Hepatitis B and C infections in HIV-1 and non-HIV infected pregnant women in the Brong-Ahafo Region, Ghana

Prevalence of occult hepatitis B infection among treatment-naive persons living with HIV in Ghana

Hepatitis B virus (HBV) constitutes a significant global health challenge, with more than 2 billion people infected globally and almost 291 million chronic cases. In Africa, coinfection of HBV with Human Immunodeficiency Virus (HIV) is high, yet the condition remains overlooked in many countries. While antiretroviral therapy (ART) has improved HIV survival, viral hepatitis continues to contribute to morbidity and mortality. Occult Hepatitis B infection (OBI), characterized by a low-level of HBV DNA in individuals with negative hepatitis B surface antigen (HBsAg), is an emerging concern among HIV seropositive individuals due to the risk of HBV reactivation and associated complications, especially hepatocellular carcinoma (HCC). Ghana has an estimated HBV/HIV coinfection prevalence of 13.6% making it important to also determine potential cases of OBI. This study aims to assess OBI prevalence in persons living with HIV (PLHIV). A cross-sectional study was conducted in five health facilities in the Cape Coast Metropolis. HBV-related serological markers were determined among 116 PLHIV using the Enzyme-Linked Immunosorbent Assay (ELISA) method. HBV DNA was extracted from 30 participants found to be HBsAg negative but positive for hepatitis B core antibody (HBcAb+). Nested PCR was employed in detecting HBV DNA and HBV viral load was performed using qPCR. The median age of the participants was 37 years (IQR 22-65). Serologically, 7.8% (n = 9, 95% CI: 3.5-22.7), 12.1% (n = 14), and 25.9% (n = 30) tested positive for solely HBsAg, HBsAb, and HBcAb respectively. OBI prevalence among HBsAg-/HBcAb+ participants was 16.7% (n = 5, 95% CI: 6.5-23.7) with a median HBV DNA level of 139.2 IU/ml (IQR, 96.7-142.0). The prevalence of OBI among HIV-positive participants in the Cape Coast Metropolis highlights the need to consider screening for HBV among HIV patients using nucleic acid amplification tests. This can inform medical management and reduce the risk of liver complications, including HCC.

Variations in CD4 counts during pregnancy in women living with HIV

OBJECTIVE

Our objective was to determine the frequency at which CD4 counts drop below 200 cells/mm3 during pregnancy in women living with HIV and to identify factors associated with this.

METHODS

Data from 2005 to 2020 from two prospective Canadian cohorts of pregnant women living with HIV were extracted. As per national guidelines, women received antiretroviral therapy and CD4 counts were monitored once per trimester and at delivery.

RESULTS

Among 775 included cases, 72 (9.3%) had CD4 counts <200 cells/mm3 at the first pregnancy visit. Of the 703 remaining pregnancies with CD4 counts ≥200 cells/mm3 at the initial visit, 20 (2.8%) were associated with a drop to <200 cells/mm3 . In univariate analysis, factors associated with this drop were coinfection with hepatitis B virus or hepatitis C virus (odds ratio [OR] 4.0, 95% confidence interval [CI] 1.52-10.50), lower first visit CD4 counts (OR 0.165, 95% CI 0.08-0.34), and baseline haemoglobin levels <11 g/dL (OR 2.89, 95% CI 1.04-8.00). In multivariable analysis, only CD4 count at first visit remained independently associated with this drop. A cut-off CD4 count ≤450 cells/mm3 at the first pregnancy visit had a sensitivity of 100% to detect cases of CD4 drop to <200 cells/mm3 .

CONCLUSION

A drop of CD4 count to <200 cells/mm3 is uncommon during pregnancy in women living with HIV. Our results suggest that CD4 monitoring only once in pregnancy would be safe in women whose CD4 count is >450 cells/mm3 at the first pregnancy visit.

A Systematic Review and Meta-Analysis of the Prevalence of Triplex Infections (Combined Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus) among Pregnant Women in Nigeria

Objective

We systematically identified the prevalence of triplex infections (combined human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV)) in pregnancy.

Methods

To gather information on the frequency of triplex infections, we searched the databases of PubMed, CINAHL, and Google Scholar. Without regard to language, we utilized search terms that covered HIV, HBV, HCV, and pregnancy. Pregnant women with triplex infections of HIV, HBV, and HCV were included in studies that also examined the prevalence of triplex infections. Review Manager 5.4.1 was employed to conduct the meta-analysis. Critical appraisal and bias tool risk data were provided as percentages with 95% confidence intervals (95% CIs), and I² was used as the statistical measure of heterogeneity. The checklist was created by Hoy and colleagues. The study protocol was registered on PROSPERO, under the registration number CRD42020202583.

