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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 3  |  Page : 140-144

Prevalence of hepatitis B in human immunodeficiency virus patients in Kubwa General Hospital


1 Department of Medicine, Kubwa General Hospital, Abuja, Nigeria
2 Department of Obstetrics & Gynaecology, University of Ilorin Teaching Hospital, Nigeria
3 Department of Medicine, University of Ilorin Teaching Hospital, Nigeria
4 Department of Family & Specialty Medicine, Nisa Premier Hospital, Abuja, Nigeria

Date of Submission22-Jan-2018
Date of Acceptance14-Nov-2018
Date of Web Publication26-Sep-2019

Correspondence Address:
Dr. Osaze Ojo
Kubwa General Hospital, Abuja
Nigeria
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DOI: 10.4103/smj.smj_5_18

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  Abstract 


Background: Both human immunodeficiency virus (HIV) and hepatitis B infections are endemic in sub-Saharan Africa and both viruses have common routes of transmission. Objectives: To determine the prevalence of hepatitis B virus (HBV) in patients with HIV in Kubwa General Hospital, Abuja, Nigeria. Materials and Methods: We carried out a retrospective study of HBV positivity among patients diagnosed with retroviral disease seen over a 1-year period. Results: The case folders of a total number of 332 patients with HIV who received care over the study period were reviewed. Men and women accounted for 30.42% and 69.58%, respectively, with a male-to-female ratio of about 1:2. Their mean age was 34.76 ± 8.84 years, while the median age was 33.5 years. The categorization of the age groups was as follows: young (<40 years; 72.29%), middle age (40–65 years; 27.41%), and elderly (>65 years; 0.3%). Hepatitis B co-infection was present in 9.24% of patients with HIV. The mean CD4 count was 409.33 ± 262.22. The classification of CD4 count values was as follows: <200 (24.83%), 200–500 (47.20%), and > 500 (27.97%). Those who were either married (58.91%) or were single (32.32%) constituted the majority of the patients. Unprotected sex (73.79%), harmful traditional practice 17 (5.12%), history of blood transfusion (5.12%), intravenous drug abuse (0.60%), and commercial sex worker (0.30%) were the commonly identifiable risk factors. Conclusion: Among patients living with retroviral disease, hepatitis B infection is more prevalent in women as well as in young and middle-aged patients compared with the elderly. Unprotected sex was the most common identifiable risk factor for hepatitis B positivity.

Keywords: Hepatitis B, human immunodeficiency virus, prevalence


How to cite this article:
Ojo O, Mamven S, Akintayo R, Onyegiri C. Prevalence of hepatitis B in human immunodeficiency virus patients in Kubwa General Hospital. Sahel Med J 2019;22:140-4

How to cite this URL:
Ojo O, Mamven S, Akintayo R, Onyegiri C. Prevalence of hepatitis B in human immunodeficiency virus patients in Kubwa General Hospital. Sahel Med J [serial online] 2019 [cited 2019 Oct 13];22:140-4. Available from: http://www.smjonline.org/text.asp?2019/22/3/140/267898




  Introduction Top


Co-infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is common, with 70%–90% of HIV-infected individuals in the United States having evidence of past or active infection with HBV.[1],[2] In sub-Saharan Africa, it is estimated that 25 million people are infected with HIV and another 50 million people are HBV positive.[3] It has been documented that one of the frequent complications of HIV infection is hepatitis B co-infection and due to the common methods of transmission of these two viruses, the incidence rate of co-infection is increasing.[4] For HIV and HBV co-infection (HIV/HBV), the seroprevalence rate ranges from 6.3% to as high as 39%.[5],[6]

Blood is the most important vehicle for transmission, but other body fluids have also been implicated, including semen and saliva.[7],[8] Currently, three modes of HBV transmission have been recognized: perinatal, sexual, and parenteral/percutaneous transmission.[9] Homosexual men have been considered to be at the highest risk of infection due to sexual contact (70% of homosexual men were infected after 5 years of sexual activity).[10] Sexual partners of injection drug users, sex workers, and clients of sex workers are at particularly high risk for infection.[11] People at high-risk of infection include those requiring frequent transfusions or hemodialysis, physicians, dentists, nurses, and other health-care workers, laboratory technicians, intravenous drug users, police, firemen, laundry workers, and others who are likely to come into contact with potentially infected blood and blood products.[9]

