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

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 Mozambi...

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Autores principales: Wandeler, Gilles, Musukuma, Kalo, Zürcher, Samuel, Vinikoor, Michael J., Llenas-García, Jara, Aly, Mussa M., Mulenga, Lloyd, Chi, Benjamin H., Ehmer, Jochen, Hobbins, Michael A., Bolton-Moore, Carolyn, Hoffmann, Christopher J., Egger, Matthias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816321/
https://www.ncbi.nlm.nih.gov/pubmed/27032097
http://dx.doi.org/10.1371/journal.pone.0152043
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author Wandeler, Gilles
Musukuma, Kalo
Zürcher, Samuel
Vinikoor, Michael J.
Llenas-García, Jara
Aly, Mussa M.
Mulenga, Lloyd
Chi, Benjamin H.
Ehmer, Jochen
Hobbins, Michael A.
Bolton-Moore, Carolyn
Hoffmann, Christopher J.
Egger, Matthias
author_facet Wandeler, Gilles
Musukuma, Kalo
Zürcher, Samuel
Vinikoor, Michael J.
Llenas-García, Jara
Aly, Mussa M.
Mulenga, Lloyd
Chi, Benjamin H.
Ehmer, Jochen
Hobbins, Michael A.
Bolton-Moore, Carolyn
Hoffmann, Christopher J.
Egger, Matthias
author_sort Wandeler, Gilles
collection PubMed
description 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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spelling pubmed-48163212016-04-14 Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia Wandeler, Gilles Musukuma, Kalo Zürcher, Samuel Vinikoor, Michael J. Llenas-García, Jara Aly, Mussa M. Mulenga, Lloyd Chi, Benjamin H. Ehmer, Jochen Hobbins, Michael A. Bolton-Moore, Carolyn Hoffmann, Christopher J. Egger, Matthias PLoS One Research Article 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. Public Library of Science 2016-03-31 /pmc/articles/PMC4816321/ /pubmed/27032097 http://dx.doi.org/10.1371/journal.pone.0152043 Text en © 2016 Wandeler et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Wandeler, Gilles
Musukuma, Kalo
Zürcher, Samuel
Vinikoor, Michael J.
Llenas-García, Jara
Aly, Mussa M.
Mulenga, Lloyd
Chi, Benjamin H.
Ehmer, Jochen
Hobbins, Michael A.
Bolton-Moore, Carolyn
Hoffmann, Christopher J.
Egger, Matthias
Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia
title Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia
title_full Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia
title_fullStr Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia
title_full_unstemmed Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia
title_short Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia
title_sort hepatitis b infection, viral load and resistance in hiv-infected patients in mozambique and zambia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816321/
https://www.ncbi.nlm.nih.gov/pubmed/27032097
http://dx.doi.org/10.1371/journal.pone.0152043
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