Results

Eight studies involving 5314 women were included. We identified one ongoing study. Pooled prevalence of triplex infections was 0.03% (95% CI: 0.02-0.04%) according to meta-analysis. Subgroup analysis demonstrated a significantly high prevalence of 0.08% (95% CI: 0.06-0.10%; 3863 women) in HIV-positive population than 0.00% (95% CI:-0.00-0.00; 1451 women; P < 0.001) in general obstetric population. Moreover, there was a significant difference in the pooled prevalence between studies published between 2001 and 2010 and between 2011 and 2021 (0.14% (95% CI: 0.12 to 0.16 versus 0.03% (95% CI: 0.02 to 0.04%; P < 0.001))) and participants recruited in the period between 2001 and 2011 and between 2012 and 2021 (0.13% (95% CI: 0.05 to 0.21; p=0.002 versus 0.00% (95% CI: -0.00 to 0.00%; p=1.00))), respectively.

Conclusion

The combined prevalence of prenatal triplex infections was 0.03%, with rates notably higher among the group of pregnant women who were HIV-positive and during the recruitment period that took place before 2012. This prevalence still necessitates screening for these infections as necessary.

Antivirals for prevention of hepatitis B virus mother-to-child transmission in human immunodeficiency virus positive pregnant women co-infected with hepatitis B virus

BACKGROUND

Hepatitis B virus (HBV)-human Immunodeficiency virus (HIV) co-infection promotes an aggressive disease course of HBV infection. In the only available non-Cochrane systematic review on antiviral therapy during pregnancy for prevention of mother-to-child transmission of HBV, none of the women studied had HBV-HIV co-infection but were either HBV- or HIV-seropositive. Treatment of HBV alone may develop HIV-strains that are resistant to non-nucleoside reverse transcriptase inhibitors. Accordingly, co-treatment of the HIV infection is recommended.

OBJECTIVES

To evaluate the benefits and harms of tenofovir-based antiviral combination regimens versus placebo, tenofovir alone, or non-tenofovir-based antiviral regimen either alone or in combination with HBV for the prevention of mother-to-child transmission of HBV in HIV-positive pregnant women co-infected with HBV.

SEARCH METHODS

We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase Ovid, LILACS (Bireme), Science Citation Index Expanded (Web of Science), and Conference Proceedings Citation Index-Science (Web of Science) on 30 January 2023. We manually searched the reference lists of included trials, searched on-line trial registries, and contacted experts in the field and pharmaceutical companies for any further potential trials.

SELECTION CRITERIA

We aimed to include randomised clinical trials comparing tenofovir-based antiviral combination regimens (anti-HIV regimen with lopinavir-ritonavir therapy, or any other antiviral therapy, and two drugs with activity against HBV, specifically, tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF), plus lamivudine or emtricitabine) with placebo alone, or tenofovir alone, or non-tenofovir-based antiviral regimen (zidovudine, lamivudine, telbivudine, emtricitabine, entecavir, lopinavir-ritonavir, or any other antiviral therapy) either alone or in combination with at least two other antivirals.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Primary outcomes included all-cause infant mortality, proportion of infants with serious adverse events, proportion of infants with HBV mother-to-child transmission, all-cause maternal mortality, and proportion of mothers with serious adverse events. Secondary outcomes included proportion of infants with adverse events not considered serious, proportion of mothers with detectable HBV DNA (deoxyribonucleic acid) (before delivery), maternal hepatitis B e antigen (HBeAg) to HBe-antibody seroconversion (before delivery) and maternal adverse events not considered serious. We used RevMan Web to carry out analyses and presented results, where feasible, using a random-effects model and risk ratios (RR) with 95% confidence intervals (CIs). We performed sensitivity analysis. We assessed risk of bias using predefined domains, assessed the certainty of the evidence using GRADE, controlled risk of random errors with Trial Sequential Analysis, and presented outcome results in a summary of findings table.

MAIN RESULTS

Five completed trials were included, of which four trials contributed data to one or more of the outcomes. They included a total of 533 participants randomised to tenofovir-based antiviral combination regimens (196 participants) versus control (337 participants). The control groups received non-tenofovir-based antiviral regimens either as zidovudine alone (three trials) or as a combination of zidovudine, lamivudine and lopinavir-ritonavir (five trials). None of the trials used placebo or tenofovir alone. All trials were at unclear risk of bias. Four trials used intention-to-treat analyses. In the remaining trial, two participants in the intervention group and two in the control group were lost to follow-up. However, the outcomes of these four participants were not described. Tenofovir-based antiviral combination regimen versus control We are very uncertain about the effect of a tenofovir-based antiviral combination regimen versus control on all-cause infant mortality (RR 2.24, 95% CI 0.72 to 6.96; participants = 132; trials = 1; very low-certainty evidence); proportion of infants with serious adverse events (RR 1.76, 95% CI 1.27 to 2.43; participants = 132; trials = 1; very low-certainty evidence), and proportion of mothers with serious adverse events (RR 0.90, 95% CI 0.62 to 1.32; participants = 262; trials = 2; very low-certainty evidence). No trial reported data on the proportion of infants with HBV mother-to-child transmission and all-cause maternal mortality. We are also very uncertain about the effect of tenofovir-based antiviral combination regimens versus control on the proportion of infants with adverse events not considered serious (RR 0.94, 95% CI 0.06 to 13.68; participants = 31; trials = 1; very low-certainty evidence), and proportion of mothers with detectable HBV DNA (before delivery) (RR 0.66, 95% CI 0.42 to 1.02; participants = 169; trials = 2; very low-certainty evidence). No trial reported data on maternal hepatitis B e antigen (HBeAg) to HBe-antibody seroconversion (before delivery) and maternal adverse events not considered serious. All trials received support from industry.

AUTHORS' CONCLUSIONS

We do not know what the effects of tenofovir-based antiviral combination regimens are on all-cause infant mortality, proportion of infants with serious adverse events and proportion of mothers with serious adverse events, proportion of infants with adverse events not considered serious, and proportion of mothers with detectable HBV DNA before delivery because the certainty of evidence was very low. Only one or two trials, with insufficient power, contributed data for analyses. We lack randomised clinical trials at low risk of systematic and random errors, and fully reporting all-cause infant mortality, serious adverse events and reporting on clinical and laboratory outcomes, such as infants with HBV mother-to-child transmission, all-cause maternal mortality, maternal hepatitis B e antigen (HBeAg) to HBe-antibody seroconversion before delivery and maternal adverse events not considered serious.

Quality Assurance for Hepatitis C Virus Point-of-Care Diagnostics in Sub-Saharan Africa

As part of a multinational study to evaluate the Bioline Hepatitis C virus (HCV) point-of-care (POC) testing in sub-Saharan Africa (SSA), this narrative review summarises regulatory standards and quality indicators for validating and approving HCV clinical diagnostics. In addition, this review also provides a summary of their diagnostic evaluations using the REASSURED criteria as the benchmark and its implications on the WHO HCV elimination goals 2030.

Prevalence trends and risk factors associated with HIV, syphilis, and hepatitis C virus among pregnant women in Southwest China, 2009–2018

Objective

This study investigated prevalence trends and identified the associated factors of HIV, syphilis and hepatitis C virus (HCV) among pregnant women in the Guangxi Zhuang Autonomous Region (Guangxi), Southwest China.

Methods

Serial cross-sectional surveys were performed annually among pregnant women in Guangxi from 2009 to 2018. Blood specimens were collected to test the prevalence of HIV, syphilis and HCV. Cochran–Armitage analysis was used to assess the trends of HIV, syphilis and HCV prevalence, as well as the sociodemographic and behavioural data. In this study, we used zero-inflated negative binomial (ZINB) regression models to identify factors associated with HIV, syphilis and HCV infection.

Results

A total of 23,879 pregnant women were included in the study. The prevalence of HIV, syphilis and HCV was 0.24%, 0.85% and 0.19%, respectively. There was a decrease in HIV prevalence from 0.54% to 0.10%, a decrease in HCV prevalence from 0.40% to 0.05% and a decrease in syphilis prevalence from 1.53% to 0.30%. The findings based on the ZINB model revealed that pregnant women who had a history of STI had significantly increased risks of HIV (OR 6.63; 95% CI 1.33–32.90) and syphilis (OR 9.06; 95% CI 3.85–21.30) infection, while pregnant women who were unmarried/widowed/divorced were more likely to have HIV (OR 2.81; 95% CI 1.20–6.54) and HCV (OR 58.12; 95% CI, 3.14–1076.99) infection. Furthermore, pregnant women whose husband had a history of STI (OR 5.62; 95% CI 1.24–25.38) or drug use (OR 7.36; 95% CI 1.25–43.43) showed an increased risk of HIV infection.

Conclusions

There was a relatively low prevalence of HIV, syphilis and HCV among pregnant women. Although decreasing trends in HIV, syphilis and HCV infections were observed, effort is needed to promote STI testing in both premarital medical check-ups and antenatal care, especially targeting couples with a history of STI or drug use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12981-022-00450-7.

