Effects of Hepatitis B Virus Co-Infection on Immune Bio-Markers among Hiv Infected Patients Attending Comprehensive Care Clinics in Makueni County

Abstract

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) co-infection represents a considerable health burden worldwide. Combination antiretroviral therapy (cART) has greatly improved survival in HIV infected people however HBV has emerged as a major cause of morbidity and mortality in this group. It is estimated that 5%–20% of the 35 million people living with HIV are also infected with HBV. Sub-Saharan Africa has the highest burden of HIV/HBV co-infection. The broad objective of this study was to determine the influence of Hepatitis B virus co-infection on immune biomarkers among HIV infected persons attending comprehensive care clinics in Makueni County. The study also assessed risk factors for HIV/HBV co-infection and its influence on liver functions (ALT).It was carried out in three selected comprehensive care clinics in Makueni County and a total 258 patients participated. This was a prospective case-control study comprised of two arms of participants, HIV infected (129) and HIV/HBV co-infected (129). It was six months follow-up study adopting the quantitative methodology. Quantitative data was collected using structured questionnaires and collection of laboratory data was done with the help of research assistants. The participants included all new HIV-infected persons enrolled in these facilities and met the inclusion criteria for the study. Participants were interviewed and blood samples collected from them for analysis of CD4 count, viral load, Alanine aminotransferase levels, and Hepatitis B at baseline and follow-up after giving informed consent. Both HIV infected patients and HIV/HBV co-infected patients were started on ARVS and enrolled in the study then followed up for six months for comparison between the two groups. Influence of co-infection with HBV was then determined and the association between the biomarkers and HBV co-infection established. Analysis was done using the statistical package for the social sciences (SPSS). There were more females 164 (63.6 %) than males 94 (36.4 %) participants in the study. The average age of the participants in the study was 31±0.402years. The mean viral load at the beginning of our current study was (30,169&21860copies/ml) while at the sixth month was (1731&1689) copies/ml for HBV co-infected and HIV mono-infected respectively. The risk factors found to be associated with HBV co-infection were having multiple sexual partners, alcohol intake, and not using condoms while having sexual intercourse. There was a significant drop in the viral load when compared at the beginning and the end of the study among the HIV/HBV co-infected and mono-infected at p<0.001. After enrolling them into ART treatment program and six months follow-up there was a significant increase in CD4 count for both the HIV and HIV/HBV positive patients at p<0.001 however there was no statistical significance between ALT at baseline and sixth month for the two groups at p=0.388. Hepatitis B virus has shown to influence CD4 count and viral load levels among HIV/HBV co-infected more than mono-infected and marked improvement is shown in co-infected individuals after ART initiation. ALT was slightly high among co-infected compared to mono-infected. Vaccination on Hepatitis B should be done on all HIV patients after undertaking the test since their immune system is weak and are at risk of contracting the virus. Molecular technologies for identification of HBV RNA levels should be introduced to determine the progression on treatment since the rapid method only detects the antibodies present and more education should be done to the general population not only HIV positive patients on transmission, prevention, and treatment of Hepatitis B to avoid a further epidemic of the disease.