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Mathew A, Ismael N, Meeds H, Vubil A, Zicai AF, Mabunda N, Blackard JT. Hepatitis B virus genotypes and drug resistance mutations circulating in blood donors in Beira, Mozambique. PLoS One 2023; 18:e0281855. [PMID: 36795797 PMCID: PMC9934330 DOI: 10.1371/journal.pone.0281855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
Hepatitis B virus (HBV) infects nearly 300 million people and is the leading cause of hepatitis and hepatocellular carcinoma worldwide. Despite the high burden of HBV in sub-Saharan Africa, countries such as Mozambique have limited data available on circulating HBV genotypes and the presence of drug resistance mutations. Blood donors from Beira, Mozambique were tested for HBV surface antigen (HBsAg) and HBV DNA at the Instituto Nacional de Saúde in Maputo, Mozambique. Regardless of HBsAg status, donors with detectable HBV DNA were evaluated for HBV genotype. PCR was performed with primers amplifying a 2.1-2.2 kilobase fragment of the HBV genome. PCR products were submitted for next generation sequencing (NGS), and consensus sequences were evaluated for HBV genotype, recombination, and the presence or absence of drug resistance mutations. Of the 1281 blood donors tested, 74 had quantifiable HBV DNA. The polymerase gene could be amplified from 45 of 58 (77.6%) individuals with chronic HBV infection and 12 of 16 (75%) with occult HBV infection. Among these 57, 51 (89.5%) sequences belonged to HBV genotype A1, while 6 (10.5%) were HBV genotype E. All genotype E sequences were E/A recombinants, and clustered separately from other genotype E references. Genotype A samples had a median viral load of 637 IU/mL, while genotype E samples had a median viral load of 476,084 IU/mL. No drug resistance mutations were observed in the consensus sequences. The current study demonstrates the genotypic diversity of HBV in blood donors in Mozambique, but the absence of dominant (consensus) drug resistance mutations. Studies in other at-risk populations are essential for understanding the epidemiology, risk of liver disease, and likelihood of treatment resistance in resource-limited settings.
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Affiliation(s)
- Ann Mathew
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Nalia Ismael
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Heidi Meeds
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Adolfo Vubil
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | | | - Jason T. Blackard
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
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Prevalence of hepatitis B virus and immunity status among healthcare workers in Beira City, Mozambique. PLoS One 2022; 17:e0276283. [PMID: 36240262 PMCID: PMC9565706 DOI: 10.1371/journal.pone.0276283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection can be prevented by vaccination. Exposure to blood or body fluids poses a high risk of transmission of HBV in health care workers (HCWs). This study aimed to determine the prevalence of markers of exposure, susceptibility, and protection to HBV infection in HCWs in Beira, Mozambique. METHODS A cross-sectional study was conducted between June and August 2020 in Beira City, Mozambique, in HCWs based on self-administered questionnaires and blood samples. Plasma samples were tested for HBV surface antigen (HBsAg), antibodies to HBV core antigen (anti-HBc), antibodies to HBsAg (anti-HBs) and HBV viral load (HBV DNA). RESULTS Most of the 315 HCWs in the study were nurses (125; 39.7%). Of the HCWs, 5.1% (16; 95% Confidence Interval (CI): 2.9 to 8.1%) were infected by HBV (HBsAg and/or HBV DNA positive). Occult HBV infection (OBI) (HBV DNA positive and HBsAg negative) was found in 0.3% (1; 95% CI: 0.0 to 1.8%) of participants; 27.9% (88; 95% CI: 23.1 to 33.2%) were susceptible (negative for all markers), 6.3% (20; 95% CI: 3.9 to 9.6) were immune due to natural infection (anti-HBs and anti-HBc positive only), while 60% (189; 95% CI: 54.4 to 65.5) were immune due to vaccination (anti-HBs positive only). CONCLUSION This study showed a high intermediate prevalence of chronic hepatitis B among healthcare workers in Beira City, Central Mozambique, and one-third of healthcare workers were susceptible to HBV infection. There is a need to implement a national hepatitis B screening and vaccination strategy among healthcare workers in Mozambique.