HIV and malaria prevalence among pregnant women with and without pre-eclampsia at the Atua Government Hospital in Ghana's eastern region

OBJECTIVE

To evaluate the association of malaria and HIV with pre-eclampsia by evaluating their prevalence among pregnant women.

METHODS

Using a case-control study design, we randomly sampled the antenatal records of 125 pregnant women with clinician-diagnosed pre-eclampsia (cases) and 125 others without pre-eclampsia (controls) who visited Atua Government Hospital in the eastern region of Ghana between June 2014 and January 2017. All selected records had available routine HIV and malaria test results and were analyzed statistically.

RESULTS

In all 250 records, 122 (48.8%) were HIV positive and 35 (14.0%) had malaria. Of the 122 HIV-positive pregnant women, 29 (23.8%) were cases and 93 (76.2%) were controls; of the 35 women with malaria, one was in the case group (1/35, 2.9%) and the other 34 (97.1%) were in the control. Group. Pregnant women with pre-eclampsia had lower odds of HIV infection (odds ratio [OR] 0.10, 95% confidence interval [CI] 0.06-0.19: adjusted AOR 0.07, 95% CI 0.04-0.13, P < 0.001). Similarly, pregnant women with pre-eclampsia had lower odds of having malaria infection (OR 0.02, 95% CI 0.00-0.17, P = 0.025; adjusted OR 0.00, 95% CI 0.00-0.01, P < 0.001).

CONCLUSIONS

Women with pre-eclampsia had lower odds of HIV and malaria infection in pregnancy.

The Screening of Rubella Virus, Cytomegalovirus, Hepatitis B Virus, and Toxoplasma gondii Antibodies in Prepregnancy and Reproductive-Age Women in Tabriz, Iran

Objectives

The organisms of Toxoplasma gondii, Rubella virus, Cytomegalovirus, and Herpes simplex virus as an acronym of TORCH are major pathogens in prepregnancy and reproductive-age women. These microorganisms are considered a serious problem and cause 2-3% of all birth defects in the fetus. Our study was aimed at screening the seroprevalence of TORCH antibodies among prepregnancy and reproductive-age women in Tabriz, Iran. Design and Setting. This study was carried out in 2726 prepregnancy and reproductive-age women, who were referred to the laboratory for prenatal TORCH screening. To detect the presence of IgG, IgM antibodies and Hepatitis B surface antigen against these microorganisms were carried out using a chemiluminescence immunoassay analyzer (CLIA).

Results

In the current study, the rates of anti-Toxoplasma gondii IgG, anti-Rubella virus IgG, and anti-Cytomegalovirus IgG were found in 722 cases (26.5%), 2579 cases (94.6%0), and 2718 cases (99.7%), respectively. Moreover, the rates of anti-Toxoplasma gondii IgM, anti-Rubella virus IgM, and anti-Cytomegalovirus IgM were discovered in 10 cases (0.4%), 13 cases (0.5%), and 16 cases (0.6%), respectively. The Hepatitis B surface antigen was found in 32 cases (1.2%). The dissemination of positive TORCH in various ages was different (P < 0.05).

Conclusions

In our study, the seroprevalence of acute TORCH infections was relatively low. Due to the probability of vertical transmission to the fetus during pregnancy and the unpleasant complication of these pathogens, it is essential to be screened for detection of specific IgG and IgM antibodies in reproductive ages.

Prevalence of HIV and hepatitis B virus among pregnant women in Luanda (Angola): geospatial distribution and its association with socio-demographic and clinical-obstetric determinants

Background

HIV and HBV infections remain responsible for high rate of morbidity and mortality in many African Countries, affecting women and newborns. This study aims to analyze the spatial pattern of HIV and HBV infections in pregnant women in Luanda, Angola, and the statistical association between HIV and HBV and socio-economic characteristics, hygiene, and health status.

Methods

Detection of anti-HIV antibodies (total anti-HIV-1, anti-HIV-2 and HIV-1 p24 antigen) and Hepatitis B antigens (HBsAg, HBeAg) and antibodies (anti-HBc Total II, HBc IgM, Anti-HBsT II) was performed by Enzyme Linked Fluorescent Assay (ELFA) in serum samples of 878 pregnant women attended at the Lucrecia Paim Maternity Hospital (LPMH). Data were collected by questionnaire after written consent, and spatial distribution was assessed through a Kernel Density Function. The potential risk factors associated with HIV HBV infection were evaluated using bivariate and multivariate binomial logistic regression analysis.

