Seroprevalence and associated factors of hepatitis B virus infection among HIV-positive adults attending an antiretroviral treatment clinic at Wolaita Sodo University Referral Hospital

Abstract

Background

Hepatitis B virus infection (HBV) constitutes major public health problems in sub-Saharan Africa from different infections occuring in HIV positive patients. Ethiopia is a part of sub-Saharan Africa with 1.5% adult HIV prevalence, and also belongs to the intermediate to high HBV prevalence category. Hence, this study aimed to measure the seroprevalence and associated factors of HBV infection among HIV-positive adults attending an antiretroviral treatment (ART) clinic at Wolaita Sodo University Referral Hospital.

Methods

An institution-based cross-sectional study was conducted from October 15 to December 10, 2017 using a systematic random sampling technique. After getting informed written consent, data were collected by a structured and interviewer-administered questionnaire. Venous blood was collected and centrifuged to separate serum. Hepatitis B surface antigen (HBsAg) was detected from serum using an advanced quality one-step rapid test kit. Data were entered into EpiData version 3.01 and exported to SPSS version 20. Summary statistics, bivariate analysis, and multivariate analyses were performed. The variables having significant association of P<0.05 in the multivariate logistic regression were taken as independent factors. OR and 95% CI were used to measure the strength of the association.

Results

A total of 442 study participants, 187 males and 255 females, were included in this study. Overall prevalence of HBsAg was 37 (8.4%). Family history of HBV (adjusted OR=8.83, 95% CI=2.56–30.49), multiple sexual partners (adjusted OR=7.08, 95% CI=2.29–21.9), and CD4 count <200 cells/μL (adjusted OR=15.34, 95% CI=4.77–49.3) were found to be significantly associated with HBsAg positivity.

Conclusion

The prevalence of HBsAg in this study was high. Family history of HBV, multiple sexual partners, and CD4 count <200 cells/μL were independently associated with HBsAg positivity. Therefore, screening for HBV is recommended before initiation of ART in HIV patients and providing appropriate treatment for co-infection. Furthermore, accurate information on risk factors for HBV transmission should be provided.

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Keywords:

• hepatitis B surface antigen
• HIV
• co-infection
• HIV-positive adults
• highly active antiretroviral treatment regimens
• hepatitis B virus infection

Abbreviations list

ABC, Abacavir; AIDS, Acquired immune deficiency syndrome; ALT, Alanine aminotransferace; AOR, Adjusted odds ratio; ART, Antiretroviral therapy; ARV, Antiretroviral; ATV, Atazanavir; AZT, Zidovudine; CI, Confidence Interval; DNA, Deoxyribonucleic acid; EDTA, Ethylene diamine tetra acetic acid; EFV, Efavirenz; ELISA, Enzyme linked immunosorbant assay; HAART, Highly active antiretroviral therapy; HBcAg, Hepatitis B core antigen; HBeAg, Hepatitis B e antigen; HBs, Hepatitis B surface antibody; HBsAg, Hepatitis B surface antigen; HBV, Hepatitis B virus; HCC, Hepatocellular carcinoma; HCV, Hepatitis C virus; HIV, Human immunodeficiency virus; OR, Odds ratio; PCR, Polymerase Chain Reaction; RPM, Revolution per minute; SPSS, Statistical Package for Social Science; STI, Sexually transmitted infection; WHO, World Health Organization; WSURH, Wolaita Sodo University Referral Hospital.

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki that provides guidance for researchers to protect research subjects. The study was approved by the institutional research review committee of Wolaita Sodo University. Then, the participants were informed, as participation is on a voluntary basis, about the benefits and harms of participation. Sample collection was done based on their agreement. Samples were handled properly and participants and physicians were informed of results based on permission of the participants for their benefit. Informed written consent is obtained from participants aged ≥18 years, and for those younger than 18 years old, informed written consent was obtained from parents or guardians.

Disclosure

The authors report no conflicts of interest in this work.