Hepatitis A, B and C viral co-infections among HIV-infected adults presenting for care and treatment at Muhimbili National Hospital in Dar es Salaam, Tanzania.
BACKGROUND
Tanzania is currently scaling-up access to anti-retro viral therapy (ART) to reach as many eligible persons as possible. Hepatitis viral co-infections are known to influence progression, management as well as outcome of HIV infection. However, information is scarce regarding the prevalence and predictors of viral hepatitis co-infection among HIV-infected individuals presenting at the HIV care and treatment clinics in the country.


METHODS
A cross-sectional study conducted between April and September 2006 enrolled 260 HIV-1 infected, HAART naïve patients aged > or = 18 years presenting at the HIV care and treatment clinic (CTC) of the Muhimbili National Hospital (MNH). The evaluation included clinical assessment and determination of CD4+ T-lymphocyte count, serum transaminases and serology for Hepatitis A, B and C markers by ELISA.


RESULTS
The prevalence of anti HAV IgM, HBsAg, anti-HBc IgM and anti-HCV IgG antibodies were 3.1%, 17.3%, 2.3% and 18.1%, respectively. Dual co-infection with HBV and HCV occurred in 10 individuals (3.9%), while that of HAV and HBV was detected in two subjects (0.8%). None of the patients had all the three hepatitis viruses. Most patients (81.1%) with hepatitis co-infection neither had specific clinical features nor raised serum transaminases. History of blood transfusion and jaundice were independent predictors for HBsAg and anti-HBc IgM positivity, respectively.


CONCLUSIONS
There is high prevalence of markers for hepatitis B and C infections among HIV infected patients seeking care and treatment at MNH. Clinical features and a raise in serum alanine aminotransferase were of limited predictive values for the viral co-infections. Efforts to scale up HAART should also address co-infections with Hepatitis B and C viruses.
Nagu
Tumaini J
TJ
Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, P,O, Box 65001, Dar es Salaam, Tanzania. jtjoyce20@hotmail.com
Bakari
Muhammad
M
Matee
Mecky
M
D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006506:Hepatitis A / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D006508:Hepatitis Antibodies / Q000097:blood* / Q000145:classification; D006509:Hepatitis B / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006526:Hepatitis C / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
D015415:Biomarkers; D006508:Hepatitis Antibodies; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens