title: Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia.
abstract: BACKGROUND
  Few data on the virological determinants of hepatitis B virus (HBV) infection are available from southern Africa.
  
  
  METHODS
  We enrolled consecutive HIV-infected adult patients initiating antiretroviral therapy (ART) at two urban clinics in Zambia and four rural clinics in Northern Mozambique between May 2013 and August 2014. HBsAg screening was performed using the Determine® rapid test. Quantitative real-time PCR and HBV sequencing were performed in HBsAg-positive patients. Risk factors for HBV infection were evaluated using Chi-square and Mann-Whitney tests and associations between baseline characteristics and high level HBV replication explored in multivariable logistic regression.
  
  
  RESULTS
  Seventy-eight of 1,032 participants in Mozambique (7.6%, 95% confidence interval [CI]: 6.1-9.3) and 90 of 797 in Zambia (11.3%, 95% CI: 9.3-13.4) were HBsAg-positive. HBsAg-positive individuals were less likely to be female compared to HBsAg-negative ones (52.3% vs. 66.1%, p<0.001). Among 156 (92.9%) HBsAg-positive patients with an available measurement, median HBV viral load was 13,645 IU/mL (interquartile range: 192-8,617,488 IU/mL) and 77 (49.4%) had high values (>20,000 UI/mL). HBsAg-positive individuals had higher levels of ALT and AST compared to HBsAg-negative ones (both p<0.001). In multivariable analyses, male sex (adjusted odds ratio: 2.59, 95% CI: 1.22-5.53) and CD4 cell count below 200/μl (2.58, 1.20-5.54) were associated with high HBV DNA. HBV genotypes A1 (58.8%) and E (38.2%) were most prevalent. Four patients had probable resistance to lamivudine and/or entecavir.
  
  
  CONCLUSIONS
  One half of HBsAg-positive patients demonstrated high HBV viremia, supporting the early initiation of tenofovir-containing ART in HIV/HBV-coinfected adults.
authors.affiliation: Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.|Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.|Department of Infectious diseases, University of Dakar, Dakar, Senegal.
authors.forename: Gilles
authors.initials: G
authors.lastname: Wandeler
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: Kalo
authors.initials: K
authors.lastname: Musukuma
authors.affiliation: Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
authors.forename: Samuel
authors.initials: S
authors.lastname: Zürcher
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.|Department of Medicine at University of Alabama, Birmingham, United States of America.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Vinikoor
authors.affiliation: SolidarMed, Ancuabe, Mozambique.
authors.forename: Jara
authors.initials: J
authors.lastname: Llenas-García
authors.affiliation: Nucleo do investigacão Operational de Pemba, Pemba, Mozambique.
authors.forename: Mussa M
authors.initials: MM
authors.lastname: Aly
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Mulenga
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, United States of America.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
authors.affiliation: SolidarMed, Lucerne, Switzerland.
authors.forename: Jochen
authors.initials: J
authors.lastname: Ehmer
authors.affiliation: SolidarMed, Lucerne, Switzerland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Hobbins
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.|Department of Medicine at University of Alabama, Birmingham, United States of America.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Bolton-Moore
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, United States of America.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hoffmann
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.|Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D060085:Coinfection / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D006515:Hepatitis B virus / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008297:Male; D019562:Viral Load / Q000187:drug effects; D014766:Viremia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D015024:Zambia / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents