title: Viral hepatitis and rapid diagnostic test based screening for HBsAg in HIV-infected patients in rural Tanzania.
abstract: BACKGROUND
  Co-infection with hepatitis B virus (HBV) is highly prevalent in people living with HIV in Sub-Saharan Africa. Screening for HBV surface antigen (HBsAg) before initiation of combination antiretroviral therapy (cART) is recommended. However, it is not part of diagnostic routines in HIV programs in many resource-limited countries although patients could benefit from optimized antiretroviral therapy covering both infections. Screening could be facilitated by rapid diagnostic tests for HBsAg. Operating experience with these point of care devices in HIV-positive patients in Sub-Saharan Africa is largely lacking. We determined the prevalence of HBV and Hepatitis C virus (HCV) infection as well as the diagnostic accuracy of the rapid test device Determine HBsAg in an HIV cohort in rural Tanzania.
  
  
  METHODS
  Prospectively collected blood samples from adult, HIV-1 positive and antiretroviral treatment-naïve patients in the Kilombero and Ulanga antiretroviral cohort (KIULARCO) in rural Tanzania were analyzed at the point of care with Determine HBsAg, a reference HBsAg EIA and an anti-HCV EIA.
  
  
  RESULTS
  Samples of 272 patients were included. Median age was 38 years (interquartile range [IQR] 32-47), 169/272 (63%) subjects were females and median CD4+ count was 250 cells/µL (IQR 97-439). HBsAg was detected in 25/272 (9.2%, 95% confidence interval [CI] 6.2-13.0%) subjects. Of these, 7/25 (28%) were positive for HBeAg. Sensitivity of Determine HBsAg was rated at 96% (95% CI 82.8-99.6%) and specificity at 100% (95% CI, 98.9-100%). Antibodies to HCV (anti-HCV) were found in 10/272 (3.7%, 95% CI 2.0-6.4%) of patients.
  
  
  CONCLUSIONS
  This study reports a high prevalence of HBV in HIV-positive patients in a rural Tanzanian setting. The rapid diagnostic test Determine HBsAg is an accurate assay for screening for HBsAg in HIV-1 infected patients at the point of care and may further help to guide cART in Sub-Saharan Africa.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland. fcfranzeck@gmail.com
authors.forename: Fabian C
authors.initials: FC
authors.lastname: Franzeck
authors.forename: Ramadhani
authors.initials: R
authors.lastname: Ngwale
authors.forename: Bernadeta
authors.initials: B
authors.lastname: Msongole
authors.forename: Marian
authors.initials: M
authors.lastname: Hamisi
authors.forename: Omary
authors.initials: O
authors.lastname: Abdul
authors.forename: Lars
authors.initials: L
authors.lastname: Henning
authors.forename: Emilio
authors.initials: E
authors.lastname: Letang
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Mwaigomole
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.forename: Christoph
authors.initials: C
authors.lastname: Hatz
authors.forename: Marcel
authors.initials: M
authors.lastname: Tanner
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1; D016174:Hepacivirus / Q000276:immunology; D006509:Hepatitis B / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000097:blood* / Q000276:immunology; D006515:Hepatitis B virus / Q000276:immunology / Q000302:isolation & purification*; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012424:Rural Population; D012680:Sensitivity and Specificity; D013636:Tanzania / Q000453:epidemiology
chemical_list: D006514:Hepatitis B Surface Antigens