title: Hepatitis B and HIV co-infection is still treated using lamivudine-only antiretroviral therapy combination in Uganda.
abstract: BACKGROUND
  Hepatitis B virus (HBV) and HIV are endemic in Uganda. Co-infection is common and leads to rapid progression of liver disease. Burden of co-infection is unknown yet most patients are on lamivudine-only ART where resistance is frequent. Most patients are initiated on antiretroviral therapy (ART) without knowing their HBV status.
  
  
  OBJECTIVE
  To determine burden of co-infection and HBV viral suppression among patients on ART in Northern Uganda.
  
  
  METHODS
  We recruited HIV infected adult patients on ART in a cross-sectional study. Age, sex, ART regimen and duration were recorded. Hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBcAb) and liver panel were performed. For those HBsAg+, hepatitis B e antigen (HBeAg) and HBV DNA were performed. CD4 cell count was recorded.
  
  
  RESULTS
  Three hundred patients were recruited. Twenty (6.7%) were co-infected, while 41% were anti-HBcAb+. Overall 188 (62.7%) were on lamivudine- only HBV active drug. Median ART duration 2 years (IQR 1-5), mean CD4+ cell count 317 cells/microlitre (SD 255-557). Of 20 HIV/HBV co-infected, 11/20 (55%) were on lamivudine-only ART, median duration 1.5 years. Nineteen (95%) had undetectable HBV DNA. Seventeen (85%) were HBeAg negative. Mean CD4+ cell count 327 cells/microlitre (SD 197-482).
  
  
  CONCLUSIONS
  A large proportion of patients were on lamivudine- only HBV-active ART. Resistance may occur long term thus testing for HBV and correct ART is recommended.
authors.affiliation: Makerere University College of Health Sciences, Department of Medicine, Gastroenterology Division, Mulago Hospital, Kampala, Uganda.
authors.forename: Ponsiano
authors.initials: P
authors.lastname: Ocama
authors.affiliation: Mulago National Hospital, Division of gastroenterology, Kampala, Uganda.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Seremba
authors.affiliation: Mulago National Hospital, Division of gastroenterology, Kampala, Uganda.
authors.forename: Betty
authors.initials: B
authors.lastname: Apica
authors.affiliation: Makerere University College of Health Sciences, Department of Medicine, Gastroenterology Division, Mulago Hospital, Kampala, Uganda.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Opio
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000188:drug therapy* / Q000821:virology; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006509:Hepatitis B / Q000175:diagnosis / Q000188:drug therapy*; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D020133:Reverse Transcriptase Polymerase Chain Reaction; D016896:Treatment Outcome; D014454:Uganda; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine; D000410:Alanine Transaminase
keywords: Co-infection; HBV; HIV; Treatment