Hepatitis B and HIV coinfection in Northern Uganda: Is a decline in HBV prevalence on the horizon?

• Published in: PloS one Vol. 15; no. 11; p. e0242278
• Main Authors: Chiesa, Annacarla, Ochola, Emmanuel, Oreni, Letizia, Vassalini, Paolo, Rizzardini, Giuliano, Galli, Massimo
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18.11.2020; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; AIDS research; Antigens; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biology and Life Sciences; CD4 antigen; Children; Coinfection - complications; Complications and side effects; Confidence intervals; Cross-Sectional Studies; Female; Females; Health risks; Hepatitis; Hepatitis B; Hepatitis B - complications; Hepatitis B - epidemiology; Hepatitis B surface antigen; HIV; HIV infections; HIV Infections - complications; Hospitals; Human immunodeficiency virus; Humans; Immune response; Immunization; Infections; Infectious diseases; Lymphocytes; Lymphocytes T; Male; Medicine and Health Sciences; Middle Aged; Outpatient care facilities; Patient outcomes; Patients; People and Places; Prevalence; Prophylaxis; Public health; Regression analysis; Regression models; Risk factors; Statistical analysis; Uganda - epidemiology; Vaccines; Viruses; Uganda; Italy; Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0242278

The available data concerning hepatitis B virus (HBV) infection in Uganda are limited, particularly in the case of people living with HIV/AIDS (PLWH). HBV is not routinely tested when starting antiretroviral therapy (ART). We aimed to determine the prevalence, the correlates of the risk of HBV infection, and the association with outcomes of ART among PLWH attending a busy HIV clinic in a referral hospital in Northern Uganda. From April to June 2016, a random sample of 1000 PLWH attending the outpatients' clinic of St. Mary's Hospital, Gulu, Uganda were systematically selected to undergo a rapid hepatitis B surface antigen (HBsAg) test after administering a questionnaire in this cross-sectional study. HIV care parameters were obtained from client files. Multivariate logistic regression and general linear model were used for the analysis. 950 of the 985 evaluable patients (77% females; mean age 42.8 years) were receiving ART. The overall prevalence of HBsAg was 7.9% (95% confidence interval [CI] 6.2-9.6%), and was significantly lower among the females (6.8% vs 11.7%; p = 0.020). The factors independently associated with higher HBV infection were having lived in an internally displaced persons' camp (adjusted odds ratio [aOR] 1.76, 95% CI 1.03-2.98; p = 0.036) and having shared housing with HBV-infected people during childhood (aOR 3.30, 95% CI 1.49-7.32; p = 0.003). CD4+ T cell counts were significantly lower in HBV patients (p = 0.025), and co-infection was associated with a poorer CD4+ T cell response to ART (AOR 0.88; 95% CI 0.79-0.98; p = 0.030). The observed prevalence of HBV among the PLWH may be underestimated or a signal of HBV decline in the region. The factors favouring horizontal HBV transmission identified suggest extending HBV screening and vaccine prophylaxis among PLWH.