Relationship of HIV/HBV Co-Infection with CD4 Cell Count and Alanine Transaminase Levels in Anti-Retroviral Therapy Naive Patients / A Cross0Sectional Study

Abstract

Hepatitis B virus (HBV) survives and replicates in the liver. In adults, it is mostly transmitted sexually. Because of this shared route with Human Immune Deficiency Virus (HIV), it is highly prevalent in HBV infected patients In sub-Saharan Africa, the prevalence of HBV is between 6-20%. In Zambia, prevalence of HIV and HBV co-infection has been reported to be between 7.1% and 31.1%. Patients infected with HBV are at increased risk of experiencing elevated Alanine Transaminase enzyme (ALT) and HIV/HBV co-infection which may lead to reduced CD4 cell count before ART initiation. We investigated the relation of HBV with CD4 cell count and Alanine Transaminase enzyme in HIV positive Anti-Retroviral Therapy-naïve patients. This was a cross-sectional study conducted in 15 government clinics in Lusaka. There were 5,436 patients who initiated antiretroviral therapy between 2011 and 2013. The data was captured using SMART CARE and Laboratory Information Management System at Centre for Infectious Disease Research in Zambia. Cases were described as HIV positive patients who tested HBsAg-positive and controls as HIV positive patients who tested HBsAg-negative. Prevalence of HIV/HBV co-infection was defined as the number of patients who tested HBsAg-positive divided by the total tested (with 95% confidence interval). Laboratory measures of CD4 and ALT were categorized in the analysis. Elevated ALT was defined as ALT ≥ 66 IU/ml. CD4 cell count was dichotomized CD4 of > 200 Cells/μl. The median age was 35 years with the highest number (44.8%) in the age group 30-39 years. The median CD4 cell count was 202 Cells/μl with the median ALT being 20 IU/ml. HIV/HBV prevalence was 12.3% (95% CI 11.4-13.1) Elevated ALT was reported in 11.1% in cases and 4.7% in controls. HIV/HBV patients had 2.4 times the odds (95% CI 1.8-3.2) of experiencing elevated ALT before ART initiation compared to their HIV mono-infected counterparts. Of the cases, 53.5% had a CD4<200 while only 48.9% of controls had CD4<200 before ART initiation (p-value 0.026). HIV/HBV co-infection was highly prevalent in ART-naïve patients. CD4 cell count was lower in patients who were HBsAg positive and our results showed that there was an association between HBV and CD4 cell count. This association was that having HBV increases the risk for CD4<200 at ART initiation. This is consistent with other studies that show that co-infections in HIV patients lead to further reduction of the CD4 count. Having HBV also increased the odds of one experiencing an elevated ALT before ART initiation, suggesting that the observed ALT elevation is due to damage to the hepatocytes by the body. In ART-naïve patients, the prevalence of HIV/HBV co-infection was high. HBV was associated with CD4 cell count <200 and elevated ALT at ART initiation. Hepatitis B virus (HBV), HIV, ALT, CD4