title: Presence of occult HBV, but near absence of active HBV and HCV infections in people infected with HIV in rural South Africa.
abstract: Human immunodeficiency (HIV), hepatitis B (HBV), and hepatitis C (HCV) viruses are endemic in Sub-Saharan Africa, but data regarding the prevalence of hepatitis co-infections in HIV-positive individuals residing there are limited. The aim of the study was to determine the prevalence of HBV, HCV, and occult HBV (presence of HBV-DNA in the absence of HBsAg) in a rural, South African cohort. The results were compared to various ethnic groups in a Dutch cohort of people infected with HIV. Antiretroviral-naïve individuals with HIV from both a rural South African clinic (n = 258), and a Dutch University hospital (n = 782), were included. Both serological (HBV and HCV) and molecular (occult HBV) assays were performed. Logistic regression analysis was used to define independent predictors of a hepatitis co-infection. HBV and HCV prevalence rates in the South African cohort were exceptionally low (0.4%, 1/242 and 0.8%, 2/242, respectively), compared to those observed in Caucasians (HBV 4.4% and HCV 10.9%) and African immigrants (HBV 8.9% and HCV 4.8%). Conversely, occult HBV was observed in a considerable proportion (10%, 6/60) of South African patients who were anti-HBc-positive but HBsAg-negative. Occult infections were less frequent in Caucasians and Africans in the Dutch cohort (3.2% and 1.4%, respectively). Independent predictors for occult HBV were not identified, but a trend towards more occult HBV at lower CD4 counts was observed. Local HBV/HCV prevalence data are needed to optimize vaccination and antiretroviral treatment strategies. Occult HBV in patients with HIV may be missed regularly when molecular analyses are not available.
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands. r.e.barth@universitymedicalcentreutrechttrecht.nl
authors.forename: Roos E
authors.initials: RE
authors.lastname: Barth
authors.forename: Quirine
authors.initials: Q
authors.lastname: Huijgen
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Tempelman
authors.forename: Tania
authors.initials: T
authors.lastname: Mudrikova
authors.forename: Annemarie M J
authors.initials: AM
authors.lastname: Wensing
authors.forename: Andy I M
authors.initials: AI
authors.lastname: Hoepelman
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count / Q000639:trends; D015331:Cohort Studies; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000208:ethnology; D015995:Prevalence; D012367:RNA, Viral / Q000235:genetics; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load; D044465:White People / Q000706:statistics & numerical data
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D012367:RNA, Viral