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. 2023 Jan 6;10(1):ofac707.
doi: 10.1093/ofid/ofac707. eCollection 2023 Jan.

High Prevalence of Hepatitis B Virus Infection Among People With HIV in Rural and Periurban Communities in Botswana

Bonolo B Phinius  1   2 , Motswedi Anderson  1   2 , Irene Gobe  2 , Margaret Mokomane  2 , Wonderful T Choga  1 , Sharon R Mutenga  1   3 , Gorata Mpebe  1   4 , Molly Pretorius-Holme  5 , Rosemary Musonda  1   5 , Tendani Gaolathe  1 , Mompati Mmalane  1   5 , Roger Shapiro  1   5 , Joseph Makhema  1   5 , Shahin Lockman  1   5 , Vlad Novitsky  1   5 , Max Essex  1   5 , Sikhulile Moyo  1   5 , Simani Gaseitsiwe  1   5
Affiliations

High Prevalence of Hepatitis B Virus Infection Among People With HIV in Rural and Periurban Communities in Botswana

Bonolo B Phinius et al. Open Forum Infect Dis. .

Abstract

Background: We aimed to determine the prevalence of hepatitis B virus (HBV) infection among people with human immunodeficiency virus (PWH) in rural and periurban communities in Botswana.

Methods: PWH from a previous population-based study, the Botswana Prevention Combination Project, which enrolled adults in 30 communities across Botswana (2013-2018), were screened for HBV surface antigen (HBsAg) and HBV core antibody (anti-HBc). HBsAg-positive (HBsAg+) samples were further screened for HBV core immunoglobulin M antibodies (anti-HBc immunoglobulin M [IgM]) and HBV e antigen (HBeAg). We quantified HBV viral load on participants who tested positive (n = 148) and negative for HBsAg (n = 381).

Results: Of 3304 participants tested, 271 (8% [95% confidence interval {CI}, 7%-9%]) were HBsAg+ while 1788 (56% [95% CI, 54%-57%]) of 3218 PWH whom we tested had positive anti-HBc. Approximately 88% of HBsAg+ participants were on antiretroviral therapy (ART), 40% and 56% of whom were receiving lamivudine- and tenofovir-containing ART, respectively. Male sex (relative risk ratio [RRR], 1.8 [95% CI, 1.2-2.7]) and the northern geographic region (RRR, 2.5 [95% CI, 1.4-4.7]) were independent predictors of HBV infection (HBsAg+). Of 381 persons with negative HBsAg who were tested for occult HBV, 126 (33% [95% CI, 29%-38%]) had positive HBV DNA. Eleven participants were highly viremic with high HBV viral load while on a lamivudine- or tenofovir-containing regimen. Ten (91%) of these participants also had positive HBeAg serology, while 4 (36%) had positive anti-HBc IgM serology.

Conclusions: The prevalence of HBV was high among PWH in Botswana while on ART regimens with activity against HBV.

Keywords: Africa; Botswana; hepatitis B virus; human immunodeficiency virus; occult HBV.

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Conflict of interest statement

Potential conflicts of interest. The authors: No reported conflicts of interest.

Figures

Figure 1.
Figure 1.
Hepatitis B virus marker screening algorithm. Abbreviations: +, positive; –, negative; anti-HBc, hepatitis B core antibody; BCPP, Botswana Prevention Combination Project; HBeAg, hepatitis B e antigen; HBsAg, hepatitis B surface antigen; HIV, human immunodeficiency virus; IgM, immunoglobulin M.
Figure 2.
Figure 2.
Hepatitis B surface antigen, hepatitis B core antibody, and human immunodeficiency virus prevalence in Botswana rural and periurban communities. Abbreviations: anti-HBc, hepatitis B core antibody; C, Central District; Ch, Chobe District; HBsAg, hepatitis B surface antigen; HIV, human immunodeficiency virus; KA, Kgatleng District; KW, Kweneng District; NE, North-East District; S, Southern District; SE, South-East District.
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