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

Tumaini J Nagu, Muhammad Bakari, Mecky Matee, Tumaini J Nagu, Muhammad Bakari, Mecky Matee

Abstract

Background: Tanzania is currently scaling-up access to anti-retro viral therapy (ART) to reach as many eligible persons as possible. Hepatitis viral co-infections are known to influence progression, management as well as outcome of HIV infection. However, information is scarce regarding the prevalence and predictors of viral hepatitis co-infection among HIV-infected individuals presenting at the HIV care and treatment clinics in the country.

Methods: A cross-sectional study conducted between April and September 2006 enrolled 260 HIV-1 infected, HAART naïve patients aged > or = 18 years presenting at the HIV care and treatment clinic (CTC) of the Muhimbili National Hospital (MNH). The evaluation included clinical assessment and determination of CD4+ T-lymphocyte count, serum transaminases and serology for Hepatitis A, B and C markers by ELISA.

Results: The prevalence of anti HAV IgM, HBsAg, anti-HBc IgM and anti-HCV IgG antibodies were 3.1%, 17.3%, 2.3% and 18.1%, respectively. Dual co-infection with HBV and HCV occurred in 10 individuals (3.9%), while that of HAV and HBV was detected in two subjects (0.8%). None of the patients had all the three hepatitis viruses. Most patients (81.1%) with hepatitis co-infection neither had specific clinical features nor raised serum transaminases. History of blood transfusion and jaundice were independent predictors for HBsAg and anti-HBc IgM positivity, respectively.

Conclusion: There is high prevalence of markers for hepatitis B and C infections among HIV infected patients seeking care and treatment at MNH. Clinical features and a raise in serum alanine aminotransferase were of limited predictive values for the viral co-infections. Efforts to scale up HAART should also address co-infections with Hepatitis B and C viruses.

