The prevalence of hepatitis B virus infection in HIV-positive and HIV-negative infants: KwaZulu-Natal, South Africa

Abstract

BackgroundThe prevalence of hepatitis B virus (HBV) amongst South African infants and children has been reported in the pre-HIV era. Despite the reported high prevalence of HIV in the general population of South Africa, the rate of HIV/HBV co-infection amongst infants and children remains poorly reported.ObjectivesWe describe the prevalence of HBV infection amongst HIV-positive and HIV-negative infants by molecular methods of diagnosis using dried blood spot samples.MethodsThis retrospective cross-sectional study was conducted between July 2011 and December 2011 in an academic referral laboratory offering viral diagnostic services to the entire KwaZulu-Natal province of South Africa. A total of 322 study samples were collected from discarded residual dried blood spot samples following routine infant diagnosis of HIV. Equal proportions of HIV-positive and HIV-negative infant specimens were studied. Statistical differences in the prevalence of HBV between the HIV-positive and HIV-negative samples were calculated using the Pearson chi-square test, and a p-value < 0.05 was considered statistically significant. Further testing for HBV DNA using a nested polymerase chain reaction method was performed.ResultsThe overall prevalence of HBV was 10%. In the HIV-positive group, 21 of 161 infants tested positive for HBV compared with 12 of 161 HIV-negative infants who tested positive for HBV. The proportion of infants infected with HBV was marginally higher amongst HIV-positive infants (13.0%; 95% CI 6.8–19.9) compared with HIV-negative infants (7.5%; 95% CI 2.5–13.7; P = 0.098), though not statistically significant.ConclusionThe finding of a 10% HBV prevalence in this infant cohort is clinically significant. The non-statistically significant difference in HBV prevalence between the HIV-positive and HIV-negative infants suggests that high prevalence of HBV infection in children may be a problem independent of HIV.

Prevalence and burden of HBV co‐infection among people living with HIV: A global systematic review and meta‐analysis

“…The mid‐point prevalence was 6.8% (IQR 2.5‐10.0). Prevalence ranged from 2% to 20% across six estimates from Nigeria and between 0% and 20.5% in South Africa . Extremely high prevalence (43%‐46%) was observed in Romania in two studies where HIV infection was acquired nosocomially prior to 1995.…”

“…Prevalence ranged from 2% to 20% across six estimates from Nigeria [37][38][39][40][41][42] and between 0% and 20.5% in South Africa. [43][44][45][46] Extremely high prevalence (43%-46%) was observed in Romania in two studies 47,48 where HIV infection was acquired nosocomially prior to 1995. A high prevalence (32.6%) was also found in Thailand among young people perinatally infected with HIV (mean age 14 years).…”

Hepatitis B sero-prevalence in children under 15 years of age in South Africa using residual samples from community-based febrile rash surveillance

“…Occult hepatitis B infection was not investigated. Occult hepatitis B, usually considered as detectable hepatitis B deoxyribonucleic acid (DNA) but undetectable HBsAg, has previously been reported in both HIV negative and HIV positive adults [20, 29, 30, 34, 35, 47] and HIV exposed infants [16, 17, 48] in South Africa. In patients with occult hepatitis B, antibody against Hepatitis B core antigen is often detected.…”

The investment case for hepatitis B and C in South Africa: adaptation and innovation in policy analysis for disease program scale-up

“…Data on the burden of HBV and HCV in South Africa are available from several studies in the general population and in selected sub-groups ( Burnett et al 2007 ; Firnhaber et al 2008 ; Lukhwareni et al 2009 ; Boyles and Cohen 2011 ; Andersson et al 2013 ; Hatzakis et al 2015 ; Mdlalose et al 2016 ).…”