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Loarec A, Nguyen A, Molfino L, Chissano M, Madeira N, Rusch B, Staderini N, Couto A, Ciglenecki I, Antabak NT. Prevention of mother-to-child transmission of hepatitis B virus in antenatal care and maternity services, Mozambique. Bull World Health Organ 2022; 100:60-69. [PMID: 35017758 PMCID: PMC8722623 DOI: 10.2471/blt.20.281311] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022] Open
Abstract
Objective To pilot an intervention on the prevention of mother-to-child transmission (PMTCT) of hepatitis B virus (HBV) in an antenatal care and maternity unit in Maputo, Mozambique, during 2017–2019. Methods We included HBV in the existing screening programme (for human immunodeficiency virus (HIV) and syphilis) for pregnant women at their first consultation, and followed mother–child dyads until 9 months after delivery. We referred women who tested positive for hepatitis B surface antigen (HBsAg) for further tests, including hepatitis B e antigen (HBeAg) and HBV viral load. According to the results, we proposed tenofovir for their own health or for PMTCT. We administered birth-dose HBV vaccine and assessed infant HBV status at 9 months. Findings Of 6775 screened women, 270 (4.0%) were HBsAg positive; in those for whom data were available, 24/265 (9.1%) were HBeAg positive and 14/267 (5.2%) had a viral load of > 200 000 IU/mL. Ninety-eight (36.3%) HBsAg-positive women were HIV coinfected, 97 of whom were receiving antiretroviral treatment with tenofovir. Among HIV-negative women, four had an indication for tenofovir treatment and four for tenofovir PMTCT. Of 217 exposed liveborn babies, 181 (83.4%) received birth-dose HBV vaccine, 160 (88.4%) of these < 24 hours after birth. At the 9-month follow-up, only one out of the 134 tested infants was HBV positive. Conclusion Our nurse-led intervention highlights the feasibility of integrating PMTCT of HBV into existing antenatal care departments, essential for the implementation of the triple elimination initiative. Universal birth-dose vaccination is key to achieving HBV elimination.
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Affiliation(s)
- Anne Loarec
- Médecins Sans Frontières - Mozambique, Av. Tomas Nduda 1489, Maputo, Mozambique
| | - Aude Nguyen
- Operational Centre, Médecins Sans Frontières, Geneva, Switzerland
| | - Lucas Molfino
- Médecins Sans Frontières - Mozambique, Av. Tomas Nduda 1489, Maputo, Mozambique
| | - Mafalda Chissano
- Médecins Sans Frontières - Mozambique, Av. Tomas Nduda 1489, Maputo, Mozambique
| | - Natercia Madeira
- Médecins Sans Frontières - Mozambique, Av. Tomas Nduda 1489, Maputo, Mozambique
| | - Barbara Rusch
- Operational Centre, Médecins Sans Frontières, Geneva, Switzerland
| | - Nelly Staderini
- Operational Centre, Médecins Sans Frontières, Geneva, Switzerland
| | - Aleny Couto
- Ministry of Health of Mozambique, Maputo, Mozambique
| | - Iza Ciglenecki
- Operational Centre, Médecins Sans Frontières, Geneva, Switzerland
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Deng H, Feng Q, Wu Y, Lin H, Cao X, Xiang F, Li L, Yu W. Immune response to hepatitis B vaccination in human immunodeficiency virus-positive patients in China: A 2-year retrospective study. J Med Virol 2021; 94:2684-2693. [PMID: 34905230 DOI: 10.1002/jmv.27523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/15/2021] [Accepted: 12/11/2021] [Indexed: 11/08/2022]
Abstract
Currently, the studies focused on the immune response to hepatitis B vaccination in Chinese human immunodeficiency virus (HIV)-positive patients are limited. In this study, the participants with an initial hepatitis B surface antibody (HBsAb) titer <10 mIU/ml were assigned to Cohort 1 to receive a standard dose of recombinant hepatitis B vaccine, and participants with an initial HBsAb titer between 10 and 100 mIU/ml were assigned to Cohort 2 to receive a single reinforced recombinant vaccine. In Cohort 1, the immune and high response rates in HIV-positive patients were 93.4%/81.4%, 87.4%/51.5%, and 83.2%/40.7% at 1-3 months, 1 year, and 2 years postvaccination. Multivariate analysis showed that only age and HIV RNA status at baseline were independent factors related to sustained immune response at 2 years postvaccination. In Cohort 2, the high immune response rates in HIV-positive patients were 78.8%, 60.6%, and 51.5% at 1-3 months, 1 year, and 2 years postvaccination. The immune or high response rates did not differ between HIV-positive patients and healthy controls at 1-3 months postvaccination in these two cohorts; however, HBsAb titers were significantly lower in HIV-positive patients. This study summarized the 2-year data of immune response to hepatitis B vaccination and analyzed the factors related to sustained immune response at 2 years postvaccination in Chinese HIV-positive patients.
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Affiliation(s)
- Haohui Deng
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Qianchang Feng
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yue Wu
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Haowei Lin
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xin Cao
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fangfei Xiang
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Weihua Yu
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
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Sagnelli C, Pisaturo M, Curatolo C, Codella AV, Coppola N, Sagnelli E. Hepatitis B virus/hepatitis D virus epidemiology: Changes over time and possible future influence of the SARS-CoV-2 pandemic. World J Gastroenterol 2021; 27:7271-7284. [PMID: 34876788 PMCID: PMC8611207 DOI: 10.3748/wjg.v27.i42.7271] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/20/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatitis D virus (HDV) is a defective liver-tropic virus that needs the helper function of hepatitis B virus (HBV) to infect humans and replicate. HDV is transmitted sexually or by a parenteral route, in co-infection with HBV or by super-infection in HBV chronic carriers. HDV infection causes acute hepatitis that may progress to a fulminant form (7%-14% by super-infection and 2%-3% by HBV/HDV co-infection) or to chronic hepatitis (90% by HDV super-infection and 2%-5% by HBV/HDV co-infection), frequently and rapidly progressing to cirrhosis or hepatocellular carcinoma (HCC). Peg-interferon alfa the only recommended therapy, clears HDV in only 10%-20% of cases and, consequently, new treatment strategies are being explored. HDV endemicity progressively decreased over the 50 years from the identification of the virus, due to improved population lifestyles and economic levels, to the use of HBV nuclei(t)side analogues to suppress HBV replication and to the application of universal HBV vaccination programs. Further changes are expected during the severe acute respiratory syndrome coronavirus-2 pandemic, unfortunately towards increased endemicity due to the focus of healthcare towards coronavirus disease 2019 and the consequently lower possibility of screening and access to treatments, lower care for patients with severe liver diseases and a reduced impulse to the HBV vaccination policy.