Results

Anti-HIV antibodies were positive in 118 samples (13.4%) and HBV infection were positive in 226 (25.7%). The seroprevalence of HIV/HBV coinfection was of 6.3%. The results showed that the seroprevalence of HBV was similar in most municipalities: 25.8% in Belas; 26.6% in Viana; 27.6% in Luanda; 19.2% in Cacuaco; and 15.6% Cazenga. For HIV, the seroprevalence was also close ranges among the municipalities: 10.0% in Belas; 14.5% in Viana 14.9% in Luanda and 12.5% in Cazenga. However, the seroprevalence in municipality of in Cacuaco was lower (5.8%) and bivariate and multivariate analysis showed a lower risk for HIV in this area (OR 0.348, CI 0.083–0.986; OR 0.359, CI 0.085–1.021). The multivariate analysis had also showed a significant increased risk for HIV in women with 2 or 3 births (OR 1.860, CI 1.054–3.372).

Conclusions

Our results underlined the need to improve the screening and clinical follow-up of HIV and HBV in Angola, as well the educational campaigns to prevent not only the morbidity and mortality associated with these diseases, but also their transmission, mainly in women in reproductive age and pregnant, encouraging the pre-natal consultations in order to avoid mother-to-child transmission.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12985-021-01698-7.

Hepatitis C Prevalence and Validation of a Clinical Prediction Score for Targeted Screening among People Living with HIV in Ghana

WHO recommends hepatitis C (HCV) screening for all people living with HIV (PLHIV). Yet, HCV coinfection was shown to be rare in some Sub-Saharan HIV cohorts, and targeted testing was suggested more efficient for such settings. We studied HCV prevalence among Ghanaian PLHIV, and assessed the external validity of a score to guide targeted testing. This score was initially derived from a Cambodian HIV cohort, and uses as predictors: age, household member/partner with liver disease, diabetes, generalized pruritus, AST, platelets, and AST-to-platelet ratio index. We enrolled 4,023 PLHIV, most from Greater Accra and Central regions, 28.4% were male, median age was 47 years, and high-risk behavior was reported to be rare. HCV seroprevalence was 0.57%, and HCV-RNA was detectable in 0.5%. Sequencing revealed genotype 1(b) and 2(q/r) infections. The discriminatory performance of the score was suboptimal in the Ghanaian setting. The area under the curve was 0.69 (95% CI 0.59-0.79). HCV coinfection prevalence was very low in this Ghanaian PLHIV cohort with reported low-risk of onward transmission. To avoid the cost of screening all PLHIV in similar cohorts in resource-constrained settings, further research to develop better tools/scores to guide targeted HCV testing is needed.

Hepatitis B and C infections in HIV-1 patients on combination antiretroviral therapy (cART) in Ghana: implications for immunologic recovery, clinical response to treatment, and hepatotoxicity

BACKGROUND

Viral hepatitis could have an impact on the treatment response in HIV patients. In this study, we sought to determine the prevalence of hepatitis B and C infections and examine the effect on the treatment response in HIV-1 patients attending antiretroviral therapy (ART) centers in the Volta and Oti Regions of Ghana.

METHOD

A longitudinal study design was employed. A cohort of 200 newly diagnosed HIV-1 positive adults who met the inclusion criteria (CD4 count ≤350 cells/μl) were enrolled at three ART Centers and initiated on the combination Antiretroviral Therapy (cART) from January 2014 to December 2015. Blood samples obtained from each participant were subsequently screened for the presence of hepatitis B surface antigen (HBsAg) and hepatitis C antibody. Out of the 200 study respondents recruited, 93 HIV mono-infected were randomly selected plus all 17 HIV co-infected were prospectively followed for twelve months. Using standard methods, three consecutive measurements of CD4 cells, haemoglobin, and liver enzymes [(aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP)] as well as weight measurements were performed at baseline, six months and twelve months, respectively, after treatment initiation.

RESULT

The overall HIV-viral hepatitis sero-positivity was 8.5%. HBV and HCV co-infections were 7.0% and 1.5% respectively. Among HIV mono-infected CD4 cell count, haemoglobin, and weight significantly increased from baseline to the twelfth month while levels remained statistically comparable in the HIV co-infected patients. The levels of AST, ALT, and ALP were more pronounced (hepatotoxicity) in the HIV co-infected compared to the HIV mono-infected at various time points within the twelve month.

CONCLUSION

The frequency of HIV-hepatitis co-infection was high. This correlates with poor immunological outcome, clinical response to treatment and pronounced hepatotoxicity. The findings, therefore, underscore the need for regular screening of HIV patients for early detection and appropriate management.

