Hepatitis B virus infection among men who have sex with men and transgender women living with or at risk for HIV: a cross sectional study in Abuja and Lagos, Nigeria

Abstract

Background Despite the development of a safe and efficacious hepatitis B vaccine in 1982, the hepatitis B virus (HBV) remains a public health burden in sub-Saharan Africa. Due to shared risk factors for virus acquisition, men who have sex with men (MSM) and transgender women (TGW) living with HIV are at increased risk of HBV. We estimated the prevalence of HBV and associated factors for MSM and TGW living with or without HIV in Nigeria. Methods Since March 2013, TRUST/RV368 has recruited MSM and TGW in Abuja and Lagos, Nigeria using respondent driven sampling. Participants with HIV diagnosis, enrollment as of June 2015, and available plasma were selected for a cross-sectional study and retrospectively tested for hepatitis B surface antigen and HBV DNA. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with prevalent HBV infection. Results A total of 717 MSM and TGW had a median age of 25 years (interquartile range [IQR]: 21–27), 5% self-reported HBV vaccination, 61% were living with HIV, 10% had prevalent HBV infection and 6% were HIV-HBV co-infected. HIV mono-infected as compared to HIV-HBV co-infected had a higher median CD4 T cell count [425 (IQR: 284–541) vs. 345 (IQR: 164–363) cells/mm3, p = 0.03] and a lower median HIV RNA viral load [4.2 (IQR: 2.3–4.9) vs. 4.7 (IQR: 3.9–5.4) log10copies/mL, p < 0.01]. The only factor independently associated with HBV was self-report of condomless sex at last anal intercourse (OR: 2.2, 95% CI: 1.3, 3.6). HIV infection was not independently associated with HBV (OR: 1.0, 95% CI: 0.7–1.6). Conclusion HBV prevalence was moderately high but did not differ by HIV in this cohort of MSM and TGW. Recent condomless sex was associated with elevated HBV risk, reinforcing the need to increase communication and education on condom use among key populations in Nigeria. Evaluating use of concurrent HIV antiretroviral therapy with anti-HBV activity may confirm the attenuated HBV prevalence for those living with HIV.

The prevalence of hepatitis C and hepatitis B in lesbian, gay, bisexual and transgender populations: a systematic review and meta-analysis

“…Finally, ten studies [ 2 , 18 – 26 ] were entered into the analysis. Out of these articles, eight studies [ 2 , 18 – 22 , 24 , 26 ] reported the prevalence of HBV, and eight studies [ 2 , 18 – 20 , 22 , 23 , 25 , 26 ] reported HCV prevalence in transgender and LGBT people (Fig. 1 ).…”

“…Of all studies, two [ 18 , 19 ] had been conducted in the LGBT community (Total sample size = 2150), and eight [ 2 , 20 – 26 ] in the transgender community (Total sample size = 4273). Seven studies were conducted with cross-sectional design in Argentina [ 2 ], The Republic of Dominican [ 18 ], Spain [ 19 ], the United States [ 24 ], Nigeria [ 25 ], and Indonesia [ 26 ]; in contrast, three ones had been retrospectively conducted in Pakistan [ 21 ], Italy [ 20 ], and the United States [ 23 ].…”

“…Six studies [ 2 , 20 , 22 , 23 , 25 , 26 ] reported the prevalence of HBV in transgender people. Luzzati et al [ 20 ] reported this prevalence in male to female and female to male, separately.…”

Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts

“…HBV is endemic in some communities of MSM and transgender women (e.g. in Papua New Guinea 150 and Nigeria 151 ), and providing reliable healthcare for these groups is challenging. Access to care for MSM, bisexual and transgender communities may be further complicated in countries where legislation prohibits same-sex relationships.…”

Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts

“…HBV is endemic in MSM and transgender women (e.g. in Papua New Guinea 149 and Nigeria 150 ), but these groups may be hard to reach for screening, surveillance and treatment. High rates of drug and alcohol misuse may both increase the risk of exposure to infection with blood-borne viruses, and present barriers to interaction with healthcare services, as well as being associated with vaccine hesitancy in some populations 151 .…”