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Affiliation(s)
- Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples 80131, Italy
| | - Mariantonietta Pisaturo
- Department of Mental Health and Public Medicine, University of Campania, Naples 80135, Italy
| | - Caterina Curatolo
- Department of Mental Health and Public Medicine, University of Campania, Naples 80135, Italy
| | - Alessio Vinicio Codella
- Department of Mental Health and Public Medicine, University of Campania, Naples 80135, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, University of Campania, Naples 80135, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples 80131, Italy
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Weldemhret L. Epidemiology and Challenges of HBV/HIV Co-Infection Amongst HIV-Infected Patients in Endemic Areas: Review. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:485-490. [PMID: 33981165 PMCID: PMC8107003 DOI: 10.2147/hiv.s273649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022]
Abstract
With the introduction of highly active antiretroviral treatment, HIV-related morbidity and mortality have declined. But underlying hepatitis B virus infection remains the major cause of AIDS-defined illness and liver-related disease progression mainly in endemic settings. Moreover, HBV-HIV co-infection is the leading cause of cirrhosis, hepatocellular carcinoma, and liver-related death. This review paper emphasizes reviewing the burden and impact of HBV-HIV co-infection in liver-related disease progression, immune recovery, and therapeutic management of HIV-infected individuals on ART regimen.
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Surial B, Wyser D, Béguelin C, Ramírez-Mena A, Rauch A, Wandeler G. Prevalence of liver cirrhosis in individuals with hepatitis B virus infection in sub-Saharan Africa: Systematic review and meta-analysis. Liver Int 2021; 41:710-719. [PMID: 33220137 PMCID: PMC8048614 DOI: 10.1111/liv.14744] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/26/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Chronic hepatitis B virus (HBV) infection accounts for 30%-50% of cirrhosis related deaths in sub-Saharan Africa (SSA). Since HBV-related cirrhosis is an indication for immediate antiviral therapy and cancer surveillance, we aimed to estimate the prevalence of cirrhosis among treatment-naïve patients with chronic HBV infection in SSA. METHODS We performed a systematic review of published articles which evaluated liver fibrosis stage among treatment-naïve HBV-infected individuals who presented to care in SSA. Our primary outcome was the prevalence of cirrhosis in HBsAg-positive persons, which was estimated using random-effects meta-analysis. Risk factors for cirrhosis were explored using subgroup-analyses and multivariable meta-regression. RESULTS Of 2129 articles identified, 17 met our eligibility criteria. The studies described 22 cohorts from 13 countries, including 13 cohorts (3204 patients) with chronic HBV mono-infection and nine cohorts (688 patients) with HIV/HBV-coinfection. Liver fibrosis was assessed using transient elastography (10 cohorts), APRI score (11 cohorts), and Fibrotest (one cohort). The pooled prevalence of cirrhosis was 4.1% (95% confidence interval [CI] 2.6-6.4) among studies from primary care facilities or general population, compared to 12.7% (95% CI 8.6-18.3) in studies performed in referral or tertiary care facilities (adjusted odds ratio 0.29, 95% CI 0.15-0.56). We found no association between cirrhosis and age, gender, fibrosis test used or HIV-coinfection. CONCLUSIONS Depending on the setting, between 4% and 13% of HBV-infected individuals in SSA have cirrhosis and need immediate antiviral therapy. These estimates should be considered when planning HBV treatment strategies and resource allocation.
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Affiliation(s)
- Bernard Surial
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik Wyser
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Charles Béguelin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrià Ramírez-Mena
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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8
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Opaleye OO, Akanbi OA, Osundare FA, Wang B, Adesina O, Oluremi AS, Sunday ST, Akindele AA, Klink P, Bock CT. Prevalence and characteristics of hepatitis B and D virus infections among HIV-positive individuals in Southwestern Nigeria. Virol J 2021; 18:20. [PMID: 33446224 PMCID: PMC7809746 DOI: 10.1186/s12985-021-01493-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Coinfections of HIV-positive individuals with Hepatitis B and D virus (HBV and HDV) are common and can be associated with rapid liver damage. Several antiretroviral drugs for HIV exhibit anti-HBV effect; however, the selection of HBV drug resistance mutations (DRMs) in individuals under HIV antiretroviral therapy (ART) has been reported but rarely in Nigeria. In this study the HBV/HDV prevalence and HBV DRMs in HIV-positive individuals in Southwestern Nigeria were assessed.
