Brief Article
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World J Gastroenterol. Mar 14, 2013; 19(10): 1602-1610
Published online Mar 14, 2013. doi: 10.3748/wjg.v19.i10.1602
Rates and impact of hepatitis on human immunodeficiency virus infection in a large African cohort
Nimzing Gwamzhi Ladep, Patricia Aladi Agaba, Oche Agbaji, Auwal Muazu, Placid Ugoagwu, Godwin Imade, Graham Cooke, Sheena McCormack, Simon David Taylor-Robinson, John Idoko, Phyllis Kanki
Nimzing Gwamzhi Ladep, Graham Cooke, Simon David Taylor-Robinson, Section of Hepatology, Department of Medicine, Imperial College London, St Mary’s Hospital Campus, London W2 1NY, United Kingdom
Patricia Aladi Agaba, Oche Agbaji, Auwal Muazu, Placid Ugoagwu, Godwin Imade, John Idoko, AIDS Prevention Initiative in Nigeria, Jos University Teaching Hospital, Jos 930001, Nigeria
Sheena McCormack, MRC Clinical Trials Unit, London, London NW1 2DA, United Kingdom
John Idoko, National Agency for the Control of AIDS, Central Business District, Abuja 905001, Nigeria
Phyllis Kanki, Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA 02115-5810, United States
Author contributions: Ladep NG, Muazu A, Cooke G and Idoko J designed, carried out part of clinical duties, analysed data; Agaba PA, Agbaji O and Ugoagwu P collated data, checked statistical correctness of the analysis helped with ethical processes and approved the use of data at study site; Ladep NG, Agaba PA, Imade G, Cooke G, McCormack S, Taylor-Robinson SD, Idoko J and Kanki P wrote up and approved final version of manuscript.
Supported by The United States Health Resources and Services Administration (U51HA02522-01-01); the Prevention of Liver Fibrosis and Carcinoma in Africa (PROLIFICA) project (EU-Framework 7); the United Kingdom National Institute for Healthcare Research (NIHR); and the London Clinic Research Fellowship Scheme
Correspondence to: Nimzing Gwamzhi Ladep, MD, Liver Unit, Imperial College London, St Mary’s Hospital Campus, 10th Floor, QEQM Building, South Wharf Road, London W2 1NY, United Kingdom. n.ladep@imperial.ac.uk
Telephone: +44-203-3121909 Fax: +44-203-3121909
Received: August 28, 2012
Revised: December 7, 2012
Accepted: January 23, 2013
Published online: March 14, 2013
Abstract

AIM: To determine the rates and impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections on response to long-term highly active antiretroviral therapy (HAART) in a large human immunodeficiency virus (HIV) population in Nigeria.

METHODS: HBV and HCV as well as HIV infections are endemic in sub Saharan Africa. This was a retrospective cohort study of 19 408 adults who were recruited between June 2004 and December 2010 in the AIDS Prevention Initiative in Nigeria in Nigeria programme at Jos University Teaching Hospital. Serological assays, including HBV surface antigen (HBsAg) and hepatitis C antibody were used to categorise hepatitis status of the patients. HBsAg was determined using enzyme immunoassay (EIA) (Monolisa HBsAg Ultra3; Bio-Rad). HCV antibody was tested using third generation EIA (DIA.PRO Diagnostic, Bioprobes srl, Milan, Italy). HIV RNA levels were measured using Roche COBAS Amplicor HIV-1 monitor test version 1.5 (Roche Diagnostics, GmbH, Mannheim, Germany) with a detection limit of 400 copies/mL. Flow cytometry was used to determine CD4+ cell count (Partec, GmbH Munster, Germany). Comparison of categorical and continuous variables were achieved using Pearson’s χ2 and Kruskal Wallis tests respectively, on MedCalc for Windows, version 9.5.0.0 (MedCalc Software, Mariakerke, Belgium).

RESULTS: With an overall hepatitis screening rate of over 90% for each virus; HBV, HCV and HBV/HCV were detected in 3162 (17.8%), 1983 (11.3%) and 453 (2.5%) HIV infected adults respectively. The rate of liver disease was low, but highest among HIV mono-infected patients (29, 0.11%), followed by HBV co-infected patients (15, 0.08%). Patients with HBV co-infection and triple infection had higher log10 HIV RNA loads (HBV: 4.6 copies/mL vs HIV only: 4.5 copies/mL, P < 0.0001) and more severe immune suppression (HBV: 645, 55.4%; HBV/HCV: 97, 56.7%) prior to initiation of HAART compared to HIV mono-infected patients (1852, 48.6%) (P < 0.0001). Of 3025 patients who were 4.4 years on HAART and whose CD4 cell counts results at baseline and end of follow up were available for analyses, CD4 increase was significantly lower in those with HBV co-infection (HBV: 144 cells/mm3; HBV/HCV: 105 cells/mm3) than in those with HCV co-infection (165 cells/mm3) and HIV mono-infection (150 cells/mm3) (P = 0.0008).

CONCLUSION: High rates of HBV and HCV infections were found in this HIV cohort. CD4 recovery was significantly diminished in patients with HBV co-infection.

Keywords: Human immunodeficiency virus, Hepatitis B, Hepatitis C, Africa, Liver disease