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Prevalence of Hepatitis B virus (HBV) and occult HBV infections among pregnant women coinfected with human immunodeficiency virus type-1 (HIV-1) in Malawi: The BAN study
C. Chasela*[1,2], P. Wall[2], E. Teshale[3], M. Hosseinpour[1], J. Drobeniuc[3], S. Ellington[4], M. Codd[2], W. Powderly[2], G. Tegha[1], C. Chavula[1], D. Kayira[1], P. Fitzpatrick[2], A. Kourtis[4], C. van der Horst[5], The UNC Project BAN Study Team
[1]UNC Project - Lilongwe, Lilongwe, Malawi, [2]University College Dublin, School of Public Health and Epidemiology, Dublin, Ireland, [3]U.S. Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, United States, [4]U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, United States, [5]University of North Carolina - Chapel Hill, Center for Infectious Diseases, Chapel Hill, United States
Background: HIV-1 and HBV are common infections in sub-Saharan Africa. Studies have shown a high rate of occult HBV infection among HIV-infected persons. We determined the prevalence of chronic and occult HBV infection among HIV-infected pregnant women enrolled in the Breastfeeding, Antiretrovirals and Nutrition (BAN) study in Lilongwe, Malawi.
Methods: We tested 2052 HIV-infected women from the BAN study for total antibody to hepatitis B core antigen (HBcAb). Those HBcAb-positive were tested for hepatitis B surface antigen (HBsAg). Both HBcAb and HBsAg testing used chemiluminescent immunoassay (Vitros ECi, Ortho CD, Rochester, NY). The first 85 HBsAg-positive women were tested for HBV DNA. Similarly, to determine occult HBV infection, HBV DNA testing was performed on the first 82 HBcAb-positive, HBsAg-negative women. Means (± standard deviation), medians (interquartile range [IQR]) and associations between demographic/health characteristics and HBV markers were calculated.
Results: The 2052 women had a mean age of 25.8 (±5.1) years, median parity 3 (IQR: 2-4), and median CD4 count 418 (IQR: 300-571) cells/υl. Overall, 0.4% of women reported a history of jaundice, 5.8% a history of sexually transmitted infections, 0.9% had abnormal ALT values and 2.0% tested positive for syphilis (RPR). Overall 48.3% (992/2052) tested HBcAb-positive and 10.4% (103/990) HBsAg-positive. Of 85 HBsAg-positive women, 64 (75.3%) were HBV DNA-positive. Of 82 women tested for occult infection 5 (6.1%) were HBV DNA-positive. HBsAg was associated with a positive RPR (unadjusted odds ratio 4.39, 95% CI: 1.71-11.20, P< 0.0007). There were no significant differences in age, CD4 count, parity and ALT level according to HBV status.
Conclusions: HIV/HBV co-infection is highly prevalent among pregnant women in Lilongwe, Malawi. Overt and occult co-infections need to be considered when implementing treatment and prevention programs to reduce mother to child transmission of these viruses.
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