Methods Plasma samples collected from 310 HIV-positive individuals including 295 ART-experienced and 15 ART-naïve persons attending the HIV clinic in three south-western states of Nigeria between June 2017 and August 2017 were analysed by ELISA for HBsAg and anti-HDV. The presence of HDV RNA and HBV DNA was analysed by (RT)-PCR followed by sequencing and phylogenetic analyses for genotyping. The HBV reverse transcription (RT) region was amplified and sequenced for the analysis of drug resistance mutations. Results Overall, 16.1% (n = 50/310) of the HIV-positive individuals were positive for HBsAg, most of which were ART-experienced (94.0%; n = 47/50). From the 50 HBsAg-positive samples, 72.0% (n = 36/50) were positive for HBV DNA and 16.0% (n = 8/50) had detectable HDV RNA while 5.6% (n = 2/36) of the HBV-DNA positive samples had anti-HDV total antibodies. Sequences were available for 31/36 of the HBV DNA-positive and 3/8 HDV RNA-positive samples. HBV DNA-positive samples were characterised as HBV genotype E infections exclusively, while HDV genotype 1 was detected in the HDV RNA-positive samples. HBV DRMs V173L, L180M, S202I and M204V/I, which are associated with lamivudine resistance, were detected in 32.2% (n = 10/31) of the HBV DNA-positive samples. Most of these mutations (90.0%; n = 9/10) were present in the ART-experienced cohort. Conclusions This study indicates that HBV/HDV coinfections are common in HIV-positive individuals under ART in Nigeria. Furthermore, a high proportion of HBV DRMs which potentially compromise future treatment options were detected, underscoring the need for HBV screening prior to starting ART. Further studies should be performed to monitor a possible increase in the spread of HDV among populations at risk of HIV and HBV infections.
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Affiliation(s)
- Oluyinka Oladele Opaleye
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Olusola Anuoluwapo Akanbi
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria.,Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Folakemi Abiodun Osundare
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria.,Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Bo Wang
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Olufisayo Adesina
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany.,Department of Microbiology, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Adeolu Sunday Oluremi
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Sola Thomas Sunday
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Abiodun Akeem Akindele
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Patrycja Klink
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - C Thomas Bock
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany. .,Institute of Tropical Medicine, University of Tuebingen, Tuebingen, Germany.
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Meier-Stephenson V, Deressa T, Genetu M, Damtie D, Braun S, Fonseca K, Swain MG, van Marle G, Coffin CS. Prevalence and molecular characterization of occult hepatitis B virus in pregnant women from Gondar, Ethiopia. CANADIAN LIVER JOURNAL 2020; 3:323-333. [PMID: 35990510 PMCID: PMC9202741 DOI: 10.3138/canlivj-2019-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND: The greatest risk of chronic hepatitis B (CHB) is from mother-to-child transmission. Approximately 20% of individuals in sub-Saharan Africa are hepatitis B virus (HBV) surface antigen–positive (HBsAg+), but the prevalence of occult hepatitis B (OHB) is unknown. Aim: This study investigated CHB and OHB prevalence and viral variants in a cohort of pregnant women in Gondor, Ethiopia. METHODS: Patients were prospectively recruited from the University of Gondar Hospital ( N = 200; median age 27 [inter-quartile range] 8.3y) from March through June 2016. Data were collected using an investigator-administered questionnaire. Plasma was tested for HBsAg and HBV core antibody (anti-HBc), and HBV genotype and presence of HBV variants (ie, vaccine escape mutants [VEMs]) were determined by polymerase chain reaction, Sanger sequencing, and phylogenetic analysis. RESULTS: Of women tested, 1% (2/200) were HBsAg+; 26.8% (47/182) of HBsAg-negative patients were anti-HBc+, of whom 37/47 (78.7%) had detectable HBV DNA. The overall rate of OHB was 20.3%. Both HBsAg+ cases were HBV genotype D, and 36/37 (97.3%) of OHB individuals were genotype D. None carried VEM, but both HBsAg+ cases and 32/37 (86.5%) of the OHB cases showed lamivudine-resistant mutations. CONCLUSIONS: Twenty-seven percent of pregnant women in this cohort showed evidence of CHB or prior HBV exposure (ie, HBsAg+ or anti-HBc+) and clinically relevant HBV variants. Data from this single-centre study suggests high HBV prevalence, reinforcing the World Health Organization’s recommendation for universal prenatal HBV screening and infant vaccination.
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Affiliation(s)
- Vanessa Meier-Stephenson
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- co-first authors
| | - Tekalign Deressa
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- co-first authors
| | - Meaza Genetu
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Debasu Damtie
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sheila Braun
- Provincial Laboratory for Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Kevin Fonseca
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Provincial Laboratory for Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Mark G Swain
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guido van Marle
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carla S Coffin
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Akanbi OA, Harms D, Wang B, Osundare FA, Adesina O, Oluremi AS, Omoruyi EC, Kappert K, Opaleye OO, Bock CT. High frequency of drug resistance mutations in the HBV genome in ART-experienced HIV-coinfected patients in southwestern Nigeria. Antivir Ther 2020; 24:521-528. [PMID: 31566576 DOI: 10.3851/imp3333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND HBV and HIV infections are highly endemic in sub-Saharan Africa and Nigeria while HBV-HIV coinfection is not uncommon. Antiretroviral (ART)-treatment for HIV can affect HBV whereby antiviral resistance mutations in the HBV genome can be selected. Here, we determined the prevalence of resistance mutations among ART-experienced and ART-naive HIV-HBV-coinfected patients in southwestern Nigeria. METHODS A total of 81 serum samples from HBV-HIV-coinfected patients who were either ART-naive or received lamivudine (3TC)-containing ART-therapy and HBV-monoinfected patients were analysed. Hepatitis B surface antigen (HBsAg) was detected using ELISA. HBV-positive samples were confirmed by PCR amplification of the surface and polymerase regions. Mutations conferring drug resistance to HBV were analysed by direct sequencing. Phylogenetic analysis was performed to identify the HBV genotype. RESULTS Of the 81 HBsAg-positive samples, 27 had detectable HBV DNA by real-time PCR with mean viral loads of 6.77 log IU/ml. Phylogenetic analyses showed a predominance of HBV genotype E. A high prevalence (22.2%; 6/27) of HBV resistance mutations among ART-experienced HBV-HIV-coinfected patients was detected. However, a relatively high selection rate of resistance mutations in drug-naive HIV-HBV-coinfected (3.7%; 1/27) and in HBV-monoinfected patients, potential drug resistance mutations (7.4%; 2/27) were also observed. HBV polymerase amino acid substitutions found included rtV173L, rtL180M, rtM204V, rtK212R, rtS213T, rtV214A, rtL229V and rtP237A/S. CONCLUSIONS Drug resistant mutations were detected frequently in ART-experienced HIV-HBV patients. Well-coordinated antiviral therapy for HIV patients coinfected with HBV should include proper HBV diagnosis and resistance testing to minimize the emergence and spread of antiviral drug resistance.
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Affiliation(s)
- Olusola Anuoluwapo Akanbi
- Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany.,Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Oshogbo, Nigeria
| | - Dominik Harms
- Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Bo Wang
- Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Folakemi Abiodun Osundare
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Oshogbo, Nigeria
| | - Olufisayo Adesina
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adeolu Sunday Oluremi
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Oshogbo, Nigeria
| | - Ewean Chukwuma Omoruyi
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Oshogbo, Nigeria
| | - Kai Kappert
- Chariteì - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Berlin, Germany
| | - Oluyinka Oladele Opaleye
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Oshogbo, Nigeria
| | - C-Thomas Bock
- Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany.,Institute of Tropical Medicine, University of Tuebingen, Tuebingen, Germany
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11
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Goverwa-Sibanda TP, Mupanguri C, Timire C, Harries AD, Ngwenya S, Chikwati E, Mapfuma C, Mushambi F, Tweya H, Ndlovu M. Hepatitis B infection in people living with HIV who initiate antiretroviral therapy in Zimbabwe. Public Health Action 2020; 10:97-103. [PMID: 33134123 DOI: 10.5588/pha.20.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/18/2020] [Indexed: 11/10/2022] Open
Abstract
Setting There is little information about the diagnosis and treatment of hepatitis B virus (HBV) infection in people living with HIV (PLHIV) in Zimbabwe despite recommendations that tenofovir (TDF) + lamivudine (3TC) is the most effective nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) backbone of antiretroviral therapy (ART) in those with dual infection. Objective To determine 1) numbers screened for hepatitis B surface antigen (HBsAg); 2) numbers diagnosed HBsAg-positive along with baseline characteristics; and 3) NRTI backbones used among PLHIV initiating first-line ART at Mpilo Opportunistic Infections Clinic, Bulawayo, Zimbabwe, between October 2017 and April 2019. Design This was a cross-sectional study using routinely collected data. Results Of the 422 PLHIV initiating first-line ART (median age 34 years, IQR 25-43), 361 (85%) were screened for HBV, with 10% being HBsAg-positive. HBsAg positivity was significantly associated with anaemia (adjusted prevalence ratio [aPR] 2.3, 95%CI 1.1-4.7) and elevated ala-nine transaminase levels (aPR 2.9, 95%CI 1.5-5.8). Of 38 PLHIV who were diagnosed HBsAg-positive, 30 (79%) were started on ART based on tenofovir (TDF) and lamivudine (3TC), seven were given abacavir (ABC) + 3TC-based ART and one was given zido vudine (ZDV) + 3TC-based ART. Conclusion In PLHIV, HBV screening worked well, the prevalence of HIV-HBV co-infection was high and most patients received appropriate treatment for both conditions. Recommendations to improve screening, diagnosis and treatment of HIV-HBV co-infection are discussed.
