Prevalence of hepatitis B virus, HIV and HBV coinfection and associated factors in pregnant women attending antenatal care at the university teaching hospital,Lusaka,Zambia

Abstract

Human Immunodeficiency virus (HIV) and Hepatitis B virus (HBV) are a global public health problem which share common risk factors and modes of transmission. Perinatal transmission is the major route of HBV transmission in endemic areas. Without vaccination, the newborn infant has 10 - 20% risks of developing chronic hepatitis B if the mother is positive for HBsAg, and 90%, if also positive for the HBeAg. The burden of HBV infection in pregnant women at the University Teaching Hospital (UTH) is not known. Hence this study explored the prevalence of HBV infection in HIV positive and HIV negative pregnant women and associated factors. This was a comparative cross-sectional study. A total of 316 pregnant women aged 16-46years were recruited including 158 HIV negative and 158 HIV positive. Recruitment of consenting participants for each subgroup in a 1:1 ratio was done from the antenatal ward until the sample size was attained. A structured questionnaire was administered for socio-demographic data to women with a known HIV status recorded on their antenatal cards. Blood for HBsAg screening were also collected. Data collection was done between 15th Dec 2016 and 30th May, 2017. Of the 316 study participants 11(3.5%) tested positive for HBsAg showing intermediate endemicity. There was no statistical difference in the prevalence of HBV in the HIV negative and HIV positive pregnant women (3.8% and 3.2% respectively, P=0.76. Similarly, there was no association between the age, marital status, parity, residence, religion, education level or form of employment with HBV infection. However, HIV antiretroviral treatment seems to have a protective effect on acquisition of HBV infection [OR = 0.09, CI = 0.01 – 0.63, P = 0.02] Given that no significant differences in the prevalence of HBV in the HIV positive and HIV negative were found, all pregnant women regardless of their HIV status or socio-demographic factors should routinely be screened for Hepatitis B as is recommended by the WHO. Policy makers should make available the Hepatitis B vaccine and Immunoglobulin for infants whose mothers test positive for HBsAg especially those that are also positive for HBeAg. All pregnant women should be counseled on hepatitis B concurrently as the HIV counseling is taking place to increase awareness. All HIV positive women should be encouraged to take antiretroviral drugs as it seems to have a protective effect on the acquisition of HBV infection. A large multi-centre study is, however, necessary to explore this association. Key words: Hepatitis B, Hepatitis C, HIV, Pregnancy