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. 2024 May 9:15:1342862.
doi: 10.3389/fmicb.2024.1342862. eCollection 2024.

Persistence and risk factors of occult hepatitis B virus infections among antiretroviral therapy-naïve people living with HIV in Botswana

Motswedi Anderson  1 , Bonolo B Phinius  1   2 , Basetsana K Phakedi  1 , Mbatshi Mudanga  3 , Lynnette N Bhebhe  1 , Girlie N Tlhabano  1 , Patience Motshosi  1 , Tsholofelo Ratsoma  1 , Kabo Baruti  1   4 , Gorata Mpebe  1 , Wonderful T Choga  1   2 , Richard Marlink  1   5 , Dieter Glebe  6 , Jason T Blackard  7 , Sikhulile Moyo  1   2   8   9   10 , Anna Kramvis  11 , Simani Gaseitsiwe  1   8
Affiliations

Persistence and risk factors of occult hepatitis B virus infections among antiretroviral therapy-naïve people living with HIV in Botswana

Motswedi Anderson et al. Front Microbiol. .

Abstract

Aim: This study aimed to determine the kinetics of occult hepatitis B virus infections (OBI) among people with HIV (PWH).

Methods: The study used archived plasma samples from longitudinal HIV natural history studies. We identified new OBI cases and assessed risk factors for OBI using Cox proportional hazards regression analysis.

Results: At baseline, 8 of 382 [(2.1%) (95% CI: 1.06-4.1)] samples tested positive for hepatitis B surface antigen (HBsAg+). Of the 374 HBsAg-negative samples, 76 had sufficient sample volume for HBV DNA screening. OBI positivity (OBI+) at baseline was reported in 11 of 76 [14.7 95% CI (8.3-24.1)] HBsAg-negative (HBsAg-) participants. Baseline HBsAg-negative samples with sufficient follow-up samples (n = 90) were used for analysis of newly identified OBI cases. Participants contributed 129.74 person-years to the study and were followed for a median of 1.02 years (IQR: 1.00-2.00). Cumulatively, there were 34 newly identified OBI cases from the 90 participants, at the rate of 26.2/100 person-years (95% CI: 18.7-36.7). Newly identified OBI cases were more common among men than women (61.1% vs. 31.9%) and among participants with CD4+ T-cell counts ≤450 cells/mL (p-value = 0.02). Most of the newly identified OBI cases [55.9% (19/34)] were possible reactivations as they were previously HBV core antibody positive.

Conclusion: There was a high rate of newly identified OBI among young PWH in Botswana, especially in men and in participants with lower CD4+ T-cell counts. OBI screening in PWH should be considered because of the risk of transmission, possible reactivation, and risk factors for the development of chronic liver disease, including hepatocellular carcinoma.

Keywords: HBV; HIV/HBV, hepatitis B surface antigen (HBsAg) negative; OBI; hepatitis B virus; incidence; occult hepatitis B.

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Conflict of interest statement

AK is the Specialty Chief Editor of the Virology Section of Frontiers in Microbiology. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer WG declared a shared affiliation with the author DG to the handling editor at the time of review. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
(A) Schematic flow chart of screening of HBV markers. (B) OBI kinetics. +, positive; −, negative; NT, not tested; anti-HBc, hepatitis B core antibody; HBeAg, hepatitis B e antigen; HBsAg, hepatitis B surface antigen; anti-HBc IgM, hepatitis B core antibody immunoglobulin M; OBI, occult hepatitis B infection; DNA, deoxyribonucleic acid; NB, some participants did not have available samples/sufficient volume for all tests. Some visits had more available samples than others.
Figure 2
Figure 2
(A) Kaplan–Meier curve for the proportion of OBI survival (years). (B) OBI survival by sex. (C) OBI survival by age category. (D) OBI survival by CD4+ T-cell count category. (E) OBI survival by HIV viral load category.
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