Abstract:
Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) co-infection are common blood borne infections with common routes of transmission. The HIV infection however is associated with more rapid progression of viral hepatitis-related liver disease. The clinical benefits of antiretroviral therapy (ART) have been associated with an apparent increase in liver disease–related mortality in coinfected patients. Antiretroviral (ARV) drugs active against both HIV and HBV may prevent development of significant liver disease by directly suppressing HBV replication. Complications due to ART treatment failures may therefore jeopardize the clinical benefits of ART, especially in HIV/HBV co-infected patients. In Kenya currently, there is a paucity of data on the prevalence of HBV genotypes and its correlation with immunological and hepatological parameters among HIV infected patients. These data are vital in development of treatment strategies especially in HIV/HBV co-infection cases. This cross sectional study enrolled 303 HIV patients attending Kericho, Kapkatet and Londiani District Hospitals in the Kericho County to answer the above objectives. The HBV status was determined using ELISA while the genotypes identified using sequence analysis. Immunological and hepatic parameters were determined using flow cytometer and chemistry analyzer respectively. Factors associated with HBV/HIV co-infection were evaluated using structured questionnaire. Patients’ characteristics were analyzed by using Kruskal–Wallis test (noncategorical variables) and χ2-test or Fisher's exact test (categorical variables). The mean age of the 303 study patients was 34.4 (SD = 9.7; range 16-71) years. The patients’ mean CD4 was 259.5 (± SD 129.1) cells per ml. The mean Alanine aminotransferase (ALT) level was 32.9 (± SD 18.95) U/L, and the mean Aspartate aminotransferase (AST) level was 36.7 (± SD 14.7) U/L with (63.4%) of them having AST level within the normal range (0-37U/L). The mean alkaline phosphatase (ALP) level was 156.9 (± SD 59.6) U/L and there was no difference between the proportion of patients who had normal levels of <147 U/L and those who had abnormal levels of > 147 U/L (51.5% and 48.5%). Only 15 (5%) of the HIV patients were co-infected with Hepatitis B virus, majority (93%) of which were HBV genotype A. The
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HBV/HIV co-infected patients had lower CD4 compared mono-infected patients (CD4 mean of 137.2 cells/ml versus 265.9 cells/ml) (P = 0.013). The HBV/HIV co-infected patients had a higher mean ALT (mean ALT of 62 U/L versus 31.4 U/L) (P = 0.001). Similarly the HBV/HIV co-infected patients had higher mean AST (mean AST of 65.5 U/L versus 35.2 U/L) (P = 0.001). This study, confirms the increasing number of HBV/HIV co-infection in Kenya with predominance of HBV genotype A. The male gender, increasing age, lower CD4 count, ART use, elevated liver enzymes are a key pointer for increased risk of HBV co-infection. Early detection of HBV/HIV co-infection are vital in instituting treatment strategies including immunization of susceptible individuals and revaccination of HIV-infected individuals who do not respond to the standard HBV vaccination schedule. Further, the community of HIV patients could benefit from clinical, molecular and immunological investigations to elucidate the interaction of HBV-HIV coinfection