Hepatitis B Vaccination Status and Associated Factors Among Healthcare Professionals Working in Health Centers at Akaki Kality Subcity of Addis Ababa, Ethiopia: A Cross-Sectional Study

Background

People at high risk for hepatitis B virus include healthcare workers in contact with blood and human secretions. Hepatitis B virus is unique compared to other sexually transmitted infections because a highly efficacious vaccine exists. However, there have been few studies conducted around the vaccination status of hospital healthcare workers in Ethiopia. Little is known about vaccination penetration among healthcare professionals working in health centers in Ethiopia.

Objective

To assess hepatitis B vaccination status and associated factors among healthcare professionals working in health centers of Akaki Kality, Addis Ababa, Ethiopia.

Methods

A facility-based cross-sectional study was conducted. Using simple random sampling, 528 healthcare workers were selected. Data were collected using a pre-tested, structured self-administered questionnaire. Data were entered into Epi-data and analyzed using SPSS version 20. Multivariable binary logistic regression analysis was used to identify the significant associations. Adjusted odds ratios were computed to measure the strength of association, with statistical significance considered at p< 0.05.

Results

Among 505 respondents, only 244 (48%) had ever received a hepatitis B vaccine. Monthly income, religion, age, working unit and educational level were found to be statistically associated with vaccinated status.

Conclusion

This study showed that the percentage of healthcare professionals who had received a hepatitis B vaccination was very low. This is a serious public health concern and a challenge for a country with high prevalence of hepatitis B infection. There is a need to promote hepatitis B screening and vaccination among healthcare professionals. The government must play its part by increasing healthcare budgets and prioritize hepatitis B prevention by establishing a national awareness campaign, and making screening and vaccination services available at all public health centers.

HIV, hepatitis B virus, hepatitis C virus, and syphilis among pregnant women attending antenatal care in Luanda, Angola: Seroprevalence and risk factors

Infectious diseases during pregnancy remain a public health concern, especially in a resource-limited setting. The study aimed to determine the seroprevalence and determinants of HIV and co-infection with hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis among pregnant women attending antenatal care in Luanda, the capital city of Angola. A cross-sectional study was conducted with 1612 pregnant women screened for HIV during antenatal care. HIV-reactive were also screened for the HBV, HCV, and syphilis using immunoassay kits. A logistic regression model, adjusted odds ratios (AOR) and their 95% confidence interval (CI) were calculated with a level of significance set at 5%. The overall seroprevalence of HIV was 2.6%. About 13% of HIV-positive pregnant women were coinfected. From which, 7.5% were reactive to HBV and 5% to syphilis. There was no reactivity to HCV. Pregnant women younger aged than 25 years were significantly protected from HIV-infection (AOR, 0.43 [95% CI, 0.20-0.91], P = .026). The co-infection was 1.3 times (AOR, 0.04-41.0) in younger aged than 25 years, 7.0 times (AOR, 0.50-99.2) to residents in urbanized areas, and 1.4 times (AOR, 0.10-20.9) in pregnant women with a high educational level. In conclusion, infectious diseases are a public health burden among pregnant women in Luanda. However, include an integrated antenatal screening mainly in urbanized areas is crucial to reduce the spread of infectious diseases in different communities of Angola.

Sero-prevalence of human immunodeficiency virus-hepatitis B virus (HIV-HBV) co-infection among pregnant women attending antenatal care (ANC) in sub-Saharan Africa (SSA) and the associated risk factors: a systematic review and meta-analysis

Background

There is plenitude of information on HIV infection among pregnant mothers attending antenatal care (ANC) in sub-Saharan Africa. However, the epidemiology of HBV–HIV co-infections in the same cohort is not clear despite the common route of transmission of both viruses. The aim of our study was to synthesize data on the prevalence of HBV–HIV co-infection among pregnant women attending ANC in Sub-Saharan Africa to assist in the design of public health interventions to mitigate the challenge.

Methods

The study was done in tandem with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards and the Cochran’s Q test, I² statistics for heterogeneity and the prevalence were calculated using commercially available software called MedCalcs (https://www.medcalc.org). A random effect model was used to pool the prevalence since all the heterogeneities were high (≥ 78%) and P_het < 0.05 indicated significant heterogeneities. The risk factors and risk differences for HBV–HIV co-infection were analyzed. Any likely sources of heterogeneity were analyzed through sensitivity analysis, meta-regression and sub-group analysis. All analyses were done at 95% level of significance and a P < 0.05 was considered significant.

Results

The overall pooled prevalence of HBV–HIV co-infection among pregnant mothers in sub-Saharan Africa was low 3.302% (95%CI = 2.285 to 4.4498%) with heterogeneities (I²) of 97.59% (P > 0.0001). Within regional sub group meta-analyses, West Africa had significantly higher prevalence of 5.155% (95% = 2.671 to 8.392%) with heterogeneity (I²) of 92.25% (P < 0.0001) than any other region (P < 0.001). Articles published from 2004–2010 had significantly higher prevalence of 6.356% (95% = 3.611 to 9.811%) with heterogeneity (I²) 91.15% (P < 0.0001) compared to those published from 2011 to 2019 (P < 0.001). The HIV positive cohort had significantly higher prevalence of HBV–HIV co-infection of 8.312% (95% CI = 5.806 to 11.22%) with heterogeneity (I²)94.90% (P < 0.0001) than the mothers sampled from the general population with a prevalence of 2.152% (95% CI = 1.358 to 3.125%) (P < 0.001). The overall and sub group analyses had high heterogeneities (I² > 89%, P < 0.0001) but was reduced for South Africa (I²) = 78.4% (P = 0.0314). Age, marital status and employment were independent factors significantly associated with risk of HBV–HIV co-infection (P < 0.001) but not extent of gravidity and education level (P > 0.05). After meta-regression for year of publication and sample size for HBsAg positivity, the results were not significantly associated with HBV pooled prevalence for sample size (P = 0.146) and year of publication (P = 0.560). Following sensitivity analysis, the HBsAg pooled prevalence slightly increased to 3.429% (95% CI = 2.459 to 4.554%) with heterogeneity I² = 96.59% (95% CI = 95.93 to 97.14%), P < 0.0001

Conclusion

There is an urgent need for routine HBV screening among HIV positive pregnant mothers attending antenatal care in sub-Saharan Africa to establish the extent of HBV–HIV co-infection in this cohort. Future studies need to investigate the putative risk factors for HBV–HIV co-infection and prioritize plausible control strategies.

Hepatitis B and C Viruses' Infection and Associated Factors among Pregnant Women Attending Antenatal Care in Hospitals in the Amhara National Regional State, Ethiopia

Introduction

Hepatitis virus infection is a major public health burden and silent killer disease in sub-Saharan Africa, including Ethiopia. Therefore, this study aimed to investigate the prevalence of hepatitis B and C viruses and associated factors among pregnant women attending an antenatal clinic in three tertiary hospitals in Amhara National Regional State, Ethiopia.

Methods

A cross-sectional study was conducted among 1121 pregnant women. Data on sociodemographic and associated factors were collected using a structured questionnaire. Serum samples were tested for hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus antibody (anti-HCV) using ELISA. SPSS version 20 was used for data analysis, and a multivariable logistic regression analysis was used to assess the relationship between factors associated with hepatitis B virus and hepatitis virus C infection.

Results

A total of 1121 pregnant women were included in the study. The mean age of study participants was 27.2 ± 4.8 yrs. The majority of pregnant women (895 (79.8%)) were from urban areas. The overall seroprevalence of HBsAg and anti-HCV antibody was 52 (4.6%) and 18 (1.6%), respectively. The coinfection rate of HBV/HCV was 1.4% (1/69). Ten (19.2%) of HBV positive cases were coinfected with HIV. There were no coinfections of HCV and HIV. Interestingly, pregnant women with a history of multiple sexual partners (AOR = 3.2, 95% CI, 1.7–7.6), blood transfusion (AOR = 7.6, 95% CI, 2.9–16.9), family history of HBV (AOR = 3.5, 95% CI, 1.7–7.6), being HIV-positive (AOR = 2.5, 95% CI, 1–5.9), and tattooing (AOR = 2, 95% CI, 1–3.8) were significant predictors of HBV infection. Similarly, young age (17–25 yrs) (AOR = 3.2, 95% CI, 1.8–8.6) and no educational background (AOR = 5, 95 CI, 1.7–14.8) were significant predictors of HCV infection.

Conclusions

Hepatitis B and C viruses' infection was intermediate among pregnant women; some risk factors were significantly associated with the majority of cases. Infants born from these infected mothers are at risk of infection. This calls for screening and integration of HBV prevention of mother-to-child transmission (PMTCT) into HIV. Thus, the provision of health education on hepatitis B and C viruses' transmission, vaccination, and screening of all pregnant women routinely are essential for the prevention of these viruses.

The prevalence of positive rapid diagnostic test of hepatitis C virus infection in Ghana

Introduction

hepatitis C virus (HCV) infection is one of the most common viral hepatitis in Africa. Rapid diagnostic test (RDT) is a useful tool to identify antibody anti-HCV in point of care. In this study, we decided to determine prevalence of cases with positive rapid diagnostic test of HCV infection.

Methods

this cross-sectional study was conducted in a polyclinic, Accra, Ghana. Using convenience sampling, 728 participants were screened with blood-based RDT and interviewed about personal risk behaviors for transmission of HCV. Data was entered in SPSS version 18 and analyzed.

