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Hepatitis B and C Co-Infections in Some HIV-Positive Populations in Cameroon, West Central Africa: Analysis of Samples Collected Over More Than a Decade

<div><p>As people infected with the human immunodeficiency virus (HIV) in Sub-Saharan Africa live longer due to availability of antiretroviral treatment (ART), so is the rise of associated infections with their burdens on patients. But reliable data on the prevalence of co-infection with hepatitis B (HBV) or C (HCV) still remains sparse and many individuals with HIV do not know their co-infection status. This study attempted to estimate the seroprevalence and identify risk factors associated with hepatitis B and/or C co-infections in HIV-infected individuals from five Regions of Cameroon by screening 531 HIV infected subjects for the presence of HBV surface antigen (HBsAg) and antibodies to HCV (HCV-Ab). A Screening and a confirmatory Enzyme linked immunosorbent assay were used to detect presence of markers of infection. CD4 count levels were also examined. The results indicate that of the 531 participants, 68% were females and 32% males. Mean CD4 count was ~400 cells/μl. Seroprevalence rates for HBsAg and HCV-Ab were 23.7%, and 7.2%, respectively. Associations assessed using logistic regression revealed that HBsAg but not HCV-Ab positivity was linked to age, lower CD4 count and residing in an urban rather than in a rural setting. This high prevalence of co-infection with HBV raises the urgent need to systematically screen all newly diagnosed HIV cases for co-infection in Cameroon and other regions of sub-Saharan Africa where HIV accounts for the majority of the global infection, so as to improve management strategies for HBV infection and ART implementation.</p></div

Associations of demographic and serological markers with risk of infection with HBV or HCV.

<p>Percentages (%) in columns were calculated by dividing the number of participants with a particular outcome by the total number of participants with the outcome of interest *100. Adjustments were made for age, sex, CD4 count, residence, region and number of sexual partners.</p><p>HBV, Hepatitis B virus; HCV, Hepatitis C virus</p><p>Associations of demographic and serological markers with risk of infection with HBV or HCV.</p

Age-specific prevalence for co-infection with HBV or HCV.

<p>Prevalence rates were calculated based on the proportion of study participants at risk of co-infection in a given age group.</p

Region-specific prevalence for co-infection with HBV or HCV.

<p>Prevalence rates were calculated based on the proportion of study participants at risk of co-infection in a given region.</p

Clinical characteristics of HIV patients who initiated antiretroviral therapy from January 2013-December 2015 in four regional hospitals in Cameroon (n = 830).

<p>Clinical characteristics of HIV patients who initiated antiretroviral therapy from January 2013-December 2015 in four regional hospitals in Cameroon (n = 830).</p

Definition of key analysis terms and measures.

<p>Definition of key analysis terms and measures.</p

Baseline characterization of HBV and HCV markers by sex.

<p>P-values for age and CD4 cell counts represent differences in mean between males and females. Other P-values stand for trend across categories of infection type. For viral markers of infection, % column was calculated as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0137375#pone.0137375.t001" target="_blank">Table 1</a>.</p><p>SE, Standard error of the mean; HBsAg, Hepatitis B surface antigen; HBeAg, Hepatitis B e antigen; HCV-Ab, Antibodies to Hepatitis C.</p><p>Baseline characterization of HBV and HCV markers by sex.</p

Viral testing algorithm.

<p>¹HBsAg: confirmatory test for HBsAg. Confirmatory test for HCV-Ab was the same test as for the screening for HCV-Ab.</p