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Affiliation(s)
- T P Goverwa-Sibanda
- AIDS Healthcare Foundation, Zimbabwe, Harare.,Mpilo Hospital, Ministry of Health and Child Care, Bulawayo, Zimbabwe
| | - C Mupanguri
- National AIDS/TB Programme, Ministry of Health and Child Care, Harare, Zimbabwe
| | - C Timire
- National AIDS/TB Programme, Ministry of Health and Child Care, Harare, Zimbabwe.,National University of Science and Technology, Bulawayo, Zimbabwe.,International Union Against Tuberculosis and Lung Disease (The Union) Zimbabwe, Harare, Zimbabwe
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - S Ngwenya
- Mpilo Hospital, Ministry of Health and Child Care, Bulawayo, Zimbabwe
| | - E Chikwati
- AIDS Healthcare Foundation, Zimbabwe, Harare
| | - C Mapfuma
- National University of Science and Technology, Bulawayo, Zimbabwe
| | - F Mushambi
- Parirenyatwa Group of Hospitals, Ministry of Health and Child Care, Harare, Zimbabwe
| | - H Tweya
- The Union, Paris, France.,The Lighthouse Clinic, Lilongwe, Malawi
| | - M Ndlovu
- Mpilo Hospital, Ministry of Health and Child Care, Bulawayo, Zimbabwe.,National University of Science and Technology, Bulawayo, Zimbabwe
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12
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Semá Baltazar C, Boothe M, Kellogg T, Ricardo P, Sathane I, Fazito E, Raymond HF, Temmerman M, Luchters S. Prevalence and risk factors associated with HIV/hepatitis B and HIV/hepatitis C co-infections among people who inject drugs in Mozambique. BMC Public Health 2020; 20:851. [PMID: 32493347 PMCID: PMC7271460 DOI: 10.1186/s12889-020-09012-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/29/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is scare information about HIV co-infections with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) among People Who Inject Drugs (PWID) in Mozambique. This information is critical to ensure the treatment necessary to decrease the progression of liver disease and the transmission of both HIV and hepatitis. We assess the prevalence of HIV, HBV and HCV co-infections as well as associated risk factors among PWID. METHODS The first Bio-Behavioral Surveillance Survey was conducted in 2013-2014 among persons who self-reported to have ever injected drugs. Using respondent-driven sampling, PWID aged 18 years and older were recruited in two cross-sectional samples in Maputo and Nampula/Nacala, two large urban centers of Mozambique. Rapid screening of HIV, HBV (HBsAg) and HCV was performed on site. Data from participants in both cities were pooled to conduct RDS-weighted bivariate analyses with HIV/HBV and HIV/HCV co-infections as separate outcomes. Unweighted bivariate and multivariate logistic regression analyses were conducted to assess correlates of co-infection. RESULTS Among 492 eligible PWID, 93.3% were male and median age was 32 years [IQR: 27-36]. HIV, HBV and HCV prevalence were respectively 44.9% (95% CI:37.6-52.3), 32.8% (95% CI:26.3-39.5) and 38.3 (95% CI:30.6-45.9). Co-infections of HIV/HBV, HIV/HCV and HIV/HBV/HCV were identified in 13.1% (95% CI:7.2-18.9), 29.5% (95% CI:22.2-36.8) and 9.2% (95% CI:3.7-14.7) of PWID, respectively. Older age, history of needle/syringe sharing and history of injection with used needle/syringe was associated with HIV/HBV co-infection. Living in Maputo city, have older age, history of needle/syringe sharing and history of injection with used needle/syringe was associated with HIV/HCV co-infection. CONCLUSION There is a high burden of HBV and HCV among HIV-infected PWID in Mozambique. Our results highlight the need for targeted harm reduction interventions that include needle exchange programs and integrated services for the diagnosis and treatment of HIV, HBV and HCV to address these epidemics among PWID. Efforts should be made to strengthen ART coverage in the population as an important treatment strategy for both viruses.
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Affiliation(s)
- Cynthia Semá Baltazar
- Instituto Nacional de Saúde (INS), Maputo, Mozambique.
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Makini Boothe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- University of California, San Francisco, USA
| | | | | | - Isabel Sathane
- National Program to Control STIs and HIV/AIDS, Ministry of Health, Maputo, Mozambique
| | - Erika Fazito
- International Center Aids Program (ICAP), Maputo, Mozambique
| | - Henry F Raymond
- University of California, San Francisco, USA
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of OBGYN, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Population Health, Aga Khan University, Nairobi, Kenya
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Burnet Institute, Melbourne, Australia
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13
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Abstract
Currently, despite the use of a preventive vaccine for several decades as well as the use of effective and well-tolerated viral suppressive medications since 1998, approximately 250 million people remain infected with the virus that causes hepatitis B worldwide. Hepatitis C virus (HCV) and hepatitis B virus (HBV) are the leading causes of liver cancer and overall mortality globally, surpassing malaria and tuberculosis. Linkage to care is estimated to be very poor both in developing countries and in high-income countries, such as the United States, countries in Western Europe, and Japan. In the United States, by CDC estimates, only one-third of HBV-infected patients or less are aware of their infection. Some reasons for these low rates of surveillance, diagnosis, and treatment include the asymptomatic nature of chronic hepatitis B until the very late stages, a lack of curative therapy with a finite treatment duration, a complex natural history, and a lack of knowledge about the disease by both care providers and patients. In the last 5 years, more attention has been focused on the important topics of HBV screening, diagnosis of HBV infection, and appropriate linkage to care. There have also been rapid clinical developments toward a functional cure of HBV infection, with novel compounds currently being in various phases of progress. Despite this knowledge, many of the professional organizations provide guidelines focused only on specific questions related to the treatment of HBV infection. This focus leaves a gap for care providers on the other HBV-related issues, which include HBV's epidemiological profile, its natural history, how it interacts with other viral hepatitis diseases, treatments, and the areas that still need to be addressed in order to achieve HBV elimination by 2030. Thus, to fill these gaps and provide a more comprehensive and relevant document to regions worldwide, we have taken a global approach by using the findings of global experts on HBV as well as citing major guidelines and their various approaches to addressing HBV and its disease burden.
