Hepatitis B virus (HBV) and Hepatitis C virus (HCV) Co-infection in HIV infected Gambians

Lead Research Organisation: MRC Unit, The Gambia

Abstract

The research was conducted in order to determine the proportion of HIV infected patients who are co-infected with hepatitis B (HBV) or hepatitis C (HCV).||The use of antiretroviral to treat HIV infection is available in the Gambia through the Global Fund initiative. However, this initiative is not extended to the treatment of HBV carriers even though some of the drugs used for HIV treatment are also active against HBV. Currently, HIV patients are not routinely screened for HBV, and co-infected patients on HAART are being treated for HBV with lamivudine (3TC) monotherapy. 3TC monotherapy is not recommended for HBV carriers because of the high rate of viral drug resistance mutations (VDR).||We tested stored samples from 597 HIV+ individuals consisting of 214 AIDS patients on HART and 383 non-HAART patients. The overall prevalence of HBsAg positivity which is a marker for chronic HBV was 15% in HAART and 11% in non-HAART. A higher proportion of HAART patients tested positive for HBeAg (35% vs. 19%) and HBV DNA (65% vs. 21%) compared to HAART-naive subject. HBeAg and HBVDNA are markers for viral replication. HCV infection was of similar low prevalence in HIV patients as reported in previous studies on HIV negative patients. 4 out of the 597 (0.1%) HIV positive individuals were confirmed positive for anti-HCV and 2 out of the 7 were HCV RNA positive.||Four of the 28 co-infected patients on HAART treatment were found to have at least one drug resistant strains of HBV following >23+ months of treatment.

Technical Summary

Limited data is available on hepatitis B and HIV (HBV/HIV) and hepatitis C and HIV (HCV/HIV) interactions in Africa. In contrast to developed countries, most HBV infections in Africa are acquired in early life and often precede HIV, whereas HCV infections are acquired later in life and share the same transmission route as HIV.||The prevalence of HIV-1 reported in The Gambia is between 0.7-2.0 % and that of HIV-2 is between 2.5-3.0%. Prior to the introduction of HBV vaccination the prevalence of HBV chronic infection was 20% in the Gambia. However, infection with HCV is at a low prevalence of 1-2%.||The use of antiretroviral for HIV therapy is available in the Gambia through the global fund initiative. However, this initiative is not extended to treatment of HBV carriers even though some of the drugs used for HIV are also active against HBV. Currently, HIV patients are not routinely screened for HBV, thus co-infected patients are being treated blindly for HBV with a HAART regime consisting of lamivudine (3TC) as the only drug active for HBV. Monotherapy with 3TC has implications for viral drug resistance mutations (VDR) which could impact o the national HBV vaccination program.||We studied 597 HIV+ individuals from two HIV cohorts consisting of 214 AIDS patients on HAART (period of 23-43 months) and 383 non-HAART patients. The study was conducted retrospectively and blood samples were tested for HBV and HCV at pre-treatment time point (HAART patients) or at baseline (non-HAART patients). The overall prevalence of positive anti-HBc was 83% whilst HBsAg positivity was 15% (HAART) and 11% (HAART naove). A higher proportion of HAART patients tested positive for HBeAg (35% vs. 19%) and HBV DNA (65% vs. 21%) compared to HAART-naive subject.||HCV infection was of similar low prevalence in HIV patients as reported in previous studies on HIV negative patients. 4 out of the 597 (0.1%) HIV positive individuals were confirmed positive for anti-HCV and 2 out of the 7 were HCV RNA positive.||We identified 28 co-infected HBV carriers who were on HAART treatment retrospective blood samples from their serial time points following treatment were tested for HIV-1 RNA, HIV-2 RNA and for HBV DNA by qPCR and HBV sequencing to look for 3TC resistance mutations. Four of the 28 co-infected patients on treatment were found to have 3TC resistant strains of the virus.||In conclusion, prevalence of HBsAg in HIV infected Gambians is similar to that obtained in non-HIV individuals but AIDS patients appeared to be less able to control HBV infection than non-AIDS individuals. The emergence of VDR mutations in co-infected patients on monotherapy confirms previous findings in studies from other countries. Thus recommendations will be sent to clinical service providers that all HIV positive patients should be screened for HBV and if treatment is indicated, treatment with 3TC alone should be avoided.

Publications

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Description influence ARV treqtment regimen
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact The recommendations from the study to screen HIV infected patients for HBsAg and to avaiod treating HIV-HBV co-infected patients with monothereapy are being considered by the national AIDS committee. Will be incorporated in the new national guidelines.