Results

there was 1.6% positive RDT in our participants. The mean age of them was 29.58 ± 12.31 years old that were younger than the participants with negative RDT (p: 0.027). The rate of positive test was 66.67% in women and 33.33% in men. There was a negative association between age and RDT positive (aOR: 0.91, 95%CI 0.85-0.96). The odds of positive RDT in married participants was 6.32 fold others after adjusting model (p: 0.014). There were no important risk behavior for HCV, except one person with history of contacting blood or needles.

Conclusion

the risk of positive RDT has a reverse relationship with aging and also it has an increase in married individuals. Therefore preventive education and screening for HCV should be a priority in young and middle-aged adults because of more sexual activity.

Molecular Characterization of Glucose-6-Phosphate Dehydrogenase: Do Single Nucleotide Polymorphisms Affect Hematological Parameters in HIV-Positive Patients?

This descriptive, cross-sectional study aimed at evaluating the prevalence of G6PD deficiency and the 376A ⟶ G, 202G ⟶ A single nucleotide polymorphisms (SNPs) among HIV patients attending care at a teaching hospital in Ghana and determine how the SNPs affect haematological profile in HIV. A total of 200 HIV-positive Ghanaians were recruited. Venous blood samples were obtained and complete blood count, and G6PD screening and genotyping for the 376A ⟶ G, 202G ⟶ A SNPs were performed. Out of the 200 participants, 13.0% (26/200) were G6PD-deficient based on the methemoglobin reductase technique, with 1.5% (3/200) and 11.5% (23/200) presenting with partial and full enzyme defect, respectively. Among the 13.0% participants with G6PD deficiency, 19.2% (5/26), 30.8% (8/26), and 19.2% (5/26) presented with 376A ⟶ G only (enzyme activity (EA): 1.19 U/g Hb), 202G ⟶A only (EA: 1.41 U/g Hb), and G202/A376 SNPs (EA: 1.14 U/g Hb), respectively. Having the 376A ⟶ G mutation was associated not only with lower red blood cell (RBC) count (3.38 × 106/µL (3.16-3.46) vs 3.95 × 106/µL (3.53-4.41), p = 0.010) but also with higher mean cell volume (MCV) (102.90 (99.40-113.0) vs 91.10 fL (84.65-98.98), p = 0.041) and mean cell haemoglobin (MCH) (33.70 pg (32.70-38.50) vs 30.75 pg (28.50-33.35), p = 0.038), whereas possessing the 202G ⟶ A mutation was associated with higher MCV only (98.90 fL (90.95-102.35) vs 91.10 fL (84.65-98.98), p = 0.041) compared to G6PD nondeficient participants. The prevalence of G6PD deficiency among HIV patients in Kumasi, Ghana, is 13.0% prevalence, comprising 1.5% and 11.5% partial and full enzyme defect, respectively, based on the methemoglobin reductase technique among HIV patients in Ghana. Among G6PD-deficient HIV patients, the prevalence of G202/A376 SNPs is 19.2%. The 376A ⟶ G mutation is associated not only with lower RBC count but also with higher MCV and MCH, whereas the 202G ⟶ A mutation is associated with higher MCV compared to the normal G6PD population.

Prevalence of viral hepatitis B in Ghana between 2015 and 2019: A systematic review and meta-analysis

Chronic hepatitis B (HBV) remains a significant public health problem in Ghana and past reviews conducted could not calculate a nationwide prevalence of the disease due to lack of primary research for some regions of the country. We therefore conducted this study to summarize and update the available information on HBV infection burden (prevalence) in Ghana from 2015–2019.We systematically searched PubMed, Embase, ScienceDirect, and Google Scholar to retrieve primary studies published in peer-reviewed journals from November 2015 to September 2019, assessing the prevalence of HBV among the Ghanaian populace. The review included 21 studies across all ten old regions of Ghana with a total sample population of 29 061. The HBV prevalence was estimated for subpopulations as follows: 8.36% in the adult population, 14.30% in the adolescent population, and 0.55% in children under five years (pre-school). Among adults, HBV infection prevalence was the highest in the special occupation group (14.40%) and the lowest prevalence rate of 7.17% was recorded among blood donors. Prevalence was lower in the north than in the southern part of the country. The Ashanti region had the most studies at 6/21 (29%), while no study was identified for the Upper West region. Across the country, the highest HBV infection prevalence rates were recorded in the age group of 20–40 years. The burden of hepatitis B is enormous and remains an important public health issue in Ghana. Addressing the issue will require an integrated public health strategy and rethinking of the implementation gaps in the current HBV infection control program. This will help propel the country towards eliminating the disease by 2030.