HIV, Hepatitis B, and Hepatitis C in Zambia

Kenneth C Kapembwa, Jason D Goldman, Shabir Lakhi, Yolan Banda, Kasonde Bowa, Sten H Vermund, Joseph Mulenga, David Chama, Benjamin H Chi, Kenneth C Kapembwa, Jason D Goldman, Shabir Lakhi, Yolan Banda, Kasonde Bowa, Sten H Vermund, Joseph Mulenga, David Chama, Benjamin H Chi

Abstract

Objectives: Epidemiologic data of HIV and viral hepatitis coinfection are needed in sub-Saharan Africa to guide health policy for hepatitis screening and optimized antiretroviral therapy (ART).

Materials and methods: We screened 323 HIV-infected, ART-eligible adults for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCV Ab) at a tertiary hospital in Lusaka, Zambia. We collected basic demographic, medical, and laboratory data to determine predictors for coinfection.

Results: Of 323 enrolled patients, 32 (9.9%; 95% CI=6.7-13.2%) were HBsAg positive, while 4 (1.2%; 95% CI=0.03-2.4%) were HCV Ab positive. Patients with hepatitis B coinfection were more likely to be <40 years (84.4% vs. 61.4%; P=0.01) when compared to those who were not coinfected. Patients with active hepatitis B were more likely to have mild to moderately elevated AST/ALT (40-199 IU/L, 15.8% vs. 5.4%; P=0.003). Highly elevated liver enzymes (>200 IU/L) was uncommon and did not differ between the two groups (3.4% vs. 2.3%; P=0.5). We were unable to determine predictors of hepatitis C infection due to the low prevalence of disease.

Conclusions: HIV and hepatitis B coinfection was common among patients initiating ART at this tertiary care facility. Routine screening for hepatitis B should be considered for HIV-infected persons in southern Africa.

