Hepatitis B serological markers and plasma DNA concentrations.
To examine hepatitis B (HBV) serological markers and plasma DNA concentrations in a large group of untreated HBV/HIV-coinfected individuals in two sub-Saharan settings.



Baseline analysis of a randomized controlled trial.



DART was a large trial of treatment monitoring practices in HIV-infected adults with advanced disease starting antiretroviral therapy at centres in Kampala or Entebbe, Uganda (n = 2317) and Harare, Zimbabwe (n = 999). HBV serological markers [antibody to HBV core antigen, HBV surface antigen (HBsAg), antibody to HBV surface antigen, HBV 'e' antigen (HBeAg), and antibody to hepatitis B 'e' antigen] and plasma HBV DNA viral load were measured retrospectively on stored baseline samples. Logistic regression was used to examine associations with baseline demographic and clinical factors.



The rate of HBsAg positivity was significantly higher in Zimbabwe than Uganda (12.2 vs. 7.7%, adjusted odds ratio = 1.54, P < 0.001) despite a similar prevalence of antibody to HBV core antigen (56.3 vs. 52.4%) in the two settings. Overall, HBsAg positivity was associated with male sex (adjusted odds ratio = 1.54, P < 0.001) but not with age, WHO disease stage, or CD4 cell count. HBeAg was detected among 37% of HBsAg-positive patients, with higher rates among those with advanced WHO stage (P = 0.02). Also in HBsAg-positive patients, HBV DNA was undetectable in 21%, detectable but below the level of quantification in 14%, and quantifiable in 65%. A total of 96% of HBeAg-positive and 70% of HBeAg-negative patients had detectable HBV DNA; 92 and 28% of patients, respectively, had HBV DNA viral load more than 2000 IU/ml.



High rates of HBV coinfection were observed, highlighting the importance of ensuring that coinfected patients receive an antiretroviral regimen, whether first-line or not, that is active against both viruses.
Centre for Sexual Health and HIV Research, Mortimer Market Centre, University College London
Huw
H
Price
MRC Clinical Trials Unit at University College London, London, UK
David
D
Dunn
Joint Clinical Research Centre, Kampala
Tamale
T
Zachary
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
Tobias
T
Vudriko
University of Zimbabwe, Harare, Zimbabwe
Michael
M
Chirara
Joint Clinical Research Centre, Kampala
Cissy
C
Kityo
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
Paula
P
Munderi
MRC Clinical Trials Unit at University College London, London, UK
Moira
M
Spyer
University of Zimbabwe, Harare, Zimbabwe
James
J
Hakim
School of Population Health, University of Queensland, Brisbane, Australia
Charles
C
Gilks
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
Pontiano
P
Kaleebu
Africa Health Research Institute, Durban, South Africa
Deenan
D
Pillay
Centre for Sexual Health and HIV Research, Mortimer Market Centre, University College London
Richard
R
Gilson
D000293:Adolescent; D000328:Adult; D000368:Aged; D060085:Coinfection / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006510:Hepatitis B Antibodies / Q000097:blood*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000737:chemistry* / Q000821:virology*; D014454:Uganda / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens