High incidence and persistence of hepatitis B virus infection in individuals receiving HIV care in KwaZulu-Natal, South Africa

• Published in: BMC infectious diseases Vol. 20; no. 1; p. 847
• Main Authors: Msomi, Nokukhanya, Naidoo, Kogieleum, Yende-Zuma, Nonhlanhla, Padayatchi, Nesri, Govender, Kerusha, Singh, Jerome Amir, Abdool-Karim, Salim, Abdool-Karim, Quarraisha, Mlisana, Koleka
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.11.2020; BioMed Central; BMC
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - epidemiology; AIDS-Related Opportunistic Infections - virology; Analysis; Anti-HIV Agents - therapeutic use; Care and treatment; Coinfection - epidemiology; Coinfection - virology; Comorbidity; Complications and side effects; Confidence intervals; Diagnosis; Female; Follow-Up Studies; HBV incidence; Health risks; Hepatitis; Hepatitis B; Hepatitis B - diagnosis; Hepatitis B - epidemiology; Hepatitis B - virology; Hepatitis B surface antigen; Hepatitis B Surface Antigens - immunology; Hepatitis B virus - immunology; HIV; HIV infections; HIV/HBV coinfection; Human immunodeficiency virus; Humans; Immunization; Immunosuppression; Incidence; Infections; Infectious diseases; Laboratories; Male; Mycobacterium tuberculosis - isolation & purification; Patients; Prevalence; Retrospective Studies; Risk analysis; Risk Factors; South Africa; South Africa - epidemiology; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - epidemiology; Tuberculosis - microbiology; Viruses; Young Adult; South Africa; Africa; HBV incidence; South Africa; HIV/HBV coinfection
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-020-05575-6

Hepatitis B virus (HBV), Human Immunodeficiency virus (HIV) and Tuberculosis (TB) are common infections in South Africa. We utilized the opportunity of care provision for HIV-TB co-infected patients to better understand the relationship between these coinfections, determine the magnitude of the problem, and identify risk factors for HBV infection in HIV infected patients with and without TB in KwaZulu-Natal, South Africa. This retrospective cohort analysis was undertaken in 2018. In-care HIV infected patients were included in the analysis. Results from clinical records were analysed to determine the prevalence, incidence, persistence and factors associated with HBsAg positivity in HIV-infected patients with or without TB co-infection. A total of 4292 HIV-infected patients with a mean age of 34.7 years (SD: 8.8) were included. Based on HBsAg positivity, the prevalence of HBV was 8.5% (363/4292) [95% confidence interval (CI): 7.7-9.3] at baseline and 9.4% (95%CI: 8.6-10.3%) at end of follow-up. The HBV incidence rate was 2.1/100 person-years (p-y). Risk of incident HBV infection was two-fold higher among male patients (HR 2.11; 95% CI: 1.14-3.92), while severe immunosuppression was associated with a greater than two-fold higher risk of persistent infection (adjusted risk ratio (RR) 2.54; 95% CI 1.06-6.14; p = 0.004. Additionally, active TB at enrolment was associated with a two-fold higher risk of incident HBV infection (aHR 2.38; 95% CI: 0.77-7.35). The provision of HIV care and treatment in high HBV burden settings provide a missed opportunity for HBV screening, immunization and care provision.