Herpertitis B and C Viral Co-infection in HIV infected Patients enrolled in the Antiretrovial Treatment Program at the Universiity Teaching Hospital in Lusaka, Zambia

Abstract

Hepatitis B and C viral co-infection in HIV infected patients enrolled in the antiretroviral treatment program at the University Teaching Hospital in Lusaka, Zambia.There are currently few studies describing the prevalence of HIV and viral hepatitis co-infection in Zambia. Such epidemiologic data are critically needed to guide national health policy in the areas of routine hepatitis screening and optimized antiretroviral therapy (ART) for co-infected patients.In this cross-sectional study, we screened HIV-infected ART-eligible adults for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCV) at the University Teaching Hospital in Lusaka, Zambia. We collected basic demographic, medical, and laboratory data to determine predictors for hepatitis and HIV co-infection.From December 2007 to June 2008, we enrolled 323 consecutive patients eligible for HIV treatment. The median age was 37 years (IQR=32.0, 44.0), median CD4 count was 118 cells/ul (1QR= 59, 199) and 174 (54%) were women. Overall, 32 (10%) were found to have active hepatitis B (i.e. HBsAg-positive) while 4 (1%) were diagnosed with hepatitis C. In univariate analysis, patients with hepatitis B co-infection were more likely to be younger than 40 years (84.4% vs. 61.4%; p=0.01) when compared to those who were not co-infected. No differences were noted in baseline WHO stage, CD4 count, or sex of subject as well as exposures to blood transfusion, tattooing and number of sexual partners. Patients with hepatitis B we more likely to have mild to moderately elevated AST/ALT (40-199 lU/L, 15.8% vs. 5.4%; p=0.003). A severe elevation of liver enzymes (> 200 lU/L) was uncommon in this population (2.2%) and not different between the two groups (14.3% vs. 9.7%; p=0.5192). We were unable to determine predictors of hepatitis C infection due to the low prevalence of the disease.HIV and hepatitis B co-infection was common among patients initiating ART at this tertiary care facility in Zambia. Programs to routinely screen for hepatitis B should be considered in this population, given the proven efficacy of optimized ART regimens including tenofovir or lamivudine.