It has been established that following reduction in the CD4-positive cell count to lower than 200 cells/ml, the immune system of HIV-positive patients fails to develop an adequate immune response against microbial agents and as a result re-activation of HBV infection and its related complications will occur.[12] It has been reported that HIV-positive men with HBV infection are at increased risk of liver-related mortality.[13] It therefore becomes imperative to determine the status of HBV for all patients infected with HIV. The purpose of this study was to determine the prevalence of HBsAg in patients with HIV infection seen in Kubwa General Hospital, Abuja.


  Materials and Methods Top


This is a 12-month retrospective study (May 2016–April 2017) conducted in Kubwa General Hospital. Records of all retroviral disease patients who accessed care at the Medical Outpatient Department/Special clinic during the study period were retrieved. The following data were obtained using a pro forma: age, sex, marital status, first CD4 count, a history of blood transfusion, harmful traditional practices, a history of unprotected sexual intercourse, commercial sex worker, intravenous drug abuser, occupational hazard, and hepatitis B status.

All patients receiving care are confirmed to be positive for HIV using the following: HIV screening was done using the national algorithm, i.e., using DETERMINE™ (Alere Medical Co., JAPAN) and UNI-GOLD test (TrinityBiotech, Ireland) and STAT PAK™ (Chembio Diagnostic Systems Inc., USA) test served as a tie breaker if there were discordant results with the first two tests. Hepatitis B surface antigen test was done using the One step Strip Style HBsAg Rapid Screen Test which is a lateral flow immunochromatographic screening test.

The data were collated and analyzed with Statistical Package for the Social Sciences software version 21.0 (IBM, Amonk, NY, USA). Continuous variables were expressed as mean ± standard deviation and categorical variables as frequencies and percentages. Approval for the study was obtained from the Federal Capital Territory Health Research Ethics Committee, Abuja (FHREC/2017/01/53/16 = 06-17) dated 16th June 2017.

Limitations

This study, being retrospective, has drawbacks including missing data. In addition some patients probably had no hepatitis B screening.


  Results Top


A total of 332 patients with HIV who received care over the study period were reviewed. Men and women accounted for 30.42% and 69.58%, respectively, with a male-to-female ratio of about 1:2 as shown in [Table 1]. Their mean age was 34.76 ± 8.84 years, while the median age was 33.5 years. The categorization of the age groups was as follows: young (<40 years; 72.29%), middle age (40–65 years; 27.41%), and elderly (>65 years; 0.3%) as shown in [Table 1].
Table 1: Gender and age distribution of patients

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Hepatitis B co-infection was present in 9.24% of patients with HIV as shown in [Figure 1].
Figure 1: Prevalence of hepatitis B in patients with HIV

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The mean CD4 count was 409.33 ± 262.22. The classification of CD4 count values was as follows: <200 (24.83%), 200–500 (47.20%), and >500 (27.97%) as shown in [Table 2].
Table 2: Categorization of CD4 count among patients

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Those who were married (58.91%) and those who were single (32.32%) constituted the majority of patients. The others were widowed (7.25%), divorced (0.91%), or separated (0.60%).

Unprotected sex (245 [73.79%]), harmful traditional practice (17 [5.12%]), history of blood transfusion (17 [5.12%]), intravenous drug abuse (2 [0.60%]), and commercial sex worker (1 [0.30%]) were the commonly identifiable risk factors for transmission of both HIV and HBV as shown in [Figure 2].
Figure 2: Risk factors for human immunodeficiency virus and hepatitis B virus transmission

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  Discussion Top


This study was carried out to determine the prevalence of hepatitis B co-infection among patients with retroviral disease. We studied 332 patients receiving care in a secondary health facility in North-Central Nigeria. All these patients were determined to be seropositive for HIV while we examined the prevalence of HBV co-infection in them. The prevalence of HBV of 9.24% found is likely manifest of a number of factors. The shared modes of transmission of HIV and HBV probably confer an inherent chance of higher rates of HBV in people with HIV. Whereas the risk factors/practices for acquiring HIV were not identifiable in some of the patients, it is definite that if an individual could get HIV, they can get HBV. However, the complex interaction of the biologic processes induced or altered by each of the two viruses may have notable impacts on survival. It is known that the progression to AIDS may be earlier in the HBV co-infected patient,[14],[15] and this is likely to be associated with a lower survival as compared with the HIV mono-infected patients.

