transmission during the early years of life [16]; yet antenatal screening remains limited in many such resource-constrained countries [17]. Of note, HBV vaccination was introduced in Sierra Leone in 2007 and incorporated into the Expanded Program on Immunization (EPI) in 2009 [18]; however, the birth-dose is yet to be implemented and full vaccine coverage for all age groups including vulnerable or high-risk groups such as pregnant women, healthcare workers, and people living with HIV has remained suboptimal [18].…”