title: High seroprevalence of HBV and HCV infection in HIV-infected adults in Kigali, Rwanda.
abstract: BACKGROUND
  Data on prevalence and incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in Rwanda are scarce.
  
  
  METHODS
  HBV status was assessed at baseline and Month 12, and anti-HCV antibodies at baseline, in a prospective cohort study of HIV-infected patients in Kigali, Rwanda: 104 men and 114 women initiating antiretroviral therapy (ART) at baseline, and 200 women not yet eligible for ART.
  
  
  RESULTS
  Baseline prevalence of active HBV infection (HBsAg positive), past or occult HBV infection (anti-HBc positive and HBsAg negative) and anti-HCV was 5.2%, 42.9%, and 5.7%, respectively. The active HBV incidence rate was 4.2/1,000 person years (PY). In a multivariable logistic regression model using baseline data, participants with WHO stage 3 or 4 HIV disease were 4.19 times (95% CI 1.21-14.47) more likely to have active HBV infection, and older patients were more likely to have evidence of past exposure to HBV (aRR 1.03 per year; 95%CI 1.01-1.06). Older age was also positively associated with having anti-HCV antibodies (aOR 1.09; 95%CI 1.04-1.14) while having a higher baseline HIV viral load was negatively associated with HCV (aOR 0.60; 95% CI 0.40-0.98). The median CD4 increase during the first 12 months of ART was lower for those with active HBV infection or anti-HCV at baseline. Almost all participants (88%) with active HBV infection who were on ART were receiving lamivudine monotherapy for HBV.
  
  
  CONCLUSIONS
  HBV and HCV are common in HIV-infected patients in Rwanda. Regular HBsAg screening is needed to ensure that HIV-HBV co-infected patients receive an HBV-active ART regimen, and the prevalence of occult HBV infection should be determined. Improved access to HBV vaccination is recommended. Active HCV prevalence and incidence should be investigated further to determine whether HCV RNA PCR testing should be introduced in Rwanda.
authors.affiliation: Department of Global Health, Academic Medical Center, and Amsterdam Institute of Global Health and Development (AIGHD), Amsterdam, The Netherlands.
authors.forename: John
authors.initials: J
authors.lastname: Rusine
authors.forename: Pascale
authors.initials: P
authors.lastname: Ondoa
authors.forename: Brenda
authors.initials: B
authors.lastname: Asiimwe-Kateera
authors.forename: Kimberly R
authors.initials: KR
authors.lastname: Boer
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Uwimana
authors.forename: Odette
authors.initials: O
authors.lastname: Mukabayire
authors.forename: Hans
authors.initials: H
authors.lastname: Zaaijer
authors.forename: Julie
authors.initials: J
authors.lastname: Mugabekazi
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Janneke H
authors.initials: JH
authors.lastname: van de Wijgert
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D015704:CD4 Antigens / Q000276:immunology; D015331:Cohort Studies; D060085:Coinfection / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D018450:Disease Progression; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D016174:Hepacivirus / Q000276:immunology; D006509:Hepatitis B / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D006515:Hepatitis B virus / Q000276:immunology; D006526:Hepatitis C / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D018937:Hepatitis C Antibodies / Q000276:immunology; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012432:Rwanda / Q000453:epidemiology; D016036:Seroepidemiologic Studies; D019562:Viral Load / Q000276:immunology
chemical_list: D015704:CD4 Antigens; D018937:Hepatitis C Antibodies