Hepatitis B virus infection among HIV-infected pregnant women in Malawi and transmission to infants

Chasela, Charles; Kourtis, Athena P.; Wall, Patrick; Drobeniuc, Jan; King, Caroline C.; Thai, Hong; Teshale, Eyasu H.; Hosseinipour, Mina C.; Ellington, Sascha; Codd, Mary; Jamieson, Denise J.; Knight, R K; Fitzpatrick, Patricia; Kamili, Saleem; Hoffman, Irving; Kayira, Dumbani; Mumba, Noel; Kamwendo, Deborah; Martinson, Francis; Powderly, William G.; Teo, Chong Gee; Horst, Charles van der

doi:10.1016/j.jhep.2013.10.029

Cited by 40 publications

(37 citation statements)

References 42 publications

(51 reference statements)

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“…In the present study, with 0.4% of HIV-exposed infants being HBV infected and a background HBsAg prevalence of 3.5% in HIV-infected women in the Western Cape [6,23], the HBV transmission rate is similar to that reported elsewhere [35]. During this study, HIV-infected pregnant women with CD4 counts below 350 cells/mm 3 received ART, including tenofovir and lamivudine.…”

Section: Discussionsupporting

confidence: 84%

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Hepatitis B virus infection in HIV-exposed infants in the Western Cape, South Africa

Chotun

Nel

Cotton

et al. 2015

Vaccine

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Hepatitis B virus infection (HBV) is a significant public health problem in sub-Saharan Africa. Universal infant vaccination with the hepatitis B (HB) vaccine has been implemented within the South African Expanded Programme of Immunization since April 1995 with concomitant reduction in HBV infection in children. However, the first vaccine dose is only administered at six weeks of age. This delay may lead to a failure to reduce the risk of perinatal HBV transmission to infants born to HIV/HBV co-infected women, in whom HBV infection is often upregulated. The aim of this study was to determine the prevalence of HBV infection in babies born to HIV-infected mothers in the Western Cape, South Africa. HBV serological markers were tested in all infant serum samples and following HB viral load testing, sequencing and genotyping were also performed. Three of 1000 samples screened tested positive for HBsAg and HBV DNA. An additional infant tested positive for HBV DNA alone. All babies had received the HB vaccine at 6, 10 and 14 weeks. The prevalence of HBV infection was therefore 4/1000 (0.4%; 95% CI, 0.01-0.79%). Three of four infants and all four mothers were followed-up. Two infants were persistently positive for HBsAg with viral loads above 10(8) International Units per millilitre. All four maternal samples were positive for HBsAg and HBeAg and one was also positive for anti-HBe. Sequencing analysis of two mother-child HBV pairs showed 100% sequence identity. This study demonstrates HBV infection in HIV-exposed infants despite HB vaccination from 6 weeks of age. A more strategic approach is needed to prevent mother to child transmission of HBV, including screening of pregnant women, HBV-targeted antiviral therapy and HB birth dose vaccine.

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Section: Discussionsupporting

confidence: 84%

“…In a Malawian study in HIV-infected women and their HIV-exposed uninfected infants, of 5% of HBsAg positive women, 38% were also positive for HBeAg. In that study, the HBV transmission rate was 10%, with all infected infants born to HBeAg positive women [35].…”

Section: Discussionmentioning

confidence: 77%

Hepatitis B virus infection in HIV-exposed infants in the Western Cape, South Africa

Chotun

Nel

Cotton

et al. 2015

Vaccine

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“…HIV induced immunosuppression is associated with a high levels of HBV replication and thus high HBV levels [8]. Indeed, in a large randomized controlled trial that enrolled ART naïve expecting mothers in Malawi and used HBVDNA as a surrogate marker for infection, nearly 10% of the babies born to HIV/HBV co-infected mothers became infected by 48 weeks of age despite receiving the pentavalent HBV vaccine at 6, 10 and 14 weeks of age [29]. Similar findings were reported in South Africa [30].…”

