Proportion and factors associated with Hepatitis B viremia in antiretroviral treatment naïve and experienced HIV co-infected Ghanaian patients

Abstract

BackgroundThe global burden of Hepatitis B virus (HBV) and HIV co-infection is enormous. The risk of developing cirrhosis and hepatocellular cancer is associated with HBV DNA levels. The main objective of the study was to determine proportion of Hepatitis B viremia in ART-naïve and ART-experienced co-infected Ghanaian patients and factors associated with HBV viremia after at least 36 weeks of lamivudine with or without tenofovir containing ART.MethodsHepatitis B and HIV co-infected patients who were ART-naïve or had received at least 9 months of lamivudine-containing ART were enrolled in a cross-sectional study at Korle-Bu Teaching Hospital. Demographic and clinical data were collected and samples obtained for Hepatitis B serology, liver function tests and HBV DNA. Factors associated with viremia were determined using univariate and multivariate logistic regression analysis.ResultsOf 3108 HIV-infected patients screened, 257 (8.3 %) were HBsAg-positive, of which 235 enrolled. Overall, 152 (64.7 %) were ART-experienced and 83 (35.3 %) were ART-naïve. Eighty-nine-percent of ART-naïve and 42.1 % of ART-experienced patients had HBV DNA > 20 IU/mL. In multivariate analysis of all patients, being ART-naïve (OR 10.1, 95 % CI 4.6 – 21.9) and elevated ALT (OR 3.7, 95 % CI 1.8 – 7.9) were associated with Hepatitis B viremia. In treatment experienced patients, elevated ALT (OR 4.8 CI 2.0 – 12.1) and male sex (OR 2.1, 95 % CI 1.0 – 4.2) were associated with Hepatitis B viremia.ConclusionsMajority of ART-naïve (89 %) and 42 % of ART-experienced patients had detectable hepatitis B viremia > 20 IU/mL. An abnormal serum ALT was significantly associated with hepatitis B viremia in HBV and HIV co-infected patients irrespective of treatment status. Baseline and on-treatment ALT may be a useful non-invasive predictor of Hepatitis B viremia in resource-constrained countries in sub-Saharan Africa where infection is endemic and viral load tests are not widely available.

HBV Genotypes and Drug Resistance Mutations in Antiretroviral Treatment-Naive and Treatment-Experienced HBV–HIV-Coinfected Patients

“…Of the 235 HIV-infected patients who were HBsAg-positive, 138 (58.7%) and 101 (43.0%) patients had detectable HBV DNA level above 19 and 400 IU/mL, respectively [13]. Of those with HBV DNA > 400 IU/mL, 100 (99.0%) were included in the current study.…”

“…The patients in the current study were enrolled previously in a study to investigate the factors associated with HBV viremia in ART-naïve and ART-experienced individuals. Overall, 89% of ART-naïve and 42.1% of ART-experienced patients had detectable HBV DNA > 20 IU/mL [13]. In the current study, the presence of drug resistance mutations in the patients with the highest level of viremia with HBV DNA > 400 IU/mL (N = 100) was investigated.…”

Prevalence of HIV and hepatitis B coinfection in Ghana: a systematic review and meta-analysis

“…After the exclusion of duplicates and irrelevant studies based on titles and abstracts, fourteen (14) articles were retrieved for detailed full-text analysis. Out of the 14 studies, twelve (12) met the inclusion criteria for addition to the review [ 24 – 35 ]. The 12 studies (Table 1 ) reported HBV coinfection prevalence rate in a total HIV-positive patient’s population size of 8162.…”

Hepatitis B and C in the adult population of Bissau, Guinea‐Bissau: a cross‐sectional survey

“…Data on HBV and HCV in West African general populations are limited. Most other reports are from specific groups such as blood donors , pregnant women , men who have sex with men and HIV‐infected individuals . Prevalence and risk factors in these specific population groups may be different from the general population.…”