title: Epidemiology of HBV infection in a cohort of Ugandan HIV-infected patients and rate and pattern of lamivudine-resistant HBV infection in patients receiving antiretroviral therapy.
abstract: BACKGROUND
  Many HIV-infected patients in sub-Saharan Africa are not routinely screened for hepatitis B virus (HBV) infection and are on antiretroviral therapy (ART) regimens containing only lamivudine as anti-HBV active drug.
  
  
  METHODS
  In 2009-2011, we screened for hepatitis B surface antigen (HBsAg) in 2820 HIV-infected adults patients at the Mbarara Hospital Uganda and investigated risk factors for HBV infection. Using samples of dried plasma or blood spots, we tested for HBV viral load and HBV drug resistance mutations in all HBsAg-positive patients on ART for ≥ 12 months.
  
  
  RESULTS
  In this study, 109 patients tested HBsAg positive (3.9%; 109/2820). HBsAg-positive patients were more likely to have had >4 lifetime sexual partners (p<0.01). Of the 55 HBsAg-positive patients on ART for ≥ 12 months, 53 were only on lamivudine as anti-HBV active drug and two were on tenofovir and lamivudine. HBV-DNA was detected in 30 patients (54.5%; 30/55), all on lamivudine-monotherapy. Of the 23 patients in whom HBV-DNA sequencing was successful, 17 had lamivudine-resistant HBV strains harbouring rtM204V/I mutations accompanied by secondary/compensatory mutations.
  
  
  CONCLUSIONS
  Our study suggests that sexual transmission may represent a major mode of spread of HBV in southwest Uganda and confirms the importance of screening for HBV and of using ART regimens containing tenofovir in HIV/HBV co-infected patients.
authors.affiliation: Department of Virology, Royal Free London NHS Foundation Trust, London, UK giorgiocalisti@gmail.com giorgio.calisti@nhs.net.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Calisti
authors.affiliation: Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Rose
authors.initials: R
authors.lastname: Muhindo
authors.affiliation: Epicentre Mbarara Research Base, Mbarara, Uganda.
authors.forename: Yap
authors.initials: Y
authors.lastname: Boum
authors.affiliation: Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Laurence A
authors.initials: LA
authors.lastname: Wilson
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
authors.forename: Geraldine M
authors.initials: GM
authors.lastname: Foster
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Geretti
authors.affiliation: Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bhagani
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000008:administration & dosage*; D060085:Coinfection; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000097:blood; D024882:Drug Resistance, Viral / Q000187:drug effects*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000097:blood / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation; D014454:Uganda / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine
keywords: Epidemiology; HBV; HIV; Lamivudine; Resistance; Sub-Saharan Africa