title: Prevalence and Characteristics of Hepatitis B Virus (HBV) Coinfection among HIV-Positive Women in South Africa and Botswana.
abstract: There is progressive concern about the evolving burden of morbidity and mortality caused by coinfection with HIV-1 and hepatitis B virus (HBV) in sub-Saharan Africa, but the epidemiology and impact of this problem are not well defined. We therefore set out to assimilate more information about the nature of HBV/HIV coinfection in this region by undertaking a retrospective observational study of southern African adult women. We used samples from previously recruited HIV-1 positive women attending antenatal clinics in three settings in South Africa and Botswana (n = 950) and added a small cohort of HIV-negative antenatal South African women for comparison (n = 72). We tested for HBsAg and followed up HBsAg-positive samples by testing for HBeAg, HBV DNA, HBV genotype, presence of drug-resistance associated mutations (RAMs) and HDV. We identified HBsAg in 72 individuals (7% of the whole cohort), of whom 27% were HBeAg-positive, and the majority HBV genotypes A1 and A2. We did not detect any HDV coinfection. HBV prevalence was significantly different between geographically distinct cohorts, but did not differ according to HIV status. Among adults from South Africa, HBV/HIV coinfected patients had lower CD4+ T cell counts compared to those with HIV-monoinfection (p = 0.02), but this finding was not replicated in the cohort from Botswana. Overall, these data provide a snapshot of the coinfection problem at the heart of the HIV/HBV co-epidemic, and are important to inform public health policy, resource allocation, education, surveillance and clinical care.
authors.affiliation: Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, Oxford, United Kingdom; Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom.
authors.forename: Philippa C
authors.initials: PC
authors.lastname: Matthews
authors.affiliation: Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Beloukas
authors.affiliation: Department of Paediatrics, University of Oxford, Peter Medawar Building for Pathogen Research, Oxford, United Kingdom.
authors.forename: Amna
authors.initials: A
authors.lastname: Malik
authors.affiliation: Microsoft Research, eScience Group, Redmond, Washington, United States of America.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Carlson
authors.affiliation: Paediatric Department, Kimberley Hospital, Kimberley, Northern Cape, South Africa.
authors.forename: Pieter
authors.initials: P
authors.lastname: Jooste
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Botswana; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Anthony
authors.initials: A
authors.lastname: Ogwu
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Botswana; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Roger
authors.initials: R
authors.lastname: Shapiro
authors.affiliation: Integrated Sexual Health Services, Northampton General Hospital, Cliftonville, Northampton, United Kingdom.
authors.forename: Lynn
authors.initials: L
authors.lastname: Riddell
authors.affiliation: Department of Sexual Health, Royal Berkshire Hospital, Reading, United Kingdom.
authors.forename: Fabian
authors.initials: F
authors.lastname: Chen
authors.affiliation: Department of Sexual Health, High Wycombe Hospital, High Wycombe, Buckinghamshire, United Kingdom.
authors.forename: Graz
authors.initials: G
authors.lastname: Luzzi
authors.affiliation: HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Manjeetha
authors.initials: M
authors.lastname: Jaggernath
authors.affiliation: Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom.
authors.forename: Gerald
authors.initials: G
authors.lastname: Jesuthasan
authors.affiliation: Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom.
authors.forename: Katie
authors.initials: K
authors.lastname: Jeffery
authors.affiliation: HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), University of KwaZulu-Natal, Durban, South Africa; Max Planck Institute for Infection Biology, Chariteplatz, Berlin, Germany; The Ragon Institute of MGH, MIT and Harvard University, Cambridge, Massachusetts, United States of America.
authors.forename: Thumbi
authors.initials: T
authors.lastname: Ndung'u
authors.affiliation: Department of Paediatrics, University of Oxford, Peter Medawar Building for Pathogen Research, Oxford, United Kingdom; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Philip J R
authors.initials: PJ
authors.lastname: Goulder
authors.affiliation: Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Geretti
authors.affiliation: Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, Oxford, United Kingdom; Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom; NIHR Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Klenerman
mesh_terms: D000328:Adult; D001902:Botswana / Q000453:epidemiology; D060085:Coinfection / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1 / Q000472:pathogenicity*; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D006515:Hepatitis B virus / Q000472:pathogenicity*; D006801:Humans; D015995:Prevalence; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load