Hepatitis B Virus Infection Among Hiv Infected Individuals With And Without Antiretroviral Therapy In North Shoa Zone Amhara Region Ethiopia

Background- The introduction of highly active antiretroviral treatment (HAART) has greatlyrndecreased morbidity and mortality in HIV-infected individuals. In this regard, HBV corninfection with HIV is becoming a major challenge. Because of shared routes of transmission,rn90% of people living with HIV have serological markers of HBV infection and 5-15% of themrnchronically infected with Hepatitis B Virus. Conditions associated with hepatitis B infectionrnare currently among the leading causes of hospital admission and recent studies have shownrnincreasing rates of liver disease and related death among those with HIV.rnThe impact of co-infection is especially apparent in regions with widespread use of highlyrnactive antiretroviral therapy (HAART) where HBV co infection increase hepatotoxicity ofrnHAART and delay immune recoveryrnObjective- To determine the prevalence of hepatitis B virus (HBV) infection amongrnHIV/infected individuals attending care and treatment services in North Shoa zonernMethods – A Cohort study was conducted in North Shoa zone from November 2010 to Mayrn2011.HIV infected individuals who were grouped into antiretroviral treatment initiated andrnPre- treatment follow up were included in the study. Socio-demographic and clinical data wererncollected from patient interview, intake form, follow up form and medical record review usingrnstructured questionnaire. HBV sero-status was determined by testing presence of Hepatitis Brnsurface antigen using 100ul of serum or plasma detected by SD BIOLINE HBsAg rapid kitrnconfirmed with AxSYM HBsAg(V2) confirmatory test from blood collected for patientsrnfollow up. Levels of Alanine transaminase and Aspartate transaminase enzymes and CD4+rncount were recorded from laboratory registry and patient follow up forms. Usage of HAARTrnwas included to assess if treatment change the natural history of HBV infection. Comparisonrngroups were HBV positive antiretroviral receiving patients and HBV positive antiretroviralrnNaïve ones.rnVIIrnResults- The cumulative prevalence of HBsAg in HIV infected individuals was 3.9%.Thernprevalence was higher in ART initiated than Pre-ART groups, 5.3% and 2.6%, respectively.rnDespite the difference is not significant. Sex was independently associated with HBsAgrnprevalence (P=0.03). Males were in increased risk of developing a positive HBsAg test result.rn(RR=2.32 95%CI: 1.09, 4.96) HBV/HIV co infection was a strong predictor of sharp drop inrnCD4 cell recovery before starting ART (RR=3.98 95%CI: 1.02,15.48) There was no significantrndifference observed in the rate of immune recovery and incidence of hepatotoxicity betweenrnhepatitis B virus Co-infected and non infected individuals after initiation of ART.rnHepatitis B Co-infected individuals isolated were found to be in the chronic Hepatitis B stagernwith low or moderate Alanine and Aspartate transaminases levels. (41.5IU/L)rnConclusion- The prevalence of hepatitis B infection is higher in ART initiated individualsrnthan Pre-ART. Neither HBsAg sero positivity nor a particular ART regimen affect immunernrecovery in ART initiated individuals. Since chronically infected individuals are the firstrncandidates of HIV/HBV treatment all markers of HBV especially HBV DNA should berndetermined to initiate treatment. Since HBsAg positivity is higher in individuals takingrncombination therapies that has dual effect for HBV and HIV, further study is necessary tornidentify the cause. Recommendation was forwarded according to the findings.rnKey words: HBV, HIV, HAART, Co-infection, HBsAg serostatus, Northshoa

Get Full Work

Report copyright infringement or plagiarism