Earlier Nigerian studies found comparable prevalence rates for HBV in people living with HIV as our finding. Otegbayo et al.[16] found a prevalence of 11.9% at the University College Hospital, Ibadan, while Tremeau-Bravard et al.[17] found a prevalence of 7.9% among patients in Abuja. A 2015 study by Ojide et al.[18] in Enugu, however, found a much higher prevalence of 15.5% for HBV among patients with HIV. The same study observed that the seroprevalence for HBV is higher among patients with the more advanced retroviral disease defined by their World Health Organization stages. Only 24.83% of our study population had CD4 count below 200 cells/μL as compared with 50.9% in the Enugu study.[18] This may be due to earlier presentation of patients in Abuja which is the Federal Capital Territory as a result of greater awareness from public enlightenment. The mean age of the patients in our study was 34.8 years. It has been reported that the highest prevalence of HBV is found in HIV-infected patients with ages in the neighborhood of 40 years.[19] This factor may contribute to the disparities in prevalence rates found in studies involving much younger or older patient subsets.[20],[21],[22] A 2014 study of 370,672 cases demonstrated an odd ratio of HBV co-infection among HIV patients to be 3.1 between the age range of 35 and 44 years, while the odd ratio is 1.0 under the age of 25 years and 2.9 above 44 years.[23] Similarly, factors such as test kit sensitivity and other demographic attributes of the patient subsets underlie some disparities in the observed figures. The possible contributions of sexual orientation and intravenous drug abuse have not been studied in the African patients. In addition, the weak health record system, low education rates, and cultural biases in many African nations may hamper the successful collation of large scale high-quality data on patient-specific risk factors for dual positivity for the two viruses.

Unsafe sex is the most important risk factor identified for the transmission of HIV in our study as it was documented in 73.8% of patients. This is consistent with the reports from other studies.[22],[23] However, it is unknown if there were other sexual practices other than heterosexuality among some of these patients. Oliveira et al.[23] reported that men who have sex with men are the most likely to have both infections while, generally speaking, 80% of the individuals with the co-infection were males. The study of sexual orientation is difficult in Nigeria, a country where homosexual marriage is criminal and an open admission of the practice of sex with an individual of the same gender is near impossible.

Crucially, an aspect of the HIV-HBV interaction of vital clinical importance is an apparent reversal of trends when comparing between low income and industrialized countries. The prevalence of HBV in the general Nigerian populace is estimated to be 13.6%,[24] a figure notably higher than the 9.2% we found among patients with HIV. Conversely, the EuroSIDA study group reported a prevalence of HBV in persons with HIV of 9.1% (strikingly similar to the prevalence from our study) across ten European national populations generally having HBV infection prevalence of <1%.[25] Based on the shared transmission processes, the higher prevalence of HBV in individuals with HIV as compared with the general population stands reasonable. However, in resource-poor settings where inadequate treatment for either or both the HBV and HIV fosters rapid progression of both with resulting excess mortality, these patients with the co-infection may have markedly shortened survival causing an apparent fewer cases of the co-infection.

While this study identified nearly a tenth of patients with HIV to be co-infected with HBV through a cross-sectional study of the hospital records in a typical Nigerian sub-urban secondary health facility, it is limited by the incompleteness of data. This fact may help draw our attention to how often we fail to screen patients receiving anti-retroviral therapy for HBV. The failure to screen patients may be due to unavailability of test kits, inadequate funding and a limited coverage of the National Health Insurance Scheme.


  Conclusion Top


Our findings reveal that hepatitis B co-infection is prevalent in retroviral disease patients. Among patients living with retroviral disease, hepatitis B infection is more prevalent in women as well as in young and middle-aged patients compared with the elderly. Unprotected sex was the most common identifiable risk factor for hepatitis B positivity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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