Hepatitis B virus (HBV) has infected over two billion people with more than 240 million chronic infections. It is the leading cause of liver failure and hepatocellular carcinoma worldwide. Chronic HBV is the primary cause of morbidity; however, occult HBV (OBI) – defined as the detection of HBV DNA without detectable HBV surface antigen (HBSAg) – is also both transmissible and associated with the same clinical consequences. Human immunodeficiency virus (HIV) co-infection is a risk factor for OBI. This study determined the prevalence of chronic and occult HBV within HIV positive Batswana (the people of Botswana).
This study utilized the Bomolemo cohort of HIV positive adults in Botswana. Subjects were followed pre- and post-initiation of tenofovir containing HIV antiretroviral therapy (ART). Baseline plasma samples were screened for HBSAg by enzyme-linked immunosorbent assay (ELISA) to detect chronic HBV infection. Real time polymerase chain reaction (rtPCR) was used to obtain quantitative HBV viral loads at baseline and at 12 month follow-up. Markers of HIV infection (CD4 count and HIV viral load), liver enzymes, platelet and age of subjects were included from the Bomolemo study. FIB-4 scores were evaluated as a non-invasive marker of liver disease.
Of the 300 subjects, 28 (9.3%) had chronic HBV, while 72 (24%) had OBI at baseline. At 12 month follow up, 65/66 (98.5%) of the OBI subjects tested had no detectable HBV in their plasma. Seventy percent (16 of 23) of the subjects with chronic infection had no detectable HBV DNA at follow up. Eight of these converted to HBSAg negative, while the other 8 remained HBSAg positive. All 7 (30%) of the chronic HBV subjects with persistent HBV DNA also had persistent HBSAg positivity. There was no difference in baseline CD4 count, HIV viral load, or FIB-4 score among chronic HBV, OBI, and HBV negative groups.
Occult and chronic HBV represent a significant burden within the HIV positive Batswana. HBV replication is suppressed in HIV positive patients with OBI while on tenofovir-containing regimens. Most patients with chronic HBV infection showed improvement while on tenofovir-containing therapy, although a significant minority have persistent disease.
S. Gaseitsiwe, None
J. Blackard, None
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