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. 2019 Oct 1;14(10):e0222835.
doi: 10.1371/journal.pone.0222835. eCollection 2019.

Integrated HIV surveillance finds recent adult hepatitis B virus (HBV) transmission and intermediate HBV prevalence among military in uncharacterized Caribbean country

Siobhan M O'Connor  1 , Tonya Mixson-Hayden  1 , Lilia Ganova-Raeva  1 , Djeneba Audrey Djibo  2 , Matthew Brown  3 , Guo-Liang Xia  1 , Saleem Kamili  1 , Marni Jacobs  2 , Maxia Dong  4 , Anne G Thomas  2 , Marc Bulterys  2 , Braden Hale  2
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Integrated HIV surveillance finds recent adult hepatitis B virus (HBV) transmission and intermediate HBV prevalence among military in uncharacterized Caribbean country

Siobhan M O'Connor et al. PLoS One. .

Abstract

Background: Guyana expanded its HIV response in 2005 but the epidemiology of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections has not been characterized.

Methods: The 2011 Seroprevalence and Behavioral Epidemiology Risk Survey for HIV and STIs collected biologic specimens with demographic and behavioral data from a representative sample of Guyana military personnel. Diagnostics included commercial serum: HIV antibody; total antibody to hepatitis B core (anti-HBc); IgM anti-HBc; hepatitis B surface antigen (HBsAg); anti-HBs; antibody to HCV with confirmatory testing; and HBV DNA sequencing with S gene fragment phylogenetic analysis. Chi-square, p-values and prevalence ratios determined statistical significance.

Results: Among 480 participants providing serologic specimens, 176 (36.7%) tested anti-HBc-positive. Overall, 19 (4.0%) participants tested HBsAg-positive; 17 (89.5%) of the HBsAg-positive participants also had detectable anti-HBc, including 1 (5.3%) IgM anti-HBc-positive male. Four (6.8%) females with available HBV testing were HBsAg-positive, all aged 23-29 years. Sixteen (16, 84.2%) HBsAg-positive participants had sufficient specimen for DNA testing. All 16 had detectable HBV DNA, 4 with viral load >2x104IU/ml. Sequencing found: 12 genotype (gt) A1 with 99.9% genetic identity between 1 IgM anti-HBc-positive and 1 anti-HBc-negative; 2 gtD1; and 2 with insufficient specimen. No statistically significant associations between risk factors and HBV infection were identified.

Conclusions: Integrated HIV surveillance identified likely recent adult HBV transmission, current HBV infection among females of reproductive age, moderate HBV infection prevalence (all gtA1 and D1), no HCV infections and low HIV frequency among Guyana military personnel. Integrated HIV surveillance helped characterize HBV and HCV epidemiology, including probable recent transmission, prompting targeted responses to control ongoing HBV transmission and examination of hepatitis B vaccine policies.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Hepatitis B virus (HBV) testing with results, 2011 Guyana Defense Force Seroprevalence and Behavioral Epidemiology Risk Survey for HIV and sexually transmitted infections.
Abbreviations: Anti-HBc, antibody to hepatitis B core antigen; Anti-HBs, antibody to hepatitis B surface antigen; DNA, deoxyribonucleic acid; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; IgM, immunoglobulin M; mIU/ml, milli-international units per milliliter; ND, not detected; QNS, quantity not sufficient for testing.
Fig 2
Fig 2. Genetic relatedness of hepatitis B virus cases as demonstrated with phylogenetic maximum likelihood tree constructed using S gene sequences, 2011 Guyana Defense Force Seroprevalence and Behavioral Epidemiology Risk Survey for HIV and sexually transmitted infections.
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