Section: Discussionmentioning

confidence: 99%

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

Seremba

Geertruyden

Ssenyonga

et al. 2017

Vaccine

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Background Hepatitis B (HBV) in sub-Saharan Africa is believed to be horizontally acquired. However, because of the high HBV prevalence in northern Uganda, no hepatitis B vaccination at birth and no access to HBV immunoglobulin, we hypothesize that vertical transmission also could also play an important role. We therefore investigated the incidence of HBV among babies presenting for their first HBV vaccine dose in Gulu, Uganda. Methods We recruited mothers and their babies (at least 6-week old) presenting for their postnatal care and first HBV vaccine dose respectively. Socio-demographic and risk factors for HBV transmission were recorded. Mothers were tested for Hepatitis B core antibody (anti-HBc-IgG) and hepatitis B surface antigen (HBsAg). HBsAg-positive sera were tested for hepatitis B e antigen (HBeAg) and HBV viral load (HBVDNA). Babies were tested for HBsAg at presentation and at the last immunization visit. A sample of HBsAg-negative babies were tested for HBVDNA. Incident HBV infection was defined by either a positive HBsAg or HBVDNA test. Chi-square or fisher's exact tests were utilized to investigate associations and t-tests or Wilcoxon rank-sum test for continuous differences. Results We recruited 612 mothers, median age 23 years (IQR 20–28). 53 (8.7%) were HBsAg-positive and 339 (61.5%) were anti-HBc-IgG-positive. Ten (18.9%) of the HBsAg-positive mothers were HBeAg-positive. Median HBVDNA levels of HBV-infected mothers was 5.7log (IQR 4.6–7.0) IU/mL with 9 (17.6%) having levels ≥105 IU/mL. Eighty (13.3%) mothers were HIV-infected of whom 9 (11.5%) were co-infected with HBV. No baby tested HBsAg or HBVDNA positive. Conclusion Vertical transmission does not seem to contribute substantially to the high HBV endemicity in northern Uganda. The current practice of administering the first HBV vaccine to babies in Uganda at six weeks of age may be adequate in control of HBV transmission.

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“…However, limited information is available on the proportion of infants who have an adequate response to the vaccine and reach anti‐HBs levels which are considered protective . This is particularly important for infants born to HIV‐positive mothers in whom a decreased response could be observed and in whom HBV transmission may more frequently occur due to high HBV‐DNA levels in co‐infected mothers . Maternal HBV co‐infection could also be potentially associated with a lower response to HBV vaccine since maternal specific antibody can interfere with the infant's own response to vaccination …”

Section: Introductionmentioning

confidence: 99%

Antibody response to hepatitis B vaccine in HIV‐exposed infants in Malawi and correlation with HBV infection acquisition

Pirillo

Liotta

Andreotti

et al. 2018

Journal of Medical Virology

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The aim of this study was to assess the immune response to HBV vaccine in HIV-exposed infants and to correlate it to HBV infection acquisition. Protective anti-HBs levels (>10 mIU/mL) were found in 54/58 (93.2%) infants at 6 months, 126/144 (87.5%) at 12 months and 141/176 (80.1%) children at 24 months. HBV infection (seven children were HBsAg + at Month 24) occurred also in the presence of levels above 10 mIU/mL. Our findings indicate limited impact of HIV exposure on anti-HBV immune response, but suggest that levels >10 mIU/mL may be required to confer protection in this context.

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Hepatitis B virus infection among HIV-infected pregnant women in Malawi and transmission to infants

Cited by 40 publications

References 42 publications

Hepatitis B virus infection in HIV-exposed infants in the Western Cape, South Africa

Hepatitis B virus infection in HIV-exposed infants in the Western Cape, South Africa

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

Antibody response to hepatitis B vaccine in HIV‐exposed infants in Malawi and correlation with HBV infection acquisition

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