Original Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Hepatol. Jul 27, 2012; 4(7): 218-223
Published online Jul 27, 2012. doi: 10.4254/wjh.v4.i7.218
Prevalence and virological profiles of hepatitis B infection in human immunodeficiency virus patients
Koffi Alain Attia, Serge Eholié, Eugène Messou, Christine Danel, Sandrine Polneau, Henri Chenal, Thomas Toni, Myreille Mbamy, Catherine Seyler, Naomi Wakasugi, Thérèse N’dri-Yoman, Xavier Anglaret
Koffi Alain Attia, Thérèse N’dri-Yoman, Department of General Medicine and Hepato-Gastroenterology, Teaching Hospital of Yopougon, Abidjan 1021, Côte d’Ivoire
Serge Eholié, Department of Infectious and Tropical Diseases, Teaching Hospital of Treichville, Abidjan 1018, Côte d’Ivoire
Eugène Messou, Christine Danel, Sandrine Polneau, Xavier Anglaret, Programme PAC-CI, Abidjan 1018, Côte d’Ivoire
Henri Chenal, Thomas Toni, Myreille Mbamy, Integrated Center of Bioclinical Research of Abidjan, Treichville, Abidjan 1018, Côte d’Ivoire
Catherine Seyler, Xavier Anglaret, INSERM Unité 897, University Victor Segalen Bordeaux 2, Bordeaux 33076, France
Naomi Wakasugi, Japanese Cooperation, Waseda University, Tokyo 162-0041, Japan
Author contributions: Attia KA, Eholie S, N’dri-Yoman T and Anglaret X coordinated the work; Attia KA, Eholie S, Messou E, Danel C, Chenal H and N’dri-Yoman T performed the patients’ inclusion in the four sites identified for the study; Toni T and Mbamy M performed blood tests; Polneau S performed statistical analysis; Seyler C and Wakasugi N contributed to materials support; all authors collaborated in writing the paper, particularly Attia KA, Eholie S and Anglaret X.
Correspondence to: Koffi Alain Attia, Professor, Department of General Medicine, Hepatology and Gastroenterology, Teaching Hospital of Yopougon, PO Box 632 Abidjan 21, Abidjan 1021, Cote D’Ivoire. attia_alain@yahoo.fr
Telephone: +225-5-644984 Fax: +225-22-482222
Received: January 30, 2012
Revised: July 12, 2012
Accepted: July 21, 2012
Published online: July 27, 2012

AIM: To determine the prevalence of hepatitis B virus (HBV) in adult human immunodeficiency virus (HIV) patients with CD4+ T-cell count less than 500/mm3 and without antiretroviral therapy; to describe different HBV-HIV coinfection virological profiles; and to search for factors associated with HBs antigen (HBsAg) presence in these HIV positive patients.

METHODS: During four months (June through September 2006), 491 patients were received in four HIV positive monitoring clinical centers in Abidjan. Inclusion criteria: HIV-1 or HIV-1 and 2 positive patients, age ≥ 18 years, CD4+ T-cell count < 500/mL and formal and signed consent of the patient. Realized blood tests included HIV serology, CD4+ T-cell count, quantitative HIV RNA load and HBV serological markers, such as HBsAg and HBc antibody (anti-HBcAb). We performed HBeAg, anti-HBe antibody (anti-HBeAb), anti-HBc IgM and quantitative HBV DNA load in HBsAg positive patients. Anti-HBsAb had been tested in HIV patients with HBsAg negative and anti-HBcAb-positive. HBV DNA was also tested in 188 anti-HBcAb positive patients with HBsAg negative status and without anti-HBsAb. Univariate analysis (Pearson χ2 test or Fischer exact test) and multivariate analysis (backward step-wise selection logistic regression) were performed as statistical analysis.

RESULTS: Mean age of 491 patients was 36 ± 8.68 years and 73.3% were female. Type-1 HIV was found in 97% and dual-type HIV (type 1 plus type 2) in 3%. World Health Organization (WHO) clinical stage was 1, 2, 3 and 4 respectively in 61 (12.4%), 233 (47.5%), 172 (35%) and 25 patients (5.1%). Median CD4+ T-cell count was 341/mm3 (interquartile range: 221-470). One hundred and twelve patients had less than 200 CD4+ T-cell/mm3. Plasma HIV-1 RNA load was elevated (≥ 5 log10 copies/mL) in 221 patients (45%). HBsAg and anti-HBcAb prevalence was respectively 13.4% and 72.9%. Of the 66 HBsAg positive patients, 22 were inactive HBV carriers (33.3%), 21 had HBeAg positive hepatitis (31.8%) and 20 had HBeAg negative hepatitis (30.3%). HBeAg and anti-HBeAb were indeterminate in 3 of them. Occult B infection prevalence (HBsAg negative, anti-HBcAb positive, anti-HBsAb negative and detectable HBV DNA) was 21.3%. Three parameters were significantly associated with the presence of HBsAg: male [odds ratio (OR): 2.2; P = 0.005; 95% confidence interval (CI): 1.3-3.8]; WHO stage 4 (OR: 3.2; P = 0.01; 95% CI: 1.3-7.9); and aspartate aminotransferase (AST) level higher than the standard (OR: 1.9; P = 0.04; 95% CI: 1.02-3.8).

CONCLUSION: HBV infection prevalence is high in HIV-positive patients. HBeAg positive chronic hepatitis and occult HBV infection are more frequent in HIV-positive patients than in HIV negative ones. Parameters associated with HBsAg positivity were male gender, AIDS status and increased AST level.

Keywords: Hepatitis B virus-human immunodeficiency virus coinfection, Prevalence, Virological profiles, Black Africa