Occult hepatitis B virus infection in patients with isolated core antibody and HIV co-infection in an urban clinic in Johannesburg, South Africa

Abstract

Summary Background The prevalence of HIV/hepatitis B virus (HBV) co-infection in South Africa ranges from 4.8% to17% using the standard marker surface antigen (hepatitis B surface antigen, HBsAg) for chronic active HBV infection. However, sensitive molecular techniques for detecting HBV DNA in serum can detect occult HBV infection. We report the first observational prospective study of occult HBV infection in HIV-positive people in South Africa. Methods Five hundred and two patients attending an urban hospital were screened for HBV using serological testing for HBsAg, core antibody (anti-HBc), and surface antibody (anti-HBs). DNA was analyzed using real-time quantitative PCR to determine the HBV viral load. Results Of the 502 participants, 24 (4.8%) were HBsAg- positive and 53 (10.6%) were positive for anti-HBc alone. Of these 53, screening for occult disease was carried out in 43, of whom 38 (88.4%) were positive. The mean HBV viral load was 2.8 × 104 copies/ml (range 1 ×102 to 1 × 106 copies/ml). Conclusions Combining the participants with positive HBsAg and occult HBV DNA results, the prevalence of HBV increases from 4.8% (HBsAg alone) to 12.4%. While the clinical impact of occult HBV infection is unclear, consideration should be given to changing the guidelines to recommend dual HBV therapy for the treatment of co-infected patients in the developing world.

Maternal hepatitis B and infant infection among pregnant women living with HIV in South Africa

“…Our proportion of 43% with “e” antigenemia is also consistent with other reports from HIV-coinfected populations in the region in which 38 to 53% of HBsAg positive participants were also positive for HBeAg [20–23]. Our finding of only 2% of women with occult hepatitis B (as defined by detectable HBV DNA with a negative HBsAg) is lower than reported from some studies that had sicker participants with lower CD4 counts [24,25]. The higher median CD4 count in our cohort and a higher fraction of participants receiving ART likely accounts for the low proportion of occult HBV as occult HBV appears to be partly a phenomenon of low CD4 count and lack of ART [26–28].…”

Occult hepatitis B virus co-infection in HIV-positive patients: A review of prevalence, diagnosis and clinical significance

“…Some of the differences are explained by the individual prevalence of HIV and HBV in the different populations studied. Although there are reports from central and south America [17][18][19][20][21][22] , the majority of the studies are from regions of Africa, India and the Far East, regions where the prevalence of both HIV and HBV is high [23][24][25][26][27] . Differences also arise from the type of high-risk group to which the co-infection patients studied belong (e.g., hemodialysis patients, homosexuals, intravenous drug users).…”

“…Furthermore, the available data suggest seronegative patients have a different clinical evolution and should therefore be evaluated separately. Another factor that is common in HIV patients and that is known to affect [46] Iran 3 (13.6) 2 (9.1) ND 1 (4.5) Bagaglio et al [47] Italy 9 (31.0) 9 (31.0) ND ND Bell et al [48] Africa [51] Spain 6 (2.4) 2 (0.8) 4 (1.6) ND Filippini et al [13] Italy 17 (20.0) 11 (12.8) 3 (3.5) 3 (3.5) Firnhaber et al [23] Africa 38 (88.4) 38 (88.4) ND ND Gupta et al [30] India 24 (45.3) 13 (24.5) 11 (20.8) ND Hakeem et al [52] Scotland 2 (2.8) 2( 2.9) ND ND Jardim et al [19] Brazil 8 (5.0) 2 (1.3) 6 (3.8) ND Khamduang et al [35] Thailand 47 (23.5) 47 (23.5) ND ND Liang et al [53] Taiwan 3 (2.3) 3 (2.3) ND ND Lo Re et al [54] United States 17 (10.0) 10 (5.6) 7 (3.9) ND Loustaud-Ratti et al [55] France [24] Africa 51 (10.0) 51 (11.8) ND ND Neau et al [58] France 1 (0.6) 1 (0.6) ND ND Nebbia et al [59] England 48 (14.0) 48 (14.0) ND ND Opaleye et al [25] Nigeria 21 (11.2) 8 (4.3) 9 (4.8) 2 (1.1) Panigrahi et al [26] India 12 (10.7) 9 (8.0) 3 (2.7) ND Santos et al [20] Brazil 16 (15.8) 2 4 (4.0) 12 (11.9) ND Sen et al [27] India 1 (5.6) 2 1 (5.6) ND ND Shire et al [60] United States 4 (10.5) 4 (10.5) ND ND Shire et al [61] United States 12 (30.2) 3 (7.0) 5 1 (11.6) 5 (11.6) Sucupira et al [21] Brazil 6 (18.8) 2 3 (9.4) 3 (9.4) ND Torres Barranda et al [22] Mexico 7 (18.4) 1 (2.6) 1 (2.6) 5 (13.2) Tramuto et al [62] Italy 24 (5.9) 8 (2.0) 7 1 (1.7) 9 (2.2) Tsui et al [63] United States 8 (2.0) 8 (2.0) ND ND 1 In some studies the anti-HBsAg positive group was also included; 2 Prevalence calculated using the reported data; anti-HBsAg+, antibodies against hepatitis B surface antigen positive; anti-HBcAg+ antibodies against hepatitis B core antigen positive. Prevalence (%) were included for each group of patients studied according the HBV serological markers (Anti-HBsAg-/anti-HBcAg+, Anti-HBsAg+/anti-HBcAg+, Anti-HBsAg-/anti-HBcAg-).…”

Prevalence and virological profiles of hepatitis B infection in human immunodeficiency virus patients

“…Indeed, HIV infection increases chronic HBV infection risk and promotes faster progression to cirrhosis and its complications, especially when HBV replication is important [4][5][6][7][8][9] . If HBV-HIV coinfection is very common in sub-Saharan Africa, there are few data on HBV infection virological aspects in HIV Black African patients [10][11][12][13][14] . This study's aims were to estimate HBV infection prevalence among an adult population, with HIV infection, less than 500 CD4+ T-cell/mm 3 and without antiretroviral therapy (ART), to describe the different profiles of virological B co-infected subjects and to search for HBs antigen (HBsAg) presence associated factors in these HIV patients.…”