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14
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Semá Baltazar C, Horth R, Boothe M, Sathane I, Young P, Chitsondzo Langa D, Condula M, Ricardo H, Dengo Baloi L, Cummings B, Schaad N, Gouveia L, Teodoro E, Raymond HF. High prevalence of HIV, HBsAg and anti-HCV positivity among people who injected drugs: results of the first bio-behavioral survey using respondent-driven sampling in two urban areas in Mozambique. BMC Infect Dis 2019; 19:1022. [PMID: 31791273 PMCID: PMC6889180 DOI: 10.1186/s12879-019-4655-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022] Open
Abstract
Background Few countries in sub-Saharan Africa know the magnitude of their HIV epidemic among people who inject drugs (PWID). This was the first study in Mozambique to measure prevalence of HIV, HBV, and HCV, and to assess demographic characteristics and risk behaviors in this key population. Methods We used respondent-driven sampling (RDS) to conduct a cross-sectional behavioral surveillance survey of PWID in two cities of Mozambique lasting six months. Participants were persons who had ever injected drugs without a prescription. Participants completed a behavioral questionnaire and provided blood specimens for HIV, hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) testing. We performed RDS-adjusted analysis in R 3.2 using RDSAT 7.1 weights. Results We enrolled 353 PWID in Maputo and 139 in Nampula/Nacala; approximately 95% of participants were men. Disease prevalence in Maputo and Nampula/Nacala, respectively, was 50.1 and 19.9% for HIV, 32.1 and 36.4% for HBsAg positivity, and 44.6 and 7.0% for anti-HCV positivity. Additionally, 8% (Maputo) and 28.6% (Nampula/Nacala) of PWID reported having a genital sore or ulcer in the 12 months preceding the survey. Among PWID who injected drugs in the last month, 50.3% (Maputo) and 49.6% (Nampula/Nacala) shared a needle at least once that month. Condomless sex in the last 12 months was reported by 52.4% of PWID in Maputo and 29.1% in Nampula/Nacala. Among PWID, 31.6% (Maputo) and 41.0% (Nampula/Nacala) had never tested for HIV. In multivariable analysis, PWID who used heroin had 4.3 (Maputo; 95% confidence interval [CI]: 1.2, 18.2) and 2.3 (Nampula/Nacala; 95% CI: 1.2, 4.9) greater odds of having HIV. Conclusion Unsafe sexual behaviors and injection practices are frequent among PWID in Mozambique, and likely contribute to the disproportionate burden of disease we found. Intensified efforts in prevention, care, and treatment specific for PWID have the potential to limit disease transmission.
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Affiliation(s)
- Cynthia Semá Baltazar
- National Institute of Health, P.O. Box 264, Maputo, Mozambique. .,Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium.
| | - Roberta Horth
- University of California, San Francisco, California, USA
| | - Makini Boothe
- Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium.,University of California, San Francisco, California, USA
| | - Isabel Sathane
- University of California, Global Programs for Research and Training, Maputo, Mozambique
| | - Peter Young
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | - Manuel Condula
- Rede Nacional Contra a Droga (UNIDOS), Maputo, Mozambique
| | - Helena Ricardo
- National Institute of Health, P.O. Box 264, Maputo, Mozambique
| | | | - Beverley Cummings
- Substance Abuse and Mental Health Services Administration, Pretoria, South Africa
| | - Nicolas Schaad
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lídia Gouveia
- Department of Mental Health, National Public Health Directorate, Ministry of Health, Maputo, Mozambique
| | - Eugénia Teodoro
- Department of Mental Health, National Public Health Directorate, Ministry of Health, Maputo, Mozambique
| | - Henry F Raymond
- University of California, San Francisco, California, USA.,School of Public Health, Rutgers University, Piscataway, NJ, USA
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15
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Chonco FM, Rangiah S. Susceptibility to hepatitis B infection, hepatitis B/HIV co-infections and hepatitis B immunity in HIV-positive patients starting HAART in Durban, South Africa. S Afr Fam Pract (2004) 2019. [DOI: 10.1080/20786190.2018.1518023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- FM Chonco
- Department of Family Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - S Rangiah
- Department of Family Medicine, University of KwaZulu-Natal, Durban, South Africa
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16
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Mokaya J, McNaughton AL, Hadley MJ, Beloukas A, Geretti AM, Goedhals D, Matthews PC. A systematic review of hepatitis B virus (HBV) drug and vaccine escape mutations in Africa: A call for urgent action. PLoS Negl Trop Dis 2018; 12:e0006629. [PMID: 30080852 PMCID: PMC6095632 DOI: 10.1371/journal.pntd.0006629] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/16/2018] [Accepted: 06/22/2018] [Indexed: 12/14/2022] Open
Abstract
