HBV/HIV co-infection: The dynamics of HBV in South African patients with AIDS

Objective. As sub-Saharan Africa is highly endemic for hepatitis Bvirus (HBV) and human immunodeficiency virus (HIV) infections,and their co-infection requires special management, we aimedto assess the serological and molecular characteristics of HBV inpatients with AIDS.Design. This was a cross-sectional, case control study, whichenrolled 200 patients with AIDS and 200 HIV-negative controls.HBV serology was done in all participants and HCV serologyin participants with a hepatitis B core antibody (anti-HBc) onlyserological pattern. Nested HBV polymerase chain reaction (PCR)and HBV viral load assays were used for HBV molecular detection.Results. Hepatitis B surface antigen (HBsAg) prevalence was3-fold higher while the ‘anti-HBc only’ pattern was 6-fold higher inthe AIDS group compared with the controls. Mean HBV viral loadwas significantly higher in HBsAg-positive patients with CD4+cell counts <100 cells/ìl than in patients with CD4+ cell counts of100-200 cells/ìl (p=0.019). There were markedly reduced hepatitisB surface antibody (anti-HBs) titres in the AIDS group comparedwith the controls (p=0.002). A significant proportion of AIDSpatients with an ‘anti-HBc only’ pattern had CD4+ cell counts <100cells/ìl (p=0.004). Occult HBV prevalence was 3.5% in the AIDSgroup compared with 1% in the controls (p=0.092). When occultHBV infection was taken into consideration, the overall HBVprevalence became 10% in the AIDS group and 3% in the controlgroup.Conclusion. We showed an increased HBV prevalence in patientswith AIDS and identified a CD4+ cell count <100 cells/ìl as amajor risk factor for the ‘anti-HBc only’ pattern and increasedHBV replication. These data have significant public healthimplications for HBV in developing countries, especially in areaswhere antiretroviral (ARV) guidelines do not cater for HBV/HIVco-infection

IP-10 Levels as an Accurate Screening Tool to Detect Acute HIV Infection in Resource-Limited Settings.

Acute HIV infection (AHI) is the period prior to seroconversion characterized by high viral replication, hyper-transmission potential and commonly, non-specific febrile illness. AHI detection requires HIV-RNA viral load (VL) determination, which has very limited access in low-income countries due to restrictive costs and implementation constraints. We sought to identify a biomarker that could enable AHI diagnosis in scarce-resource settings, and to evaluate the feasibility of its implementation. HIV-seronegative adults presenting at the Manhiça District Hospital, Mozambique, with reported-fever were tested for VL. Plasma levels of 49 inflammatory biomarkers from AHI (n = 61) and non-HIV infected outpatients (n = 65) were determined by Luminex and ELISA. IP-10 demonstrated the best predictive power for AHI detection (AUC = 0.88 [95%CI 0.80-0.96]). A cut-off value of IP-10 ≥ 161.6 pg/mL provided a sensitivity of 95.5% (95%CI 85.5-99.5) and a specificity of 76.5% (95%CI 62.5-87.2). The implementation of an IP-10 screening test could avert from 21 to 84 new infections and save from US$176,609 to US$533,467 to the health system per 1,000 tested patients. We conclude that IP-10 is an accurate biomarker to screen febrile HIV-seronegative individuals for subsequent AHI diagnosis with VL. Such an algorithm is a cost-effective strategy to prevent disease progression and a substantial number of further HIV infections