Keywords: Africa; HIV; Hepatitis B; Hepatitis C; Prevalence; Zambia.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Stringer JS, Zulu I, Levy J, Stringer EM, Mwango A, Chi BH, et al. Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: Feasibility and early outcomes. JAMA. 2006;296:782–93.
    1. Bolton-Moore C, Mubiana-Mbewe M, Cantrell RA, Chintu N, Stringer EM, Chi BH, et al. Clinical outcomes and CD4 cell response in children receiving antiretroviral therapy at primary health care facilities in Zambia. JAMA. 2007;298:1888–99.
    1. Sulkowski MS, Thomas DL, Mehta SH, Chaisson RE, Moore RD. Hepatotoxicity associated with nevirapine or efavirenz-containing antiretroviral therapy: Role of hepatitis C and B infections. Hepatology. 2002;35:182–9.
    1. Martinez E, Blanco JL, Arnaiz JA, Perez-Cuevas JB, Mocroft A, Cruceta A, et al. Hepatotoxicity in HIV-1-infected patients receiving nevirapine-containing antiretroviral therapy. AIDS. 2001;15:1261–8.
    1. de Maat MM, ter Heine R, van Gorp EC, Mulder JW, Mairuhu AT, Beijnen JH. Case series of acute hepatitis in a non-selected group of HIV-infected patients on nevirapine-containing antiretroviral treatment. AIDS. 2003;17:2209–14.
    1. Aceti A, Pasquazzi C, Zechini B, De Bac C. Hepatotoxicity development during antiretroviral therapy containing protease inhibitors in patients with HIV: The role of hepatitis B and C virus infection. J Acquir Immune Defic Syndr. 2002;29:41–8.
    1. Arribas JR, Ibanez C, Ruiz-Antoran B, Pena JM, Esteban-Calvo C, Frias J, et al. Acute hepatitis in HIV-infected patients during ritonavir treatment. AIDS. 1998;12:1722–4.
    1. Oshitani H, Kasolo FC, Mpabalwani M, Mizuta K, Luo NP, Suzuki H, et al. Prevalence of hepatitis B antigens in human immunodeficiency virus type 1 seropositive and seronegative pregnant women in Zambia. Trans R Soc Trop Med Hyg. 1996;90:235–6.
    1. Kasolo F, Sakala I, Baboo K. Paris, France: Conference on HIV Pathogenesis and Treatment; 2003. Hepatitis B virus infection in human immunodeficiency virus seropositive patients at the University Teaching Hospital, Lusaka, Zambia: Interrelationship. [Abstract no. 963]. 2nd.
    1. Mwaba P, Zulu I, Kafula T, Chisembele M, Mtonga V, Kankasa C, et al. The GRZ ARV Pilot Program: The UTH Experience. Zambia Med J. 2004;6:118–20.
    1. Antiretroviral therapy for HIV infection in adults and adolescents in resource-limited settings. Geneva: towards universal access; 2006. World Health Organization.
    1. Morris MB, Chapula BT, Chi BH, Mwango A, Chi HF, Mwanza J, et al. Use of task-shifting to rapidly scale-up HIV treatment services: Experiences from Lusaka, Zambia. BMC Health Serv Res. 2009;9:5.
    1. Table of grading severity of adult adverse experiences. Rockville, MD: Division of AIDS, National Institutes of Allergy and Infectious Diseases; 2004. AIDS Clinical Trials Group.
    1. Paris, France: 2nd IAS Conference on HIV Pathogenesis and Treatment; 2003. Hepatitis B virus infection in human innumodeficiency virus seropositive patients at the University Teaching Hospital, Lusaka, Zambia: Interrelationship. [abstract no. 963]
    1. Firnhaber C, Reyneke A, Schulze D, Malope B, Maskew M, MacPhail P, et al. The prevalence of hepatitis B co-infection in a South African urban government HIV clinic. S Afr Med J. 2008;98:541–4.
    1. Otegbayo JA, Taiwo BO, Akingbola TS, Odaibo GN, Adedapo KS, Penugonda S, et al. Prevalence of hepatitis B and C seropositivity in a Nigerian cohort of HIV-infected patients. Ann Hepatol. 2008;7:152–6.
    1. Diop-Ndiaye H, Toure-Kane C, Etard JF, Lo G, Diaw P, Ngom-Gueye NF, et al. Hepatitis B, C seroprevalence and delta viruses in HIV-1 Senegalese patients at HAART initiation (retrospective study) J Med Virol. 2008;80:1332–6.
    1. Nagu TJ, Bakari M, Matee M. Hepatitis A, B and C viral co-infections among HIV-infected adults presenting for care and treatment at Muhimbili National Hospital in Dar es Salaam, Tanzania. BMC Public Health. 2008;8:416.
    1. Hadler SC, Judson FN, O’Malley PM, Altman NL, Penley K, Buchbinder S, et al. Outcome of hepatitis B virus infection in homosexual men and its relation to prior human immunodeficiency virus infection. J Infect Dis. 1991;163:454–9.
    1. Colin JF, Cazals-Hatem D, Loriot MA, Martinot-Peignoux M, Pham BN, Auperin A, et al. Influence of human immunodeficiency virus infection on chronic hepatitis B in homosexual men. Hepatology. 1999;29:1306–10.
    1. Thio CL, Seaberg EC, Skolasky R, Jr, Phair J, Visscher B, Munoz A, et al. HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS) Lancet. 2002;360:1921–6.
    1. Puoti M, Bruno R, Soriano V, Donato F, Gaeta GB, Quinzan GP, et al. Hepatocellular carcinoma in HIV-infected patients: Epidemiological features, clinical presentation and outcome. AIDS. 2004;18:2285–93.
