Low rates of active hepatitis B and C infections among adults and children living with HIV and taking antiretroviral therapy: A multicenter screening study in Lesotho

Abstract

Lesotho presents the second‐highest adult human immunodeficiency virus (HIV) prevalence globally. Among people living with HIV, data on hepatitis B virus (HBV) or hepatitis C virus (HCV) coinfection are limited. We report HBV and HCV coinfection data from a multicentre cross‐sectional study among adult and pediatric patients taking antiretroviral therapy in 10 health facilities in Lesotho. Among 1318 adults screened (68% female; median age, 44 years), 262 (20%) had immunologically controlled HBV infection, 99 (7.6%) tested anti‐HBs positive and anti‐HBc negative, indicating vaccination, and 57 (4.3%) had chronic HBV infection. Among the patients with chronic HBV infection, 15 tested hepatitis B envelope antigen (HBeAg) positive and eight had detectable HBV viremia (median, 2 477 400 copies/mL; interquartile range, 205‐34 400 000) with a mean aspartate aminotransferase‐to‐platelet ratio index of 0.48 (SD, 0.40). Prevalence of HCV coinfection was 1.7% (22 of 1318), and only one patient had detectable HCV viremia. Among 162 pediatric patients screened, three (1.9%) had chronic HBV infection, whereby two also tested HBeAg‐positive, and one had detectable HBV viral load (210 copies/mL). Six of 162 (3.7%) had anti‐HCV antibodies, all with undetectable HCV viral loads. Overall prevalence of chronic HBV/HIV and HCV/HIV coinfection among adults and children was relatively low, comparable to earlier reports from the same region. But prevalence of immunologically controlled HBV infection among adults was high. Of those patients with chronic HBV infection, a minority had detectable HBV‐DNA.

The performance of hepatitis C virus (HCV) antibody point‐of‐care tests on oral fluid or whole blood and dried blood spot testing for HCV serology and viral load among individuals at higher risk for HCV in South Africa

“…Furthermore, HCV diagnosis requires confirmation of antibody positivity by nucleic acid confirmatory testing (qualitative or quantitative) 13‐15 . In sub‐Saharan Africa (SSA), the use of anti‐HCV POC is increasing as more research is focused on viral hepatitis 16,17 . However, dried blood spot (DBS) testing and the uptake of anti‐HCV POC for diagnostics has been slow as innovative diagnostic methods focused on priority diseases, such as HIV and TB 18 in SSA.…”

“…[13][14][15] In sub-Saharan Africa (SSA), the use of anti-HCV POC is increasing as more research is focused on viral hepatitis. 16,17 However, dried blood spot (DBS) testing and the uptake of anti-HCV POC for diagnostics has been slow as innovative diagnostic methods focused on priority diseases, such as HIV and TB 18 in SSA. Currently, whole blood is still being transported to centralized laboratories for HCV antibody and then confirmatory HCV RNA testing.…”