title: Rates and impact of hepatitis on human immunodeficiency virus infection in a large African cohort.
abstract: OBJECTIVE
  To determine the rates and impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections on response to long-term highly active antiretroviral therapy (HAART) in a large human immunodeficiency virus (HIV) population in Nigeria.
  
  
  METHODS
  HBV and HCV as well as HIV infections are endemic in sub Saharan Africa. This was a retrospective cohort study of 19,408 adults who were recruited between June 2004 and December 2010 in the AIDS Prevention Initiative in Nigeria in Nigeria programme at Jos University Teaching Hospital. Serological assays, including HBV surface antigen (HBsAg) and hepatitis C antibody were used to categorise hepatitis status of the patients. HBsAg was determined using enzyme immunoassay (EIA) (Monolisa HBsAg Ultra3; Bio-Rad). HCV antibody was tested using third generation EIA (DIA.PRO Diagnostic, Bioprobes srl, Milan, Italy). HIV RNA levels were measured using Roche COBAS Amplicor HIV-1 monitor test version 1.5 (Roche Diagnostics, GmbH, Mannheim, Germany) with a detection limit of 400 copies/mL. Flow cytometry was used to determine CD4+ cell count (Partec, GmbH Munster, Germany). Comparison of categorical and continuous variables were achieved using Pearson's χ(2) and Kruskal Wallis tests respectively, on MedCalc for Windows, version 9.5.0.0 (MedCalc Software, Mariakerke, Belgium).
  
  
  RESULTS
  With an overall hepatitis screening rate of over 90% for each virus; HBV, HCV and HBV/HCV were detected in 3162 (17.8%), 1983 (11.3%) and 453 (2.5%) HIV infected adults respectively. The rate of liver disease was low, but highest among HIV mono-infected patients (29, 0.11%), followed by HBV co-infected patients (15, 0.08%). Patients with HBV co-infection and triple infection had higher log10 HIV RNA loads (HBV: 4.6 copies/mL vs HIV only: 4.5 copies/mL, P < 0.0001) and more severe immune suppression (HBV: 645, 55.4%; HBV/HCV: 97, 56.7%) prior to initiation of HAART compared to HIV mono-infected patients (1852, 48.6%) (P < 0.0001). Of 3025 patients who were 4.4 years on HAART and whose CD4 cell counts results at baseline and end of follow up were available for analyses, CD4 increase was significantly lower in those with HBV co-infection (HBV: 144 cells/mm(3); HBV/HCV: 105 cells/mm(3)) than in those with HCV co-infection (165 cells/mm(3)) and HIV mono-infection (150 cells/mm(3)) (P = 0.0008).
  
  
  CONCLUSIONS
  High rates of HBV and HCV infections were found in this HIV cohort. CD4 recovery was significantly diminished in patients with HBV co-infection.
authors.affiliation: Section of Hepatology, Department of Medicine, Imperial College London, St Mary's Hospital Campus, London W2 1NY, United Kingdom. n.ladep@imperial.ac.uk
authors.forename: Nimzing Gwamzhi
authors.initials: NG
authors.lastname: Ladep
authors.forename: Patricia Aladi
authors.initials: PA
authors.lastname: Agaba
authors.forename: Oche
authors.initials: O
authors.lastname: Agbaji
authors.forename: Auwal
authors.initials: A
authors.lastname: Muazu
authors.forename: Placid
authors.initials: P
authors.lastname: Ugoagwu
authors.forename: Godwin
authors.initials: G
authors.lastname: Imade
authors.forename: Graham
authors.initials: G
authors.lastname: Cooke
authors.forename: Sheena
authors.initials: S
authors.lastname: McCormack
authors.forename: Simon David
authors.initials: SD
authors.lastname: Taylor-Robinson
authors.forename: John
authors.initials: J
authors.lastname: Idoko
authors.forename: Phyllis
authors.initials: P
authors.lastname: Kanki
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D018937:Hepatitis C Antibodies / Q000097:blood; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D015415:Biomarkers; D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D012367:RNA, Viral
keywords: Africa; Hepatitis B; Hepatitis C; Human immunodeficiency virus; Liver disease
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