title: Proportion and factors associated with Hepatitis B viremia in antiretroviral treatment naïve and experienced HIV co-infected Ghanaian patients.
abstract: BACKGROUND
  The global burden of Hepatitis B virus (HBV) and HIV co-infection is enormous. The risk of developing cirrhosis and hepatocellular cancer is associated with HBV DNA levels. The main objective of the study was to determine proportion of Hepatitis B viremia in ART-naïve and ART-experienced co-infected Ghanaian patients and factors associated with HBV viremia after at least 36 weeks of lamivudine with or without tenofovir containing ART.
  
  
  METHODS
  Hepatitis B and HIV co-infected patients who were ART-naïve or had received at least 9 months of lamivudine-containing ART were enrolled in a cross-sectional study at Korle-Bu Teaching Hospital. Demographic and clinical data were collected and samples obtained for Hepatitis B serology, liver function tests and HBV DNA. Factors associated with viremia were determined using univariate and multivariate logistic regression analysis.
  
  
  RESULTS
  Of 3108 HIV-infected patients screened, 257 (8.3%) were HBsAg-positive, of which 235 enrolled. Overall, 152 (64.7%) were ART-experienced and 83 (35.3%) were ART-naïve. Eighty-nine-percent of ART-naïve and 42.1% of ART-experienced patients had HBV DNA > 20 IU/mL. In multivariate analysis of all patients, being ART-naïve (OR 10.1, 95% CI 4.6-21.9) and elevated ALT (OR 3.7, 95% CI 1.8-7.9) were associated with Hepatitis B viremia. In treatment experienced patients, elevated ALT (OR 4.8 CI 2.0-12.1) and male sex (OR 2.1, 95% CI 1.0-4.2) were associated with Hepatitis B viremia.
  
  
  CONCLUSIONS
  Majority of ART-naïve (89%) and 42% of ART-experienced patients had detectable hepatitis B viremia > 20 IU/mL. An abnormal serum ALT was significantly associated with hepatitis B viremia in HBV and HIV co-infected patients irrespective of treatment status. Baseline and on-treatment ALT may be a useful non-invasive predictor of Hepatitis B viremia in resource-constrained countries in sub-Saharan Africa where infection is endemic and viral load tests are not widely available.
authors.affiliation: Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana. tnaa@doctors.net.uk.|Korle-Bu Teaching Hospital, Accra, Ghana. tnaa@doctors.net.uk.
authors.forename: Timothy N A
authors.initials: TN
authors.lastname: Archampong
authors.affiliation: Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana. malart38@yahoo.com.|Korle-Bu Teaching Hospital, Accra, Ghana. malart38@yahoo.com.
authors.forename: Margaret
authors.initials: M
authors.lastname: Lartey
authors.affiliation: Department of Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana. kwcsagoe@chs.edu.gh.
authors.forename: Kwamena W
authors.initials: KW
authors.lastname: Sagoe
authors.affiliation: Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana. saintadjoa@yahoo.com.
authors.forename: Adjoa
authors.initials: A
authors.lastname: Obo-Akwa
authors.affiliation: Korle-Bu Teaching Hospital, Accra, Ghana. ernest_kenu@yahoo.com.
authors.forename: Ernest
authors.initials: E
authors.lastname: Kenu
authors.affiliation: Warren Alpert Medical School of Brown University, Providence, RI, USA. FGillani@lifespan.org.|The Miriam Hospital, Providence, RI, USA. FGillani@lifespan.org.
authors.forename: Fizza S
authors.initials: FS
authors.lastname: Gillani
authors.affiliation: Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Hongmei_Yang@urmc.rochester.edu.
authors.forename: Hongmei
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana. ikebosa@yahoo.com.
authors.forename: Isaac
authors.initials: I
authors.lastname: Boamah
authors.affiliation: Warren Alpert Medical School of Brown University, Providence, RI, USA. TFlanigan@lifespan.org.|The Miriam Hospital, Providence, RI, USA. TFlanigan@lifespan.org.
authors.forename: Timothy
authors.initials: T
authors.lastname: Flanigan
authors.affiliation: Warren Alpert Medical School of Brown University, Providence, RI, USA. Akwara@lifespan.org.|The Miriam Hospital, Providence, RI, USA. Akwara@lifespan.org.
authors.forename: Awewura
authors.initials: A
authors.lastname: Kwara
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D000998:Antiviral Agents / Q000008:administration & dosage*; D060085:Coinfection / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology; D006509:Hepatitis B / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D006515:Hepatitis B virus / Q000187:drug effects / Q000502:physiology; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D000068698:Tenofovir / Q000008:administration & dosage; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000998:Antiviral Agents; D019259:Lamivudine; D000068698:Tenofovir