Occult HBV infection in untreated HIV-infected adults in Côte d'Ivoire

Abstract

Background

In countries with high rates of chronic HBV, the World Health Organization recommends screening all HIV-infected adults for hepatitis B surface antigen (HBsAg) before initiating antiretroviral therapy (ART), and starting HIV–HBV-coinfected patients on regimens containing lamivudine (3TC) or emtricitabine (FTC) plus tenofovir disoproxil fumarate (TDF). Here, we estimated the prevalence of untreated HIV-infected adults with negative serum HBsAg and detectable plasma HBV DNA in Côte d'Ivoire.

Methods

This was a cross-sectional survey. We tested all untreated HIV type-1 (HIV-1)-infected adults with CD4⁺ T-cell counts <500 cells/mm³ for HBsAg, hepatitis B core antibodies (anti-HBc) and HBsAg antibodies (anti-HBs). We measured plasma HBV DNA in patients who tested positive for HBsAg and/or anti-HBc.

Results

We included 495 adults, of whom 73% were women. Median CD4⁺ T-cell count was 329 cells/mm³ and median HIV RNA was 4.9 log₁₀ copies/ml. Overall, 63 (13%) patients had chronic hepatitis B (HBsAg-positive), 115 (23%) had never been exposed to HBV (HBsAg-negative, anti-HBc-negative and anti-HBs-negative), 108 (22%) had signs of cured infection (anti-HBc-positive and anti-HBs-positive) and 209 (42%) had isolated anti-HBc (HBsAg-negative, anti-HBc-positive and anti-HBs-negative). Of these, 51 (10%) had detectable HBV DNA. Median HBV DNA level was 5.2 log₁₀ copies/ ml (interquartile range [IQR] 3.2–8.8) for patients with chronic hepatitis and 2.2 log₁₀ copies/ml (IQR 1.8–2.7) for those with occult HBV infection.

Conclusions

Among ART-naive HIV-1-infected African adults, 13% were HBsAg-positive and 42% had isolated anti-HBc, including 10% who had occult HBV. The clinical implications of high occult HBV prevalence are unknown. Future studies should assess the benefits of routine use of 3TC or FTC plus TDF as first-line ART in African settings, where HBV DNA tests are unavailable.

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