    1. Nikolopoulos GK, Paraskevis D, Hatzitheodorou E, Moschidis Z, Sypsa V, Zavitsanos X, et al. Impact of hepatitis B virus infection on the progression of AIDS and mortality in HIV-infected individuals: A cohort study and meta-analysis. Clin Infect Dis. 2009;48:1763–71.
    1. Kaplan JE, Benson C, Holmes KH, Brooks JT, Pau A, Masur H. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58:1–207.
    1. Rapid advice: Antiretroviral therapy for HIV infection for adults and adolescents, November 2009. Geneva: WHO Press; 2009. World Health Organization.
    1. Adult and adolescent antiretroviral therapy protocols. Lusaka, Zambia: Printech Press; 2010. Zambian Ministry of Health.
    1. Matthews GV, Seaberg E, Dore GJ, Bowden S, Lewin SR, Sasadeusz J, et al. Combination HBV therapy is linked to greater HBV DNA suppression in a cohort of lamivudine-experienced HIV/HBV coinfected individuals. AIDS. 2009;23:1707–15.
    1. Matthews GV, Avihingsanon A, Lewin SR, Amin J, Rerknimitr R, Petcharapirat P, et al. A randomized trial of combination hepatitis B therapy in HIV/HBV coinfected antiretroviral naive individuals in Thailand. Hepatology. 2008;48:1062–9.
    1. Chi BH, Mwango A, Giganti M, Mulenga LB, Tambatamba-Chapula B, Reid SE, et al. Early clinical and programmatic outcomes with tenofovir-based antiretroviral therapy in Zambia. J Acquir Immune Defic Syndr. 2010;54:63–70.
    1. World Health Organization. WHO vaccine preventable disease monitoring system: 2010 global summary. [Last Accessed on 2011 Jan 20]. Available from: .
    1. Burnett RJ, Francois G, Kew MC, Leroux-Roels G, Meheus A, Hoosen AA, et al. Hepatitis B virus and human immunodeficiency virus co-infection in sub-Saharan Africa: A call for further investigation. Liver Int. 2005;25:201–13.
    1. Lukhwareni A, Burnett RJ, Selabe SG, Mzileni MO, Mphahlele MJ. Increased detection of HBV DNA in HBsAg-positive and HBsAg-negative South African HIV/AIDS patients enrolling for highly active antiretroviral therapy at a Tertiary Hospital. J Med Virol. 2009;81:406–12.
    1. Pang T, Peeling RW. Diagnostic tests for infectious diseases in the developing world: Two sides of the coin. Trans R Soc Trop Med Hyg. 2007;101:856–7.
    1. Yager P, Domingo GJ, Gerdes J. Point-of-care diagnostics for global health. Annu Rev Biomed Eng. 2008;10:107–44.
    1. Wester CW, Bussmann H, Moyo S, Avalos A, Gaolathe T, Ndwapi N, et al. Serological evidence of HIV-associated infection among HIV-1-infected adults in Botswana. Clin Infect Dis. 2006;43:1612–5.
    1. Rouet F, Chaix ML, Inwoley A, Msellati P, Viho I, Combe P, et al. HBV and HCV prevalence and viraemia in HIV-positive and HIV-negative pregnant women in Abidjan, Cote d’Ivoire: The ANRS 1236 study. J Med Virol. 2004;74:34–40.
    1. Shimelis T, Torben W, Medhin G, Tebeje M, Andualm A, Demessie F, et al. Hepatitis B virus infection among people attending the voluntary counselling and testing centre and anti-retroviral therapy clinic of St Paul's General Specialised Hospital, Addis Ababa, Ethiopia. Sex Transm Infect. 2008;84:37–41.
    1. Mboto CI, Fielder M, Davies-Russell A, Jewell AP. Hepatitis C virus prevalence and serotypes associated with HIV in The Gambia. Br J Biomed Sci. 2010;67:140–4.
    1. Harania RS, Karuru J, Nelson M, Stebbing J. HIV, hepatitis B and hepatitis C coinfection in Kenya. AIDS. 2008;22:1221–2.
    1. Moore E, Beadsworth MB, Chaponda M, Mhango B, Faragher B, Njala J, et al. Favourable one-year ART outcomes in adult Malawians with hepatitis B and C co-infection. J Infect. 2010;61:155–63.
    1. Nyirenda M, Beadsworth MB, Stephany P, Hart CA, Hart IJ, Munthali C, et al. Prevalence of infection with hepatitis B and C virus and coinfection with HIV in medical inpatients in Malawi. J Infect. 2008;57:72–7.
    1. Ahmed SD, Cuevas LE, Brabin BJ, Kazembe P, Broadhead R, Verhoeff FH, et al. Seroprevalence of hepatitis B and C and HIV in Malawian pregnant women. J Infect. 1998;37:248–51.
    1. Pirillo MF, Bassani L, Germinario EA, Mancini MG, Vyankandondera J, Okong P, et al. Seroprevalence of hepatitis B and C viruses among HIV-infected pregnant women in Uganda and Rwanda. J Med Virol. 2007;79:1797–801.
    1. Di Bisceglie AM, Maskew M, Schulze D, Reyneke A, McNamara L, Firnhaber C. HIV-HBV coinfection among South African patients receiving antiretroviral therapy. Antivir Ther. 2010;15(3 Pt B):499–503.
    1. Hoffmann CJ, Charalambous S, Martin DJ, Innes C, Churchyard GJ, Chaisson RE, et al. Hepatitis B virus infection and response to antiretroviral therapy (ART) in a South African ART program. Clin Infect Dis. 2008;47:1479–85.
    1. Kallestrup P, Zinyama R, Gomo E, Dickmeiss E, Platz P, Gerstoft J, et al. Low prevalence of hepatitis C virus antibodies in HIV-endemic area of Zimbabwe support sexual transmission as the major route of HIV transmission in Africa. AIDS. 2003;17:1400–2.

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