Burden of hepatitis B virus and syphilis co-infections and its impact on HIV treatment outcome in Ethiopia: nationwide community-based study

Abstract

Background

Hepatitis B virus (HBV) and syphilis have been the most common co-infections that hinder treatment outcomes and increase early mortality among people living with human immunodeficiency virus (PLHIV). In this study, we aimed to determine the burden of HBV and syphilis co-infections and its impact on treatment outcomes among PLHIV in Ethiopia.

Methods

We used data from the Ethiopian Population-based HIV Impact Assessment (EPHIA), which was a household-based national survey in 2017/2018. Human immunodeficiency virus (HIV) testing was done among 19,136 participants using the national testing algorithm and 662 participants (3.50%) were HIV positives who were further tested for viral hepatitis and syphilis co-infections using HBV surface antigen and Chembio DPP syphilis assay, respectively. Viral load, CD4 count and high-sensitivity C-reactive protein (hsCRP) were done to measure HIV treatment outcomes. Descriptive statistics were used to determine the burden of co-infections and a logistic regression model to evaluate the determinants of co-infections using STATA V17.0.

Results

Overall prevalence of HBV and syphilis co-infection was 5.5% and 2.2%, respectively. HBV and syphilis (double co-infection) was 5.9%. The highest prevalence of HBV co-infection was observed among 10–19 years age group (12.9%) and male participants (7.44%) while the highest syphilis co-infection was among people aged ≥50 years (3.5%) followed by age groups 40–49 (3.3%) and 10–19 years (3.2%). Syphilis co-infection was higher among males (5.2%) compared to females (1.1%). After adjusted regression analysis, HBV co-infected PLHIV had higher odds of virologic failure (AOR (95% confidence interval (CI)) = 6.3 (4.2–14.3)), immunosuppression (CD4 count < 500 cells/mm³) (AOR (95%CI) = 2.1(1.3–4.9)) and inflammation (hsCRP >10 mg/dL) (AOR (95%CI) = 9.2(4.3–14.6)). Immunosuppression was also significantly higher among syphilis co-infected PLHIV (AOR (95%CI) = 3.4 (1.3–5.2)).

Conclusions

Burden of HBV and syphilis co-infections is high particularly among male and adolescent PLHIV and these co-infections hinder virologic and immunologic outcome in Ethiopia. Hence, the program shall enhance HBV and syphilis testing and treatment.

Keywords:

• Co-infection
• HBV
• HIV/AIDS
• syphilis
• Ethiopia

Acknowledgments

The authors are grateful to the Chinese Center for Disease Prevention and Control, Zhejiang University, School of Medicine and the Ethiopian Public Health Institute for the support and facilitation of coordination. The authors would like to express their special thanks to all data collectors and the study participants.

Author contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Ethical approval

Ethical approval was obtained from the Ethiopian Public Health Institute Scientific and Ethical Review Office (SERO) with approval number; EPHI-IRB-19111-2019. Confidentiality was respected during abstraction of data by the use of specific identification code for each enrolled patient number. Eligible study participants were identified by trained and experienced data collectors and supervisor at facility level. Written informed consent was also obtained from adults. Those aged 13–17 years old who because of being married, or having independent incomes, or have a living arrangement separate from the other family members, were considered emancipated minors. Hence, these segments of the study population (13–17) who were willing to provide written informed consent were included. Moreover, for adolescents (10–17) able and willing to provide written assent and parent/guardian able and willing to provide written informed consent/permission were included in the study. All methods were performed in accordance with the approved protocol, relevant guidelines and regulations.

Consent form

Authors and responsible authorities were informed and agreed for this publication.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

Since data analysis for other objectives is ongoing, the raw data can be obtained from the first corresponding author.

Additional information

Funding

There were no funding for this study.