Prevalence of HBeAg, anti-HBe serological markers and HBV-DNA in asymptomatic carriers in Ethiopia

Hepatitis B and C viral coinfections and their association with HIV viral load suppression among HIV-1 infected patients on ART at Mekelle hospital, northern Ethiopia

BACKGROUND

Although Ethiopia is endemic to viral hepatitis and HIV, data that could guide population-specific interventions are limited. In this study, we determined the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) and assessed their associations with HIV-1 viral load suppression among HIV-1 infected patients on antiretroviral therapy (ART) at Mekelle hospital in northern Ethiopia.

METHODS

Between February and April 2020, blood samples were collected from 439 participants. Samples were screened for HBsAg and anti-HCV on the immunochromatographic test and confirmed using the Enzyme-Linked Immuno-sorbent assay (Beijing Wantai Co. China). HIV-1 viral load was quantified using reverse transcription-polymerase chain reaction (RT-PCR) on the Abbott platform. Binary and multivariable logistic regression was performed to identify potential predictors.

RESULTS

Overall, 10% (44/439) and 3.6% (16/439) of the participants were coinfected with HBV and HCV, respectively. In a multivariate analysis, being illiterate (AOR = 6.57; 95% CI 1.04-41.6), and having a history of sexually transmitted infections (AOR = 4.44; 95% CI 1.31-15.0) and multiple sexual partners (AOR = 29.9; 95% CI 7.82-114.8) were associated with HBV infection. On the other hand, participants with a history of chronic non-communicable diseases (AOR = 10.6, 95% CI 1.61-70.1), and those reporting a history of sexually transmitted infections (AOR = 5.21, 95% CI 1.39-19.5) were more likely to be infected with HCV. In further analysis, HCV infection status was significantly associated with decreased viral load suppression rate (AOR = 7.14; 95% CI 2.18-23.3) whereas no significant association was observed with the HBV infection.

CONCLUSIONS

The HBV coinfection rate in our study is high and, as per WHO's standard, corresponds to a hyperendemic level. The HCV coinfection rate is also substantially high and urges attention given its influence on the viral load suppression of HIV patients on ART at our study site. Our findings suggest the need to adopt universal screening and vaccination of people with HIV against HBV and screening for HCV at our study site and in Ethiopia at large, which contributes to Ethiopia's progress towards the 2030 global target of reducing the HBV infection.

Hepatitis B Virus Infection and Associated Factors Among Adults in Southwest Ethiopia: Community-Based Cross-Sectional Study

Purpose

Ethiopia is grouped with countries with no national strategy for surveillance of viral hepatitis. Hence, data on hepatitis B virus (HBV) infection in the general population are limited. The aim of this study was to estimate the prevalence and associated factors of HBV infection among adults in Southwest Ethiopia.

Materials and Methods

A community-based cross-sectional study was conducted in Southwest Ethiopia, from November 1, 2017–January 30, 2018. A total of 612 individuals were included in the study using a multistage sampling technique. A structured questionnaire was used to collect data and a whole blood sample was aseptically collected and tested for HBsAg using a commercially available rapid serological test kit. Bivariate and multivariate logistic regression were employed and odds ratio with 95% confidence interval was retrieved. P-value <0.05 was considered as statistically significant.

Results

Among 612 participants, half of them, 310 (50.7%), were in the age range of 25–34 years. The mean age of the respondents was 32.5 [SD ±7.5] years. Seroprevalence of HBsAg among adults was 55/612 (9.0%). Tattooing on gums (AOR=23.9, 95% CI (2.2–26.3)), tattooing on the body (AOR=6.8, 95% CI (1.1–43.1)), and contact with a jaundiced person (AOR=20.7, 95% CI (6.7–63.8)) were significantly associated with seroprevalence of HBsAg.

Conclusion

Hepatitis B virus infection in adults at the community level is highly endemic. Modifiable risk factors such as tattooing on gums, tattooing on body, and contact with a jaundiced person account for the high HBV infection. Hence, behavioral education and communication programs designed to reduce HBV infection need to address these modifiable factors.

