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HBV/HIV co-infection: The dynamics of HBV in South African patients with AIDS


SH Mayaphi
TM Rossouw
DP Masemola
SAS Olorunju
MJ Mphahlele
DJ Martin

Abstract

Objective. As sub-Saharan Africa is highly endemic for hepatitis B
virus (HBV) and human immunodeficiency virus (HIV) infections,
and their co-infection requires special management, we aimed
to assess the serological and molecular characteristics of HBV in
patients with AIDS.
Design. This was a cross-sectional, case control study, which
enrolled 200 patients with AIDS and 200 HIV-negative controls.
HBV serology was done in all participants and HCV serology
in participants with a hepatitis B core antibody (anti-HBc) only
serological pattern. Nested HBV polymerase chain reaction (PCR)
and HBV viral load assays were used for HBV molecular detection.
Results. Hepatitis B surface antigen (HBsAg) prevalence was
3-fold higher while the ‘anti-HBc only’ pattern was 6-fold higher in
the AIDS group compared with the controls. Mean HBV viral load
was significantly higher in HBsAg-positive patients with CD4+
cell counts <100 cells/ìl than in patients with CD4+ cell counts of
100-200 cells/ìl (p=0.019). There were markedly reduced hepatitis
B surface antibody (anti-HBs) titres in the AIDS group compared
with the controls (p=0.002). A significant proportion of AIDS
patients with an ‘anti-HBc only’ pattern had CD4+ cell counts <100
cells/ìl (p=0.004). Occult HBV prevalence was 3.5% in the AIDS
group compared with 1% in the controls (p=0.092). When occult
HBV infection was taken into consideration, the overall HBV
prevalence became 10% in the AIDS group and 3% in the control
group.
Conclusion. We showed an increased HBV prevalence in patients
with AIDS and identified a CD4+ cell count <100 cells/ìl as a
major risk factor for the ‘anti-HBc only’ pattern and increased
HBV replication. These data have significant public health
implications for HBV in developing countries, especially in areas
where antiretroviral (ARV) guidelines do not cater for HBV/HIV
co-infection.

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eISSN: 2078-5135
print ISSN: 0256-9574