International sustainable development goals for the elimination of viral hepatitis as a public health problem by 2030 highlight the pressing need to optimize strategies for prevention, diagnosis and treatment. Selected or transmitted resistance associated mutations (RAMs) and vaccine escape mutations (VEMs) in hepatitis B virus (HBV) may reduce the success of existing treatment and prevention strategies. These issues are particularly pertinent for many settings in Africa where there is high HBV prevalence and co-endemic HIV infection, but lack of robust epidemiological data and limited education, diagnostics and clinical care. The prevalence, distribution and impact of RAMs and VEMs in these populations are neglected in the current literature. We therefore set out to assimilate data for sub-Saharan Africa through a systematic literature review and analysis of published sequence data, and present these in an on-line database (https://livedataoxford.shinyapps.io/1510659619-3Xkoe2NKkKJ7Drg/). The majority of the data were from HIV/HBV coinfected cohorts. The commonest RAM was rtM204I/V, either alone or in combination with associated mutations, and identified in both reportedly treatment-naïve and treatment-experienced adults. We also identified the suite of mutations rtM204V/I + rtL180M + rtV173L, that has been associated with vaccine escape, in over 1/3 of cohorts. Although tenofovir has a high genetic barrier to resistance, it is of concern that emerging data suggest polymorphisms that may be associated with resistance, although the precise clinical impact of these is unknown. Overall, there is an urgent need for improved diagnostic screening, enhanced laboratory assessment of HBV before and during therapy, and sustained roll out of tenofovir in preference to lamivudine alone. Further data are needed in order to inform population and individual approaches to HBV diagnosis, monitoring and therapy in these highly vulnerable settings.
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Affiliation(s)
- Jolynne Mokaya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Anna L. McNaughton
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Martin J. Hadley
- Oxford University Academic IT Department, Oxford, United Kingdom
| | - Apostolos Beloukas
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Anna-Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Dominique Goedhals
- Division of Virology, University of the Free State/National Health Laboratory Service, Bloemfontein, Republic of South Africa
| | - Philippa C. Matthews
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom
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17
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First report of occult hepatitis B infection among ART naïve HIV seropositive individuals in Maputo, Mozambique. PLoS One 2018; 13:e0190775. [PMID: 29320552 PMCID: PMC5761887 DOI: 10.1371/journal.pone.0190775] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/20/2017] [Indexed: 12/21/2022] Open
Abstract
Background The prevalence of hepatitis B virus (HBV) infection and human immunodeficiency virus (HIV) infection in Mozambique is one of the highest in the world, though in spite of this the prevalence of occult hepatitis B infection (OBI) is unknown. Objectives This study was conducted with the aim to investigate the prevalence of OBI and frequency of isolated hepatitis B core antibody (anti-HBc alone) among antiretroviral (ART) naïve HIV-positive patients in Mozambique. Methods A cross-sectional study was conducted in two health facilities within Maputo city. All ART-naive HIV seropositive patients attending outpatient clinics between June and October 2012 were consecutively enrolled. Blood samples were drawn from each participant and used for serological measurement of HBV surface antigen (HBsAg), antibodies against HBV surface antigen (anti-HBs) and antibodies against core antigen (anti-HBc) using ELISA. Quantification of HBV DNA was performed by real time PCR. A questionnaire was used to obtain demographics and clinical data. Results Of the 518 ART-naive HIV-positive subjects enrolled in the study, 90.9% (471/518) were HBsAg negative. Among HBsAg negative, 45.2% (213/471) had isolated anti-HBc antibodies, and the frequency of OBI among patients with anti-HBc alone was 8.3% (17/206). OBI was not correlated either with CD4+ T cells count or transaminases levels. A total of 11.8% of patients with OBI presented elevated HBV DNA level. Frequency of individuals with APRI score > 2 and FIB-4 score > 3.25 was higher in patients with OBI as compared not exposed, immune and anti-HBc alone patients. Conclusion Our data demonstrate for the first time that OBI is prevalent among HIV patients in Mozambique, and will be missed using the commonly available serological assays that measures HBsAg.
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18
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Chambal LM, Samo Gudo E, Carimo A, Corte Real R, Mabunda N, Maueia C, Vubil A, Zicai AF, Bhatt N, Antunes F. Correction: HBV infection in untreated HIV-infected adults in Maputo, Mozambique. PLoS One 2017; 12:e0190460. [PMID: 29267379 PMCID: PMC5739498 DOI: 10.1371/journal.pone.0190460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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19
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Known, new and emerging risk factors of hepatocellular carcinoma (review). Presse Med 2017; 46:1000-1007. [DOI: 10.1016/j.lpm.2017.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/30/2017] [Accepted: 09/20/2017] [Indexed: 12/24/2022] Open
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