References

    1. United Republic of Tanzania. Ministry of Health Report of the 3 by 5 Mission to Tanzania on Scaling up Antiretroviral Treatment as Part of the Global Emergency Response to HIV/AIDS
    1. United Republic of Tanzania. Ministry of Health National AIDS control program (NACP) Annual report, Tanzania. 2007.
    1. Swash M. Hutchison's clinical methods. London Royal Hospital, Saunders Press; 1995.
    1. World Health Organization Treat 3 million by 2005. Interim WHO clinical staging of HIV/AIDS and HIV/AIDS case definitions for surveillance. African region. WHO/HIV/2005.02
    1. SPSS Inc version 10.0 . The statistical Package for the Social Sciences. Chicago, II: SPSS Inc; 2004.
    1. Telatela SP, Mecky MI, Munubhi EK. Seroprevalence of hepatitis B and C viral co-infections among children infected with human immunodeficiency virus attending the paediatric HIV care and treatment center at Muhimbili National Hospital in Dar-es-Salaam, Tanzania. BMC Public Health. 2007;7:338. doi: 10.1186/1471-2458-7-338.
    1. Matee MI, Magesa PM, Lyamuya EF. Seroprevalence of Human Immunodeficiency Virus, Hepatitis B and C Viruses and Syphilis Infections among Blood Donors at the Muhimbili National Hospital in Dar Es Salaam, Tanzania. BMC Public Health. 2006;6:21. doi: 10.1186/1471-2458-6-21.
    1. Waddell RD, Magesa PM, Pallangyo KJ, Matee MI. Co-infection with HIV and HCV in Blood bank population in Dar es Salaam Tanzania. J Clin Virol. 2006;36:237–238. doi: 10.1016/j.jcv.2006.04.002.
    1. Matee MI, Lyamuya EF, Magesa PM, Mbena EC. Prevalence of transfusion-associated viral infections and syphilis among blood donors in Muhimbili Medical Centre in Dar es Salaam, Tanzania. East Afr Med J. 1999;76:167–171.
    1. Hollander H, Wright T, Held M. Hepatitis C serology and viremia in HIV-infected men. Int Conf AIDS. p. 358.
    1. Kondili LA, Chione P, Constantino A. Infection rate and spontaneous seroreversion of anti-hepatitis C virus infection in the general population. Gut. 2002;50:693–696. doi: 10.1136/gut.50.5.693.
    1. Fainboim H, Gonzalez J, Fassio Prevalence of hepatitis viruses in an anti-human immunodeficiency virus-positive population from Argentina – A multicentre study. J Viral Hepat. 1999;6:53–57. doi: 10.1046/j.1365-2893.1999.t01-1-6120135.x.
    1. Barin F, Baty G, Bastides F, Dubois F, Besnier JM, Choutet P, Goudeau A. Incidence of hepatitis B virus reactivation in HIV-1 infected patients. Antivir Ther. 2003;8
    1. Tabor E, Bayley AC, Cairns L, Gerety RL. Horizontal transmission of hepatitis B virus among children and adults in five rural villages in Zambia. J Med Virol. 1985;15:113–120. doi: 10.1002/jmv.1890150203.
    1. Mphahlele MJ, Lukhwareni A, Burnett RJ, Moropeng LM, Ngobeni JM. High risk of occult hepatitis B virus infection in HIV-positive patients from South Africa. J Clin Virol. 2006;35:14–20. doi: 10.1016/j.jcv.2005.04.003.
    1. Atina JO, Ogutu O, Hardison Prevalence of hepatitis A, B, C and human immunodeficiency virus seropositivity among patients with acute icteric hepatitis at the Kenyatta National Hospital, Nairobi. East Afr Med J. 2004;81:183–187.
    1. Horvath J, Raffanti SP. Clinical aspects of the interactions between human immunodeficiency virus and the hepatotropic viruses. Clin Infect Dis. 1994;18:339–347.
    1. Zhang YH, Chen XY, Jiang Y. Analysis of causes for liver function deterioration in patients with HIV/HCV co-infection. Hepatobiliary Pancreat Dis Int. 2004;3:538–542.
    1. Krogsgaard K, Lindhardt BO, Nielson JO. The influence of HTLV-III infection on the natural history of hepatitis B virus infection in male homosexual HBsAg carriers. Hepatol. 1987;7:37–41. doi: 10.1002/hep.1840070109.
    1. Plellzzer G, Ble C, Zamperetti N. Serological survey of Hepatitis B infection in Tanzania. Public Health. 1994;108:427–431. doi: 10.1016/S0033-3506(94)80100-2.
    1. Sulkowski MS, Moore RD, Mehta SH. Hepatitis C and Progression of HIV disease. JAMA. 2002;288:241–243. doi: 10.1001/jama.288.2.199.
    1. Otedo AE. HBV, HIV co-infection at Kisumu District Hospital, Kenya. East Afr Med J. 2004;81:626–630.
    1. Harcourt G, Gomperts E, Donfield S, Klenerman P. Diminished frequency of Hepatitis C virus specific interferon γ secreting CD4+ T cells in Human immunodeficiency virus co-infected patients. Gut. 2006;55:1484–1487. doi: 10.1136/gut.2005.083758.
    1. The United Republic of Tanzania. Ministry of Health. National AIDS Control Program . National Guidelines for the Clinical Management of HIV and AIDS. 2 2005.
    1. Cooper D, Dore G, Pozniak AL. Tenofovir Disoproxil Fumarate and Lamivudine Combination Therapy Compared to Lamivudine Alone for HBV in Therapy-naive HIV/HBV Co-infected Patients: 48-week Interim Results. 10th Conf Retrovir Oppor Infect. 2003;10:10–14.
    1. Alberti A, Clumeck N, Collins S, Gerlich W, Lundgren J, Palu' G, Reiss P, Thiebaut R, Weiland O, Yazdanpanah Y, Zeuzem S. Short statement of the first european consensus Conference on the treatment of chronic Hepatitis B and C in HIV co-infected patients. Hepatol. 2005;42:615–624. doi: 10.1016/j.jhep.2005.03.003.
    1. Cooley L, Bartholomeusz A, Ayres A. Hepatitis B Virus and HIV Co-Infection: Development of Lamivudine Resistance. 9th Conf Retrovir Oppor Infect. 2002. pp. 24–28.
    1. João E, Calvet G, Menezes J. Nevirapine toxicity in a cohort of HIV-1 infected pregnant women. Am J Obstet Gynecol. 2006;194:199–202. doi: 10.1016/j.ajog.2005.05.015.

Source: PubMed

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