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Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia.

Wandeler G, Musukuma K, Zürcher S, Vinikoor MJ, Llenas-García J, Aly MM, Mulenga L, Chi BH, Ehmer J, Hobbins MA, Bolton-Moore C, Hoffmann CJ, Egger M, IeDEA-Southern Afri - PLoS ONE (2016)

Bottom Line: HBsAg-positive individuals were less likely to be female compared to HBsAg-negative ones (52.3% vs. 66.1%, p<0.001).HBsAg-positive individuals had higher levels of ALT and AST compared to HBsAg-negative ones (both p<0.001).In multivariable analyses, male sex (adjusted odds ratio: 2.59, 95% CI: 1.22-5.53) and CD4 cell count below 200/μl (2.58, 1.20-5.54) were associated with high HBV DNA.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.

ABSTRACT

Background: Few data on the virological determinants of hepatitis B virus (HBV) infection are available from southern Africa.

Methods: We enrolled consecutive HIV-infected adult patients initiating antiretroviral therapy (ART) at two urban clinics in Zambia and four rural clinics in Northern Mozambique between May 2013 and August 2014. HBsAg screening was performed using the Determine® rapid test. Quantitative real-time PCR and HBV sequencing were performed in HBsAg-positive patients. Risk factors for HBV infection were evaluated using Chi-square and Mann-Whitney tests and associations between baseline characteristics and high level HBV replication explored in multivariable logistic regression.

Results: Seventy-eight of 1,032 participants in Mozambique (7.6%, 95% confidence interval [CI]: 6.1-9.3) and 90 of 797 in Zambia (11.3%, 95% CI: 9.3-13.4) were HBsAg-positive. HBsAg-positive individuals were less likely to be female compared to HBsAg-negative ones (52.3% vs. 66.1%, p<0.001). Among 156 (92.9%) HBsAg-positive patients with an available measurement, median HBV viral load was 13,645 IU/mL (interquartile range: 192-8,617,488 IU/mL) and 77 (49.4%) had high values (>20,000 UI/mL). HBsAg-positive individuals had higher levels of ALT and AST compared to HBsAg-negative ones (both p<0.001). In multivariable analyses, male sex (adjusted odds ratio: 2.59, 95% CI: 1.22-5.53) and CD4 cell count below 200/μl (2.58, 1.20-5.54) were associated with high HBV DNA. HBV genotypes A1 (58.8%) and E (38.2%) were most prevalent. Four patients had probable resistance to lamivudine and/or entecavir.

Conclusion: One half of HBsAg-positive patients demonstrated high HBV viremia, supporting the early initiation of tenofovir-containing ART in HIV/HBV-coinfected adults.

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Related in: MedlinePlus

Flow chart of patients included in virological analyses.(HBV: hepatitis B virus; VL: viral load)
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pone.0152043.g001: Flow chart of patients included in virological analyses.(HBV: hepatitis B virus; VL: viral load)

Mentions: Among HBsAg-positive patients, 156 (92.9%) had an available pre-ART HBV DNA measurement (Fig 1). Median DNA level was 13,645 IU/mL (interquartile range [IQR]: 192–8,617,488). Overall, 26 (16.7%) had an undetectable viral load (<20 IU/mL) and 77 (49.4%) had high values (>20,000 IU/mL). Men were more likely to have high HBV DNA than women (p = 0.01), whereas the proportion of patients with high DNA was highest in patients with advanced WHO stage of HIV disease (p = 0.02) and low CD4 cell counts (p = 0.001, Fig 2). Age and HBV genotype were not associated with the presence of a high HBV DNA level. Of 72 patients with available HBeAg serology, 33.3% had a positive result. All HBeAg+ participants had an HBV DNA>20,000 IU/mL, whereas a high HBV DNA level was only present in 12.8% of HBeAg- individuals (p<0.001, Fig 2). In multivariable analyses, male sex (adjusted odd ratio [aOR]: 2.59, 95% CI: 1.22–5.53) and CD4 cell count below 200/μl (aOR: 2.58, 95% CI: 1.20–5.54) remained associated with having a high pre-ART HBV viral load.


Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia.