Hepatitis viruses in Ethiopia: a systematic review and meta-analysis

BACKGROUND

The existing seroepidemiological data on viral hepatitis in Ethiopia showed a wide variation in prevalence pattern and the clinical and public health burden have been underestimated. The aim of this systematic review and meta-analysis was to provide a clear and comprehensive estimation of viral hepatitis epidemiology and the potential clinical burdens in Ethiopia.

METHODS

A comprehensive literature search was carried out from five decades (1968-2015) published studies from biomedical databases; PubMed, Google scholar, Medline and Web of Science.

RESULTS

The overall pooled prevalence of hepatitis B virus (HBV) was 7.4% (95%CI: 6.5-8.4). The pooled prevalence among subgroups showed 5.2% (95%CI: 3.7-7.4) in human immunodeficiency virus (HIV) infected individuals, 8.0% (95%CI: 5.9-10.7) in community based studies, 8.4% (95%CI: 5.4-12.7) in blood donors, 11.0% (95%CI: 7.5-15.9) in immigrants and 6.9% (95%CI: 5.6-8.5) in other groups. Among study parameters considered during meta-regression analysis, only study years were associated with a decreasing HBV prevalence rate over time. The overall pooled prevalence of anti-hepatitis C virus antibody (anti-HCV) was 3.1% (95%CI: 2.2-4.4). Unlike HBV, the anti-HCV prevalence in HIV infected individuals was higher (5.5%, 95%CI: 3.8-7.8%, p = 0.01) than the prevalence observed in the other subgroup of study population. Although relatively few data were available, hepatitis virus A (HAV), D (HDV) and E (HEV) were also circulated in Ethiopia.

CONCLUSIONS

This review indicates that all types of viral hepatitis origins are endemic in Ethiopia. Adapting a recommended diagnostic and treatment algorithm of viral hepatitis in the routine healthcare systems and implementing prevention and control policies in the general population needs an urgent attention.

Familial pattern of infection with hepatitis B virus among immigrating Ethiopian Jews in Israel

Seventy-eight families (506 members) of recently immigrating Ethiopian Jews to Israel, were tested for the presence of HBV serological markers to evaluate the intrafamilial horizontal transmission of the virus. Eighty-four members (16.6%) were carriers and 20.2% were HBeAg positive, the overall infection rate was 67.8%. In 40 families (51.3%) at least one family member was HBsAG positive, and in 19 families (24.4%) two or more family members were HBsAg positive. Thirty-six carriers (42.8%) were children under the age of 10, by one year of age 30% have contracted the virus, and by the age of 5 and 10 years 43.5% and 57.1% have had serological markers for past HBV infection, respectively. Our data correlate with other studies regarding the importance of horizontal spread of HBV among Sub-Saharan Africans.

Age- and sex-related study of HBV-DNA in HBsAg asymptomatic children from an endemic area (Cameroon)

A sero-epidemiological survey was carried out in Cameroon in January 1989 on a sample of 702 children of primary school age. A high HBV endemicity level was observed: 60.3% of the sera were positive to any HBV marker, 23.2% (163 sera) were HBsAg-positive. HBV-DNA positivity was observed in 38/163 (23.3%), thus showing a high level of infectivity among these carriers. Seventy-seven HBsAg-positive sera were tested for HBeAg/anti-HBe: 20 (26%) were HBeAg-positive 31 (40%) anti-HBe-positive, and 26 (34%) were negative for both. All sera were anti-HD-negative. Twenty-five per cent of HBeAg-positive sera were HBV-DNA-negative. This finding could be explained by a delayed HBeAg/anti-HBe seroconversion phase with fluctuant HBV-DNA. Only one case of HBV-DNA-positive anti-HBe-positive serum was observed. This study showed that HBV-DNA prevalence was significantly higher in boys (31.8%) than in girls (14.1%) (p less than 0.02). This difference was not observed for any HBV marker. We therefore conclude that in boys a prolonged HBV replicative phase might explain the observed high chronicity rate.