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
