Date Published: April 19, 2019
Publisher: Public Library of Science
Author(s): Richard Boateng, Mohamed Mutocheluh, Albert Dompreh, Dorcas Obiri-Yeboah, Enoch Odame Anto, Michael Owusu, Patrick Williams Narkwa, Jason Blackard.
The study assessed the hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection paradigm among the human immunodeficiency virus (HIV) infected patients attending a tertiary hospital in Ghana. Also, the immunological and virological characterisation of these viruses, prior to antiretroviral therapy (ART) initiation was investigated.
A total of 400 HIV infected (HIV type-1) treatment naïve subjects ≥18 years were enrolled and tested for HBsAg and anti-HCV. Hepatitis B virus serological profile was performed on samples that were HBV positive. CD4+ T-cell count and HIV-1 RNA viral loads were determined using BD FacsCalibur analyzer (USA) and COBAS AmpliPrep/COBAS TaqMan Analyzer (USA) respectively.
The overall prevalence of HBV/HCV co-infection among the HIV-1 patients was 18.0%. The prevalence of HIV-HBV and HIV-HCV co-infections were 12.5% and 5.5% respectively. The prevalence of active viral hepatitis (HBeAg-positive) among HIV-HBV co-infected patients was 40%. None of the patients had anti-HBc IgM. HIV-HBV co-infection was associated with lower CD4+ T-cell count as well as higher HIV-1 viral load compared to both HIV mono- infection and HIV-HCV co- infection (p<0.05) respectively. HBeAg positivity was associated with severe immunosuppression and higher HIV viral load. Patients aged 18–33 years [aOR = 9.66(1.17–79.61); p = 0.035], male gender [aOR = 2.74(1.15–6.51); p = 0.023], primary education [aOR = 9.60(1.21–76.08); p = 0.032], secondary education [aOR = 14.67(1.82–118.08); p = 0.012] and being single [aOR = 2.88(1.12–7.39); p = 0.028] were independent risk factors of HIV-HBV co-infections but not HIV-HCV co-infections. The present study highlights the predominance of HBV exposure among the HIV infected patients in Ghana. HBV coinfection was associated with severe immunosuppression and higher HIV-1 viral load.
The current study was motivated by reports that data on individuals co-infected with HIV and viral hepatitis in West Africa was still emerging [1–3]. Moreover, there has been conflicting reports on the effects of viral hepatitis on the immunity of HIV patients co-infected with either HBV or HCV. Whereas some studies showed HBV and HCV coinfections were linked to a more severe form of immunosuppression of pre ART CD4+ T-cell counts compared to those with HIV mono-infection [4–6] others observed no differences [7, 8].
A total of 400 HIV-1 treatment naïve subjects successfully participated in the study comprising of 162 (40.5%) males and 238 (59.5%) females. The overall mean age of both sexes was 40.94 years (18–64) years. Majority (49.5%) of the subjects were married, attained at least primary level of education (71.5%), were employed (73.5%) and (68.0%) were living in the urban areas. The overall prevalence of viral hepatitis (HBV/HCV) was 18.0% (72/400). HIV-HBV co-infection was 12.5% (50/400) of which 28/50 (56%) were females and 22/50 (44.0%) were males whereas that of HIV-HCV co-infection was 5.5% (22/400) of which 16/22 (72.72%) were females and 6/22 (27.27%) were males. HIV mono-infection prevalence was 82.0% (328/400). Prevalence rate of both HIV-HCV and HIV-HBV concurrent infection was high among females than males. None had trio infection. Regarding the risk factors for HIV-HBV or HIV-HCV co-infection, there was significant association between the age, gender, level of education and marital status variables and HIV-HBV co-infection, however, the predictive capacity of socio-demographic variables for HIV-HCV co-infections were insignificant. Participants who were 18–33 years (aOR = 9.66, 95%CI (1.17–79.61), p-value = 0.035), male gender (aOR = 2.74, 95%CI (1.15–6.52), p-value = 0.023), had primary school education (aOR = 9.60, 95%CI (1.21–76.08), p-value = 0.032), secondary school education (aOR = 14.67, 95%CI (1.82–118.09), p-value = 0.012) and participants who were single (aOR = 2.88, 95%CI (1.12–7.39), p-value = 0.028) all had higher odds of having HIV-HBV co-infections (Table 1).
Individuals with HIV infection could live longer in the era of increased access to ART but that could be complicated because many are coinfected with viral hepatitis B and or C in sub-Saharan Africa. Viral hepatitis B and or C coinfected HIV-patients have been associated with increased immunosuppression pre-ART during ART and also increased ART-related liver toxicity  although some studies reported to the contrary . Therefore, the current study sought to establish the burden of viral hepatitis B and C among ART naïve HIV patients and to herald the deleterious effects of these hepatitis viruses.
The present study highlights the predominance of HBV exposure among the HIV infected patients in Ghana. HBV coinfection was associated with severe immunosuppression and higher HIV-1 viral load compared with the HIV/HCV and HIV monoinfection groups respectively. Majority of the HIV/HBV group had chronic HBV infection. HCV surprisingly boosted immunity but not HIV viral load. Socio-demographic factors such as age (18–33 years), male gender, having primary and secondary education and being single was associated with increased risk of HIV-HBV co-infection.