Hepatitis B Virus Infection among HIV Infected Individuals with and without Antiretroviral Therapy in North Shoa Zone, Amhara region, Ethiopia
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Date
2011-06
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Addis Ababa University
Abstract
Background- The introduction of highly active antiretroviral treatment (HAART) has greatly decreased morbidity and mortality in HIV-infected individuals. In this regard, HBV co infection with HIV is becoming a major challenge. Because of shared routes of transmission, 90% of people living with HIV have serological markers of HBV infection and 5-15% of them
chronically infected with Hepatitis B Virus. Conditions associated with hepatitis B infection are currently among the leading causes of hospital admission and recent studies have shown increasing rates of liver disease and related death among those with HIV. The impact of co-infection is especially apparent in regions with widespread use of highly active antiretroviral therapy (HAART) where HBV co infection increase hepatotoxicity of HAART and delay immune recovery
Objective- To determine the prevalence of hepatitis B virus (HBV) infection among HIV/infected individuals attending care and treatment services in North Shoa zone
Methods – A Cohort study was conducted in North Shoa zone from November 2010 to May 2011.HIV infected individuals who were grouped into antiretroviral treatment initiated and Pre- treatment follow up were included in the study. Socio-demographic and clinical data were collected from patient interview, intake form, follow up form and medical record review using structured questionnaire. HBV sero-status was determined by testing presence of Hepatitis B surface antigen using 100ul of serum or plasma detected by SD BIOLINE HBsAg rapid kit confirmed with AxSYM HBsAg(V2) confirmatory test from blood collected for patients follow up. Levels of Alanine transaminase and Aspartate transaminase enzymes and CD4+ count were recorded from laboratory registry and patient follow up forms. Usage of HAART was included to assess if treatment change the natural history of HBV infection. Comparison groups were HBV positive antiretroviral receiving patients and HBV positive antiretroviral Naïve ones. VII
Results- The cumulative prevalence of HBsAg in HIV infected individuals was 3.9%.The prevalence was higher in ART initiated than Pre-ART groups, 5.3% and 2.6%, respectively. Despite the difference is not significant. Sex was independently associated with HBsAg prevalence (P=0.03). Males were in increased risk of developing a positive HBsAg test result.(RR=2.32 95%CI: 1.09, 4.96) HBV/HIV co infection was a strong predictor of sharp drop in
CD4 cell recovery before starting ART (RR=3.98 95%CI: 1.02,15.48) There was no significant difference observed in the rate of immune recovery and incidence of hepatotoxicity between hepatitis B virus Co-infected and non infected individuals after initiation of ART. Hepatitis B Co-infected individuals isolated were found to be in the chronic Hepatitis B stage with low or moderate Alanine and Aspartate transaminases levels. (41.5IU/L)
Conclusion- The prevalence of hepatitis B infection is higher in ART initiated individuals than Pre-ART. Neither HBsAg sero positivity nor a particular ART regimen affect immune recovery in ART initiated individuals. Since chronically infected individuals are the first candidates of HIV/HBV treatment all markers of HBV especially HBV DNA should be determined to initiate treatment. Since HBsAg positivity is higher in individuals taking combination therapies that has dual effect for HBV and HIV, further study is necessary to identify the cause. Recommendation was forwarded according to the findings.
Key words: HBV, HIV, HAART, Co-infection, HBsAg serostatus, Northshoa
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Keywords
HBV, HIV, HAART, Co-infection, HBsAg serostatus, Northshoa