Wandeler G, Musukuma K, Zürcher S, Vinikoor MJ, Llenas-García J, Aly MM, Mulenga L, Chi BH, Ehmer J, Hobbins MA, Bolton-Moore C, Hoffmann CJ, Egger M, IeDEA-Southern Afri - PLoS ONE (2016)

Flow chart of patients included in virological analyses.(HBV: hepatitis B virus; VL: viral load)
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4816321&req=5

pone.0152043.g001: Flow chart of patients included in virological analyses.(HBV: hepatitis B virus; VL: viral load)
Mentions: Among HBsAg-positive patients, 156 (92.9%) had an available pre-ART HBV DNA measurement (Fig 1). Median DNA level was 13,645 IU/mL (interquartile range [IQR]: 192–8,617,488). Overall, 26 (16.7%) had an undetectable viral load (<20 IU/mL) and 77 (49.4%) had high values (>20,000 IU/mL). Men were more likely to have high HBV DNA than women (p = 0.01), whereas the proportion of patients with high DNA was highest in patients with advanced WHO stage of HIV disease (p = 0.02) and low CD4 cell counts (p = 0.001, Fig 2). Age and HBV genotype were not associated with the presence of a high HBV DNA level. Of 72 patients with available HBeAg serology, 33.3% had a positive result. All HBeAg+ participants had an HBV DNA>20,000 IU/mL, whereas a high HBV DNA level was only present in 12.8% of HBeAg- individuals (p<0.001, Fig 2). In multivariable analyses, male sex (adjusted odd ratio [aOR]: 2.59, 95% CI: 1.22–5.53) and CD4 cell count below 200/μl (aOR: 2.58, 95% CI: 1.20–5.54) remained associated with having a high pre-ART HBV viral load.

Bottom Line: HBsAg-positive individuals were less likely to be female compared to HBsAg-negative ones (52.3% vs. 66.1%, p<0.001).HBsAg-positive individuals had higher levels of ALT and AST compared to HBsAg-negative ones (both p<0.001).In multivariable analyses, male sex (adjusted odds ratio: 2.59, 95% CI: 1.22-5.53) and CD4 cell count below 200/μl (2.58, 1.20-5.54) were associated with high HBV DNA.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.

ABSTRACT

Background: Few data on the virological determinants of hepatitis B virus (HBV) infection are available from southern Africa.

Methods: We enrolled consecutive HIV-infected adult patients initiating antiretroviral therapy (ART) at two urban clinics in Zambia and four rural clinics in Northern Mozambique between May 2013 and August 2014. HBsAg screening was performed using the Determine® rapid test. Quantitative real-time PCR and HBV sequencing were performed in HBsAg-positive patients. Risk factors for HBV infection were evaluated using Chi-square and Mann-Whitney tests and associations between baseline characteristics and high level HBV replication explored in multivariable logistic regression.

Results: Seventy-eight of 1,032 participants in Mozambique (7.6%, 95% confidence interval [CI]: 6.1-9.3) and 90 of 797 in Zambia (11.3%, 95% CI: 9.3-13.4) were HBsAg-positive. HBsAg-positive individuals were less likely to be female compared to HBsAg-negative ones (52.3% vs. 66.1%, p<0.001). Among 156 (92.9%) HBsAg-positive patients with an available measurement, median HBV viral load was 13,645 IU/mL (interquartile range: 192-8,617,488 IU/mL) and 77 (49.4%) had high values (>20,000 UI/mL). HBsAg-positive individuals had higher levels of ALT and AST compared to HBsAg-negative ones (both p<0.001). In multivariable analyses, male sex (adjusted odds ratio: 2.59, 95% CI: 1.22-5.53) and CD4 cell count below 200/μl (2.58, 1.20-5.54) were associated with high HBV DNA. HBV genotypes A1 (58.8%) and E (38.2%) were most prevalent. Four patients had probable resistance to lamivudine and/or entecavir.

Conclusion: One half of HBsAg-positive patients demonstrated high HBV viremia, supporting the early initiation of tenofovir-containing ART in HIV/HBV-coinfected adults.

Show MeSH
Related in: MedlinePlus