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Randomized Controlled Trial
. 2017 May 15;31(8):1109-1117.
doi: 10.1097/QAD.0000000000001454.

Hepatitis B serological markers and plasma DNA concentrations

Huw Price  1 , David Dunn  2 , Tamale Zachary  3 , Tobias Vudriko  4 , Michael Chirara  5 , Cissy Kityo  3 , Paula Munderi  4 , Moira Spyer  2 , James Hakim  5 , Charles Gilks  6 , Pontiano Kaleebu  4 , Deenan Pillay  7 , Richard Gilson  1 ; DART Virology Group
Affiliations
Randomized Controlled Trial

Hepatitis B serological markers and plasma DNA concentrations

Huw Price et al. AIDS. .

Abstract

Objectives: To examine hepatitis B (HBV) serological markers and plasma DNA concentrations in a large group of untreated HBV/HIV-coinfected individuals in two sub-Saharan settings.

Design: Baseline analysis of a randomized controlled trial.

Methods: DART was a large trial of treatment monitoring practices in HIV-infected adults with advanced disease starting antiretroviral therapy at centres in Kampala or Entebbe, Uganda (n = 2317) and Harare, Zimbabwe (n = 999). HBV serological markers [antibody to HBV core antigen, HBV surface antigen (HBsAg), antibody to HBV surface antigen, HBV 'e' antigen (HBeAg), and antibody to hepatitis B 'e' antigen] and plasma HBV DNA viral load were measured retrospectively on stored baseline samples. Logistic regression was used to examine associations with baseline demographic and clinical factors.

Results: The rate of HBsAg positivity was significantly higher in Zimbabwe than Uganda (12.2 vs. 7.7%, adjusted odds ratio = 1.54, P < 0.001) despite a similar prevalence of antibody to HBV core antigen (56.3 vs. 52.4%) in the two settings. Overall, HBsAg positivity was associated with male sex (adjusted odds ratio = 1.54, P < 0.001) but not with age, WHO disease stage, or CD4 cell count. HBeAg was detected among 37% of HBsAg-positive patients, with higher rates among those with advanced WHO stage (P = 0.02). Also in HBsAg-positive patients, HBV DNA was undetectable in 21%, detectable but below the level of quantification in 14%, and quantifiable in 65%. A total of 96% of HBeAg-positive and 70% of HBeAg-negative patients had detectable HBV DNA; 92 and 28% of patients, respectively, had HBV DNA viral load more than 2000 IU/ml.

Conclusion: High rates of HBV coinfection were observed, highlighting the importance of ensuring that coinfected patients receive an antiretroviral regimen, whether first-line or not, that is active against both viruses.

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Figures

Fig. 1
Fig. 1
Algorithm for hepatitis B serology testing.
Fig. 2
Fig. 2
Hepatitis B DNA viral load by hepatitis B ‘e’ antigen status.
See this image and copyright information in PMC

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